From an on line medical dictionary: Delirium: A disorder characterized by Confusion; inattentiveness; disorientation; Illusions; Hallucinations; agitation; and in some instances Autonomic Nervous System overactivity. It may result from toxic/metabolic conditions or structural Brain lesions. (From Adams et al., Principles of Neurology, 6th ed, pp411-2)
I have now had three people tell me recently that I was "scary" when I was sick.
It is an interesting perspective and I was surprised. Because as a physician I know that when people are systemically ill, they are often delirious. We are taught to watch for ICU psychosis. Just being sick enough to be in the ICU, people are bats. They will pull out ventilator tubes, intravenous lines and foley catheters (without lowering the balloon, ouch).
I had gone to the ER four times in 2012 and was at last hospitalized for observation. For 24 hours. But the docs were so sure that I was bananas from my sister's death that they ignored the labs. To the point that the discharging physician wrote in her note that I had two blood tests positive for strep A and she was giving me a penicillin shot, but she "didn't believe that it had anything to do with the hospitalization." They ignored the potassium and magnesium levels low enough to make my muscles cramp when I arrived. They ignored the "ins and outs". The nurse wrote down how much I got iv for the 24 hours and how much liquid I drank. Those are the "ins". The outs is how much you urinate. Normal output is up to 3000cc in 24 hours. When I was sent home, my ins were at 4200cc. My outs were at 10400 cc. This means that I was 6200 cc behind. Fluid "third spacing" is common in sepsis, where the fluid leaks from the arteries and veins into the tissues. I did not run a fever, I did not have a high white blood cell count, but I was septic as shit. However, I had been drinking fluid to keep up until I was hospitalized. I just had not kept up on potassium and magnesium.
So I had to drink 6 liters when I got home. Adding electrolytes.
Why, then, did I go home? Two reasons: my fellow doctors were so locked in to thinking me psychotic or manic from my sister's death that I was afraid of them. And secondly, I had figured out how to reduce the fluid shifts.
It took me another week to realize that a penicillin shot treats strep throat. For strep A sepsis you are supposed to give 1.2 million units of iv penicillin every 6 hours and iv clindamycin every 6 hours. A bit difficult at home. And I'd been told not to treat myself. What to do? I wrote a letter to the psychiatrist who they'd required me to see and got high dose oral clindamycin and penicillin.... four times a day.
Seems to have worked.
But.... in the hospital I thought, I am sick as shit and technically septic and borderline delirious and I am STILL the only one who is thinking straight about my labs and the "medical case". I think doctors are terrified of thinking that a doctor could go nuts. So their brains shut down. I was really trying hard not to die. Also, septic people looked whacked out, they can be anxious as hell. A lot of adrenaline as the body is screaming at the brain, "HELP HELP HELP HELP!!!"
I can understand that I scared friends. I was not scared about being delirious because that is normal with sepsis. Normal from a doctor perspective. I was scared that I could very well die or if I let my blood pressure drop too far, I could damage brain/heart/kidneys/extremities. So I drank to keep up and tried to balance the damned electrolytes at home. Guesswork.
They were worried that I WAS crazy. I wasn't worried about it. But after a friend told me I scared him too, I felt very very sad for the last two days. Because I was so alone. I had the medical knowledge and skills to survive, but the medical community labelled and refused to listen, and my friends probably thought about calling the people with white coats....
....it was scary.
http://www.cdc.gov/sepsis/survival/index.html Sepsis is on the rise, it gets missed and once you have had it you are at higher risk to get it again. I have had it twice. My infectious disease specialist said cheerfully "You can take twice a day Penicillin 250mg, but we have no idea if that will work." I am NOT reading the "life after sepsis" link for patients today.
http://www.cdc.gov/sepsis/pdfs/life-after-sepsis-fact-sheet.pdf