Where Does Your Mind Go When Your Body Is Near Death?

Where Does Your Mind Go When Your Body Is Near Death?

I am in New York City, at JFK. At the check-in desk, a young woman with a ponytail is taking deep breaths and pointedly adding “Sir” or “Madam” to her repeated apology for the lateness of the plane. The room is crowded and the mood is ugly. Some of the passengers are expressing deeply unpleasant views about Mexicans, pinkos, and snowflakes.

I start arguing with them about how Donald Trump’s America is becoming a hateful place, and a betrayal of the values of liberty and open-mindedness upon which it was founded. A pretty young woman who looks like a glamorous version of my ex-wife, Moira, puts her hand on my arm. She tells me I am a hero and she agrees with every word I say. Her name is Lucy, she says, as she kisses me on both cheeks. “Look, I have to go now but I promise I will come and see you in Europe. I love you, Eugene… ”

Only a handful of passengers are left, and some are still fuming from my rant. So with hours to kill before my flight home, I head towards the subway. A gang is hanging around the turnstiles, including a Latina woman with a ponytail and a baseball cap whom I recognise from the airport check-in desk. She starts telling the others I’m a Trump hater and the gang becomes restless. “Who the fuck do you think you are, coming over here to lecture us?”

Another young woman laughs and pulls out a handgun. “Maybe I should cap the fucker?” she snarls. I’m in a state of mild panic, though I don’t believe she will really shoot me in front of all these witnesses, including two men in NYPD uniforms a few hundred yards away. But then she does shoot me, in the upper abdomen, and there’s a flash of light before everything grinds into slow motion. As I go down, the two cops start running towards me, but it’s too late. The darkness takes over. I am gone.

As anyone with more than a cursory knowledge of JFK and the New York City subway system will know, none of this really happened. I was experiencing postoperative delirium. 

In early August this year, I was on holiday in the French Pyrenees and experienced a week of severe chest pains (specifically, in the armpits) that turned me cold and clammy. When I got home, I eventually took myself to my local hospital in London and later found out that I had been having a serious heart attack; three of the main arteries to my heart were blocked.

From my local hospital, I was transferred by ambulance to St Bartholomew’s Hospital in central London. I am told that after I arrived they tried, unsuccessfully, to insert stents to unblock the arteries, and then a balloon pump, which also failed. Some time the following morning, I had a massive coronary when another artery failed, and was taken straight into the operating room for an emergency triple bypass. They opened up my sternum with a circular saw, and used a large vein from my leg to graft new arteries in three places, navigating around the blockages. It should have been a two-hour operation but ended up taking more than twice as long.

During the operation, I suffered a stroke. They found a blood clot on my brain. My lungs were full of fluid and looked pneumonic, and there were further complications with my kidneys. My body shut down and I was put on life support with a ventilator breathing for me. Later, my surgeon told me how lucky I had been. “These were catastrophic events. But for a unique set of circumstances, they would not have been survivable. Had this occurred in the Pyrenees, or on the plane, or had my colleague and I not arrived just as you had a huge heart attack, there is very little chance that you would still be here.”

Shakespeare’s Hamlet described death as an “undiscovered country from whose bourne no traveller returns.” I felt I had been waved through by customs and yet here I am, now back — although not without some confusion…

As I began to come round, all I could see were gold stars against a deep-blue background, maybe for seconds or minutes or hours or days. Then, the vivid hallucinations started. After I miraculously recovered from my shooting in New York, I travelled to Dublin with my 13-year-old daughter, Evie. I was drugged and held prisoner in a stately home that was also a hospital. Later, I went to Italy with Evie and my lovely new friend, Lucy from the airport, came to visit me. I went to a wedding near Jaipur, Rajasthan, with my friends Charlie and Naz. Then, my sister-in-law, Claire, appears and tells me I need to pull myself together. I am back in London, where Evie announces that she is out on the town with a crowd that includes the 17-year-old son of a colleague. They are staying at his trailer home, parked on Richardson Street in Bermondsey, an inner-London neighbourhood.

Moira and Evie visit me at the hospital most days, but I get angry during one visit because they don’t take my New York shooting seriously. After they’ve left, I heave myself out of bed and force my withered, useless legs into a wheelchair. I push myself to the nurses’ station where I pick up a phone and demand to be put through to the hospital’s press office. I tell the young lady at the other end that I am livid about the dirty tricks campaign they have been running to discredit me, to preserve the reputation of their sister hospital in Wicklow, outside Dublin. There is a pause, and she asks me whether I am in the intensive care unit. I fail to see what that has to do with anything, but she says she can hear the beeping of the life support machines around me.

I tell various visitors that I am being held against my will, and that I have cancer. I whisper “carcinoma,” hoarsely, and point at my throat. Behind me, a nurse monitoring the machines looks at them and shakes her head with a weary smile. It’s the 10 days on a ventilator with a breathing tube down my throat that has caused the hoarseness, while the stroke is causing me to slur my words. I’m drifting in and out of delirium; a dramatis personae of real-life nursing and medical staff come and go, mixed up with a kaleidoscopic carousel of faces from my hallucinations. I feel scared and confused.

One day, I tell my wife that I have had a vivid dream in which I managed to get out of bed and brandish a metal stool at a nurse, threatening to “smash her fucking head in” if she won’t let me use the phone. Moira looks at me with an expression of both pity and concern, and says, “Euge, that wasn’t a dream. That really happened.”

I realise that she and Evie do not believe me about anything, and I hit on a mechanism by which I can prove it. I say to Evie that I have been to the trailer where she has been staying. “It’s on Richardson Street in Bermondsey,” I say triumphantly, knowing that now they must accept that I have been telling the truth all along. Evie whips out her phone and looks on Google Maps. “Dad, there is no Richardson Street in Bermondsey,” she says gently. I don’t believe her, so she shows me her iPhone. I struggle to take it in; finally, I collapse back against the pillows in defeat, salty tears coursing down my cheeks. It is the beginning of accepting my delirium.

My ex-wife patiently explained that I was reinterpreting fragments of what my semiconscious mind was experiencing. Her look-alike in the airport telling me that she loved me, and would see me again? Moira visited me every day while I was on life support. The wedding in Jaipur? My bed in intensive care was next to an elderly Indian gentleman who played Indian music on the radio all day and night, forming the soundtrack to my Indian wedding delusion. The friends I saw at the “wedding” had come to visit me in intensive care, too, perhaps just as I was becoming aware of those around me. My sister-in-law, Claire, was there when medical staff were considering moving the ventilator tube from my throat to a hole in my neck. She had grabbed my hand and said loudly to me: “You need to show us a sign that you’re in there, Eugene, or they will cut a hole in your windpipe,” she had said. “Squeeze my hand.” I squeezed her fingers; I was coming back.

Medical experts still do not understand exactly what causes postoperative delirium, but it is most common in intensive care patients who are heavily sedated or on ventilators after major surgery — particularly heart surgery — or those who are over 65. The American Delirium Society estimates it affects as many as 7 million hospitalised patients in the U.S. every year, and costs as much as $150 billion in extended hospital stays and health complications.

Dr. Valerie Page is an intensive care consultant at Watford General Hospital in north London, and an expert on postoperative delirium. It is the physical trauma of major surgery, rather than the effect of anaesthetics or sedatives, that triggers delirium, she explains. “Opening someone up, fumbling around inside, taking some bits out, putting some bits in and then closing them up again — it’s a massively traumatic event for a body.”

Travel, escape, and death are all common experiences. But most are simply a misinterpretation of their environment, creating complex delusions to try and make sense of it. “People talk about seeing a white light, but that’s because as your optic nerve loses blood, a white light is what you see,” says Dr. Page. She believes that there is a physiological explanation for delusions, and that they are not psychologically revealing. “These are simply physical neurological manifestations of the brain malfunctioning due to transmitters, blood flow, and inflammation.”

Some patients, like me, exhibit agitated delirium but tend to recover more quickly; others have more withdrawn delirium that presents more like depression and is harder to diagnose. Researchers are exploring how to minimise delirium, including minimising the use of certain tranquilizers, encouraging patients back into healthy sleep cycles, coming off ventilators sooner and getting patients out of bed and moving around.

I’m unlikely to be as sharp as I was before, Dr. Page concludes. But she also suggests, surprisingly, that having a busy intellectual mind may help my recovery. “You’re educated, so you have what we term ‘cognitive reserve.’ Because your brain has been active, the theory is that you can use other bits of your brain to take over the jobs that the affected part used to do. So, an active brain and education give you cognitive reserve to be resilient.”

Three months later, I’m recovering well. I struggled to find words at first, wasn’t very mobile, and also suffered mood swings. But now I’m losing weight at the gym, and just completed a four-week drive from the U.K. to Mali in West Africa to raise money for the British Heart Foundation and a couple of journalists’ charities.

Some experts say survivors of these major health events — including the delirium — can experience a form of post-traumatic stress disorder. In my case, my trauma is as mitigated as it could be. I am as well as can be expected — better, in fact — and for that I am grateful. And of course, I am here to tell the tale.

This was first published by Medium in December 2018