Having been through hospital psychosis with my husband several times, I feel profound sympathy with all patients and family members who are struggling to deal with it.
My husband suddenly began to "reject" knowledge of where he was and why in 2000, when he was admitted for gall bladder surgery while I was out of town, several hours away. To my horror, they proceeded without me, and by the time he was out of surgery and I was with him, he was absolutely gone -- didn't know where he was or why. This has been a constant occurrence ever since. He has suffered lingering memory loss and confusion between hospital admissions. His doctors have diagnosed Alzheimer's, utterly ignoring his long-time, severe headaches, which, meantime, have increased in frequency, duration, and severity, disturbing his sleep and his circadian rhythms, and eventually affecting his ability to walk (ataxia).
Next he developed tremors, first only in his hands, now affecting his arms; these, too, have increased in frequency, yet his doctors have never even acknowledged either his ataxia or his tremors. Last week he had an anomalous seizure, which means no one knows what caused it. (I think it was unrelenting severe pain.) He was admitted to the hospital through the ER on Saturday. Today, on Friday, after waiting 45 minutes for pain medicine, 25 minutes to be assisted to the bathroom, and 1-1/2 hours for his breakfast (no food from 5:30 p.m. until 9:15 a.m., more than 15-1/2 hours), he announced he was coming home. Although the hospitalists (in-house hospital physicians) and his nurses all had been saying for days that he would need to go to a rehab facility until pain from muscle spasms in his back (caused by rigor during the seizure) and ataxia (which causes veering and tipping while walking) were under control, for his safety, while I was out of his room they all agreed that since he insisted on going home, he should be discharged. However, they issued no discharge papers, no statement of his diagnosis or in-hospital treatment, no recommendations or appointments for subsequent care, only a prescription for seizure medicine (without any directions on how to take it or when to start it) -- no pain reliever or muscle relaxer, even though they had been pumping him full of both, including morphine, less than two hours earlier. Not only are we without medicines he needs, guidance on how to proceed at home, or arrangements for his subsequent care, we now will have a struggle to obtain orders for any future care that our insurance will cover.
The recommendations in the article above are spot on and absolutely critical. Fight with all your might to protect your loved one from developing hospital psychosis. ("He" and "him" refer to a patient of any gender.)
1. Never leave him alone for a single second, not even to go out for meals. If you need to use a bathroom, use the one in his room, no matter what hospital rules say. Arrange for people he knows well, likes, and is accustomed to seeing to spell you so he is not alone even at night.
2. Keep a log of everything that happens, noting the time and date it happens, including that he used the bathroom and the result; what and how much he drank; when medications, especially pain meds, were dispensed and by whom; the result of any checks, such as blood pressure, temp, etc.; when meals arrived and how much of them he ate; how long it took for staff to respond to a call for assistance. Create an accurate record of the care he's received, his meals, and when doctors and nurses attended him. You will need that record if you want to dispute anything.
3. Safeguard him from everything that is strange or disturbing that you possibly can alleviate: no beeping monitors; no alarms that go off in his room; no lights in his eyes for any "checks" while he is sleeping. Keep the door to his room closed at all times; put a sign on it, or you'll be worn out trying to keep it shut. Consistent with his safety and medical condition, introduce as much familiarity as you can: Bring his own razor, shaving cream, aftershave, toothbrush, toothpaste, mouthwash, comb and brush, coffee made the way he likes it, his preferred soft drinks.
4. Investigate sliding scale insulin, and have your own family physician determine whether it should be used on him, but check it out for yourself, too. If he is a diabetic, let him continue to manage his diabetes himself to the greatest extent possible, if he usually does so, or continue to manage it yourself if he cannot or if you usually do so. (My husband's type 2 diabetes is under perfect control. His A1c is 6. Type 2 diabetics produce insulin, but lack whatever it is that enables a body to use insulin. Therefore, pumping them full of insulin is useless. In my husband's case, it more than triples his blood sugar level, which makes him delirious.) Remember: Not many years ago, the medical profession insisted that diabetics should eat nothing but carbohydrates!
5. Investigate, too, constant carb hospital diets; they are much higher in carbs and much lower in protein than the diet my husband follows at home, and contribute to jacking up his blood sugar level. Don't let his glucose control meds be withheld so that imaging with contrast can be performed unless someone can convince you that using contrast is absolutely critical; insist that the imaging be done without contrast. (Combining Metformin and contrast presents a dire danger to kidney function, but I prefer to risk that scans might not be quite as good without contrast so that he can continue to take Metformin and keep his blood sugar within bounds.)
4. Insist on food that suits him. If he's a vegan, eats no salt, keeps a diet at home that successfully controls diabetes, or eats mostly protein, and he and his primary physician have been satisfied that his diet has maintained or advanced his health, stick to his regime, even if that means you must bring in food. Repeat: if his home diet has been working, stick to it unless you have verified for yourself, independently, that a recommended or ordered change really will be beneficial to him. Make sure meals arrive on his usual schedule. (my husband's hospital feeds at 8:00 a.m., 12:30 p.m., and 5:30 p.m., leaving patients to starve for 14 hours! Some diabetics must eat every four hours; my husband eats about every 6 hours except at night.) Resist orders that he go without food or liquid for more than 8 hours because of some scheduled test; demand competent justification, with a thorough explanation. ("that's our protocol" is not good enough!) Insist that liquid and food be available immediately when the test is completed, without waiting for the next scheduled meal.
5. Make sure he can sleep comfortably. At our hospital, the fairly comfortable mattresses are made into torture chambers by being encased in a thick, stiff plastic that feels as if one were lying upon metal shards. It makes whatever part of the torso is in full contact with the mattress, over which only a thin flannel sheet is stretched, feel both poked and scratched, and burning hot from the nearness of the plastic. Bring in a good, thick, twin bed mattress pad that won't wrinkle and be prepared to change it, if necessary, as many as three times each day. Fasten it and the bottom sheet snugly with elastic bed garters, available at Bed, Bath and Beyond and similar stores, to eliminate as many wrinkles as possible. Bring his own pillow, or any other one or combination that will make him comfortable, each slipped into a single layer of thin plastic bag such as a dry cleaner's garment bag to keep it clean, then into a pillow cover to cover the plastic, then into a pillow case, which can be changed several times a day. Take him a blanket or afghan he uses at home, if it is unlikely to be soiled by blood, vomit, etc. Anything familiar will help him to feel less alienated and to sleep restfully.
6. Experiment with all the lights in his room. Our hospital has night lights under the bed, which are great. A light in the wall at the foot of the bed that shines right into my husband's eyes if his head is even slightly elevated above level. I put a piece of tape over that switch! There is a sort of vestibule light which doesn't seem to disturb him yet still provides adequate light for most nursing duties, even with the privacy curtain drawn between it and the part of the room where the bed is. There also is a ceiling light that doesn't disturb him unless he is lying nearly flat. There is a computer screen (used by nurses and doctors) that can be darkened when not in use. There also is a light above his sink, which, even thought it is reflected by a large wall mirror behind the sink, does not seem to disturb him unduly. Insist that lights are used for his comfort, not for the convenience of nurses, and are not used at all if he is sleeping or lying down unless absolutely necessary. Cover light switches or post notes to help enforce restrictions.
7. Insist that all possible checks, tests, etc., be conducted outside of normal nighttime hours. Last night, just as my husband fell asleep, a nursing tech showed up with a scale--at midnight! She insisted he had to be weighed either then or at 4:00 a.m. Mercifully, he awoke because he wanted to use the bathroom, and stepped onto the scale on his way back to bed. Yet that scale had been standing in the hall outside his room all day long; surely his weight could have been obtained during his waking hours.
8. Post a large, easily readable sign where he can see it from his bed that gives the day of the week, the date, month, and year, and something like this: "You are a patient in Baptist Hospital. You had a seizure Saturday morning, but you are safe. You are staying here so your blood pressure can be monitored until it returns to normal." Don't say when he will be released, because that information seems to change constantly. You might add a line to indicate that you have "gone home to sleep" (or feed the cat, get the kids to bed, whatever), but that he can call you at (give the phone number). If you can, you might add a photo of the family, including pet members, a simple map showing where the hospital is in relation to home, or a brief description of the weather. If there isn't a clock in the room that he can see from his bed, provide one!
9. Once he is even slightly stable, have him repeat after you, one line at a time, and as often as necessary, a litany of what's up, as, "I am a patient at Baptist Hospital. I had a seizure on Saturday. Today is Tuesday. I am staying in the hospital until my heart slows down and my blood pressure returns to normal."
10. Whenever any of the staff comes into the room, tell him, "Here's Sally, your nurse, with your medicines", giving him the person's name and the reason they are in the room. Insist that they speak to his, even if you must interpret or correct his replies, even when they are answering a question you have asked.
11. Unless you absolutely cannot manage, you assist him in getting to and from the bathroom; don't wait for a nurse or tech to show up.
12. As soon as possible, get him out of that room for at least a brief time. Put him in a wheelchair if he cannot walk steadily, and roll him around the "ward" where his room is. If he does not absolutely need to be attached to life support equipment, roll him to an area where he can at least look outside. Our hospital has many small gardens, easily accessible from one of several entrances, although it might take an act of congress to get the nursing staff to agree to my rolling him outside for 15 minutes.
13. Be as patient as you can with the hospital staff. Find out how many other patients his nurse is assigned to care for. Remember that she may be helping another patient in dire circumstances when she does not come immediately to answer a call for her assistance. Don't assume that she is primping, filing her nails, or gabbing with the rest of the staff just because she's not in his room taking care of his needs. I doubt that any hospital has enough nursing staff, outside of their ICU, to provide a full-time attendant for your loved one. If you have no one to help you keep a continuous watch on him, you may need to hire someone to do it. Try for an experienced nursing tech or CNA, if you can afford to do so. Expect to spend at least a few hours with such a person, to familiarize them with all the things that concern you and how you have been dealing with them. If possible, write out as much information as possible for their use.
14. If you must lodge a complaint, start with the Charge Nurse, who is responsible for the entire team that is caring for him. If that doesn't work, talk to the Director of Nursing. If that doesn't work, speak to the Director of Clinical (medical) service. If there's a problem with hospital food, ask to speak with the dietitian. If something is not working properly, ask for someone from building maintenance or engineering. If the room is not clean, ask to speak to the head housekeeper. Try to be polite and calm and reasonable, which is sometimes a very tall order!
15. Be sure your are eating on schedule, drinking plenty of liquids, taking your medications on time, and getting at least 6 hours of unbroken sleep each 24 hours, so you can keep going and will be in good shape when he comes home and you wll become his primary caregiver. You cannot afford to wind up in the hospital, too!
Before the next hospital session, have an attorney draw up a Durable Family Power of Attorney for you, which gives to absolute power to speak as him. Also have drawn a document that names you as primary Surrogate Caregiver, and others as your surrogates, and enumerates all the things you have power to handle.
Add a statement, if appropriate, that no clinical assessments are to be made unless you are present, since clinical information collected from him alone might not be an accurate or complete basis upon which to formulate clinical assessments, decisions, or plans. Have him sign it, if possible; otherwise, sign it yourself, as his attorney-in-fact, and have it signed by an attorney-at-law. (If this statement is appropriate, hand one to every doctor who sees him, and insist upon being present all the time when he is seeing a doctor or having a test made. Accurate and compete information is absolutely critical, and if he can't provide it himself, you must be present to do so.)
All three of the foregoing should be drawn on an attorney's letterhead, because that helps them to be taken seriously.
Prepare a dated list of all meds he takes – everything, even over-the-counter and occasionally-taken prescriptions. Indicate the name of the medicine, its exact form (tab, ER, whatever--it should be on prescription labels, or your pharmacist can tell you), its dosage (how much), the schedule on which it's taken (morn, noon, eve, bedtime), the reason it's prescribed (to control high blood pressure, heal a rash, relieve a specific pain, etc.), and the full name and title of the prescriber. For something he takes voluntarily, prescriber is "self".
At the bottom of the mediation list, in large print, indicate allergies (to latex, adhesives on tapes and the patches for electrodes, penicillin or any of its kin, medications--anything that doesn't agree with him). If he is taking any blood thinner, he should never be given aspirin or any NSAID!) Below that, in large print, indicate critical conditions such as Type 2 diabetes, atrial fibrillation, that he has only one lung or only one kidney, etc.).
Also indicate any preferences, such as no IVs in the arm he uses most, or no IVs in hands. My husband has a severely damaged ankle which has mended well enough but is exquisitely tender. Note something like that.
Then prepare a medical history, beginning at the bottom of the page with childhood diseases or injuries and ending at the top with the latest diagnosis, the date of onset and resolution if it has been resolved, the name of the diagnosing and treating doctor, if it still is being treated. I separated my husband's list into resolved conditions (bottom of page) and those still unresolved.
Next, make up a "hospital bag", like the one expectant mothers prepare against the day they go into labor. Put it some place handy to the door you'd be most likely to go out if he must go suddenly to a hospital. Include:
At least one copy of the papers above. (You should make several, and have at least one on you at all times.)
The things discussed above: comfort items, bed linens, pajamas, if he would be comfortable in them, nonskid slippers, compression hose if he normally wears them, at least two pair of clean undershorts, a roomy and comfortable shirt with at least one pocket for the gizmo to which all the chest monitoring devices are attached, a pair of shorts or loose, soft slacks he can don to walk around outside his room. Keep the walker he uses handy, even if he doesn't uses it all the time, at least two cans of his favorite soft drink, a coupe of his preferred teabags, if he's a tea-drinker, and if he uses a sugar substitute, at least a dozen packets of his usual brand.
Add some comfort items for yourself, especially comb, brush, toothbrush, sanitary items, truly comfortable shoes for those concrete floors, and some short of sweater or light jacket.
At least $100 in cash.
Don't forget eyeglasses for both of you.
Make and carry a list of phone numbers for doctors, family, neighbors, who can support you and him, or be called upon to feed the cat or turn off the coffee pot you dashed out and left on. Make certain that someone has a set of keys to your house.
Don't forget: Never leave your loved one alone. Try to remain calm and civil, whatever the provocation. Ask all the questions you want answered, but pick your time carefully. If you can't get anywhere, ask at an information desk whether there is a patient advocate or a problem resolver available. If more than one person accompanies your loved one, only one should speak for the patient at a time, and without shouting, if possible.
Never forget what you're trying to do:
First, obtain the best possible care for the patient.
Second, ward off hospital psychosis by making him as comfortable, relaxed, and confident as possible.
Third, get him as quickly as possible into shape to return home safely.
Nothing that you discuss should be about you. Try to speak about care, medical concerns, comfort. Try not to refer to others' personalities or appearances. Try very hard to acknowledge that the hospital staffs have protocols they are compelled to follow. Although patients can refuse anything they want to refuse, and using your power-of-attorney or surrogate-caregiver status, so can you, refuse only after calm, rational deliberation and with intelligent justification.
Good luck