Dear Friends,

On July 14, 2010 Herb passed the nine-year marker for his massive stroke. During these years we have chiseled out a “new normal” even with right-sided paralysis and diminished eyesight. We continue to travel, see friends, go to plays and restaurants and Herb still attacks his New York Times crossword puzzles in ink.

A recent CAT scan of Herb’s heart showed that major arteries were closing up. Rather than perform bypass surgery, not recommended because of impairments from his stroke and Charcot Marie Tooth, a degenerative neuromuscular disease, the surgeons opted to stent arteries leading from the left side of his heart. Herb underwent three massive procedures on three consecutive days. We are very grateful for the skill and guidance of his cardiologist, Dr. Miriam Cohen, Heart Associates P.A., in Baltimore, Maryland (we live in Cleveland, OH) and the cardio-renal surgeons on her team.

Herb survived these cumulative procedures but after four days in the post-surgical cardio-unit he became delirious. Whether the cause was the iodine used for scoping these tests, pre-meds to offset his sensitivity to the iodine, or conditions in the unit itself is unclear. Only two weeks later The New York Times ran a front-page article on the prevalence of hospital delirium. Widely recognized and of particular danger to the elderly, it can lead to dementia and even death.

Glued to Herb’s bedside for three nights and four days while he was in the recovery unit, I became an eyewitness to his care. Not to disparage a highly regarded hospital and an outstanding medical team, I saw policies and procedures that motivated me to respond with a letter to The New York Times. Although they chose not to print my response, Medical News Today did position it online in its entirety.

In my letter I made six recommendations for surgical and post-op care help that I believe can help to lessen the frequency of hospital delusion and even alter the medical “acceptance” of this problem:

1.  Include a pharmacologist as part of the surgical team to monitor medications and procedures.

2. Allow patients to sleep off their surgical procedures. Use a rheostat to turn down any unnecessary lighting, especially above or near the patient’s bed.

3. Control voices of nurses, physicians, and technologists who work shifts around the clock. Their “daytime” may well be their patients’ much needed sleep time. Normal voices and extraneous conversation should be out of place in a recovery facility. Or even on the hospital floor, especially at night.

4. When monitoring patients at night, nurses and technicians might just as effectively use a laser flashlight rather than turning on all the lights multiple times during the night.

5. TURN OFF THE FIRE ALARMS!!!! Unless that particular section, floor or unit is under threat and requires immediate evacuation, alarms should not ring through these post-op sections, or anywhere else in the hospital for that matter.

6.  And finally, institute a major change in policy by adding rather than deleting staff on holidays and weekends. Studies show the level of mortality rises for heart attack and stroke patients admitted during hospital off-hours during these short-staffed spans than those admitted on weekdays. 

I would love to hear from survivors, family members and medical professionals who have direct experience with hospital delusion even if you disagree with me. I hope our posted discussion will build greater awareness of this problem and lead to eliminating an unnecessary problem.

All my best,