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Tuesday 13 August 2019

the edge of reason

Delirium tremendous

Ten days in a coma wasn’t the problem. It was the flying beds, Russian spies and being kidnapped

By Matthew d’Ancona

This story appears in the new edition of Tortoise Quarterly. Depending on your membership, you’ll receive your copy in glorious, old-fashioned print or as an ebook in mid-August. To buy a copy of our short book of long reads visit tortoisemedia.com/shop

 

It was a moment when you might have expected something emotional, even, at a pinch, portentous. My father and elder son were visiting me in the high dependency unit (HDU) at University Hospital Lewisham, south-east London, for the first time since I had fallen seriously ill. I was awake and talking, croakily, but talking all the same.

I beckoned my dad, who was clad in the regulation plastic apron for visitors, eager to exchange words with his eldest son for the first time since he had fretfully watched me being taken away by ambulance on a gloomy September evening. What did I have to say? What greeting would do justice to this moment of reunion? Back from the almost-dead, how would I announce my return? “Dad,” I said. “For God’s sake, get on the phone to my agent.”

It says a lot for my father, and his phlegmatic, limitlessly compassionate approach to the business of lifelong parenting (I was, after all, 48 at the time) that he took this ridiculous remark in his stride. A lesser man would have faltered. But he nodded and said: “Absolutely”.

I suppose, to put the exchange in context, he was relieved that I was saying anything at all. In July 2016, on a trip to Bayreuth to comment on Wagner’s Ring cycle for Sky Arts, I had started to experience severe, stabbing stomach pains. After Götterdämmerung – doing my best to conceal my discomfort from my neighbour, Stephen Fry – I had crawled back to London via Munich.

Like an idiot, I did not go straight to A&E to admit that, on balance, I felt like I was dying. Instead, I saw a doctor (and even that, reluctantly) who prescribed antibiotics, anti-nausea meds and paracetamol, and told me – you guessed it – to drink plenty of fluids.

But when the pain returned at full blast in September, I was all out of evasive options: this time I fainted whenever I tried to stand up. Up, crash. Up, crash. The cats were seriously alarmed. The paramedics came, stretchered me downstairs from the landing where I lay, and whisked me straight off to the emergency room.

A CT scan and gastroscopy – camera down the gullet, no fun at all – suggested a perforated ulcer. I would be out of action for a few days after surgery. I remember grumbling, in the way that men of my age do when they want it to be known that they have important stuff on their plate that cannot be postponed.

But my frustration was pretty half-hearted. By then, I just wanted the pain to stop. A jolly anaesthetist called Ax, with superbly colourful tattoos all over his forearms, invited me to count down from ten. I got to seven before slipping into welcome oblivion.

I have dim recollections of some odd dreams: a trip to China, a BBC workshop, a close-to-the-bone conversation in a plush library about the alleged harvesting of organs for sale in America. Definitely dreams. And then, no less abruptly, I was awake.

A nurse called Sally was by my side as I came around. “You’ve done very well, Matt,” she said. “And you’re much, much better.” Beat. “But you’ve been asleep longer than we expected.” Beat. “Asleep for ten days, actually.”

So glad was I not to be in pain, and to be awake, that this astonishing disclosure did not astonish me all that much. I noticed that I had a pretty nifty track of staples down the centre of my stomach, suggesting a more invasive surgical procedure than I had expected. But the missing ten days? Well, these things happen. Can’t be helped.

As it turned out – and a lot of this I was to learn only much later – the agonising ulcer had saved my life. I had, in fact, been in the full grip of abdominal sepsis, a form of infection that has a 75 per cent fatality rate. I got lucky, to say the least. The pain had forced them to open me up – and to discover the extent of the poison in my system. And then, doubly lucky, my brilliant surgeon, Adrian Steger, and his team had saved my life and spared me from the loss of limb that is such a miserably common price of septic shock.

Post-surgery, Adrian and his colleagues had put me into an induced coma to allow the cocktail of industrial-strength antibiotics and other drugs to do their cleansing work. It worked. And I still feel that every day is a spectacular bonus. Is it good to see you? Hell, to quote Keith Richards, it’s good to see anyone.

But that’s now. Back in the HDU, three years ago, with all this mortality-narrowly-evaded stuff going on, you might have thought that I would have been lying in bed, trapped like Gulliver by the Lilliputians in a web of tubes, drips and leads connecting me to beeping machines, contemplating the mysteries of life and the caprice of the Grim Reaper. But not a bit of it. No, sir. I had only business on my mind. Show business to be precise.

From this most unlikely position, in a hospital cubicle in autumnal south London, I was planning my next step to Hollywood stardom. Well, my first step, really. But that was not the way I saw things at the time.

My illness and incapacity, I was absolutely convinced, were an irritating diversion from my preparations for a new HBO spy series – for which I was both finishing the screenplays and in which I would co-star. Hence my initial request to my dad to get on to my agent.

 

Entitled The Collaborators, the series was set in a proto-fascist world in which my character – a seasoned MI6 agent – would team up with a Russian counterpart to fight the bad guys, both criminal and governmental.

In the early episodes (of course) the Russian FSB operative and I would circle one another with the conventional suspicion of traditional enemies. But, by the end of season one, he and I would be close allies, a maverick duo bonded by professional respect, sharp badinage and a growing fear that our real enemies were the authoritarian politicians who were our ultimate masters. Contemporary, eh?

Crucially, I managed to persuade myself that the pulse oximeter – the clip they put on a patient’s finger to check blood oxygenation – was in fact a sophisticated alphanumeric device, enabling me to send emails and WhatsApp messages to the showrunners and location scouts around the world.

My dad and the elder of my two younger brothers had wisely confiscated my iPhone. But what did they know? I could still contact all the principals in this global project with a cunning click of my clip. Even in hospital, I was issuing commands to the crew.

I also held regular meetings at bedside with script editors, fight choreographers and – looking ahead – the merchandising team and video game designers. We were thorough. We were good, quite frankly.

My co-star, Yuri – I never got his surname – was a frequent visitor, always wearing a flat cap and cashmere hoodie, often accompanied by members of his family. Yuri was as edgy as me about the implications of my illness for the show’s production schedule: we were meant to start principal photography in March, after all, which left only six months for me to recuperate and get into physical shape for what was bound to be a demanding shoot (I had scripted plenty of fight scenes).

This was his break, his chance to become a household name. But he was supportive of my predicament. It never occurred to me that he would push for my role to be recast, and he never mentioned it. He used to pace the ward a lot, but I was grateful for his loyalty.

If all this sounds like total, unmitigated nonsense, that’s because it was. But – and it’s hard to exaggerate this point – it was real for me in every possible detail. This was not dreaming, or psychedelia, or occasional lapses into blurry fantasia. This was hallucination.

 

The distinction is very important. In his Principles of Psychology (1890), William James makes the point clearly: “An hallucination is a strictly sensational form of consciousness, as good and true a sensation as if there were a real object there. The object happens to be not there, that is all.” And here’s the late Oliver Sacks, in his excellent book Hallucinations (2012), describing a morphine-induced vision of his own in 1965:

“I could see silken tents of different colors, the largest of which was flying a royal pennant. There were gaily caparisoned horses, soldiers on horseback, their armor glinting in the sun, and men with longbows. I saw pipers with long silver pipes, raising these to their mouths, and then, very faintly, I heard their piping, too. I saw hundreds, thousands of men – two armies, two nations – preparing to do battle… I realized that what I was gazing at from my aerial viewpoint was Agincourt, late in 1415, that I was looking down on the serried armies of England and France drawn up to do battle. And in the great pennanted tent, I knew, was Henry V himself. I had no sense that I was imagining or hallucinating any of this; what I saw was actual, real.”

So it was for me. I had absolutely no intuition that this was all a fabrication of my upended imagination. My work on the television series was perfectly integrated with the daily round of injections, blood tests, consultations and scans. Indeed, members of the HBO gang often lingered while Adrian’s medical team gathered around my bed. On one occasion, Chelsea Clinton popped in, on her way to meet her parents at a party by the Thames.

I had brand-new manufactured memories, too: of a recent trip with my dad to see Billy Connolly – suddenly a family friend – perform Highland classics at a concert in Scotland; and a press junket to a luxury hotel in San Diego that had included a party with the recently deceased Gene Wilder. The intensity of these new (and entirely bogus) recollections was as great as the imagined experiences that were now occupying me daily. Never did I have the slightest sense of the real being at odds with the hallucinatory – of a door to weirdness opening suddenly and alarmingly. Indeed, the striking thing is how seamlessly the actual and the imaginary were integrated – what technologists would call “augmented reality”.

This must have been heavy going for my family. As I perked up a little, and became more talkative, I was sharing more of my fictional world with them: surprisingly lucid, they recall, in my description of all this absurdity, coherent in my nonsense. I informed them – by now patiently united in their decision to let me get all this out of my system – that the hospital was enterprisingly involved in the television production process, raising funds for the NHS by assisting me with the series development. They nodded generously, wondering with some anxiety how long this was going to go on. I will always hate the fact that they had to go through that.

I watched pre-production dailies on a huge – if non-existent – screen at the end of my bed. I also arranged a live feed from the Steadicam used by this first unit.

The pilot episode hinged on the pursuit of the lead characters by two deadly Russian assassins: twins, perfectly attired in Savile Row suits and bowler hats, they resembled a psychopathic version of Thomson and Thompson from the Tintin books. I was delighted with the early rushes: the epic cinematography of the twins against a bleak but beautiful Siberian landscape, closing in on their prey.

Not that I was confined to my ward. In a convenient Bedknobs and Broomsticks touch, my bed was able to travel all over the world: to a home in Malaysia for a quite delicious meal; a New York hotel off Times Square; a pleasant house party in Brighton; a Monaco-themed bistro in Chelsea; a Sealink ferry, where (details, details) the medical staff had company logos on their lanyards; a Star Wars memorabilia store in Turin; and – more seriously – a board reception to celebrate the successful creation of the first tranche of merchandising for the series. It was fun to be wheeled among the television grandees in my bed, glad-handing studio bosses and money men.

The only potential glitch in these travels was that, one evening, I was kidnapped by Class War, who spirited me off to one of their safe houses, fed me beans on toast and, after an interesting ideological discussion about the internal contradictions of capitalism, drove me back. Charming people. Badly misrepresented in the media, I concluded.

More worrying, given how much scriptwriting I had on my plate, was a visit to an Area 51-style facility, where shadowy scientists were working on alien technology. I remember being more exasperated than unnerved by this.

Lying on my hospital bed in the genetics laboratory, I asked these sinister eggheads and spooks whether they really needed me as they tried to engineer an alien-human hybrid species. “I’ve got work to do, you know,” I declared. I wouldn’t say they were exactly contrite – but they took me back to Lewisham hospital fairly sharpish.

In all this, it is only fair to report that I had struck lucky yet again. I was – though I did not know it at the time – suffering from a very common condition that afflicts intensive care patients: ICU delirium. Depending upon which survey you consult, a third to 80 per cent of those who pass through this section of a medical facility will experience confusion of a kind.

Surprisingly, given the high level of incidence, comparatively little research has been conducted on the syndrome. There is broad agreement that a cocktail of factors is involved: the combination of powerful drugs, mechanical ventilation, physiological weakness, insomnia, and the underlying psychological stress of being seriously ill.

But the sheer power of the delusions has not been explained, and there is little consensus on treatment protocols (in my case, a short course of sleeping pills and routine rehydration did the trick). Many thus affected never truly recover, and suffer from something like PTSD for the rest of their days.

As for the hallucinations themselves, most who experience ICU delirium have a rotten time. My friend, the Times journalist David Aaronovitch, suffered terribly in 2011 in intensive care. He heard the voice of vicious bigots plotting “against blacks, against Jews, lefties and homosexuals”, believed the nurses were turning him into a zombie and that he was going to be eaten by cannibals.

There is literary precedent, too, in Evelyn Waugh’s semi-autobiographical novel The Ordeal of Gilbert Pinfold (1957), which describes the descent into hallucinatory torments of a novelist on a cruise to Ceylon. Loaded with bromide and chloral hydrate, Pinfold overhears a series of taunting voices, accusing him of countless shortcomings, urging him to suicide. Even when he has recovered, Pinfold feels “like a warrior returned from a hard fought victory… No sound troubled him from that other half-world into which he had stumbled but there was nothing dreamlike about his memories. They remained undiminished and unobscured, as sharp and hard as any event of his waking life.”

John Betjeman described the book – accurately enough – as “a picture of hell on earth”. In a BBC interview in 1960, Waugh himself recalled the real-life delusion that inspired Pinfold thus: “At first I conceived that everyone was involved. I was rationalising it all the time; it was not in the least like losing one’s reason, it was simply one’s reason working hard on the wrong premises.”

Yes: that’s absolutely what it was like. The all-important difference was that my encounter with ICU delirium was, for the most part, free of fear and suffering. There was one incident – a second, and very disagreeable gastroscopy – that involved being restrained by a doctor and two nurses as the tube was plunged down my throat. In my confusion, I was convinced that this was the filming of an “enhanced interrogation” scene for the TV series that had gone wrong – and I was inconsolably furious afterwards at such amateurism on my set.

For the most part, though, I was content in my dreamland and the medical staff – hideously overstretched at the best of times – left me to it. In a high dependency unit, full of patients making the transit back from the border between life and death, a journalist rambling on about his plans for Hollywood glory ranks low on the scale of priorities. I have nothing but praise for the doctors and nurses who treated me.

 

What was it all about? Interestingly, work often features in these hallucinations. It is at the centre of Pinfold’s torments. And in his essay on the delusions he suffered in hospital in 1982, ‘A Peep Round the Twist’, Kingsley Amis writes of a compelling “Kenneth Tynan dream” in which he was collaborating on a non-existent project with the great theatre critic – “perhaps a musical about George Orwell”.

That struck a chord when, much later, I tried to make sense of my own dance with the gods of nonsense. It was true that, after I left the editorship of The Spectator in 2009, I had worked for a few months as a scriptwriter with David Milch, the creator of NYPD Blue and Deadwood, and the journalist, Sarah Standing. Sarah and I had spent some of the time at Milch’s offices in Los Angeles – and Milch did indeed have a big development deal with HBO.

My off-the-wall plan for a 21st-century version of The Man from U.N.C.L.E. – starring me, naturally – must have included echoes of this agreeable collaboration. It’s true, too, that while I usually write about things like Brexit, and serious culture, and the philosophy of post-truth, I have watched an awful lot of B-movie thrillers and C-division Netflix in my time.

I was once accused by another Fellow of All Souls of having “hidden shallows” – a badge of honour that I think revealed itself to be right on the money when, many years later, my psyche became temporarily unmoored. I didn’t see Jesus, zombies or Hitler: I saw myself picking up an Emmy. When, in my final week in hospital, I gradually realised that the whole thing was imaginary from start to finish, that I wasn’t going to Hollywood and that there was no aikido instructor waiting to get me ready for shooting – well, I was officially relieved but privately a bit disappointed.

Thoughtfully, one of the doctors played me a recording on her iPhone of a programme Aaronovitch had made about his terrible experience – and hearing David’s penetratingly sane voice, full of warmth and wisdom, I felt myself starting to return to the terra firma of reality unblemished by my psychic clutter. And then, during a family visit soon after, I experienced at last the full weight of reason and empiricism come crashing back through the membrane of delusion. No series, no HBO, no campaign for that elusive first Emmy. “Oh, fuck,” I said to myself.

Not that ICU delirium is a subject to make light of: it isn’t. Indeed, as more of us live longer and recover more frequently from serious illnesses after intensive-care treatment, the more pressing this particular pathology will become as a public health issue.

It is especially hard on families. Even my frequently-comic monologues were, I realised afterwards, difficult for my loved ones to hear, day in, day out; it is exhausting to humour those who talk gibberish, even harmless gibberish. And many relatives have to deal with a lot worse: prolonged confusion, psychosis, disruptive behaviour for many years. So I salute those who are already investigating the syndrome’s roots, its symptoms and its treatment, and hope that many others are given the funding and facilities to follow suit.

After three weeks – a shorter period than initially expected – I was home, convalescing, walking with a cane, eventually doing very low-key Pilates to get my body used to normality again. I badly wanted to be back on the journalistic beat to write about the presidential election. I managed to achieve that target, and was then plunged, with everyone else, into the real insanity of the Trump era.

The lasting impact, if I am honest, has been philosophical. I am a liberal rationalist, an unashamed champion of modernity, and an enemy of superstition, snake oil, New Age hokum and (basically) anyone who has a go at the Enlightenment. So my brief exile from that intellectual homeland was much more unnerving in retrospect than at the time.

It is alarming to discover that the border separating the rational from the irrational is so porous, that the guard-rails keeping delusions, visions and unwanted apparitions at bay can be smashed through so easily. It is unsettling to feel the foundations of your world-view rocked, however briefly, by the deepest of psychic forces.

I still laugh, remembering the preposterousness of it all. But such moments of recollection give me pause, too. These days, I have a healthier respect than I did for the power of unreason, and its ceaseless pounding at the door of our lives. I now know that the door is always ajar; and I wonder, more than ever, in the words of the prince, what dreams may come.

Illustrations: Laurie Avon, for Tortoise

Further reading

– Evelyn Waugh’s The Ordeal of Gilbert Pinfold (the “mad book” as he himself called it) was published in 1957. The author was quite open about its autobiographical character, though he took vigorous issue with J.B. Priestley’s claim in the New Statesman that the psychological breakdown described in the novel had its deepest roots in the tension between Waugh’s dual identity as a writer and a country squire.

– Kingsley Amis’s ‘A Peep Round the Twist’ is a chapter in his Memoirs – which is itself less an autobiography than a collection of personal essays. His son, Martin, recalls his conversations with Kingsley about the original experience in his own memoir, Experience.

– Oliver Sacks’s Hallucinations is a readable account – often deeply personal in nature – of the neurological and psychological meaning of such delusions; especially good on their sheer variety and the fragility of what might be called our rational view of the world.