A little psychosis doesn't make you crazy

Today was Day 17 in the Trauma ICU. I needed to stop and count because the days all run together for those of us whose lives now revolve around the ninth floor of UAB Hospital.
But if our lives seem out of whack, imagine what it's like for the actual patients.
There is something that goes on in ICU that is referred to as "ICU Psychosis," and it's very real. Medically (and I looked this up) it is defined as "A disorder in which patients in an intensive care unit (ICU) or a similar hospital setting may experience anxiety, become paranoid, hear voices, see things that are not there, become severely disoriented in time and place, become very agitated, even violent,  ..."
You may remember me writing about the young lady whose family was up here, whose mother hadn't slept for 72 hours because when she did go to sleep, she had nightmares about robots coming to get her.
Another of the waiting room community told me of their patient who was sitting in his bed, desperately looking for the steering wheel, convinced he was in a car.
Yes, the stories are funny. And no, they are not funny.
I have witnessed them first-hand. Part of the problem with coming off four surgeries, as MG is doing, is that she lives in sort of a dream world. She needs to be awake enough to follow instructions from the doctors and nurses, but asleep enough not to feel any more pain than is necessary.
I'm not going to embarrass her by repeating any of her disoriented moments, except to say they are very real. Some are funny. Some are sad as she tries to understand exactly what happened to her. I went over the accident in great detail today, because at various times over the last few days she's lived through a range of emotion. At times she has thought she was just being 'checked out' as if the accident had just happened that morning; at others, she's been very afraid that, among other things, her children were in the car with her (upon meeting one orthopedic surgeon today, she thanked him for operating on her son), or that someone else was hurt or that I wasn't telling her everything that had happened.
I was quite busy with MG Sunday night and all day Monday. She is starting to deal with very real pain from multiple surgeries, combined with the side-effects of finding the right balance of pain-numbing drugs, plus multiple "tests" to determine: if she has any damage to her throat from the ventilator tubes,if  her lungs are remaining clear, how much she can move her feet (particularly her left foot), and if there was any nerve damage to the left leg.
So far, thankfully, MG has passed every important test (there are a few side effects she's dealing with, but there is every chance those will correct themselves with time).
But it occurred to me, after a particularly fitful night and frustrating morning, the problem is that while I realize the dangerous part is over, MG got to "sleep" through all of that and for her, the hard part is really just beginning as she comes to terms with all that has happened and all that will happen.
Needless to say, it's a shock to her system.

Finding the right balance to the drugs has not been easy, and paranoia is very real, particularly at night.
In fact, defining "night" is part of the problem: it's almost impossible for patients to determine day and night. If they sleep, it is usually a short "nap" that they often wake up from thinking it is a new day. By far, the nursing staff is caring and professional. But when two "strangers" come in and start dragging you around on your bed, it is frightening (the "dragging" is just repositioning the patients body, but it often involves pulling the patient over to one side or dragging them back up to the top of the bed when they slide down to the bottom or off to the side).

We all know you can't sleep in a hospital. Even the doctors in the trauma unit shake their heads and admit it's impossible to get a good night's sleep. Everyone just accepts that this is the way it is.
But my question is, why does it have to be that way?
Oh, for some patients I can understand. But it seems to me that with a little planning and scheduling, a good many of the night-time intrusions could be handled consecutively, instead of the nurses coming in to check medicine, then 10 minutes later a respiratory therapist comes in for a breathing treatment, then 10 minutes after that someone else comes in to check a temperature. Why can't they all make their rounds together? For that matter - with all apologies to respiratory therapists - why can't nurses be trained to do the breathing treatment they do? I mean, after watching them hook up a tube, turn a valve, then put a mask over the patients nose and mouth, I could do it. I'm not saying respiratory therapists aren't valuable and necessary; I'm just suggesting it's one more intrusion that could be done immediately after temperature taking and med-checking and patient-sliding, perhaps giving the patient at least 30 minutes of uninterrupted rest.
I know and am thankful that the nurses check constantly on the patients. But what are the monitors for, if not to tell them that the patient is breathing normally, the heart rate and blood pressure are normal, etc. etc.? Do they really have to wake the patient? The machines give off a warning when anything "reads" incorrectly - and that happens all the time. But I've yet to see a machine give off a "normal" reading when things are not normal.

I am sure this is all more complicated than I realize. But I can't believe hospitals can't come up with a better system for checking on patients during the night, to allow maximum sleep time. My friend Mitch spent a month in the hospital and told me they were concerned because he slept all day and was awake all night. But he said it was very simple: during the day, his wife was there to care and protect him, while at night the nurses and attendants were constantly waking him and disturbing him. His sleep patterns got completely out of whack.
There has to be a better way.
Today, MG was almost in tears because she needed to sleep. The day nurse, thankfully, closed the doors almost completely to shut out as much hallway noise as possible, and let us draw the curtain and turn down lights. Why can the day nurses get it, but the night nurses don't?
The good news is that by the end of the day, MG was worn out from so much activity - particularly the physical therapy - that she crashed and slept uninterrupted for several hours.

Again, she passed her swallowing tests, so hopefully MG will begin to get the three basic hospital food groups today: water, applesauce, and broth. She's breathing on her own. Her vitals are near-perfect. I was told as soon as a room in the "step-down" unit becomes available, she's on the list to move.

The waiting room community folks whose family member has already graduated to the "step-down" unit regale the rest of us with stories of how nice they are. MG was actually starting to get excited yesterday afternoon at the prospect of moving to a new, more private room where family and friends can visit in more comfort.
The best news, to me, is that she seems to be finding a balance and coming out of the episodes of ICU Psychosis. She understands how serious her condition is, and I think now understands we're in this for a long haul that will be painful, but manageable - with planning.

It is good to know that the psychosis is not permanent. It is nothing that shouldn't pass in a few days out of the ICU, with a few days of living "normal."
We weren't meant to live this way.
Thankfully, we won't have to live this way forever.

And that, too, will preach.