Hearing things, seeing things

A male patient of mine developed visual and auditory hallucinations two days after surgery. This started about 10 o’clock at night. Naturally the family members were quite distressed. This continued overnight and in the morning, the wife was visibly distressed and agitated by her husband’s behaviour. Other family members, with good intentions, kept telling the patient that the visual and auditory hallucinations were untrue.

Acute confusion following surgery can occur for several reasons. Some causes are correctable and some occur without a cause and require supportive measures and the patient recovers spontaneously. Examples of common correctable causes include:

1.      Poor oxygen content in the blood due to poor inspiratory effort, pain which prevents the patient from taking a good breath and chest infection.

2.      Any infection elsewhere in the body.

3.      Blood electrolyte disturbance following surgery or after having been on intravenous infusion.

4.      Cerebrovascular accident.

5.      Alcohol withdrawal syndrome (this can occur when the patient did not admit to being a regular heavy drinker).

It is important for the doctor to exclude the correctable causes and if found, to take the corrective measures to treat the underlying condition. Once these causes have been excluded then the doctor’s role is to institute supportive measures to help the patient through this period. The medication may take a little while to calm the patient.

To the patient, the visual and auditory hallucinations are very real. No amount of persuasion or reasoning from the family members will dissuade the patient from believing in the hallucinations. Indeed, excessive attempts by loved ones to prove to the patient that such hallucinations are false may make the patient more angry and less cooperative.

Post operative confusional state is a known complication following any surgery. It can occur suddenly but not uncommonly tends to come on in the night. It is also more common among the older age group and it affects both male and female patients alike. In the hospital, the patient finds himself in an alien environment with many unfamiliar faces (of health care personnel) coming into contact with him. This is likely to cause disorientation and confusion. In some patients, a slight degree of confusion / disorientation will persist even when it is time for discharge. Once the patient gets home to his familiar surroundings and sees familiar faces of family members, the disorientation and confusion goes and the patient resumes normality.

To the patient, the voices and the visions are real. To the relatives, they are unreal. The natural reaction of a relative is a mixture of fear, frustration and later anger at the irrational insistence of the patient. The best thing a relative can do is be supportive and just be there.