I have been told that when treating delirium, you should look for reversible causes first. In other words, before adding in lots of medication, try to see if a simple solution exists.
One such reversible cause for delirium is hypoxia, or not getting enough oxygen to your brain. This can be a very simple thing to fix for some patients; just add oxygen. However, this can be more difficult when the delirium is at play.
Such was the case with Ronald. He had been diagnosed with lung cancer, and had spent a few days in our hospice home to give his disabled wife, who was also his caregiver, a break. Ronald was just starting to show signs of the roller coaster ride of up and down moods and confusion that can happen as the body slowly begins to shut down. He was a handful, and the staff was beginning to feel they needed a break as well.
When the nurses took him to his rural home 15 miles away after his respite stay, they made sure to alert his wife of some of the changes we were seeing, especially the new delirium and confusion that was worse when he didn’t wear his oxygen. They bid he and his wife farewell until the following day’s scheduled nurse visit and departed with relief.
I need to mention at this point that it was winter in Kansas. We had recently had several inches of snow, and more was on the way.
Several hours passed of peace and quiet at the Hospice House, when all of a sudden one of the nurses heard a banging sound at the back door. Confused on who it would be, she made her way to the back hall and opened the door. As a blast of snow and air hit her, she squinted in the bright light, her draw dropping as she took in Ronald standing in the snow in sweatpants and bare feet.
“Nurse, you have to come now!” He said in a panicky voice. The nurse had to prioritize the multiple shocking things in front of her. Ronald needed help, Ronald had no shoes on in a snow storm, Ronald had somehow arrived from his home 15 miles away.
That’s when the nurse noticed Ronald’s old pickup idling in the back parking lot. She blurted out “Ronald, what in the world is going on?” which seemed to sum up all of her concerns.
“I had to get here, my oxygen tank is broken at home. I can’t get it to work, and I absolutely need oxygen now. YOU need to come with me back to my house to fix it” Ronald explained.
Here’s were delirium’s irrational side comes in. Instead of having his wife call the nurse, or he calling the nurse to work thru the problem, Ronald had run to his truck in his bare feet and driven through a snowstorm to come get a nurse.
There really was no way to persuade him of any other solution than having a nurse follow him back to his house to figure things out.
The nurse drove in her own car, and followed to make sure Ronald was safe as he made his way back to his home. Even back at his house, he spoke in a rapid, paranoid way. She helped him inside, and he led her to the troubled oxygen concentrator.
“You see, there, it’s not working!” Ronald said flipping the switch on and off in exasperation. The nurse immediately glanced to the wall were the cord to the concentrator lay, unplugged. She calmly walked over, plugged the machine in, and the machine’s whirring sound began again.
The remedy to Ronald’s delirium was oxygen, which was readily available, however it was the delirium itself which prevented him from being able to help himself.