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Column: August Passes and Its Dark Shadows Lift

Strafford

I think it’s likely I relish September more than any person alive because every year as August approaches, I feel a shadow pass over my life. On a hazy morning in 2006 as July turned to August, I entered Dartmouth-Hitchcock Medical Center by way of the emergency room and stayed for a full month. A galloping respiratory infection nearly killed me and turned the lives of my family upside down, but I survived and very gradually had to learn once again how to walk, to run and to think clearly.

We all mark anniversaries, happy or sad, formal or imaginary, and stop to think about what they mean. The process usually begins in the intellect with a date on a calendar — for me, the birthdays of my parents, or my older sister, all dead — then moves to the emotions. The final stage is back in the mind for a kind of understanding that often involves language and conversation. My annual August event is different because I feel it first. It starts inside me with a sensation of darkness followed by dread and vivid flashbacks. The last step for me is intellectualization when I say to myself, “Of course. It’s that time of year again.”

I read recently about a study by researchers at Johns Hopkins University on patients in the intensive care unit with respiratory illness who had been sedated and intubated, as I had been in 2006. In their study they found symptoms of post-traumatic stress disorder in a significant number of the patients, a third of them, who experienced feelings of paranoia and had terrifying, recurrent dreams that lasted sometimes as long as two years, causing serious psychological problems. The study fascinated me, not because it was news (I had written an article about my illness for Dartmouth Medicine and mentioned this phenomenon), but because it described some new hospital protocols to help patients deal with and recover from the stress of respiratory illness.

I wasn’t part of the study. If I had been, I would have appeared on the least-damaged end of the spectrum because of some lucky circumstances. For starters, I was able to survive my illness — pneumococcal pneumonia coupled with acute respiratory distress syndrome, a disease that kills roughly half of those who contract it — because I was healthy and strong when it hit me. My health and some good medicine saved my life, but my real luck really began when I woke from a two-week coma and had family at my bedside to help me through the fog. They had been there while I slept, and they were there for the next two weeks as I struggled with the symptoms described in the Hopkins study.

When I believed a night nurse was out to kill me, my wife spent the night in a chair in my ICU room so I could sleep. When I doubted I was getting antibiotics to combat the infection in my chest, my daughter and her husband, both physicians, read my chart aloud and showed me the line running into my arm. When I believed the hospital had neglected me for a week, my sister drew a calendar on a piece of paper and showed me how only two days had passed since I woke up. My son tuned in a Red Sox game on the television over my bed and told me what had happened in the time that had slipped away. Patiently, they escorted me from a kind of madness. While the hospital treated my body, my family and my friends took care of my mind and spirit.

The combination of luck and support I had is rare. My wife and son and daughter were able to take time off from work. My younger sister was a nurse in the same hospital and could explain the mystery of some of the hospital protocols. Some patients are alone with the distress as they battle respiratory infection, alone with the pain and the panic and with the dreams. Doctors and nurses on rotating shifts can provide continuous and coherent medicine, but addressing the craziness of their patients is another matter. How ironic, that the very medicines that give patients a chance at survival — the sedatives, paralytics, anti-inflammatories and antibiotics — can also combine to produce powerful side effects and leave some patients with psychic damage.

What struck me about the Hopkins study is that it affirmed that the fears and dreams of respiratory patients are events that doctors and nurses need to take seriously. They can help by listening carefully to their patients and by recording what they say in a log or journal that the patients can take home when they are discharged and use as a timeline to better understand the experience. Taking the patients’ craziness seriously will help the healing. The recommendations I read about sounded like what I had experienced, not just with my family but also with some key hospital people.

After a few days after my breathing tube had been removed, a physical therapist got me on my feet, right there in the I.C.U., although I was unable to move my legs. Patiently, she sat me up in bed, moved my legs to the side, and pulled me onto my feet with a bear hug. The next day she helped me take 15 steps with a walker, and she told me her name was Sam, and I learned that she had young twins at home. She was a real person and she cared enough to look for the person in me. A week later a doctor casually suggested that I keep a journal, and later that day my wife went out to buy a notebook. My first words were impressionistic and illegible, but I soon improved and continued to write several times a day. When I was discharged, I continued to write entries for months. The journal helped me understand what had happened to me and helped me find perspective on the madness that comes with respiratory distress.

I recovered, and when I left the hospital I greeted September with a new affection. Two weeks after leaving the hospital, I could walk without a cane; and after a month I was able to go back to work. After two months I could run again, a little at a time, a whole mile by Thanksgiving, and two by Christmas. But every day for the next two years I involuntarily revisited my hospital stay. All of a sudden, a vision or an old dream would rush at me, and for a minute or two I would feel, more than anything, my mortality. Then very gradually, the experience receded, and I rarely think about it until I feel a passing shadow as August draws near.

A couple months ago my wife and I went to a movie in Hanover. We bought our tickets early then went out for dinner, so when we arrived at the Nugget, we were able to bypass a long line of people waiting to buy their tickets. As we squeezed through the door, a woman looked at me and said, “Remember me?” It was Sam, my physical therapist, and she wanted to know how I was.

Jonathan Stableford lives in Strafford.