The Surgical Psychosis

Post-operative behavioural changes are a well-known phenomena—in one such case, a gentle god-fearing soul turned into a violent person


“You need an operation on your neck, Mrs. Smith,” I told the god-fearing 66-year-old lady after conducting a detailed evaluation in her hospital room. The medicine cabinet next to her bed had three different-sized photo frames of Christ, two rosaries, and the Bible. The window sill was lined with a picture of The Last Supper, and next to it were a couple of wooden crosses. There was gentle ‘Praise the Lord’ music playing on her husband’s phone. I felt as though I had just walked into the kingdom of heaven.

Over the past year, Joanne Smith had started to complain of a difficulty in walking on uneven surfaces. She had tripped over and fallen a few times. She found it hard to cook, as vegetables and utensils kept slipping out of her hands. As a well-built lady, she was used to a large amount of physical labour, but most of her activities had been curbed owing to her ailment.

“I feel like I’m walking on fluffy clouds all the time,” she said in a reticent voice, describing the sensory impairment in her feet. I really was in the kingdom of heaven. “Squeeze my fingers tight,” I instructed as I put them on her palm for her to grasp. Her hand slipped off easily, and her husband, who was standing stoically next to me, nodded his head, expecting this outcome.

I prophetically held the MRI films against the light streaming in from the window to show them where her cervical spine was being compressed by her thickened bone and ligaments. “We will remove whatever is pinching on the cord, and over the next few months, you’ll regain most of your function back,” I explained, advising them of the usual complications that could arise with an operation like this. “God has chosen you as an instrument for her healing,” her silver-haired, dark-skinned husband proclaimed. “I will do my best,” I said, with my hand on my heart, albeit a little nervous of their proximity to God.

The next morning, we flipped her on her belly, fixed her head on pins, and sliced down the back of her neck. I went ahead and meticulously drilled off the bone, punching out the thickened ligament to allow for her spinal cord to breathe again. “I don’t want anything to go wrong with this lady,” I said, which is what I assert loudly when my subconscious tinkles that something might. The surgery had gone off well, and I sounded off the postoperative instructions as we closed. We shifted her to the ICU for overnight observation.

I saw her again in the evening before I left for the day. As I placed my hand over her forehead, she softly smiled at me and said, “Thank you,” still groggy from the anaesthesia. She was moving her arms and legs well, which was an excellent sign. “Thank you, Jesus!” I said to myself for a change, a variation from the oft-used “Thank you, Khodaiji,” hoping my Parsi God wouldn’t mind. I drove back recalling the Smiths’ belief in God and I wondered if atheists or agnostics recover just as well as devotees of the divine. It might be a study worth conducting one day, although I am convinced that providence plays a big role in successful outcomes, especially in the kinds of cases I do.

The next morning, I walked into the ICU with a bounce in my step and a freshness that comes from having slept deeply. After the previous day’s successful operation, I was hoping to see Joanne sitting up in a chair and eating breakfast. But when I walked over to her, I was aghast to see her lying flat with all four limbs restrained to the bed. She was thrashing around violently with a strength I never knew could exist in someone who was so weak before surgery. Her heart was thumping at 200 beats a minute and her blood pressure had the same numerical value. I looked urgently over at the ICU registrar and a couple of nurses who were around, my eyes wide open and arms up in the air, questioningly. “She’s become violent and aggressive over the past hour,” the nurse explained, showing me her own arm that had been clawed into by Joanne. “She almost bit the ward boy who tried to help her,” another continued.

“Everyone here is trying to kill me!” Mrs. Smith yelled at the top of her voice. I thought that looking at me – a familiar face – might ease things a little, but I was wrong; the screams continued. “You are the devil and my murderer,” she growled at me with fiery eyes. The way she was moving her neck while chained to the bed made me worry if she would suffer a whiplash injury. The junior doctor in the ICU came over to confer with me. “We gave her something to calm her down, but it hasn’t worked so far,” he said, pointing to her chart.

“We should shift her out of the ICU now, she’ll be fine,” announcing it with the panache of James Bond, who knew exactly what might be going on. “But her blood pressure and heart rate are uncontrollable; it might not be safe,” the doctor responded, reasoning for the well-being of the patient. I put my arm around him and said, “Please shift her out. Being in the ICU is part of the problem.”

Post-operative psychosis is a rare but known phenomenon. A wide range of behavioural symptoms may occur after any kind of surgery, not necessarily those performed on the brain or spine. Patients have been reported to develop depression, mania, hallucinations, and impulsivity. In an ICU setting, however, listening to the constant beeping of various machines, hushed voices of the nurses, and the wails of some who are gravely ill, patients may experience disturbed sleep and start hearing voices, feel severe anxiety, and see things that aren’t there. This might result in them being severely disoriented, agitated, and even violent. We call this ICU psychosis and it shows up acutely. It is best treated by transferring the patient out of the ICU and into the comfort of their loved ones. If lifesaving treatment is being administered and that might not be possible, appropriate medication is administered instead.

The next morning, Joanne greeted me with a cheery “How are you, Dr. Turel?” exhibiting an effusive warmth that was oblivious of the apocalypse of the previous day. I tested her hand grip and it was as strong as a beast. My operation was a hit, but I wanted to get to the bottom of all the drama. “Do you have any recollection of what happened in the ICU yesterday?” She shook her head sideways, unaware. “You were not a good girl in there!” I reprimanded her in jest, knowing fully well that what she had gone through was beyond her control. “Jesus died for our sins,” she said apologetically. “And it would be a complete waste of his time and effort if you didn’t commit them!” I concluded in agreement.

 

20 Comments on “The Surgical Psychosis
  • Dr. Pradip Kumar Tiwari says:

    Absolutely true. Nice write up. We all Surgeons must always remember that post operative psychosis is a common thing and can happen to anyone.

    Reply
  • Supriya Correa says:

    Incredible stuff, is this neurosurgery or a storyboard of a film? How metaphorical. Starts off with light, then goes terribly dark, then back into light. Almost biblical in theme. Beautiful storytelling, Maaz. And such a departure from your regular. Thoroughly enjoyed reading this. How amusing to see Jesus included. Trust he’s loving the spotlight.

    Reply
  • Priyadarshan Pradhan says:

    excellent piece as always doctor saheb

    Reply
  • Rita singh says:

    Dear doctor, u have rightly described the grim atmosphere of the icu.I myself been in ur hospital icu.Yet I must say that I had the most precious experience of my life their.God and self realised Gurus r not bound by conditions. Nobody may believe but I know that my experience was a gift from them (in my icu) room. The experience is too sacred to describe here on an open platform.

    Reply
  • Arun Pushkarna says:

    Very illuminating! To the layman, your articles are education. Especially this one. I doubt if many non- medical types knew about this syndrome.

    Reply
  • Mrs sunaina saraf says:

    Hello sir

    So true & very knowledgable!

    Regards,
    Mrs Sunaina Saraf

    Reply
  • Anita says:

    Very educational article. Hope all other medical practioners have a chance to read this and understand post operative psychosis. Thank you for educating us very much needed. Thank you🙏

    Reply
  • Armaiti Ronnie Mistry says:

    Mazda, I absolutely enjoy reading all your articles forwarded to me by my Huti n some others too. They are a delight to read! May your magical touch heal all who come to you. God bless.

    Reply
  • Anuradha says:

    A very interesting topic to delve into. Post operative psychosis stems from fear of the unknown especially after surgery. This article to some degree has prepared me to face such a situation with the right attitude. There’s so much to learn from your articles that I beseech you to keep writing and giving us valuable inputs on how one can face serious situations with simple faith and dignity.

    Reply
  • Anjali Patki says:

    Wonderful article enlightening on the common yet lesser known element of icu psychosis, in your ever humourous, entertaining and easy flowing narrative style.

    Reply
  • Marzian Mowji says:

    My father went through a similar episode. He went in for a Hernia operation and because of his age they put him in the ICU after his surgery. When he woke up he started screaming at the nurses. He complained to me that they were parading him on the road with no clothes. After 2 days of this nonsense he was shifted to his room. There he calmed down as if nothing happened in the ICU. So I presume this kind of behavior is common after surgery.
    Thank you for explaining it. I always wondered why that happened.

    Reply
  • Leah G says:

    Thank you, Dr. Mazda, for more “edutainment”…I was totally unaware of such a syndrome. As usual, you are able to educate and entertain in one fell Mazda-like swoop!!

    Here’s wishing you even more grease to your writing elbow!

    Reply
  • Burzin Panthaki says:

    Wonderful piece. Dr Mazda.
    My 90 year old grandmother was admitted to the hospital for a hip surgery. A very quiet and mild manner lady who never hurt a fly, we were shocked to see her grinding her teeth and shouting at the nurses the next day.
    Afterwards she was quite normal and did not even remember what had happened.

    Reply
  • Vipul Shah says:

    Dear Dr Mazda

    Article after Article the non medical persons like us are gaining immense Knowledge thru your perfectly explained Difficult Medical terminology in your lucid & simple style ….

    You have gathered superb Grip on psychological aspects of your Readers to stick to you for your out of the world while describing Medical Incident’s in style

    God bless & keep on enlighten us with your all round expertise sir….

    Reply
  • Chandan R. Sanjana says:

    As much as I enjoy reading every article of yours, this one did it for me! Such a fear went through me. But thankgod the lady was fine in the end was fine. Your judgement of getting her out of the ICU was so correct.🙏🙏

    Reply
  • Sooni Homi Daver says:

    Tks v much mazda for this v enlightening msg. My grson has taken up medical line in New York he will b v much interested in all yr brilliant msgs Godbless u

    Reply
  • Gloria Msampha says:

    The beeping of the machines, the very sick people and the “silence” in the ICU can drive anybody crazy. But God was goof to Mrs Smith and glad she is ok.

    Reply
  • Cashmira says:

    What a wonderfully written article..as always imparting such valuable knowledge Dr Mazda.
    I wait eagerly to read them every week.

    Reply
  • Martha J. Quaghe says:

    Thank you Dr. Mazda for the beautiful and wonderful article. You are awesome, humorous and your writings are inspiring.
    Shallom 🙏
    Martha John Quaghe,
    From Abuja – Nigeria

    Reply
  • Di says:

    Another good read… well written… i was unaware that such behavioural changes can happen after a surgery… thank God/Jesus that she recovered and you had the good sense to shift her out of the ICU… Jesus, Khodaiji, all Gods are with you… loved the end, your concluding statement lol so witty

    Reply

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