Delirium

Delirium

Information for patients, family and friends. This text will help you to learn more about: What delirium is, its signs and symptoms, how can it be treated, how family and friends can help, where to find more information or resources.

What is delirium?

Delirium (dih-leer-ee-uhm) is a condition which causes a person to become confused in their thinking. It is a physical problem (a change in the body), not a psychological one (change in how the mind works).

Delirium usually starts over a few days and will often improve with treatment.

Delirium happens more often in those who already have dementia or depression, but it is different in these ways:

Delirium happens quickly and then can disappear. It can come and go at any time. This does not happen with dementia and depression.

Patients with delirium cannot focus their attention. This is different from patients with dementia or depression.

There are two types of delirium:

1. Hypoactive delirium happens most often in elderly patients. These patients are often mistaken for having depression or a form of dementia.

Patients with hypoactive delirium may:

• Move very slowly or not be active
• Not want to spend time with others
• Hesitate when speaking or not speak at all.

2. Hyperactive delirium is easier to recognize.

Patients with hyperactive delirium can:

• Be worried or afraid
• Be restless (not able to stay still or have trouble sleeping
• Repeat the same movements many times
• Experience hallucinations (seeing something or someone that is not really there)
• Experience delusions (believe something that is not true)
• At times, a patient can have both hyperactive and hypoactive symptoms.

What causes delirium?

Delirium can be caused by:

• A physical illness: Changes to body chemicals, dehydration (lack of water) or an infection, such as a urinary tract infection, could cause someone who is ill to become delirious.
• Medications: Some medicines used to treat illness or control pain may cause delirium.

Remember: Anyone can become delirious when ill.

What are the signs and symptoms of delirium? Here come common symptoms and signs:

Disorganized thinking: Saying things that are mixed up or do not make sense

Difficulty concentrating: Easily distracted or having difficulty following what is being said

Memory changes: Not able to remember names, places, dates, times or other important information

Hallucinating: Seeing or hearing things which are not real

Having delusions: Thinking or believing things which are not true or real

Feeling restless: Not able to stay still, trouble sleeping, climbing out of bed

Changing energy levels: Changes from being restless to being drowsy or sleepier than usual.

Other things to know about delirium

A person with delirium may not be able to understand when people are trying to help them. They may become irritated (angry) with hospital staff and family. They may start to think that everyone is against the, or are trying to harm them. Some delirious people may want to call the police to get help.

Delirium is like being in the middle of a very strange dream or nightmare. The difference is that the person with delirium is having these experiences while they are awake.

Can delirium be prevented? Illustration by Elena.

How can delirium be prevented?

Medicine has focus on patient safety preventing delirium from happening to any patient.

Doctors carefully screen (check) patients for factors that may cause delirium. They then address these factors early to help prevent it. These factors include:

• Hearing problems
• Vision problems
• Not enough water in the body (dehydration)
• Not being able to sleep or other sleep problems
• Dementia, depression or both
• Having trouble in thinking clearly – reasoning, remembering, judging; concentrating, understanding, expressing ideas
• Difficulty getting up and walking around
• The medications being taken
• History of alcohol or recreational drug use
• Chemical changes or imbalances in your body
• Low oxygen in your body
• Other health conditions or illnesses.

 How is delirium treated?

• The healthcare teams at hospital will create a safe environment for the patient and help them stay calm.
• They will look into the cause of the delirium based on the screening factors and symptoms. Many times, there is no single cause.
• They will then address the factors and symptoms. This could include: reviewing and changing medications, providing fluids, correcting chemical problems in the body, treating infections, treating low oxygen levels.

What can family and friends do to help?

Patients, family and friends can all help to prevent delirium. There are also many things that family members and friends can do to help someone who has delirium:

• Talk with the health care team about any signs of delirium you see developing in your loved one. Use the signs and symptoms described above to help you.
• Make sure your loved one always has their hearing aid, dentures, and glasses close by, if needed.
• Use a calm, soft voice speaking to your loved one or when speaking with others in the room.
• Place a soft light in the room at night so that your loved one will always know where they are. Before bringing in any electrical items, check with the healthcare team first. Keep the window curtains open to help your loved one know if it is daytime or nighttime.
• Remind your loved one where they are, what time it is, the date and the season. If possible, place a large sign in their room or write this information on a whiteboard. For example, you could write: “Today is Thursday, January 22, 2015. You are at Toronto General Hospital.” This will help them to stay connected.
• Gently reassure them that they are safe.
• Encourage your loved one to drink fluids, but check with the healthcare team first if they have any fluid restrictions. Feel free to bring their favourite foods from home, but check first with the health care team about any foods they should not eat.
• Make up a schedule of family and close friends who will stay with your loved one day and night so they will not be alone. This will help them feel more secure, less frightened and calm.
• Bring familiar photos into the room or play familiar music softly in the background.
• Limit the number of visitors who come to see your loved one until the delirium goes away.
• Make sure to look after yourself and get some rest and relaxation. Go out for short walks, remember to eat, and drink fluids to keep up your energy level.
• It is not easy to be with a delirious person, even though you may understand the problem. It may help to share your thoughts and feelings with someone. Feel free to speak with the health care team.
• Try not to become upset about the things your loved one with delirium may say. Delirious people are not themselves. In many cases, they will not remember what they said or did while delirious.

Preventing delirium in the hospital: Clocks and calendars may help patients stay oriented.

With the right kinds of treatments, the delirium should go away or be greatly reduced.

There are many healthcare professionals who can support and help you during this time. Please feel free to speak with your doctor or nurse and any other member of the team, including the Psychiatry service, spiritual care of social work.

Who can I talk to if I have more questions or any concerns?

The healthcare team can answer any questions or concerns you have about delirium. Many helpful websites, articles, books can help you find more information about delirium.

With the right kinds of treatments, the delirium should go away or be greatly reduced. Illustration: Megan Jorgensen.

Finding Employment

Finding Employment

Finding a job can be a quite daunting task, especially if the local, or even global, economy is in a recession. Frightening accounts in the news state massive unemployment rates and dark prospects for graduates. In actuality, the situation may be even worse, since unemployment rates exclude from calculation those who are studying, working part-time, outside productive age range, and especially important, those who have given up all hope of getting work. Thus, for econometricians, the unemployed are defined as people without permanent employment who are actively seeking employment.

In the Western world, as well as other parts of the planet, the traditional path to securing employment is to first acquire qualifications or skills, through education and experience. Then, one looks for work according to how qualified one is. One niche in the marketplace, so to speak, is easily picked up in one CV (curriculum vitae) or resume, as well as the cover letter and references.

Today, many individuals turn to the Internet unlike the help wanted sections of newspaper ads. Interestingly, statisticians report low rates of success on electronic boards. Nonetheless, studies differ, so one never knows for sure. Most human resource professionals would advise to turn to one's social networks, friends and acquaintances can often point one in the right direction.

Being fired and/or prolonged joblessness may lead to feelings of sadness and despair. Image: Copyright © Elena.

Stars as in Astro

Stars as in Astro

Stars have captivated human attention since times immemorial; popular media phenomena Star Wars and cult-inspiring Star Trek are just two among many proofs.

Further, astrology is the practice of attempting to foretell the future based on the position of the stars, as in the twelve horoscope signs that stem from the belief that a person born under a particular stellar arrangement has a predetermined destiny and personality.  JoJo Savard, a Quebec born television personality of the 1990s, was the first astrologer to gain public recognition in Canada.

In the scientific realm, there are astronomy, astrobiology, astrochemistry and astrophysics. In Quebec, the most prominent are: astronomical professional endeavor Mont Mégantic Observatory (AstroLab of the National Park of Mount Megantic), the non-professional association FAAQ (Fédération des Astronomes Amateurs du Québec), and the astrophysical CRAQ (Centre of Research in Astrophysics of Quebec).

Stars as in Astro. Illustration by Elena.

Due to the impossibility to place a massive gaseous object into empty space and watch it evolve for a million years, astrophysics and astronomy are observational and not experimental sciences. Although physics is indeed a science, debates nonetheless remain. For example, Pluto has recently (circa 2008) lost its planetary status, due to the many “Plutos” in similar elliptical outer orbits. Eris, a planet larger than Pluto, has been discovered and it is expected that similar others will follow in the near future (the Hubble telescopes and the Voyager probes launched in the 1970s have advanced the field tremendously). Similarly, the Moon, essentially a rock, is larger than Pluto and due to the unusual, as compared to other planets, Earth-Satellite proportion, they could be considered as two planets.

Our solar system is part of the Milky Way Galaxy, one star (the Sun) among billions of stars, among billions of galaxies. The closest spiral galaxy to us is Andromeda; the two are expected to collide in billions of years to form a mega-galaxy, as is often the case elsewhere. Now, this is much more impressive when actually drawn to scale, but the order of magnitude (non-exhaustive list) is as follows:

Moon < Earth < Jupiter < Sun < Sirius < Arcturus  < Rigel < Antares < Betelgeuse < Binary Star VV Cephei < Vy Canis Majoris. Which of Betelgeuse or Antares is larger is a matter of argument, but both are the brightest visible red supergiants in Earth’s sky. Vy Canis Majoris, a red hypergiant located in the Canis Majoris constellation in our galaxy, is the most luminous and biggest star known to man. All entries in the above sentence including and following the Sun are stars. The Sun is young; a middle aged star turns into a red giant, and a dying star becomes a white dwarf (extremely dense). After one tries to ponder just how enormous a star like Vy CM is, one goes further by contemplating that of these stellar masses there are trillions. Still, all these stars, planets, comets, gas and other floating materials in the universe comprise only 4.9% of its totality, ¾ of the universe being dark energy (human comprehension largely pending), and the rest dark matter.

Finally, black holes are so dense that even light cannot escape them, which is why we fail to see them since we only perceive objects as photons get reflected from them. A black hole escape velocity is greater than the speed of light; therefore even light gets trapped inside once it reaches the event horizon (the point of no return). Maybe with a telescope from Naturaliste à Québec, the next black hole will be discovered from the province…

Stars as in Astro. Our solar system is part of the Milky Way Galaxy, one star (the Sun) among billions of stars, among billions of galaxies… Photo by Elena.

Chasse Galerie

La Chasse Galerie

(extract from The Forever Man by Gordon R. Dickson)

She stepped back from the open port of La Chasse Gallerie, and gestured to the interior, “Want to come in?”

Jim hesitated.

“I don’t have a Secret clearance for this project – “ he began.

“Don’t worry about it”, interrupted Mary. “That’s just to keep the news people off our necks until we decide how to handle this. Come on”.

She led the way inside. Jim followed her. Within, the ancient metal corridor leading to the pilot’s compartments seemed swept clean and dusted shiny, like some exhibit in a museum. The interior had been hung with magnetic lights, but the gaps and tears made by Laagi weapons let almost as much light in. The pilot’s compartment was a shambles that had been tidied and cleaned. The instruments and control panel were all but obliterated and the pilot’s com-chair half gone. A black box stood in the center of the floor, an incongruous piece of modern equipment, connected by a thick, gray cable to a bulkhead behind it.

“I wasn’t wrong, then”, said Jim, looking around him. “No human body could have lived through this. It was the semianimate control center that was running the ship as Penard’s alter ago, then, wasn’t it? The man isn’t really alive?

“Yes,” said Mary, “and no”. You were right about the control center somehow absorbing the living personality of Penard. – But look again. Could a control center like that, centered in living issue floating and growing in a nutrient solution with no human hands to care for it – could something like that have survived this, either?”

Jim looked around at the slashed and ruined interior. A coldness crept into him and he thought once more of the legend of a great ghost cargo canoe sailing through the snow-filled skies with its dead crew, home to the New Year’s feast of the living.

“No…” he said slowly, through stiff lips. “Then… where is he?”

“Here!” said Mary, reaching out with her fist to strike the metal bulkhead to which the gray cable was attached. The dull boom of the struck metal reverberated in Jim’s ears. Mary looked penetratingly at Jim.

“You were right,” said Mary, “when you said that the control center had become Penard – that it was Penard, after the man died. Not just a record full of memories, but something holding the vital, decision-making spark of the living man himself. – But that was only half the miracle. Because the tissue living in the heart of the control center had to die, too, and just as the original Penard knew he would die, long before he could get home, the tissue Penard knew it, too. But their determination, Penard’s determination, to do something, solved the problem”.

She stopped and stood staring at Jim, as if waiting for some sign that she had been understood.

“Go on,” said Jim.

“The control system,” said Mary, “was connected to the controls of the ship itself through an intermediate solid state element which was the grandfather of the wholly inanimate solid-state computing centers in the ships you drive nowadays. The link was from living tissue through the area of solid-state physics to gross electronic and mechanical controls”.

“I know that,” said Jim. “Part of our training…”

“The living spark of Raoul Penard, driven by his absolute determination to get home, passed from him into the living tissue of the semianimate control system” went on Mary, as if Jim had not spoken. “From there it bridged the gap by a sort of neurobiotaxis into the flow of impulse taking place in the solid-state elements.

Once there, below all gross levels, there was nothing to stop it infusing every connected solid part of the ship.”

Mary swept her hand around the ruined pilot’s compartment.

“This,” she said, “is Raoul Penard. And this!” Once more she struck the bulkhead above the black box. “The human body died. The tissue activating the control center died. But Raoul came home just as he had been determined to do!”

Mary stopped talking. Her voice seemed to echo away into the silence of the compartment.

“And doing it,” said Mary more quietly, “he brought home the key we’ve been hunting for in the Bureau all this time. We pulled the plug on a dam behind which there’s been piling up a flood of theory and research. What we needed to know was that the living human essence could exist independently of the normal human biochemical machinery. Now, we know it. It’ll take time, but someday it won’t be necessary for the vital element of anyone to admit extinction, unless whoever it is wants to”.

You want to go out and fight the dragons, but life is too short… Image: © Megan Jorgensen.

Tricked

Tricked

The Iron Druid chronicles

By Kevin Hearne

Chapter 15

The key to faking deaths is a fine appreciation of arterial spray patterns. One might be tempted to simply smear a bit of blood here and there, but forensics fellows these days are a bit more sophisticated than they used to be. If they figure the scene is a fake, they'll tell the family and the said family will never hold that all-important funeral for closure. Without a body, the coroner would never issue a death certificate, but the police would at least designate it a cold case if you could convince them there was a high probability of death.

I have found that blood bags work very well at simulating spray with a strategically poked hotel apply pressure to the bottom of the bag, practice a bit, and before long you will be able to write stories of carnage and odes to gore.

A small fan brush – the sort that one dude used to paint happy little trees – can paint a picture of bluntforce spatters if you flick the surface properly. Don't use a toothbrush; those patterns are recognizable. You could even talk to yourself, as that painter did while you flick blood around : ”And may be over here we have a nice stab wound. And, I don't know, may be there is a few more back over here. Multiple stab wounds. It doesn't matter, whatever you feel like.”

When it comes to the actual blood, my former policy was that it was best to use somebody's else. You could even leave someone else”s hair, as long as it was plausibly the same color, and that was the best practice, because magic users would have no way to track you down. Can't do that anymore, however. Police routinely send all blood and other biological samples to labs for DNA matching, because some of theses goodies might belong to the suspect. It's tougher to fool the coppers these days, but I enjoy the challenge.

Granuaile wasn't worried about constructing the crime scene, however. She steered me away from that topic.

“What I want to know is how you get around the documentation issues,” she said. She was driving us down to Flagstaff as Oberon napped in the backseat.

“Documentation of what?”

“Of your life before you take on a new identity. I mean, you can't just show up. You need all this stuff. A credit history. How do you do it?

Tricked. Illustration by Elena.