The City Of Oblivion

As NDEs go, it was a non-event. When everything stopped on 5 January 2019 – at about 1 a.m. – I was already unconscious. My shut-down and my reboot, when medical staff worked to resuscitate me in the corridor of Emergenza ed Accetazione (A&E), both completely passed me by.

Afterwards, while the hours passed and my heart was beating anew, I rested in nothingness, until an in-breath started to suck me out of the neither-dark-nor-light:

After the out-breath I begin to hear things: gurgles, mechanical hisses and competing rhythms of breathing. One is slow, one is fast. The trouble is, both of them are mine. I fight to maintain the slow, mindful rhythm, but the faster one wins out – one-two, in-out – as if my lungs are under the orders of a drill-sergeant.

And then a voice: “The mask controls your breathing. Just give into it. Work with the oxygen.”

Who is saying this? I’m not sure. I could be talking to myself but, whoever speaks them, the words bring me back decisively from the fuck-all. First there is darkness, then light. Maybe a phosphene or two. Then this much comes back to me: I am in Rome; I am ill – I don’t know with what – and that I went to hospital. Dimly, I recall triage, a trolley and an oxygen mask.

When I open my eyes, I see a young woman wearing big Wayfarer glasses, busying herself around the bed I have little sense of but must be lying in. Oddly, I think she might be Dutch. She wears a green gown and has strawberry-blonde hair and a kind, serious smile.

And then L speaks. My wife. I can’t see her but her voice is a rare moment of clarity: “This is Chiara*,” she says. “She’s been looking after you.”

While we are agreed on the big glasses, L remembers Chiara as being blonder and wearing a white tunic. This is the first evidence of the idiosyncratic way I would process sound and vision in the coming days. Embarrassingly – and I don’t remember this – it seems I tried to say hello to Chiara in a Leslie Phillips “ding-dong” voice. Soon afterwards, I drifted off again. When I came round, both L and Chiara had gone:

Breathing is still unnatural – I’m all too aware of the ventilator and the gurgles of the oxygen tank – but it has been supplanted by a new need: water. To live I must breathe, and to breathe I must drink. I feel dry, if not cured, like bresaola. To find water, I must find Chiara, but there is no sign of her. For the first time, I look out beyond my bed.

I can’t see a hospital ward, as such, but for the first time I am aware of a bigger space. There seems to be a lot of old, dark wood, like you would find in church pews. I think I see others around me and that they, too, are sick. And I think I glimpse Chiara, tending to one of them.

And I become convinced of two things. One, we are utterly alone in our sickness. And two, that Chiara isn’t a nurse but another patient, just less unwell, and she has taken it upon herself to care for the rest of us. If we have hope, in this strange and unreliable place, then it rests with her.

* * *

Chiara was an ICU nurse, of course, and although I hadn’t figured it out then, my hydration needs were being met intravenously. After the cardiac arrest, I was resuscitated, intubated and placed in an induced coma. Briefly, I was brought out of sedation the next day, so probably this happened then. We will return to Terapia Intensiva (ICU) in Policlinico Umberto I for longer next time – but these were my first experiments with consciousness after I swapped a holiday in the Eternal City for a mini-break to oblivion.

Given that all this happened over six years ago, and it’s almost as long since I blogged (see Same geezer, different hat: After sepsis), why return to it now? Isn’t it a bit Aunt Ada Doom, reminding you that I once saw something nasty in the woodshed?

Perhaps. And those close to me could be forgiven for thinking so. There are variables to factor in such as age, cause and underlying health – but it’s generally thought that it takes a sepsis survivor at least a year to recover. I suspect I’m not the only one who read this somewhere early in convalescence and took it to mean ‘no more than a year’. In the second half of 2019, I went to a couple of support group meetings+ run by the UK Sepsis Trust. These were chaired by ICU nurses. To protect the privacy of others I must generalise but, young and old, we sat around a table to describe our experiences and the physical and emotional challenges we had faced or continued to face. These all differed from and overlapped with one other, but common to all was a sense of bewilderment behind the eyes. (Later, when I described this to a friend who visited me soon after I got back from Rome, she replied, “Yes, of course. That’s what I saw in you.”)

Some people were there barely weeks after their crises. Seven or eight months on, I was near the median. But some survivors present were anything from three to six years into their recoveries. At the time, I assumed they had come more to support others than for their own needs: sharing their experience on practical matters like managing different parts of the health system, or PIP claims, or to provide a useful outlet for the nurses when they wanted to underline a general point with some specifics. Six years on, while I still believe this, I understand that they were probably still ‘carrying’ sepsis with them, albeit in a better, lighter backpack than once they had.

Here, I can only describe my own experience. They say that scars are proof you have lived or, in this instance, survived. Well, I have two scars on my right arm that were initially black and have bleached out over time. These were from unsuccessful attempts to cannulate me on arrival at Umberto I. This is OK. Because the ends of my necrotic toes auto-amputated, my new ‘tips’ get tired and sore quite easily because they are performing functions they were never designed for. In the same way, the once-necrotic wound on my left heel, the one that took over four years to close up, also gets tired and sore sometimes, and splits once in a while. And this is OK. I still have occasional moments of brain fog (i.e., more than usual) and days of seemingly random fatigue. These, too, are OK. More unsettling are the little things that only capriciously prompt fear or anxiety: a smell of rubber or silicone that suddenly reminds me of an oxygen mask; feeling chilled; the little scratchy feeling at the back of the throat at the start of a cold; a particularly dark December night; TV images of hospitals or of the city of Rome.

I should stress that this is all entirely manageable. I’m not saying “Poor me” here, just that I still ‘carry’ sepsis with me, and see those ‘old-timers’ at the support groups now in a different light.

After one of the meetings, I fell into conversation with one of the Trust nurses. First, I told him how well I’d been cared for at Umberto I. He said that to bring me back from meningococcal sepsis meant they clearly knew what they were about. I went on to tell him that I had feelings, not of guilt, exactly, but of ‘survivor-pressure’, of a need to pay some dues. He replied – from his perspective as an ICU nurse – that given I looked so well and was living my life meant I was already paying them.

This was the kindest thing he could possibly say. All the same, the taxman in my head still drops by whenever he’s passing through. I never undertook the sponsored pilgrimage I envisaged in my bed in Malattie Infettive (Infectious Diseases) one January afternoon in 2019 – a reminder, this, that our expectations need constant surveillance and occasional pulling in for questioning – but I did a month of sponsored dog-walking with our beloved springer spaniel – now passed – last year.

Now, the taxman is back again. He’s reminding me that a doctor in Rome once said I was the luckiest sepsis patient he’d ever seen. And this is why I’m reviving my very-long-dormant blog.

To begin with – because they are strangely precious to me – I’ll focus on the hallucinations, dreams and delusions from those early weeks, and that brief period when I lived in a bi-polar universe, flitting between the coherent world of my family, and the parallel, often paranoid, telenovela world of the hospital, all based on what I thought I heard – in a language I don’t speak – in the corridor outside my room. Why those particular hallucinations: when ICU was sometimes a ward, or a Paris hotel, or a Soviet spacecraft? Why did a doctor’s smile frighten me so? Why were Queen performing live behind a curtain? Why was a nurse leading a sex and death cult on the ward? And why on earth did I call that nurse ‘Henry’?

I can’t possibly repay for all the work of health professionals in Italy and the UK, or the love and patience of my family and my closest friends. And I can’t pretend that what follows isn’t part of my own interminable rehab. But if anyone reads this, or subsequent posts, and at the very least feels some fellow feeling is going their way, then maybe I’ll have begun to pay some of those dues.

This is me, having a go.

* * *

* Chiara is the first of a few changed names to come.

+ As well as providing support for sepsis survivors, these meetings are also intended for those caring for a survivor, or grieving for a loved one lost to sepsis. In my own case, my family essentially transplanted themselves to Rome for a month, creating chaos not only in their emotions but in their work and study too. There is a substantial parallel story to be told here, only it isn’t mine to tell.