I've never been so close to an unraveling human brain. A 70ish man had collapsed after having a bleed in his brain. He'd had other complications in the hospital including a seizure and respiratory failure. We met him when he was already on the breathing machine. Unfortunately, even with no medicines to make him sleepy, he was still not responding, even when we caused him pain. This is a very ominous sign.
This man had a wife and a severely mentally challenged son. His wife and son would come visit every day at the same time. The son was in his 30s, with debilities in seeing and cognition. He was a gifted pianist and always had headphones on listening to music to keep him calm.
A helpful thing in this case, was that the patient had an advance directive that spelled out exactly what he'd want and not want in this situation. It was explicit that he'd not want to be on the breathing machine, or have dialysis or even tube feedings. Our team had begun the slow process of helping support his wife and walking her through the process of letting go.
Unlike any other person I'd ever met, his wife had this unnatural ability to control our meetings by not letting anyone else talk. She'd open her mouth and talk non stop for an hour. It was if she couldn't stop her brain. You could tell she didn't trust herself, so if she kept talking, she'd not have to hear the bad news we were telling her, and she'd not have to make any decisions on what to do next.
My last day I met with her for 2 1/2 hours. I was just trying to clarify her wishes, to either keep him on the machines even though he never wanted it or to change our approach. I remember listening to her talk, fascinated by her thought process. I didn't realize then, it really was unwinding. Think of someone on the brink of insanity, with thoughts popping in their mind, but the filter gone. She seemed to not be able to control the direction of what she was saying, and actually realized she was on the cliff of insanity. At one point I had been able to get in a sentence about her husband and she panicked. "Don't say another word" she half screamed as she grabbed my hands. "Okay" I said and was shocked as she reached out and literally grabbed my mouth to close it. "I told you, not another word...oh look what you're making me do, I didn't want to think about this today, I can't do this" Her eyes looked frantic, as she kept talking...it was as if I, by speaking, was some how stealing what little control she had on her brain. I stepped back worried if I did utter another sound she'd really attack me.
She managed to get it back together and we left the meeting calmly after another hour. Amazingly, she decided to withdraw care a few days later. Then, her fragile mind did collapse- she had a true psychotic break and is currently admitted to a psychiatric ward.
How strange to witness a brain unraveling. All the safety mechanisms gone, verbally I was witnessed what it was like to be in her brain as it spun out of control... In someways I'm lucky all she did was grab my mouth and hands, you can never predict what truly psychotic people may do!
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