On the threshold between pain and dream

It is one of those standard phrases that one reads in connection with the accident reports often, but hardly registered: “The Patient was transferred to emergency surgery in a state of artificial coma.” The sounds for the first time after conservation, and discharge. After a deep sleep, during which it can regenerate the body. In fact, it is a medication-initiated long-term anesthesia, the oxygen demand of the brain is reduced.

Thies Grimm has not made any good experiences with the artificial coma. Grimm suffered from birth, under a narrowing of the Aorta, the main artery that directs blood from the heart to the body. At the age of 17 he was operated on, after that, everything seemed fine.

In 2007, tore the Aorta, all of a sudden, without warning. “Normally you have to live in the case of a few minutes,” says Grimm. However, he was lucky. As an er doctor arrived, ordered them immediately to bring him to the hospital. “Later, she told me that she wanted me to die in front of the eyes of my son.”

Like in the movie

Grimm survived. Because the Aorta does not tear completely, it was the blood loss is not massive. This gave him time. Also, an er doctor realized his life-threatening condition and be alerted immediately to the hospital, so all the preparations for surgery could be made. Because it was a Saturday morning, there was on the way to the clinic in the l├╝beck city centre, no traffic, and the ambulance driver was able to turf with more than 100 kilometers per hour to the heart clinic. A variety of lucky circumstances were in his case, to a story that would work in a movie is probably unrealistic.

Very real the consequences of the Emergency, with which he has to fight more than ten years later, still are for Grimm, however, He is quickly exhausted, often has heart palpitations and is sometimes out of anxiety, when an ambulance drives past him. The cause for these problems is also, as Grimm believed, in the aftermath of the emergency.

After the nine-hour surgery, the Doctors put him in an artificial coma. “While I was in intensive care, continue to I’ve while dreaming that I’m being held prisoner by terrorists and tortured,” says Grimm. “Once I fought with all his might against it, my thoughts were desires defined by revenge. In the end I gave up completely.”

The Problem: In his perception, it was not dreams. “It was absolutely real,” says Grimm. “I have recognized in these fantasies, even faces clearly, which is very unusual.” Later it turned out that was the main tormentor in Grimm’s Dream of the anesthesiologist, who had accompanied him during the SURGERY. In retrospect, his Doctors suspect that the anaesthetic, in which they had Grimm moved, was not very deep, so that her Patient could perceive the physician.

Nightmare or Delirium?

Patients are placed in an artificial coma, is in intensive care units relatively common. Of the 16 intensive care beds at the hospital Klinikum Dortmund are assigned an average of ten beds of patients who were treated in a General anesthesia, depending on the disease to different depths,. The Internist Werner sea Meier, head of the Station, knows the Problem with the nightmares and know that patients react quite differently to the artificial coma. “Many of them have nightmares, but not everyone can remember later on,” says sea-Meier.

In technical language, the phenomenon is referred to as Delirium. The term describes a state of consciousness disturbance, the Affected often compare it with a nightmare, you are not of the reality may differ. What exactly triggers the Delirium, is not yet proven clearly. However, there is evidence that the constant delivery of Medication during the artificial coma an impact – especially if it is ketamine. The drug is used in intensive care units, long-term anesthesia, because it is in contrast to other drugs, the spontaneous breathing and protective reflexes are less affected.

According to the journal Of “Anaesthesiologist” is ketamine a special position under the injection of anesthetics. The effects ranged up to a decoupling of the patient from the outside world. Already in 1970 a clinical study of ketamine as an induction agent released, in the different dosages, respectively, a high frequency of Deliren was found was in the “British Journal of Anaesthesia”. These were in some cases unusually heavy and especially uncomfortable.

Similar to hallucinations

Nightmares can also occur independently of the drugs used. “In the ICU, the patient’s life is threatened most directly,” says Teresa Deffner. As a psychologist on the intensive care unit at the University hospital of Jena, she cares for patients who lay in an artificial coma. “You are not to put the pain and the near-death experience in the other scenarios, which are often the reality in line.”

At this point, a differentiation is necessary: nightmares come in your sleep, Wake up and stops it. “The patients sleep, but not, they are more or less awake. Their experiences are more likely to experiences with hallucinations and delusional to compare. This makes it much more difficult for you to distinguish later what happened really.”

In fact, this is exactly one big Problem: patients take significantly more Details of your Situation, as you suspected. Susanne Lorf, nursing Manager of the intensive care unit of the Klinikum Dortmund, says: “The dreams usually have to do with violence and often in the dream happen to people in blue Tunics are involved, so how we carry them here at the hospital.” According to a study by the Institute for General medicine of the University of Jena in 2003, patients who had survived a serious blood poisoning developed from the 175 intensive, approximately 20 percent have symptoms of post-traumatic stress disorder.

With the patients, talking helps

But how can you reduce this number? “Communication is key,” says intensive care specialist at sea-Meier. “If we unannounced to someone insert a catheter, he will perceive this experience as painful. He feels only the touch or the pain.” Therefore, it is important that even a seemingly harmless treatments in advance. “The patients really understand all that is unlikely. The drugs also affect cognitive function. But it is better than to say anything.”

Because it is unclear how much of the record, the patient, calls the sea by Meier, to treat them as if they were mentally present. Talks about other patients or a diagnosis of a ban on the hospital bed in there.

Psychotherapy, Trauma Treatment, Talks

But how people can be otherwise helped, especially when you Wake up, in spite of all the careful handling traumatized from the artificial coma? “There are different forms of therapy for the resulting Trauma,” explains Teresa Deffner. “The basic offer are psycho-therapeutic interviews. For some time there is also an online offer for a writing therapy, because it falls some patients are difficult to talk about it.” Some patients have tried the experience alone or in a family environment, work, some help, a visit to the intensive care unit, to separate your dreams from reality, so Deffner.

“I took after the incident a long time in pain and trauma treatment,” says Thies Grimm. “My psychologist explained it to me at the time, so: a pain to flooding during the coma my brain was unable to process the dreams. Therefore, they feel so real.” In Thies Grimm’s case, the therapy did associate the main objective of Memory fragments and in the memory store. So problematic reactions, such as, for example, Flashbacks can be reduced.

Meanwhile, there are weeks in which Grimm no longer thinks of his Trauma. And also the pain of his scar, he has to get used to slowly. “I’ll probably always feel something out of it. But everyone has to bear in the age of its loads, I can’t complain,” says the 58-Year-old.

Thies Grimm and his Savior three years after the emergency

And there’s also a nice way that he remembers the incident. “At the time, I tried to contact to the it’s happened to this record, I owe my life. The music was not so easy, because the hospital can not give out such information easily. But indirectly it worked then. She was quite surprised to hear from me. After all, she was convinced that I’m dead. Now we meet from time to time, and I invite you to dinner.”

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