A note from my recent stay in Stanford Hospital: into the emergency room on Friday 1/30 in the afternoon, returning home late in the afternoon on Thursday 2/5. Not about the afflictions that brought me there, but about an odd experience during the long time waiting on a gurney in a very small room in the emergency department while tests were made and a hospital room sought. I had company all through the day: my daughter Elizabeth and grandchild Opal, who patiently enjoyed a card game together and played some interesting music softly for me.
Hallucination: the curtain. This tiny room had a curtain that could be drawn to make it private from the hallway outside: a pleasant beige color with somewhat glossy horizontal strips of a slightly darker tint.
But for me it was, startlingly, much more than that: what I saw inside those strips was the (unfortunately illegible) text of a substantial article that I was writing to post on this blog. I was entirely aware that this material was a hallucination, visible to me but not to Elizabeth or Opal, though I described it for them. Fascinating, in no way disturbing. But I was unable to dismiss or erase the text from my visual field — it persisted for more than an hour, with no way for me to un-see it. And then I was moved to a different room, with a different kind of curtain, so no more hallucination.
This sort of cognizant hallucination — my ad hoc label for hallucination (in this case, visual) with full awareness on the part of the experiencer — is, apparently, not unusual, though not much seems to be known about the triggers for it. They are common in the moments when people are dropping off to sleep and, especially, when they are wakening.
Hallucination: the morphine light show. Cognizant hallucinations are famously triggered by psychoactive drugs, cocaine and morphine in particular — I got cocaine runnin’ ’round my brain — so now I bring you a report from (my wife) Ann Daingerfield Zwicky, in some of the last moments of her life. I was sitting with her (a she lay in hospice care, in our bed at home) as she struggled with the breast cancer that had metathesized catastrophically to her liver, playing a favorite piece of music for her and slipping her tabs of morphine as needed.
She fell into unconsciousness for brief periods, then woke for short stretches in which she was treated to a fabulous light show of morphine-induced hallucination — elaborate fireworks shooting off in air just above her. She was entirely aware that this display was all hallucination, but it was extraordinary, and delightful, so the last thing she said was an attempt to describe the light show for me, so that I could share it with her. A lovely gift.
Delusion: the threat of murder. My husband-equivalent — we were a committed couple before same-sex marriage was available — Jacques Transue slipped through years of radiation-caused dementia crowded by visual and auditory hallucinations and delusional beliefs that, almost without exception, he took to be utterly real. Very different from cognizant hallucinations. I’ve written elsewhere about some of the details of this distressing history.
But now I have a tale of paranoid delusion from my recent stay in Stanford Hospital. From a period when I shared a small room with another patient, separated only by a curtain. Which means that each patient hears a lot of the other’s care. That brings me to a patient I’ll call D, whose interactions with the nursing staff sounded a red alarm for me, from my past experience in dealing personally and professionally with a variety of schizophrenics (and with Jacques, whose disorder accompanying his dementia was technically labeled peri-ictal schizophreniform-like psychosis).
Side note. Schizophrenia is an umbrella term for an assortment of disordered mental states. NOAD‘s entry gives some sense of the range of phenomena that might come under this umbrella:
noun schizophrenia: Psychiatry a long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
Schizophrenics of all types tend to be highly visible, because they notably violate our expectations of customary public behavior. They are often scary and may seem terribly threatening, though in general they’re more likely to harm themselves than other people; and in fact they are likely to incite people to respond to the threat they present to the common order by harming them. In years gone by, I worked comfortably with a number of schizophrenics, in institutional settings and individually outside such settings, without fear. Distress on their behalf, but not fear.
But there are also some people (not usually labeled as schizophrenic) in the grip of paranoid delusions that move them to strike out against the objects of these delusions. They are genuinely dangerous. I now return to the case of patient D in Stanford Hospital.
Patient D. D was something of a trial for the nursing staff; he would be apparently compliant with simple requirements of care, but threw medications and medical equipment in the trash, saying it was all useless. The staff was astoundingly patient with these outbursts, never once challenging him, but instead offering models of how he should behave; he would briefly appear to comply, but then break out into invective against the nursing staff, damning them all as fucking cunts. (His delusions were apparently centered on affirmations of his masculinity and defense against a feminine /effeminate world.)
D was at first bedridden, but then offered superficial compliance if he could be moved into a wheelchair. He then became an ambulatory menace. And, increasingly, I became the main object of his paranoia. He heard the MSNow commentary on my tv, even at very low volume, and he heard references to my homosexuality in talk with my doctors and visitors. Apparently, he fixed on individual words, and spun each word into an elaborate fantasy of machinations against him, which he had to strike back at.
When he was still bedridden, he attacked me by throwing all the cups in his space over the curtain at me, then managed to spray buckets of water over the partition, soaking everything around me thoroughly; the staff then worked to get everything dry and cleaned up and to try to calm him down
As soon as he got the wheelchair, he pulled the curtain all the way back and came at me in a rage, shouting “I am going to fucking kill you”. Utterly terrifying.
Hospital security staff — sturdy young men — then materialized and there was a long period of utter chaos, in the end resolved only by security guys holding D down while the staff shot him up with every downer med they had on hand. I could hear him breathing, so I lay there, hypervigilant and shaking, fearing that he would somehow rise up again and kill me. Eventually he was carted away to a closed facility, and I needed medication to put me to sleep.
Afterwards, a long series of staff people came by to apologize abjectly and offer me whatever help they could provide. Understood in all this: please don’t sue us. I had no intention of suing them; indeed, I find it hard to see what they could have done differently. Nobody expects murderous paranoia on an ordinary hospital floor — trouble of all kinds, but not this. It’s something that might appear in an emergency room, but emergency rooms always have security staff on hand.
I suppose the intake staff might have detected the whiff of paranoid delusion, but how common is this? (I have had first-hand experience of sociopaths, and of course of students and friends undone by drugs, but not this terrifying brand of delusion), and in any case they’re a hospital, offering care to all who need it, not set up for confinement. Meanwhile, I’m still deranged by the experience, in a form of ptsd; please don’t tell me just to get over it.
February 19, 2026 at 2:27 pm |
I’m so sorry, Arnold. My mother and sister had/have paranoid schizophrenia, and it can be terrifying.