How my 22-day coma saved my mental health
Only later did I understand how alarming it must have been, how uncomfortable to see how utterly changed I was, how awkward for them to sit in my stuffy sick room while I cried and apologised for the way I was, how much one particular friend, who had his own worries, had wanted to get away.
My anxiety cycled relentlessly through the same themes: that I would be sick for years; that I would lose my job; that I would never have the clarity of mind to write again; that I would never be able to look after my daughter or have another child; that Ellie would leave me or send me away; that my incurable anxiety would cause all these things to happen. At other times the anxiety detached itself from these specifics entirely and simply became the thing itself. This was anxiety in its purest, most concentrated form, an abstraction with almost no relation to the world around me, as rampant and absolute when I looked out of the window and watched a boy kicking a ball as it was each time I phoned work to say I would not be coming in.
I hung on desperately to the hope that the citalopram would work. Each day I took the drug was one day closer to the three or four weeks when this feeling might begin to be relieved. I was terrified, however, of what else the tablets might do to me and this became a toxic new strand to my anxiety. The doctor had said the drug could make me feel worse before I felt better. Google searches confirmed this and much more. There were infinite numbers of forums where anxious, depressed people reported violent physical side effects, psychotic episodes and suicide attempts as a result of taking citalopram.
I spoke to my mother several times a day. Poor mental health – depression and anxiety – had dogged my parents’ lives. I had known and witnessed much of this but at 35 I thought I had dodged that bullet. Now that did not seem to be the case. When my mother came to visit, she lay on the bed with me, put her arms around me and held my hand. She talked to me constantly, reassuring me, reminding me of things from my childhood. She talked about a family holiday when she and I had walked around Ullswater in the Lake District and my father and brother had rowed across the lake to meet us. The weather was beautiful and my brother and I were trying to persuade our parents to get a dog. Later, we met my grandparents for tea. ‘That was a happy day,’ she said to me, over and over again, like a mantra, an incantation. ‘That was a happy day.’
The citalopram did not work but, seeing the state I was in, my friend Chris told me about Ativan, a benzodiazepine tranquilliser. The day he came round I was in a wretched state. I had not slept and was so exhausted that I found it difficult to move. Chris had been prescribed Ativan himself for anxiety. He was a good deal older and had taken it for decades. He said it would help me rest but I was reluctant. I felt I was taking too many pills already – paracetamol, sleeping pills, citalopram. In the end, my desperation outweighed my fear. I sat up in bed and Chris broke the pill in two and gave me half.
After 30 minutes I felt no different, so I took the other half.
Thirty minutes later I got out of bed and went into the kitchen. My physical symptoms had evaporated entirely. I made myself a sandwich and ate it sitting at the kitchen table with Chris. The stiffness in my hands had faded away. I had strength and energy. I felt mellow, but not dozy – alert, clear-headed, my thoughts no longer running into and climbing on top of each other. The feeling lasted for the rest of the afternoon and evening. It was miraculous. When Ellie returned with my daughter I played with her in the garden. Later on, I ate another meal which Ellie made and we watched TV together. Chris left me with a strip of pills, 10 in total. ‘Make them last,’ he said, ‘it’s not an endless supply.’
The GP did not approve of this and warned me off, but the pills Chris continued to provide gave me enormous relief in the worst of my anxiety. Gradually I got back on my feet and in late 2011 our second child, a boy, was born. I was terrified – I had not coped well the first time around – but he was an easy-going baby, healthy, a good sleeper. My anxiety seemed to be under control. I had started writing again and one story was shortlisted for a prize which came with a substantial amount of money. The ceremony was at an Oxford college, but a few days before I began to feel unwell. It seemed like a nasty flu and I lay in bed taking aspirin and paracetamol, barely able to eat, trying to keep my fluids up. We cancelled the trip to Oxford.
The prize aside, I had picked another bad time to be ill. Our son was only six months old and our daughter was in her first year of school. Over the past few years I had been making a habit of not being much use, of dramatising my health. It felt like part of the usual pattern and Ellie was frustrated. But on the seventh night it was so bad that I asked her to call an ambulance.
In A&E I asked the doctor if I was going to be OK. ‘You’re in the right place,’ he said.
I was moved to a bed in intensive care and an oxygen mask was strapped over my mouth and nose. They put me on fluid, painkiller and antibiotic drips, and took blood and sputum samples. An X-ray showed that both my lungs were black with infection and the tests confirmed the diagnosis of bacterial pneumonia. My lungs were failing and my blood was starved of oxygen. On my fourth day in hospital I was put into a medically induced coma but the antibiotics did not work and my condition did not stabilise. I was diagnosed with severe sepsis and then, a few days later, acute respiratory distress syndrome (ARDS), the lungs’ extreme reaction to an infection (a condition that is among the main issues with severe Covid). The alveoli become inflamed, then collapse, the lungs harden and the oxygen saturation in the blood drops rapidly. At the time I was ill, ARDS had a mortality rate close to 50 per cent. The literature says: ‘as loss of aeration progresses, the end tidal volume grows to a level incompatible with life’.
I was kept in the coma for 22 days.
A breathing tube down my throat pumped 100 per cent oxygen into my lungs. An intravenous line in my neck delivered up to eight different drugs from bags that hung from metal stands next to the bed. There was a feeding tube up my nose and down into my stomach, and saline and electrolyte drips into my arms. Every 30 minutes another line took blood out of my arm to be sent away for testing. I had a catheter in my penis, another in my anus, five sticky pads on my chest to monitor my heart, and a clip, like a clothes peg, on my finger that shone an infrared light through my blood to measure the oxygen saturation.
After 10 days the oxygen level in my blood had still not stabilised and I was moved to an oscillator, a machine that provided a different, more aggressive form of ventilation. The oscillator holds the brittle lungs open while air is pumped in and out, and the whole body vibrates with the force of it. A cooling blanket was laid over me to keep my raging temperature down. I was bloated with fluid, my body so swollen I was almost unrecognisable. These were, I was told later, the worst, the most dangerous days.