It is one of these standard sentences, which are often read in connection with accident reports but hardly registered anymore: "The patient was put into an artificial coma after an emergency operation." This sounds for the first time after protection and relief. After deep sleep, during which the body can regenerate. In fact, it is a drug-induced long-term anesthetic that reduces the oxygen demand of the brain.
Thies Grimm has not had any good experiences with the artificial coma. Grimm has been suffering from a narrowing of the aorta, the main artery leading the blood from the heart into the body. He was operated on at the age of 17, after that everything seemed fine.
2007, the aorta ruptured, suddenly, without warning. "Usually you have to live a few minutes in the case," says Grimm. But he was lucky. When the paramedic arrived, she immediately ordered him to be taken to the hospital. "Later, she told me that she did not want me to die before my son's eyes."
Like in the movie
Grimm survived. Because the aorta did not rupture completely, the blood loss was not massive. That gave him time. In addition, the emergency doctor recognized his life-threatening condition and promptly alerted the hospital so that all preparations for surgery could be made. Because it was a Saturday morning, there was no rush hour traffic on the way to the clinic in the city center of Lübeck and the ambulance driver could race to the heart clinic at more than 100 kilometers per hour. A multitude of happy circumstances in his case made for a story that would probably seem unrealistic in a movie.
For Grimm, however, the consequences of the emergency, with which he still struggles even more than ten years later, are very real. He is quickly exhausted, often has tachycardia and sometimes gets into anxiety when an ambulance drives past him. The cause of these problems is, so Grimm suspects, in the post-emergency period.
After the nine-hour operation, the doctors put him into an artificial coma. "While I was in intensive care, I kept dreaming that I was being held captive and tortured by terrorists," says Grimm. "Sometimes I fought it with great force, sometimes my thoughts were determined by revenge, in the end I actually gave up completely."
The problem: his perception was not about dreams. "It was absolutely real," says Grimm. "I even recognized faces in these fantasies, which is very unusual." It later turned out that the main detonator in Grimm's dreams was the anesthesiologist who had accompanied him during the operation. In retrospect, his doctors suspect that the anesthetic they had put Grimm in was not very deep, so that her patient could see the doctor.
Nightmare or delirium?
The fact that patients are put into an artificial coma is comparatively common in intensive care units. Of the 16 intensive care beds in the Dortmund hospital, an average of ten beds are occupied by patients who have been put into anesthesia, which varies in depth depending on the disease. The internist Werner Meermeier, head of the ward, knows the problem with the nightmares and knows that the patients react differently to the artificial coma. "Many of them have nightmares, but not everyone remembers that later," Meermeier says.
In technical language, the phenomenon is called delirium. The term describes a state of disturbance of consciousness that sufferers often compare to a nightmare that they can not distinguish from reality. What exactly triggers the delirium, has not yet been clearly established. However, there are indications that the constant drug delivery during the artificial coma has an impact - especially if it is ketamine. The drug is also used in intensive care units for long-term anesthesia, because it unlike other drugs less affect spontaneous breathing and protective reflexes.
more on the subject
According to the journal "Anesthesiologist", ketamine occupies a special position among injectable anesthetics. The effects reached to a decoupling of the patient from the outside world. As early as 1970, a clinical study on ketamine as an induction agent was published in the British Journal of Anesthesia, in which a high frequency of delirium was found for different dosages. These were in some cases unusually difficult and particularly unpleasant.
Similar to hallucinations
Nightmares can also occur regardless of the drugs used. "In the intensive care unit, the lives of patients are usually directly threatened," says Teresa Deffner. As a psychologist in the intensive care unit at the University Hospital Jena, she takes care of patients who were in an artificial coma. "They translate the pain and near-death experience into other scenarios that are often inconsistent with reality."
At this point, however, a differentiation is necessary: nightmares occur in sleep, waking them up. "Patients do not sleep, they are more or less awake, their experiences are more like hallucinations and delusional experiences, which makes it much harder for them to distinguish later on what really happened."
In fact, this is a big problem: patients perceive significantly more details of their situation than one would expect. Susanne Lorf, nursing station manager of the Intensive Care Unit at the Klinikum Dortmund, says: "The dreams usually have something to do with violence and often people in blue masks are involved in the trauma, as we carry them here in the hospital." According to a 2003 study by the University of Jena Institute of General Medicine, 175 out of 175 intensive care patients who survived severe blood poisoning developed about 20 percent of symptoms of posttraumatic stress disorder.
Helping with the patient helps
But how can you reduce this number? "Communication is a key," says intensive care physician Meermeier. "If we give someone a catheter unannounced, he will perceive that experience as agonizing, because he feels only the touch or the pain." Therefore, it was important to announce even supposedly harmless treatments beforehand. "The fact that patients really understand everything is unlikely, the drugs also affect cognitive function, but it's always better than not saying anything."
Because it is unclear how much the patients are taking, Meermeier advocates treating them as if they were spiritually present. Conversations about other patients or a diagnosis at the bedside are prohibited.
Psychotherapy, trauma treatment, talks
But how else can people be helped, especially if they wake up traumatized from the artificial coma, despite all their careful handling? "There are different forms of therapy for the resulting trauma," Teresa Deffner explains. "The basic offer is psychotherapeutic conversations and there has also been an online offering for writing therapy for some time, because some patients find it difficult to talk about it." Some patients tried to work up the experience alone or in the family environment, some also help a visit to the intensive care unit to separate their dreams from the reality, so Deffner.
"I took a long time after the incident to a pain and trauma treatment," says Thies Grimm. "My psychologist explained it to me like this: Pain overloading the coma did not allow my brain to process dreams properly, which is why they feel so real." In Thies Grimm's case, the main purpose of the therapy is to reconnect memory fragments and to memorize them. This can reduce problematic reactions such as flashbacks.
Meanwhile, there are weeks in which Grimm no longer thinks of his trauma. And he has slowly gotten used to the pain of his scar. "I'll probably always feel something of it, but everyone has to bear his burdens in old age, because I can not complain," says the 58-year-old.
Thies Grimm
Thies Grimm and his rescuer three years after the emergency
And there is also a nice way he remembers the incident. "At the time, I was trying to get in touch with the paramedic to whom I owe my life, which was not so easy in the beginning, because the hospital can not just hand over such data, but it did work out of the way After all, she was convinced that I was dead and now we meet again and I invite her to dinner. "