I didn’t know there was such as thing as a Delirium Prevention Bag filled with Delirium Prevention Activities.

From Caring.com:

“Delirium is usually a sign of a stress, such as an illness, affecting the body overall. Common serious causes include infections (such as urinary tract infections or pneumonia), abnormalities of blood chemistry (such as high levels of blood sugar or sodium), dehydration, or even excessive pain after surgery. Delirium can also be caused by or worsened by intoxication or by certain medications (such as antihistamines, which have side effects that influence brain chemistry).

Although younger people with healthy minds can develop delirium, elderly people and people with dementia are especially prone to becoming delirious when sick. A frail elder may also develop delirium when stressed by seemingly minor issues such as constipation, lack of sleep, or not having eyeglasses and hearing aids while in the hospital.

Research has shown that delirium is common in hospitalized patients; up to 50 percent of postsurgical patients may be affected. Unfortunately, delirium is often missed by hospital personnel.

Especially in a frail older person, delirium can be the only outward sign of a serious medical illness.”

Just after the new year, Mom was brought to the hospital with a hemoglobin count of 3. An average value or count for a woman after middle age is 11.7-13.8. A count of 3 is near death. No one had any idea what made her hemoglobin drop so low. And no one expected the severity of delirium that occurred shortly after being admitted to the hospital. Not only was she severely ill with low hemoglobin, but stressed by lack of sleep due to nightmares, possible dehydration, and appeared to have an internal bleed accelerated by her blood thinner. All these factors can stimulate signs of delirium, which is different from dementia. Delirium is temporary. Dementia isn’t. Delirium is temporary confusion that can get better. Dementia can cause confusion, and the confusion gets worse.

What we also didn’t realize at the time is that delirium can be a sign that death is near.

“Organs begin to fail, including the brain. Higher-order consciousness tends to change. ‘Few conditions leave people hyperaware when they’re dying,’ says palliative-care physician Ira Byock, author of Dying Well.

“The person may not be aware of where he or she is or who else is in the room, may speak or reply less often, may respond to people who can’t be seen in the room by others, may seem to say nonsensical things, may be confused about time, or may act restless and pick at bed linens.”

All we knew was that Mom was suddenly acting almost crazy and stubborn as a pit-bull about being able to leave the hospital. She wanted to go ‘upstairs’, thinking she was in her house. She wanted to make sure everything was all right ‘upstairs’. That everything was taken care of. I thought she probably had unfinished business with the house or her possessions, but my sister thought that going ‘upstairs’ meant going to heaven. Both were probably true.

Mom became obsessed about getting someone to help her leave. “What about you?” She said to my brother. “Can’t you take me home?” When he said no, you have to stay here for now, she turned to me and asked me the same thing. When I shook my head, she turned to my partner, Leon, whom I could tell she didn’t even recognize. She looked at him, and then looked harder at him and said, “Well? What about you?” We all laughed, including her. But she wasn’t distracted for long.

We had an overnight care-giver stay with Mom in order to give us all some sleep. Mom kept her up all night, as well as a nurse who was trying to help.

That’s when the Delirium Prevention Bag appeared.

It contained four items. An oven mitt, a highly colored garden glove, a soft brush, and a slinky. The care-giver said she would let Mom play with the bag when Mom got really wild, and the items seemed to calm her down. She loved the brush and asked our care-giver to brush her hair with it.

But the calmness was temporary.

The next day, Mom focused on a different topic, and was just as relentless. But when I would think, ‘Ok, I think we’re done with wanting to leave,” Mom would lean over and whisper to me, “We’ve got to get out of here.”

I knew in my heart that she believed people died in hospitals. And as she kept telling the doctors, “I’m not ready to die yet.” Yet somewhere inside her, she knew that if she stayed there, she would die. That was why she wanted to leave so badly.

The hospice doctor was the only doctor who helped us to understand what was going on, and what our options were. “Is she talking to people who aren’t here?”

Yes, we answered. She had been talking to my Dad for a whole day now. And he passed a year ago.

“Does she call for people who have already gone before her?”

Yes, she’s been asking for her sisters and parents. They all died before she did.

“Does she seem a bit confused, or like she’s making up stories?”

Yes, she keeps saying people are gathering to look for the lost children. We don’t know what that means. And she just shakes her head, and says well, it could be children who were stolen, lost, or dead.

“You don’t have to have her here. You can move her to The Hospice House, where there are care managers who are trained in end of life. They know what to do. They’ll help. Or you can have hospice come to the rehab facility. It’s up to you. She doesn’t have to stay here.”

What a relief! Immediately we made arrangements to have Mom moved the next day to rehab and receive hospice care. Because, after all, the doctor said Mom could continue to live like this for some time. No one could predict when she would die.

The moment I told Mom she was going to leave the next day, she smiled a beautific smile. The years fell away from her face. She reached for her makeup, had me brush her hair, became happy and removed her oxygen. “I don’t have to use that any more,” she declared. And we spent several hours laughing over her stories she was telling the different nurses and therapists. Her delirium was gone. Her confusion was gone. Her insistence was gone. Mom was back and herself again.

Until the next morning when I arrived to help her dress for moving to rehab and hospice. And she was unresponsive.