The phone rings late motzei Shabbos. It is Zelda, Dovid's older cousin in Florida. "You've got to come quick Dovid! Your mother fell and broke her hip! She needs surgery, and she's gone crazy. I don't know what to do!" Dovid is beside himself. His mother, Myna, has been living independently in a retirement community in Florida for years. He immediately calls his sister Shayna in California who is a nurse. "What do we do?" asks Dovid. Shayna replies, "You'll have to go to Florida. I'm really worried, but I can't leave now because our Rivkie is still in the hospital. I know you can do this Dovid. Please, make sure mom is well taken care of." Dovid cancels his business trip and flies to Florida the next day. He is frightened by what he might find.

When Dovid arrives at the hospital late Sunday evening, there is not a doctor or nurse available to speak with. His mother seems to be having a conversation with her deceased sister, during which she alternates between laughing and crying without any clear reason. Myna is so confused that she thinks Dovid is his deceased father and repeatedly calls him Shlomo. She complains of raccoons biting at her ankles and frantically swats these imagined critters away. There are moments when Myna seems more like herself, but overall, this disoriented woman is so unlike the bright, sophisticated mother who raised him. Dovid is scared and doesn't know what to do. He wonders if his mother is crazy, or if unbeknownst to the family, she has developed Alzheimer's dementia.

Dovid stays at Myna's bedside all night. He is abruptly awakened early the next morning when the doctors come to make rounds. They examine his mother briefly and then leave. Dovid has many questions for the doctors but all they tell him is that Myna needs surgery and the surgeon will come later. Dovid anxiously waits by his mother's bedside, growing more and more impatient as the hours go by and no one can tell him what needs to be done about Myna's broken hip or why she is behaving so strangely. Finally, the surgeon arrives and tells Dovid about the operation that Myna needs. Dovid agrees to the surgery, but remains worried about his mother's mental health.

After the operation, Myna is sleepy for a few days and then wakes up in an even worse state. She is extremely confused and tells Dovid she plans to overdose on her pain pills and he should cremate her after she dies. Dovid is mortified. Despite asking many questions, he cannot get answers from the doctors or nurses that make sense to him. They keep telling him that the operation went well and that Myna is healing beautifully and will be discharged to a rehabilitation facility the next day. Dovid knows that his mother cannot participate in physical therapy in this state. He insists that she cannot be discharged tomorrow and demands that a neurologist or psychiatrist evaluate her.

The psychiatrist, Dr. P, comes later that day. Much to Dovid's relief, Dr. P takes time to speak with both of them at length. Dr. P asks a lot of questions about Myna's life, both past and present, and he seems genuinely interested in how Myna's behavior in the hospital is different from how she typically acts. After speaking with them, Dr. P orders blood tests and a CAT scan of Myna's brain. He also prescribes a low dosage of an antipsychotic medication at bedtime to help Myna sleep and to stop her hallucinations.

After his extensive evaluation, Dr. P explains to Dovid that Myna is not going crazy, and she does not have dementia. Dr. P tells Dovid that Myna's confusional state is a temporary and very common condition called delirium, which should completely resolve as she recovers from the surgery.

Delirium is a common medical/psychiatric syndrome that can occur when a person becomes physically ill. It is more likely to happen in the very young and very old, or in people who have preexisting brain problems, like dementia or strokes. Delirium is a relatively sudden change in consciousness or attention with dysfunction in a person's thinking that comes and goes throughout the day. Like Myna, the person can seem fine one minute and be confused or agitated the next minute. Delirium typically affects attention, awareness of one's physical surroundings, and memory, but symptoms can range from hallucinations and paranoia to agitation, anxiety, or social withdrawal. Occasionally, a person affected by delirium can become suicidal or even homicidal. Delirium, which is also known as acute brain failure, can mimic psychiatric disorders like schizophrenia, depression, anxiety, or dementia. It can be caused by almost any medical problem, from something minor like a urinary tract infection to a more serious medical issue like kidney failure, stroke, heart attack, or cancer. Additionally, some of the medications that are given in the hospital can also lead to a delirium, especially sedatives and pain medications. People who have delirium are not crazy; their brains are physically sick, just as their bodies are ill. Unlike dementia, delirium is reversible, and people become themselves again within a few weeks. However, occasionally in someone with a preexisting dementia, the person will not return to their prior level of functioning.

Luckily for Dovid and his family, Myna recovers from her delirium and is discharged to the rehabilitation facility. A few months later, she returns to her active life and lives independently for many years without any further episodes of delirium. Dovid's frightening\memories of his mother 's delirium fade into the past, but he uses his knowledge of delirium to assist others in the community who don't know what to do when their relatives are admitted to the medical hospital and suddenlystart acting "crazy."

Naalla Schreiber, MD is an attending psychiatrist at Montefiore Medical Center in the Bronx, NY. She specializes in the psychiatric treatment of medically ill patients and can be reached at [email protected].