Windows for the Soul

Transient postoperative delirium, a syndrome which occurs frequently during the first few days of treatment in intensive care units, is not clearly understood. What causes the impairment of orientation, memory, cognition, and judgment as well as the emotional changes, hallucinations, and occasional paranoid delusions characteristic of this syndrome? Some authorities stress basic personality traits, such as emotional instability, proneness to worry, and addiction to alcohol or drugs; others emphasize preexistent or concurrent organic disorders caused by cerebral emboli, infections, or metabolic and electrolyte disturbances; still others accent the immediate preoperative states of mind—unrealistic expectations of surgery, excessive anxiety, or denial of fear. Recently, attention has focused on specific features of the intensive care unit environment as possible factors in triggering or aggravating postoperative psychotic reactions. In hisMaximum Security Ward¹—the grim metaphor of the title bespeaks the poem's message—Ramon Guthrie, a former patient, provides insights into the adverse