Delirious distractions

Re-reading the chapter on Delirium in the “Harrison's Principles of internal Medicine” was a re-learning time. Delirium is defined as an acute confusional state, leading to major morbidity and mortality. The diagnosis is based on Confusion Assessment Method Diagnostic Algorithm. Two necessary criteria, and one of the other two as an additional criterion. 

• Acute onset and fluctuating course – mental status changes, sudden in onset and fluctuates during the day.

• Inattention – difficulty in focussing attention, easily distractable or difficulty in keeping track of what is being said.

• Disorganised thinking – thinking is disorganised or incoherent, rambling, irrelevant, unclear, illogical, unpredictable.

• Altered Level of consciousness – not alert – either vigilant (hyperalert) lethargic (drowsy or easily aroused) or come (unarousable).

Reading this was not only re-learning but revealing too. I suddenly realised, sometime during the day I am in Delirium too! And many around me too! Sudden inability to focus attention, easy distractibility, disorganized thinking, and hypervigilance is part of my life too.  I am distracted by the noise coming in from the virtual space accessing devices I use. I am unable to focus, disorganized with information overload, and hypervigilant for the next message! Distraction leads to procrastination, and procrastination leads to discontentment. Many of our distractions are gladly received. And distraction leads to shallow communication, and shallow communication leads to shallow relationships. (If you want to know more you will need to read Harrison’s Principles of Practice of Medicine.)

Time Challis writes in his blog, (https://www.challies.com/articles/look-a-distraction/) “We are distracted. We are so distracted, and so accustomed to it, that after a while we almost become distraction” And that distraction leads to delirious outcomes! 

 

Paul Graham says it well: “Distraction is not a static obstacle that you avoid like you might avoid a rock in the road. Distraction seeks you out.” We surround ourselves with devices that bring us so many good gifts, but even these good gifts exact a cost—the cost of distraction. 

Tim Challis recognises three outcome of such distraction, Shallow Living, Shallow Doing and Shallow Loving. “If we are unable to think deep thoughts, we will be unable to live deep lives.

Distraction leads to shallow thinking, and shallow thinking leads to shallow living.

Our distraction prevents us from deep engagement with other people.  We are always just one beep or one more buzz away from disengaging from a conversation and turning our attention to that text message, that email, that notification.” 

Quentin Schultze says that “we have become like tourists who are so enamoured by our mode of transportation that we cruise through nation after nation largely indifferent to the people and the cultures around us. We have our passports filled with the little stamps telling people just how many places we’ve been, but what is the purpose of being in places if we have not experienced them? And what is the purpose of knowing people if we do not care to know them on anything more than a surface level? The trend today is toward these fleeting, surface-level interactions”.

 

We are Homo-Sapiens who have become ‘Homo-technologicus’ are becoming ‘Homo-distraticus’.

 

If this is not delirium I wonder if there is another term for it. The textbook of Medicine gives treatment protocols too, as Delirium reduction care protocols, simple and effective! 

 

One - Practice and promote wakefulness - by very simple steps for a hospitalised patient. Sit in a lighted room, plan for the day, get out of bed, have a discipline of three meals, walk and exercise etc.  In one sense - prioritise and set up a schedule for activities so that you are not distracted into delirium!  

Two - Promote sleep – simple steps of shutting down the light, drawing the blinds, avoiding stimulating drinks like coffee after evening and putting in rhythms for moving from wakefulness into sleep.  Shut down, give up, set boundaries, and go off to sleep at times! 

But then, you do not need technology to be distracted – Remember what the Master told Martha “Martha, dear Martha, you're fussing far too much (distracted) and getting yourself worked up over nothing (Cooking). One thing only is essential, and Mary has chosen it—it's the main course and won't be taken from her.”

I wonder how delirious and distracted am I and what main course am I missing?