To Hell and back: an insider's account of post-traumatic psychosis

When Sue Kay heard her son had been in an accident during his gap year, she rushed to his side. Joe survived - but he'd changed into a violent, psychotic stranger
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Indy Lifestyle Online

I'd heard nothing from my son for two weeks when I got the call: Joe, who was working on a post-tsunami relief project in Galle, Sri Lanka, during his gap year, was in a coma. His father, Nick, a diplomat in Afghanistan, rang me from Kabul to say Joe had come off a scooter, been left in the road, and then abandoned in a Sri Lankan government hospital. He'd had no identity on him. A stranger had traced Joe's lodgings and found his passport. The British High Commission rang Nick in Kabul. And Nick rang me in London. It had taken 20 hours.

For 40 minutes I paced. With so little information, I could not pass the burden to anyone else just yet. Then another call from across the world - Joe's eyelids had fluttered. His friends had moved him from the big hospital. They had manhandled the deadweight of our son into the back of a van they'd hired for the purpose, and taken him to a small private hospital (negotiating admission without insurance papers), and into the care of a neurosurgeon. Joe had severe contusions to both frontal lobes and severe oedema (swelling) of the brain.

Nick got there before me. Joe did not recognise him. The hospital assembled medicines and prepared for the transfer up to Colombo where I would be arriving shortly from London. But just before departure the neurosurgeon said there was no clinical reason for moving him. In this small hospital far from anywhere, Joe was at least stable. Nick stopped the preparations and returned to sit alone with sleeping Joe. "Change of plan then, Joe," he said, thinking aloud - not in his wildest dreams expecting the quiet response which came back from the stock-still body on the bed. "So what are we going to do now then?" There was a person surfacing.

That day was a good one. Joe sat up. He had no idea where he was, what year it was (he had a stab at both but got the continent and the century wrong). He was not aware he had sisters, much less their names. When I arrived he did not recognise me. But nevertheless, in retrospect, it was still a good day.

Seven immaculate Sri Lankan nurses decided it was time to wash all that long blond hair. Joe slept right through the ministrations of those seven angels at his head. We sat on the balcony, in speechless surrender to our relief. A family of monkeys played on a tree nearby and a flock of parrots skimmed the swaying tops of the forest of palm trees.

It was not until the next day that the psychosis set in and Joe became intent upon escape. The nurses locked all the doors. Angry at being thwarted, Joe drew on the strength the psychosis lent him, which was a force to be reckoned with. He barged his way out on to the balcony and straddled the railing. There were 12 of us squashed on to that balcony, trying to prevent a tragedy. This was a toddler we were dealing with, a toddler with the strength of Samson.

Joe now needed two strong men with him at all times. (Our driver, Ruhita, made it clear he was not leaving us.) We were told he had post-traumatic psychosis, which sometimes occurs as a result of a brain injury, possibly because of post-traumatic stress. There was no way of knowing how long it would last. When not overwhelmed by exhaustion, Joe rampaged around the intensive care ward. Our position was now untenable. We had to get to Colombo.

Before the dragon awoke, that journey would have been easy. Now it seemed impossible. He would be unmanageable in the ambulance, so the hospital manager boldly decided to put him in the back of Ruhita's car between me and Nick, and the ambulance would follow. In Sri Lanka, blindly overtaking four-abreast at crazy speed is normal. Flimsy tuk-tuks throw down the gauntlet in front of juggernauts, cars metamorphosise in a flash to fit spaces like in cartoons. And with the ambulance siren blaring behind him, Ruhita, one hand permanently depressing the horn, outdid them all.

Oblivious to danger, Joe decided it was time to get out and climbed across me, shouting. He grabbed the door handle and it flew open, as we clung on to him (by the hair). Accelerator flat against the floor, Ruhita pulled in across two lanes of traffic amid a scream of brakes. The ambulance overtook us and stopped. Its back doors opened and the tiny nurses in their long white socks, blue and white uniforms and white hats, emerged carrying little trays of medication, needles poised for sedation.

In Colombo, Joe's sedation was upped again. We walked together along the corridor and when things got bad, we got him counting along the door-numbers, until he found our room again, went inside, lay down and slept. But on the last of these excursions he noticed the emergency exit and its written instruction "lift bar to open". He began to ascend the fire escape on his wobbly legs, two steps at a time. He was going on to the roof, he said, to sunbathe. I screamed for help. Nick gave chase. I don't know how he caught up with Joe, let alone how he got him down from the top floor, but he did.

But it did not stop us from being thrown out of the hospital. We were told we had to go that minute. But where? We were given the telephone number of the asylum, and Joe's sedation was upped again. The director of the asylum turned up - a man of immense professionalism who refused to have Joe certified. Somewhere in his shattered brain, Joe must have known what was in the offing because he told this psychiatrist he liked him, just like that, "I like you". The director looked through Joe's terrible manic stare and said simply that Joe had come to help Sri Lanka recover from the tsunami, and so it was his duty to help him in return.

He got us admitted to another hospital. The High Commission negotiated a room, we paid a large porter to be vigilant. Joe's sedation was upped again. Two endless days and nights we were there, caught up in the unreal world of Joe's hallucinations and delusions.

We needed to get home. Ruhita and I headed for the airport to buy tickets for Joe on a stretcher occupying four seats, Nick and myself as well as return tickets for the psychiatrist's registrar and male nurse who would be travelling with us, plus 12 canisters of oxygen.

After endless bureaucracy, we got our flight, but nothing would make Joe lie down on the stretcher. The nurse held Joe's legs down with all the force that was required and began to bind a cord around them. We stopped him.

Joe woke often, pushing back the stretcher curtain and glaring out like someone in a horror movie, and yet another needle went into his arm, as we held our breath until it finally took effect again. Our terror of Joe awake was only matched by our fear when he was asleep - as we repeatedly checked that he was still alive. Joe woke for the last time as the plane descended and he climbed across several rows of other passengers in a final bid for escape. The stewards calmly let us move around and field him as the plane touched down.

Two ambulances awaited us. Joe moved through the procedures of A&E at the Chelsea and Westminster, telling an Australian nurse that he was in Melbourne. "Confabulating" was the name for this, the brain's trick of creating stories to make things make sense. I had the wound dressed where Joe had bitten me on the flight. That night Joe punched one of the mental health nurses.

But that was to be the last of it. The psychosis had run its devastating course. For six weeks we did jigsaws and chronicled every tiny improvement, each more-Joe-like mannerism returning - a familiar angle of the head, an expression. But Joe's memory wiped out after three minutes. He heard with surprise the oft-repeated news of why he was in hospital. After four weeks he still could not find the bathroom - less than 20 yards away. Then one afternoon something shifted. Joe remembered that his sisters had visited, and three days later he found the bathroom on his own. He was transferred to the Royal Hospital for Neuro-disability, for rehabilitation and assessment. Six weeks later he was discharged back into his own life again.

I took Joe to university last month. To read philosophy. I'm not sure I quite believe that yet... that he did come back from his gap year safely, after all.