Far Above The Moon

"Your circuit's dead, there's something wrong": Space Oddity, David Bowie, 1969

“Can you hear me Major Tom?” Yes, but I'm a nurse, and no I don't want to look at it

I first met the patient during his post-operative status on a quiet Intensive Care Unit (ICU), with just the occasional wheeze of a ventilator, the odd beep of a monitor, or the ring of a phone from the nurses station to break the silence. It was only a few days after his admission, and his notes stated that his wife had taken him to Accident & Emergency (A&E) as she was extremely concerned about him. Within 10-minutes of arriving at A&E, the patient had gone in to Respiratory Failure and had stopped breathing. At this point he was incubated, a tube inserted through his mouth and down into his trachea (windpipe), connected to a ventilator via the tube, and sedated.

Following the life saving interventions of the A&E team, the patient was moved to the ICU. The next day, the ICU doctors and nurses brought him out of his sleep and removed the ventilator. The patient managed to breathe on his own for an hour, but then had a further Respiratory Failure and stopped breathing again, requiring him to be re-connected to the ventilator and re-sedated.

Given the poor condition of the patient, it was agreed that a tracheotomy needed to be performed to open a direct airway to the trachea for the safe delivery of oxygen/air to his lungs. A tracheostomy is a surgical procedure, in which a surgeon creates a hole through the front of the neck and into the trachea. The resulting stoma (hole) can then act as an independent airway for a tracheal tube to be inserted. Once introduced, the tube allows a person to breathe without the use of their nose or mouth.

In addition to the tracheal tube, a central line (also known as a Central Vascular Catheter - CVC) was also inserted into one of the big veins on the left side of his neck. A CVC is a long, flexible tube that is used to deliver fluids, nutrition, and drugs straight into the bloodstream. Unfortunately the CVC soon became infected, so a new central line had to be introduced to a large vain on the right side of the neck. It was at this point I met with the patient and started to care for him on the ICU.

"Take your protein pills and put your helmet on"

I helped the patient with the shock and enormity of the situation he had suddenly found himself in. However, after a couple of days, I was made aware of some chatter and commotion that gave me cause to investigate the situation. The following bullet points are a synopsis of my findings:

• A Chinese businessman had bought the hospital, and that changes to the structure and formation of the ICU had taken place. These alterations allowed a clear view of the passenger area of a spaceship that was parked on the roof of the hospital.

• At the far end of the ICU there was now a staircase that led up to the roof and the entrance to the spaceship. The spaceship's function was to take poorly children and their parents into space to help them with their recovery, including a full orbit of earth and a swim in the onboard pool.

• However, when questioned, all of the doctors and nurses said they hadn't been allowed aboard the spaceship yet.

• There were two televisions on the wall of the ICU that had a Chinese lady on one screen, and a Chinese chap on the other set, loudly reading the news in Mandarin with english subtitles. Amongst the various news reports, there was coverage on both screens of a small carbon-fibre submarine that had imploded whilst exploring the wreck of the Titanic. Unfortunately, there were three high profile Chinese billionaires on board and nobody had survived. The newsreaders said that the Americans had caused the implosion to assassinate its passengers, and that China had started mobilising their troops for war.

"I'm floating in a most peculiar way and the stars look very different today"

• Away from the ICU, there was a Dragon Boat Race. Each boat was captained by a Chinese military officer, but the crews were made up of emaciated British Army prisoners. The rowers on each boat were held in their seats by a thick wooden plank that was clamped on top of their thighs and attached to the oars. The clamps were designed to push the plank downwards and crush their legs, if the attached oar wasn't being rowed at the speed set and demanded by the Captain. The faster the prisoners rowed, the better chance they had of walking away. Although, judging by the piles of bloodied and screaming British soldiers on the banks of the river, it hadn't been the first race of the day.

• Behind the dying soldiers on the side of the river bank, there was an entrance to a cave. In the mouth of the cave, carved into the rock, were a pair of fierce looking Chinese Foo dogs. The dog carvings guarded the beginning of a labyrinth of eerily dark tunnels, with the only the slight crackle and faint light of the flame torches that hung at intervals from the walls to guide you. Every so often the tunnels would offer up a red door. Each door was a different size and shape, but all of them were adorned with beautiful unique Chinese characters painted in gold. Behind each of the doors, lay an assortment of death related artefacts. Small rooms stacked with human bones and skulls, larger rooms containing black lacquered coffins, with an ornate suit of leather armour and a sword next to each one, and behind two giant red doors lay a cavernous chamber with a large gold chariot and four gold horses in the middle of a circle of jade soldiers.

• Finally, back on the ICU, other changes had taken place. A pop-up Apple shop was giving out iPads and vacuum cleaners. A section of the Unit was selling football shirts. The metal rails that hung from the ceiling, to provide a curtain track around each bed, now displayed colourful scrolling 'ticker tape' advertising around the top of the frames. Scientists had found human DNA in pollen, and from the new yellow and pink flowered wallpaper, four tiny people in Chitty Chitty Bang Bang had flown out of the centre of a flower. The people were later identified as Caractacus Potts, Mary Poppins, and Jane and Micheal Banks.

"Far above the moon. Planet Earth is blue, and there's nothing I can do"

These findings led me to conclude that all of these events had been witnessed and experienced by my patient, as he was higher than a cow jumping over the moon. Completely off his crumpet.

It transpired that the patient, David, had been having extremely vivid and disturbing audio/visual hallucinations since his operation to insert his tracheal tube and central line(s). The reason for these seemingly real episodes, that are now etched in his mind as actual clear memories, is that he had suffered a rare hallucinogenic reaction to me. Whilst you might recognise me as Morph, at work I use my proper given title of Oramorph.

I am part of the Morphine family, with our evolved name being derived from the ancient Greek god Morpheus, the god of dreams and sleep. Morphine is the naturally occurring opioid in the opium poppy, 'papaver somniferum', and we are a powerful narcotic analgesic, a pain-relieving medication often prescribed to patients after surgery. We reduce pain by changing the way the brain and body interpret and respond to it. However, as we are opioids, there can be serious side effects, like hallucinations. People can also abuse us and become addicted, just like Major Tom.

"...I think my spaceship knows which way to go"

Goodbye, thanks for reading