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This subcategory of ‘how I was before’ describes the participants’ stories of their emotional stability and strength before experiencing the emotional wound of delirium.

3.3.1.1 Their strength

Their strength was evident from the axial coding words strong willed; resilient; sound mind; level headed; strong in mind; never like that; wouldn’t do it normally; never been in hospital.

In defending her strength Daisy said ‘I have always been level headed, resilient and of sound mind’ and said this with emphasis and pride about herself and her abilities. Daisy also said ‘I’ve always been level headed person and to think something like that went to my brain’. Daisy was ashamed about her behaviour.

‘I’m not a woman who swears and I am a loving mother’ said Dorothy when she was recalling her behaviour towards her son. Validating her personality and her ability as a mother was very important to Dorothy.

Gavin said ‘I am pretty strong willed and hard to scare’ but his delirium was more than scary, it was beyond his capability of being ‘pretty hard to scare’. George explained this was ‘the first time in hospital’. George was proud of his strength of maintaining his good health during his lifetime of being a farmer, orchardist, bulldozer driver and a saw-miller.

Mabel described herself ‘I was really like a little child and depending on others’. Mabel was distressed by her regressive behaviour.

Alfred said ‘I was not confused or anything like that’ when he was describing the terrible pain he suffered for two nights. Alfred was emphasising his awareness of his real pain with pride and not something that he had imagined.

Throughout the interview Ted was very talkative about his losses over recent years, especially his driver’s licence and the consequence of not being able to drive his vintage cars. This was Ted identifying himself in the past.

The participants needed to identify themselves as normal, capable people because they were very aware their stories of their terrifying experience of

delirium had possibly portrayed them as terrible people doing terrible things. However whilst identifying their own strengths and their capabilities as a person, they were also seeking reasons for the cause of the delirium. They asked questions around the functions of the brain, was ageing a factor, were their other medical conditions and prescribed medications causative factors for them to become delirious.

3.3.1.2 Why was this happening to me?

The ‘why was this happening to me’ was made up from the axial coding words and phrases: why; couldn’t think straight; previous episode; all the medication; what causes it; I thought I was going silly; my other conditions; loss of mind; muddled mind; something that just happened.

The participants struggled to make sense of the experience and looked for explanations. Daisy said ‘it was the infection in my water’. Daisy was acknowledging the information she had been given about urinary tract infection being a common cause for becoming delirious. Daisy also said ‘I thought it might have been my age’. Daisy was querying if her age was a cause for her being delirious and she was horrified by the knowledge that her brain was vulnerable ‘and to think that something like that went to my brain’

Some participants queried the variety of explanations they were given for being delirious. Lance described his astonishment that he had become delirious while he was in hospital and questioned

there was no reason for it, I don’t know whether it is the amount of drugs that I’ve had in my lifetime. Could be the drugs but why? It is unbelievable how your mind works. I don’t know what causes it. I was all right but when I woke up don’t know what happened.

Gavin identified having an epidural anaesthetic for his total knee replacement as the cause of his delirium: ‘I think if I was, had any delirium after the operation, it was most likely caused through the experience’.

Gilbert said ‘I just think it’s probably the drugs they give me plus the drugs I’m taking that brings about a situation where I am not aware of what I’m saying and doing’. This was Gilbert searching for a cause for the delirium.

Dorothy queried ‘I don’t know if there is something in the back brain somewhere’ as a cause for her experience of delirium. Dorothy also asked ‘do you have many people that have this?’ The researcher explained to Dorothy that delirium is not an uncommon experience for the older person who undergoes surgery.

Dorothy said ‘don’t know what did it, but it did it’. Dorothy used the word ‘it’ to describe delirium. The word ‘it’ used by Dorothy describes the need of not wanting to own or be responsible for the delirium.

For some there were concerns about their state of mind and for others there were concerns about independence and the ability to return to their own homes. Daisy, with panic in her voice, stated ‘It was that business in my head that set it off’. Daisy was very frightened that her experience of being delirious would convince others that she needed to be placed in a nursing home.

Charlie said with doubt in his voice that he felt ‘it would never get out of my mind’. Charlie was very concerned that being delirious had damaged his brain permanently. Charlie also said ‘I thought I was going really silly, no, it wasn’t

very nice at all’. As an older person, Charlie was concerned that he was going senile.

The relatives of the participants that were present at the interviews identified sleep as being a very important reason for their loved one not being delirious any longer. George’s wife said ‘once he had slept the next day he was right’.

Trying to come to terms with having been delirious seemed painful for participants, they pondered over and struggled to make sense of why they had become delirious and they were only able to understand the reasons by the questioning of their own physical health prior to their orthopaedic surgery. They were concerned about the implications for their state of mind. They were searching for the meaning of why this has happened to me.