The Psychedelic Madness of Covid-19: A Personal Journey Through the Italian and American Health Care Wonderlands

Cary Tennis was a brother-in-arms during the wild struggles of Salon, the web startup I led during the dotcom free-for-all. Not only did he write the popular “Since You Asked” advice column, Cary was one of Salon’s free spirits — a member of the band of brothers and sisters who helped create a unique publishing oasis for over ten years. Or, as I sometimes described it in those giddy years before Big Tech and Big Media swallowed digital media, we were the inmates who took over the asylum.

After our wild ride at Salon, we went our separate ways, and Cary and his wife Norma sold their home in San Francisco — a city that felt less and less like the bohemian refuge that had once upon a time attracted us — and moved to a Medieval town in Tuscany where they started a new life.

Then Cary came down with Covid and began another hallucinatory journey — one that I could relate to after being hospitalized for five weeks with a serious stroke in 2017. So once again Cary and I became brothers — linked by medical calamity, survival (or “Stayin’ Alive” as we recently sang to teach other), and a late-in-life appreciation for life.

So today I’m reviving our Salon by posting Cary’s first-person story. Here’s to my brother’s durable spirit — and to Norma’s own resolute heroism.

Learning from Delirium: My Covid-19 Nightmare

By Cary Tennis

When the Italian ambulance crew brought me home on a stretcher after five weeks in the Arezzo hospital, I was so weak I could not walk. I had lost 30 pounds. I had to be helped into the house. The doctors had told my wife, Norma, by phone that I had been close to death, that she should prepare for the worst, that the situazione was molto, molto grave. They had also asked her, in a roundabout way, if I had a history of mental illness, if I was mentally fit enough to, say, drive a car. That is because I went crazy in the hospital. I experienced postoperative delirium, or Covid-19-induced psychosis.

It began on Election Day. Since I live in Italy and follow American politics closely, I had planned to go to bed early on Tuesday, Nov. 3, so that I could get up at 3am Wednesday—9pm Tuesday on America’s East Coast—and follow the early returns as polls closed. But early that evening we received an urgent phone call from an American neighbor whose husband had just been taken to the hospital in an ambulance. She needed to take his medicines to the hospital and was afraid to drive on the Italian roads at night, so I volunteered to drive her. At this point, I was only thinking of responding to the emergency. Though of course the pandemic was raging, I had no thought of Covid-19, other than to take the usual precautions. She sat in the back seat of the car on the passenger side. We were both masked. I kept the windows open.

The next day I felt a bit ill, and I learned that she and her husband had both tested positive for the virus. By Thursday, prudence dictated that I be tested. By Saturday, Nov. 7, I had learned I was positive, and went into quarantine.

Here is the tricky part. A few days into my quarantine at home for Covid-19, I became seriously ill with a relatively rare gastric problem called a volvulus, or twisted section of the colon. I was taken to the hospital immediately and operated on. Soon after surgery, I became infected with the Klebsiella bacterium, and had internal bleeding, and acute renal failure, and Covid-19-induced pneumonia. That was around the time the doctors called my wife, telling her to prepare for the worst, that I might not make it, and asking her, in a roundabout way, if I was sane. Because I’d been acting like a nut job.

My memories of those first few days after surgery are sketchy and filled with hallucinations. I remember only flashes. I know this: The doctors were struggling to save my life, while I, in an animal fury, fought them, believing they were there to kill me.

If I had been in an American hospital, perhaps I would have understood what was happening to me. As it was, I had awakened from the deepfreeze of anesthesia into a frightening world of alien voices from which I believed I needed to escape to save my life.

If this had been an American hospital, my biggest shock might have been the bill. This being Italy, my biggest shock afterwards was that there was no bill. Having had major surgery in San Francisco and in Italy, I can say this: American healthcare is great except for two things: If you get sick, the cost of treatment might drive you into bankruptcy. And your doctor’s good judgment may be overruled by your insurance company.

American hospitals are clean, beautiful, gleaming temples to wealth and prosperity. Tuscan hospitals are drab, poorly maintained, government-style buildings where the wait is long and the “system” is a frustrating patchwork of forms and officials.

The difference is, in Italy, no one is turned away for lack of insurance or lack of funds. Everyone receives high-quality care. No one gets a bill. Healthcare is a human right.

In America, we venerate freedom. We enjoy freedom, not only the freedom to maximize profit according to market forces, but the freedom to be tricked, conned, swindled and victimized, a freedom we call “individual responsibility.”

In Italy, people aren’t so free. In Italy, “big-government” laws and regulations protect the innocent from predation and, to an extent, hamstring business. For instance, one is not “free” to fall into ruinous credit card debt because credit cards have strict limits and must be paid back monthly. Nor can most employees be fired “at will.” Nor is one “free” to opt out of the healthcare system. You’re going to get medical care whether you like it or not. People are going to care about you whether you want them to or not. You are a part of society whether you like it or not. Every day people brought Norma food while I was in the hospital. She had more food than she knew what to do with. These were not social workers and visiting nurses. These were what you call “neighbors.”

I find that kind of nice.

But back to my Covid-19-induced delusions. In the intensive care unit where I was recovering, nurses kept telling me to put my oxygen mask on. In my delirium, I did not know what the oxygen mask was for. I came to believe that it had special powers, that it was linked to the Internet. I believed I was not in a hospital actually but in a hotel room, a resort of sorts, with others and that somehow when the account to pay for the room was set up, our account and the accounts of the other “guests” in the room were connected via unseen wires in a big block of oak wood mounted on the wall. I surmised that via quantum physics the setup, or the password, or the account, existed in two states at once, and thus our account was being drained by the others in the room which was why they kept telling me to put my mask on. In this delusion I believed that we went on a shopping trip to a grocery store in some locality which I recognized but could not name. There, I was given a ham to hold. I saw myself in diapers sliding down a stainless-steel chute, or conveyor. I had to hold the ham and go through a scanner which would divide the cost of the ham between me and the other “guests” and “hotel staff.” I believed that the reason “nurses” kept telling me to wear the oxygen mask had something to do with our linked accounts, which had something to do with a dense oak log with wires in it, which I could not see but knew was there.

Later in my stay, I began planning to undo this treachery once I was released. To do so I would need to purchase a lead-shielded briefcase, so I began searching the Internet (by this time my phone and computer had been returned to me) for a lead-shielded briefcase I could put my laptop in. That would solve all my problems.

 At another point in my ordeal, at another hospital location, they took my clothes and put me in a medical gown. I hated the gown. So I dug my safety razor out of my bag and, quite laboriously, as a safety razor is designed precisely to not cut things, I began tearing the sleeves of the hospital gown until I could pull it off.

Then I got out of my bed—I was temporarily in a single room—and made my way to the bathroom, tearing out the IV lines as I went. Because I wanted a shower!

I made a terrible bloody, shitty mess of the bathroom. I was caught and sent back to bed. They confiscated my safety razor.

People ask me why I did that. How should I know? I had gone crazy.

It’s been pretty hard to take, this knowledge that I lost my mind. For I am not the person who did these things.

Or am I?

Of course I am. Research suggests that what happened to me is not all that uncommon among Covid-19 patients.

“Many of the psychiatric manifestations of COVID-19 are a consequence of psychological stressors, such as fear of illness and death, prolonged social isolation, and uncertainty and fear about the future. However, a growing body of evidence suggests that the virus itself can precipitate psychosis among infected individuals.”

So says this study on Covid-19-induced psychosis. Several mechanisms are suggested. One is “direct viral infiltration into the central nervous system.” Another involves “dysregulation of cytokine networks.” And “a third possible mechanism of psychosis in Covid-19 patients may be related to the severe sensory deprivation associated with hospital isolation measures.”

This last possibility would fit my case. Not only could I receive no visitors, but the language barrier isolated me even from the doctors and nurses. Hard as I have studied Italian over the past five years, I still find it hard to follow Italian speech. The hospital rooms were noisy with electronic beeps, doors slamming, nurses yelling, machines whirring. I could neither understand simple instructions nor conduct the casual banter with nurses that can be very reassuring in a stressful situation.

I wonder if the subjects of my hallucinations arose out of what was actually happening to me. For instance, did my struggling with the nurses turn into this delusion: sliding down a stainless-steel chute … in a chilly room full of waiting shoppers, and then placed in the back of a pickup truck, still holding the ham and the grocery bags, to be driven back to Arezzo from Florence? Or was it Florence? I have a vivid memory of an elevator on a hillside to the grocery store below. I don’t know what city it is in. Possibly a German city, or Lisbon, or Florence? A university town … with a commercial street … we stayed in a hotel … it was on the river …

As these fragments of memory come together, this, too, is a part of recovery: sorting out the images that are clearly delusional and attempting to replace them with memories of things that actually did happen, which is hard because the delusions are often more vivid than the memories of what really happened. Parts of real memories have become enmeshed in the delusions! Will they return, these pieces of actual experience, to take their rightful places in my factual memory? Or will they be discarded along with my delusions?

Unlike normal dreams had while sleeping, these dreams persist as though they actually happened. They’re in the wrong box. They have gotten mixed in with the box of “stuff that actually happened.” I have to put them in the other box, the box of “stuff I imagined.”

That’s not easy. It’s a new box I’ve had to create to accommodate this new category of phenomenon. I never had a box for persistent delusions before. It is similar, I will say, to the box that contains certain hallucinations I had as a teenager and young adult under the influence of LSD. In both cases, the visions are vivid and long-lasting.

The only difference is, when I came off the LSD, I knew immediately that what I had experienced were hallucinations. By contrast, it is taking me much time and effort to fully accept that the things I thought happened in the hospital did not actually happen.

It’s scary. I feel I walk on a knife edge now, an edge that I could fall off of again. That is frightening. Now, as I contemplate that possibility, the fear rises in my throat. It’s early morning, I’m safe in my house in Italy, Norma is upstairs taking a shower and listening to her Greek language tapes, the pigeons are cooing outside, and I am safe. But could this happen again? Could I be slowly losing my mind?

I fear that my brain has been damaged.

But who knows? Perhaps for my whole life I have taken my sanity for granted. Perhaps all along my “sanity” has been precarious. So where is the boundary line? What differentiates certain somewhat crazy impulsive decisions I have made, based on what I imagine may happen in the future, and these vivid delusions, in which I believe something to be real in the present?

But back to the hospital. More than anything, I longed to be home. I did not understand the gravity of my illness. I did not know that my kidneys had failed. I did not understand that I had Covid-19 pneumonia. All I knew was I wanted to be home, and every time a nurse or doctor would come to my bedside I asked the same question: When can I go home?

Norma claims that I was never in the psychiatric ward, but I have a vivid memory of an Italian doctor saying, “You are in the psychiatric hospital. You are in the psych ward.” All I could say to him was, please, I just want to go home.

Speaking of going home, here is another difference between healthcare in Italy and in the U.S. Incredibly, in the U.S., in December 2009, after a similarly serious and in some ways more traumatic surgery, I was kept in the hospital for only seven days and discharged on Christmas Eve, with no training for caring for my surgical wound and living with my new reality. Nor was an ambulance even provided for the short trip from University of California-San Francisco medical complex to our house at Ocean Beach. So, because I could not bend from the waist, Norma and I had to improvise with pillows in our Toyota RAV4. Once home, with drainage tubes still coming out of my back, with my surgical wound still fresh, with no knowledge of how to use the intermittent catheter, I was more or less on my own. “Free” to handle this on my own. “Free” to make my own medical decisions. The only explanation for this was the pressure of the insurance company to get me out of the hospital as quickly as possible. 

Why the reluctance to provide an ambulance for the short trip home? Why the difficulty acquiring home care afterwards? And why the fight to respect my doctor’s orders for radiation treatment at Loma Linda? My suspicion is that many of these “shortcomings” were not the fault of the medical practitioners themselves, but rather the chokehold that the insurance industry has over the practice of medicine in the United States.

That would not happen in Italy. In Italy, the minute I was home, the nurses started coming by. I was under constant care. I was not abandoned, as I was in the US. In the US, it seems, the business of medicine is like any other business: It’s about money. In Italy the business of medicine is medicine. 

Unfortunately, while in the Tuscany hospital I could not eat. I spent hours imagining the food I would consume  when I got out. Food was placed on the table by my bed but I ate very little. It was painful to eat, and the food disgusted me. Was my sense of taste gone? Had it been distorted by the virus, so that good food tasted disgusting? I do not know. I do know that eating was painful. My esophagus, after surgery, was very sensitive. Even swallowing water was painful. Also, this may sound like a luxury problem, but eating while lying in a hospital bed, unable to fully prop myself up, having to twist to my left and lean over a stack of Tupperware containers of deliberately bland fare … made the experience especially difficult. I am a man, not an animal! I needed to sit at a table, with a table cloth and silverware!  So I did not eat. So I lost weight. I became thin. I shrank. I became weak. I could barely turn myself over in bed or push myself up to a sitting position. And I could not walk.

This is one way in which the Italian system failed me. I think it is because Italian hospitals do not usually feed patients. Families feed patients! But since we were in isolations wards, no families could come in. So the hospital did the best it could.

When two physical therapists finally visited me near the end of my stay, it was terrifying to find that my legs would not hold me up. The physical therapists helped me across the room and back to my bed, and I was already exhausted. Oh, the fear! What had happened to me? How would my life go on after this?

And then I would spend hours again dreaming about food.

I thought about spaghetti alle vongole — spaghetti with clams. And this is another example of the altered state I was in: Norma takes ceramics classes with Edi Magi, a highly regarded local artist. It occurred to me that I could propose a spaghetti alle vongole project to them. For in my state I considered it paramount that one have the correct bowls, that the whole spaghetti alle vongole experience depended on having a complete set of white ceramic bowls. Another hallucination, whose vividness and urgency verged on the obsessive.

This is what my journal shows, with drawings:

From my journal:

“(1) Deep Large Heat-Conserving (in oven) Serving Dish for up to 1,000 grams pasta & clams.

(1) Shell Bowl

(6) Deep individual pasta bowls

(6) Wide Saucers

Lemon Water to drink.

And for the hands, 6 nice hot towels, a bowl of hot water w/a gardenia floating in it. Also 6 drying towels.

Also: The One Bright Towel—the pleated towel keeping the serving bowl hot long after the expectations of tepidness.

Plus 6 small Frizzante & lemon bottles.”

From my journal:

“Now I obsess about food, mostly food from my past. I lie here imagining recipes for jambalaya, chicken and yellow rice, paella, and for spaghetti alle vongole, and a surprise today, a craving for canned peaches and cottage cheese. Also for a white bread grilled cheese with pickle slices.

“I bought a juicer [online from my hospital bed]. I just pulled the trigger on Amazon.it. It has arrived [at the house, so Norma told me]. I have this vision of buying carrots, celery, beets, spinach, fruit, sprouts, and doing a daily juice. And hanging out around my downstairs door. Just hanging around.”

And now to the present. As the pandemic rages on, as our town goes into lockdown again, I feel day by day the energy and strength of a healthy man return. I mark the milestones: Today I walked up a flight of steps; today I circumnavigated the town; today I walked all the way to the grocery store and back.

Like a ragged man returning from war or shipwreck, I am greeted with cheers by friends and strangers alike. News travels. I am one of the lucky ones. I take up again the routines of caffè and cornetto, fish and vegetables at the Friday market, sitting in the park in the afternoon looking west out over the Valdichiana.

Often during these long, slow days of lockdown, I will be sitting in the sun or reading or walking idly along when the happy memory again rushes into view: I’m lying in that Misericordia ambulance on December 15, 2020, heading south from Arezzo on Stradale Regionale 71, looking out the window at the restaurant signs and stoplights of Ripa di Olmo, of Madonna di Mezzastrada, of Puliciano and Rigutino, Ottavo and Vitiano, on the way to Castiglion Fiorentino. What a wonderful thing. I endured. I survived. I came home.

Cary Tennis