Takeaway
Caring for patients with delirium requires coordinated medical management—like early mobilization, minimizing sedation, and consistent re-orientation. Integrating familiar activities, like listening to music, may aid their recovery.
Connecting with Patients | July 1, 2025 | 3 min read
By Avani Kulkarni, MD, Johns Hopkins Observership Program, with Carolina Musri, MD, Johns Hopkins Medicine
There are moments in medicine that linger, etched deep into memory, tethered to something more than science. While completing the observership in hospital medicine at Johns Hopkins, I met a man cloaked in confusion. An older patient recovering from spine surgery had slipped into the throes of severe postoperative delirium. He stared blankly at his surroundings, agitated and lost, unable to recognize the two women who loved him most: his wife and daughter.
Their eyes, weary and brimming with unspoken fear, held stories they shared with me, the stories of a man who had once been witty, vibrant, the life of every room. It was hard to reconcile that image with the man before me: restless, unreachable, a silhouette of his former self.
We know that delirium doesn’t occur in isolation and is often the result of multiple overlapping stressors. In populations at risk, like in older patients, prevention is just as crucial as treatment. A problem like delirium can escalate into more significant issues and can be prevented by timely measures. So, his care team rallied around him, prioritizing early ambulation, encouraging consistent day-night cues, optimizing hydration and nutrition, minimizing sedation, and gently reorienting him to time and place with every interaction. But equally as important, his wife and daughter became vital allies in that healing process, anchoring him with familiar voices and presence.
I saw him again a week later, and this time, it was as though light had cracked through the fog. He was more present; meeting eyes, holding conversation, even making a joke or two. The transformation was quiet, yet miraculous.
As the physical therapist gently coaxed him into movement, I watched him push past stiffness and uncertainty. His favorite country music began to play, and he stood—wobbly, but upright—and shuffled a few tentative steps to the side. The air in the room changed. A smile tugged at his lips. He tapped his fingers to the rhythm. And soon, he was moving—not just to walk, but to dance.
It was as if the music found a part of him that medicine couldn’t reach. The lyrics, familiar and warm, seemed to bridge the gap between disorientation and identity. In the steady beat and familiar twang, he rediscovered agency and joy.
We all clapped and laughed with him, a celebration not just of progress, but of presence. In that moment, surrounded by laughter and music, I didn’t see a patient. I saw a person returning to himself.
Delirium isn’t just a clinical state—it’s a deeply human one. It often fluctuates, shaped by multiple, interwoven factors: medical care, environment, sleep, sensory input, nutrition, mobility, and most of all, connection with loved ones. Recovery is rarely linear, but when all these elements come together, witnessing someone find their way back to clarity can be one of the most humbling and moving experiences in medicine.
Here are two things I’ll carry with me from this encounter:
1. Healing is a team effort.
From surgery to physical therapy to emotional support, every discipline plays a role in restoring dignity and identity.
2. Joy matters.
Recovery isn’t only about medical milestones—it’s about the small, meaningful moments that remind patients (and us) that they’re still whole, still themselves.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.