The man accused of killing a Florida couple before trying to eat one of their faces has been in and out of consciousness at the hospital where he is being held, according to reports from the Palm Beach Post over the weekend.

Austin Harrouff, the 19-year-old Florida State University student who has been accused of stabbing the couple to death, has been at the St. Mary’s Medical Center in West Palm Beach since the Aug. 15 attack. While in the hospital, he had surgery on his hand for an undisclosed reason and has been using a breathing tube.

Investigators aren’t completely sure why Harrouff is in such poor shape but Sheriff William D. Snyder said Friday that hospital officials suspect he may have swallowed chemicals in the garage where he killed John Stevens and Michelle Mischon. Whether or not other drugs were in play isn’t yet known and officials are waiting on toxicology results from that evening. The street drug Flakka, or bath salts, has been suspected given the similarities between this case and similar attacks in 2012.

“He’s coming out of heavy, heavy sedation,” Snyder said, noting that Harrouff hadn’t given police a statement about the incident yet. “But he’s alert enough to nod to his mother.”

Harrouff is said to have walked over three miles after storming out of a sports bar in Jupiter, Florida, before finding the couple that he attacked and killed. After stabbing the two to death, he reportedly began eating part of Stevens’ face and ripping flesh off of his abdomen.

The scene was discovered by a neighbor, Jeff Fisher, who attempted to stop the attack but was also stabbed at least three times in the back. Police, later responding, were unable to subdue the rising sophomore with a taser and eventually used a police dog and multiple officers to bring him down.

He is facing two charges of first degree murder and one for first degree attempted murder.