“Last night the porters took me to the basement in a supermarket cart. I came across some hooded monks who stole my soul and turned me into a zombie. I woke up in my own coffin. “
“I heard the nurses whispering about me at night behind the blue curtains. They are plotting to murder me and my baby, and I saw one of them take a gun out of his bag. “
“There was a wild animal rampaging through the market in the hospital, attacking everyone until the police shot it.”
These are the terrifying or strange experiences that I hear on a daily basis as a psychologist working in intensive care units (ICUs) and Covid-19 wards in a London hospital. The stories are hallucinations or delusions of ICU delirium, a syndrome caused by drugs, infections, lack of oxygen, and other medical reasons. But for patients, these visions are vivid and indisputably real.
Up to 80% of ICU patients have delirium, particularly those who are sedated to help them tolerate time on a ventilator. These patients are often given a cocktail of psychotropics (drugs that affect their mental state) to promote calm, comfort, sleep, and security, but also cause amnesia, confusion, and delirium.
Delusions usually resolve before people go home, but delusions, along with traumatic medical events, can haunt people in flashbacks and nightmares for months or even years.
These intrusive and terrifying memories are part of post-ICU syndrome (PICS). This affects the body, leaving patients with pain and severe respiratory, muscle or joint problems, but also the mind. Research suggests that one in three have “brain fog” or problems with concentration, memory or the ability to plan or organize their life. Up to 50% may develop severe anxiety, depression, or post-traumatic stress disorder.
Unsurprisingly, PICS has profound effects on people’s quality of life, relationships, and livelihoods. People forget to take important pills or lose the ability to drive or manage their finances. One third of ICU survivors who previously worked do not return to their jobs.
The psychological impact of severe Covid-19 is not qualitatively different from other critical illnesses, but many more people have been affected than usual. In our hospital, during this latest increase, we had more than 100 people in ICUs at one time, compared to our usual 35.
And during Covid-19, the conditions in the ICU are even more terrifying: there are no families next to the beds, staff with PPE that looks alien, little time to talk or hold hands, crowded rooms with few windows, and the constant hum of monitors and audible alarms. The delirium seems deeper than usual, and it takes weeks for patients to wake up to normal.
It is too early to know the long-term psychological impact, but the early data suggest that approximately 28% of people who were in the ICU with severe Covid-19 have PTSD, 31% depression, and 42% anxiety one month after hospital.
Of course, thousands of other people make a good recovery and feel deep gratitude for saving their lives. Many ICU survivors feel that it is a second chance at life, a chance to grow. As I write, an email has come in from a former patient who is experimenting with art, decorating her flat, and making new clothes out of old ones. He has adopted a song by Nina Simone to overcome the pandemic: “It’s a new dawn / It’s a new day / It’s a new life for me / And I feel good.”
Another survivor, the journalist David aaronovitch, belongs to a group of patients that helps us to carry out research at the national level to improve psychological care in the ICU. He says: “The five days of delirium were the worst days of my life, without exception. ICU patients are terrified for their lives. If there is anything we can do about it, we must do it. “
ICUs are trying to meet the challenge. When I entered this field 10 years ago, there were a handful of ICU psychologists in the UK. We created a network to defend the role, and today we are 80. We are crucial members of the rehabilitation teams, along with physical therapists, dietitians, speech and language. therapists and others.
Rehabilitation teams take over where doctors and nurses leave off. They save people’s lives; We help them get back to the life they want to live. National guidelines say that rehabilitation should start early in the ICU, continue throughout the hospital stay and beyond, and that all ICUs should have psychology staff. ICU psychologists help patients with delirium, panic, bad mood, or nightmares, as they wake up and learn to breathe and walk again.
Approximately half of the hospitals with ICUs are multidisciplinary follow-up clinics that patients attend after two or three months, to review physical and psychological recovery. Here they can discuss puzzling ICU experiences and fill in memory gaps and wasted time. If problems are found, we refer patients to medical services, community rehabilitation, or specialized psychology clinics.
Although progress has been made, 50% of hospitals do not provide follow-up in the ICU. Many Covid patients hospitalized during the first surge have been left stranded as community services struggle to cope. Last week, our ICU follow-up team telephoned a young mother of three who was in the ICU for four months in 2020 with serious complications from the virus. He is now unable to walk and has severe depression and post-traumatic stress disorder. While speaking little English, her teenager tries to seek services for her. We reached out to vendors to get you the help you need, but how many more are in this difficult situation?
For some, a life preserver can be thrown by post-ICU support groups run by hospitals or patient charity ICU steps. At our group’s first online meeting, people said they were having a hard time. A man, who was previously a fit athlete, is still partially confined to bed and on oxygen, with his lungs tagged, a year after contracting Covid-19. A young woman faces many complications and operations. Several people have not left home since the pandemic began for fear of returning to the ICU. Some still struggle to distinguish reality from ICU nightmares.
Everyone generously shared stories and gave understanding and encouragement to others. We were later told that the reunion was emotional and painful, but a crucial step in her recovery from intensive care. For anyone reading this and on this road to recovery: know that you are not alone and that help is available.
Dr Dorothy Wade is Senior Intensive Care Psychologist at University College Hospital, Honorary Associate Professor at University College London and Co-Chair of Intensive Care Psychologists, UK (PINC-UK) and the Post-Covid Rehabilitation Psychology Network .
George is Digismak’s reported cum editor with 13 years of experience in Journalism