Every year, almost a quarter of a million adult Canadians with
life-threatening illnesses are admitted into an intensive care unit (ICU). Last year I was one of them. ICU staff are dedicated and to be thanked
profoundly. Because of medical
procedures, ICU patients are probably the most vulnerable. Powerful sedatives
are administered to numb pain and to keep the patient still, preventing the
accidental removal of life-saving devices. Immobilized, intubated with few
lucid moments, they are disabled and unable to speak or respond normally during
crucial life-saving periods. These experiences can lead to overwhelming
abandonment issues which are hard to overcome, as do other side effects and
studies suggest that on discharge, 74% of patients suffer cognitive impairment.
ICU survivors recall this coma-like experience where they are unable to
speak or move as absolute helplessness, despair and terror. Of all the
symptoms, the commonly reported hallucinations remain the most frightening and
haunting - often left unresolved or disclosed because they are considered
shameful with unbelievable images and story lines experienced when there is no
Unfortunately, this is one of the residual symptoms of ICU that calls
for physiological and psychological aid, Healing Circles, grief counselling,
mentors and interactions with various social services. Although encountered in the mind, these
visuals are laid down in the brain as a singular reality, scene by scene. When no other consciousness is available, images
that can be bizarre and truly terrifying, leave disturbing backwashes and
lingering violent flashbacks.
My work as a registered psychotherapist in private practice for the past
30 years includes wartime exposure to post-traumatic stress disorder (PTSD)
before it became a syndrome. Training
and working with clients enabled an understanding of the impact of PTSD from my
ICU experience as well. Background
practices and life experiences helped to address PostHospital
challenges. A mindful awareness of the
depth of the spiritual and personal challenges faced in the dark silence of ICU
and hallucinations is needed for the psychological and spiritual well-being and
the recovery from these traumas. Symptoms of energy deprivation and
interruption of healthy stress responses flatten emotions and create emotional
A colleague, initially researched Post Intensive Care Syndrome (PICS). The information confirmed and validated the
experience. An environment where there is no memory can be debilitating,
causing identity loss in our inner spiritual world. The
Society of Critical Care Medicine in the US
quotes research that demonstrates the catastrophic nature of PICS and
hallucinations, as does medical research conducted in Europe.
Hallucinations replace cognition for periods of immobility in ICU and
returning to consciousness, there are records of frightening scenes experienced
as reality, that replay again and again. Even if these horror-movie images are
recounted, they may be dismissed or disbelieved, leaving the PICS sufferer silenced and denied
PICS shares some similarities with PTSD.
Both are the result of trauma leading to circadian sleep disorders,
difficulty focusing and often an inability to return to work. But there is a significant difference: while
PTSD is generally a shared experience - the precipitating event is generally
witnessed together with others in a critical emergency or war zone. Those who have been abused, assaulted or
raped, however, have an aggressor as the object on which to vent impacted
feelings of recognition of the event and anger from the trauma. It is a psychological process required for a
health recovery and healing grief work. In a coma, there is no object on which
to project the frozen or aggressive feelings of desperate helplessness and
The lingering effects for survivors leads to PICS and unrecognized
symptoms are known to last for years.
These include energy loss, depression and disinterest in life itself.
Grieving is impossible in inactivity and isolation. One is isolated in a coma - no body or mind
sensing consciously - not even self is present.
Death is close. The pain of these
events demands resolution.
PatientsPostHospital question their ability to recover a meaningful life after ICU and
intubation. During recovery there is a period of de-personalization. They are
bewildered and isolated on familiar ground, with complex physical, emotional
and intellectual needs. What is devastatingly missing is Care of the Soul,
grief and psychotherapy, all the healing arts are needed to relieve the
pressure of burdensome grief, compacted horrors of hallucinations, memory loss,
chronic bewilderment and insecurity.
Awareness of PICS is gradually expanding in
Canadian hospitals, but patients and their caregivers are not sufficiently
supported prior to discharge. There are few adequate resources in communities
for their return home. PostHospital support requires
a great diversity of multi-faceted support that includes first and foremost
physical, then mental and cognitive functioning, developed gradually during
recovery. Since PICS is generally an overlooked condition, long-reaching
symptoms can be misdiagnosed as delirium or
early-onset of Alzheimer’s. PostHospital,
Individualized programmes are required in an separate environment of
understanding and validation, away from the hospital.
ICU survivors of intensive care and intubation return home, worried
about an inability to recover a meaningful life. An important support for those
with PICS would be programmes fuelled by therapists, social and community
providers and mental health care. Humane
and professional grief work is imperative. As Francis Weller writes in his
book, “Entering the Healing Ground”, after physical issues are improved, grief
work is a primary ingredient in the resolution of trauma and depression,
allowing for release, acceptance, empathy and increased understanding of self
Since PICS symptoms do not emerge immediately, treatment is best
implemented two to three months PostHospital. There needs to
be some acceptance of life changes and willingness to be helped. A safe venue
and supportive help from someone they trust will help to assert health. Using individually-selected preferences,
programmes to consider might include EMDR (Eye Movement Desensitization and Reprocessing), CBT and Reiki. Creative therapy such as music, dance, art,
poetry, journaling, writing and song can be incorporated to help with healing.
Being immobile in ICU for a length of time affects the body
resulting in muscle weakness. This makes daily living activities
difficult, so incorporating physical therapy, massage and regular exercise is
fundamental to regenerating energy and to aid recovery.
Data indicates that with increasing advances in medicine, the number of
patients who survive ICU is growing and PICS clinics have the potential to
become an important part of PostHospital care. There are
many opportunities for those with PICS to recover emotionally. Integral to
their condition is the phenomena of isolation that continues beyond the ICU
experience. A key element is the recognition and validation of their hallucinations,
in particular acknowledging the need for a witness to their experience and that
they are not alone. Research and case histories have the symptoms remain over
months or years.
The experience of ICU patients is complicated and difficult to absorb
and process, especially as there is insufficient information available. This is
a crucial factor because critical illness is a crisis that extends beyond the
patient. Education is needed for family
members under the strain of caring and accommodating for the long-term mental
and physical effects of ICU. Studies find that 30% of carers surveyed
experienced mental health problems, anxiety and depression. Those who observe
hospital procedures can also be vulnerable to these issues.
There are no medical pamphlets about PICS with information for the
community anywhere to be seen. This is vitally needed to guide ICU survivors to
a healthy recovery.
o Mikela Ronning-Philip MA, OSP,
CRPO is an accredited psychotherapist with over thirty years’ experience as a
clinician. Her private practice, based in Dundas,
Ontario, specializes in PTSD counseling
and expressive arts therapy.
A MD, FCCP; Peters, NA, PharmD, BCPS, BCCCP: Kim, D, MD, FRCSC, FACS, FCCP. (2016). Delirium: A Multidisciplinary Approach to PICS, SCCM (Society
of Critical Care Medicine).
-Hoffman, LA, RN,
PhD, University of Pittsburgh: Guttendorf J, DNP, RN, CRNP, ACNP-BC, CCRN,
University of Pittsburgh School of Nursing. (2015) Post Intensive Care
Syndrome: Risk Factors and Prevention Strategies, AHC Media: Continuing Medical
- MacLullich, AMJ: Ferguson, KJ: Miller, T: EJA de Rooij, S: Cunningham, C. (2008), Unravelling the Pathophysiology of delirium: a focus on the
role of aberrant stress responses. Journal of Psychosomatic Research.
- Boodman, SG (2016). A Surprising Side Effect of Hospital Stays. Next Avenue.
- Weller F. (2009).
Entering the Healing Ground - Grief, Ritual and the Soul of the World. Santa Rosa, California:
- Herman, JL MD. (1992) Trauma and Recovery. New York, NY: