She has adopted a Nina Simone song to get through the pandemic: “It’s a new dawn/ It’s a new day/ It’s a new life for me/ And I’m feeling good.”Īnother survivor, the journalist David Aaronovitch, belongs to a patient group that helps us conduct national research to improve psychological care in ICU. As I write, an email has arrived from a former patient who is experimenting with art, decorating her flat and making new clothes from old. Many ICU survivors feel it is a second chance at life, a chance to grow. Of course, thousands of other people make good recoveries and feel profound gratitude that their life was saved. It is too early to know the long-term psychological impact, but the first data suggests that about 28% of people who were in ICU with severe Covid-19 have PTSD, 31% depression and 42% anxiety a month after hospital. The delirium seems more profound than usual, with patients taking weeks to awake to normality. In our hospital, during this last surge, we had more than 100 people in ICU at a time, compared with our normal 35.Īnd during Covid-19, ICU conditions are even more frightening: no families at bedsides, staff in PPE resembling aliens, little time to talk or hold hands, overcrowded wards with few windows and the constant hum of monitors and beeping alarms. The psychological impact of severe Covid-19 is not qualitatively different from other critical illness, but many more people have been affected than usual. A third of ICU survivors who previously worked don’t return to their jobs. People forget to take important pills, or lose the ability to drive or manage their finances. Unsurprisingly, PICS has profound effects on people’s quality of life, relationships and livelihoods. Up to 50% may develop serious anxiety, depression or post-traumatic stress disorder. Research suggests that one in three has “brain fog” or problems with concentration, memory or the ability to plan or organise their lives. This affects the body – leaving patients with pain and serious breathing, muscle or joint problems – but also the mind. These scary, intrusive memories form part of post-ICU syndrome (PICS). The delirium usually resolves before people go home, but the delusions, along with traumatic medical events, may haunt people in flashbacks and nightmares for months or even years. These patients often receive a cocktail of psychotropics (drugs affecting their mental state) to promote calm, comfort, sleep and safety, but which also cause amnesia, confusion and delirium. Up to 80% of ICU patients have delirium, particularly those who are sedated to help them tolerate time on a ventilator. But to patients these visions are vividly and unarguably real. The stories are hallucinations or delusions from ICU delirium, a syndrome caused by drugs, infections, lack of oxygen and other medical reasons. These are the terrifying or bizarre experiences I hear about daily as a psychologist working on the intensive care units (ICUs) and Covid-19 wards in a London hospital. “There was a wild animal rampaging through the marketplace in the hospital, attacking everyone until the police shot it.”
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