PTSD in the Intensive Care Unit (ICU)

JOHN SHARP: So when somebody is admitted to intensive care, they are there because of an initial significant illness or have just undergone significant surgery or procedures which are often life-threatening. It’s a scary and frightening place to be for most people. They are also often heavily sedated and on drugs that force them to drift in and out of consciousness. It can be disorientating and confusing for people and obviously very distressing. Surviving ICU is one thing, but there’s often consequences in the aftermath. And many people who leave ICU have a legacy of trauma as a consequence of it. I remember cases where people have had horrendous hallucinations and episodes within ICU which can often be distressing for them during their stay there.

One particular patient I recall– we’ll call him Nick– described scenes that are straight out of a horror movie. He described blood dripping down the wall, faceless staff coming in and out of his room. He described believing he was on a ship, that he was a prisoner there, that there were sharp instruments used to keep patients at bay, and the staff were, again, flowing in and flowing out from this ship to look after the inmates. This was obviously incredibly distressing for him at the time. And it was clear from speaking to him he wasn’t certain which of the things he remembered were true and which were not. Nick and I met three months after his discharge from hospital.

At that time, he was keen to tell me how well he was doing– that he was walking so far, that his wound was healing. And he was really thriving physically. However, every time I tried to discuss his emotional well-being with him, he quickly changed the subject. Then the phone rang, and I let it ring. And it was clear that he was becoming increasingly distressed the longer the phone rang. Eventually it stopped and he slumped back in his seat. He explained to me that the ring tone in the phone was exactly the same as the one that they had in ICU. That had been enough to prompt him into acute anxiety.

Nick and I discussed his other difficulties, and he revealed lots of other problems similar to the ringing of the phone. He described an unwillingness to be exposed to anything that reminded him of his admission to ICU. He avoided places and scenarios in which it might remind him of his stay. He allowed his wife to take care of his medication and organise all his hospital appointments. He even described one incident in which he left his order in McDonald’s because one of the machines in the kitchen had a similar beeping alarm to a machine within ICU.