First COVID, then ICU delirium; Hatzalah founder calls for ICU mental healthcare
The author with vehicles for his organization, Hatzalah, an Israeli volunteer-run EMS service. Image by Unknown (courtesy of Eli Beer)
In March while I was in Miami, I contracted Covid-19. I was put into an induced coma on a respirator twice, for nearly 30 days total. But by far the worst part of my experience was the dreams I had while under, my emotional and mental reaction to the drugs used to put me into a coma.
Both times I woke up, I was confused. I was heavily dosed with powerful drugs that often cause horrible dreams, and I thought that these dreams were my reality. At one point, I thought that I was in Switzerland and everyone around me was dying. Another time, I thought that I was being chopped up into little pieces. The dreams were absolutely horrific and, throughout it all, I thought that I was going to die.
I didn’t know it at the time, but I was suffering from something called ICU Delirium.
Over the past few years, hospital staff all over the world have been discovering and documenting that patients who are kept in the ICU for long periods of time often suffer from this condition. ICU Delirium can cause a patient to have horrifying, violent hallucinations to the point where they feel that they are going crazy. When they talk about it to others, their feelings are often ignored, making them feel alienated and depressed.
When I finally woke up the second time, I needed to re-learn how to walk, how to eat and even how to use the bathroom. It was a terrible experience. My body was so weak I couldn’t do anything by myself.
Worse than that, I kept asking the doctors and nurses if I’d be home in time for Pesach;; I desperately wanted to spend the holiday with my family. Everyone was afraid to tell me the truth: Pesach had already come and gone, and I had missed an entire month of my life. When my wife Gitty finally told me, it was a serious blow.
Between the deep disappointment of missing Pesach with my family and losing a month of my life, plus suffering the hallucinatory dreams of my ICU Delirium, I was in dire need of someone to counsel me, ground me and help me recover from the effects of the drugs that were still running through my system, making me doubt everything and everyone around me.
The author celebrates Pesach Sheni after being in a coma for the first one. Image by Unknown (courtesy of Eli Beer)
At one point, I even recall telling my friends Dr. Joel Sandberg and Mark Gerson, the Chairman of the Board for United Hatzalah, how the medical staff at the hospital were trying to kill me. The medical staff at Miami University hospital are some of the best doctors and nurses I have ever met. I cannot praise them enough for the high level of care they provided me. To think they were trying to hurt me was simply absurd and both of my friends knew that. I was hallucinating wildly.
At one point, one of the doctors, Dr. Maria Carolina Delgado-Lelievre, noticed my distress and came over to me to help put my mind at ease. She sat with me for an hour and explained everything that had gone on and everything that I was going through. This helped me a lot, but it’s not common there — or anywhere else.
ICU Delirium is sudden and intense confusion that can include hallucinations, delusions, and paranoia. According to a recent study in the Annals of Intensive Care Medical Journal, “Delirium is extremely common in the intensive care unit (ICU), especially amongst mechanically ventilated patients… and it is frequently undiagnosed unless specific diagnostic instruments are used.”
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Tens of thousands of people have been put on respirators around the globe as a result of coronavirus. Those who are lucky enough to wake-up and recover from the disease often suffer from ICU Delirium as I did. However, many times this condition goes undiagnosed, leaving people with mental trauma following the physical trauma of the disease, allcompounded by a recovery process that is itself traumatic.
Another report in STAT about ICU Delirium stated that “anywhere from a third to more than 80% of ICU patients suffer from delirium during their hospital stay. And a quarter of all ICU patients suffer from post-traumatic stress disorder once they leave, a rate that’s comparable to PTSD diagnoses among combat veterans and rape victims. Patients with ICU delirium are less likely to survive and more likely to suffer long-term cognitive damage if they do.”
In order to ease the patients out of their induced comas, whether those comas were corona-related or not, there needs to be someone by their side who can guide them and help them through the process. As a patient who went through this, I can attest that this can greatly ease the suffering of recovering patients.
Thanks to Dr. Delgado-Lelievre, I got the help I needed. And when the hospital saw what happened, they instituted a new protocol that requires a trained professional to be present with patients after they are woken up from induced comas on respirators to help them through the process.
I strongly urge all hospital managers and staff to do what the University of Miami Hospital has begun doing — to be aware of the emotional state of your patients who are recovering from this terrible disease, and to have someone by them to help them emotionally. Please, have a mental health professional by recovering patients’ sides. It is incredibly necessary yet often overlooked. It will help speed the recovery process,and, most importantly, make it less traumatic for the patients.
Eli Beer is the father of five children, a social entrepreneur and president and founder of United Hatzalah of Israel, an independent, non-profit, fully volunteer EMS organization that provides fast and free emergency first response throughout Israel. He is also a recovering Covid-19 patient.
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