The patient’s experience in the intensive care unit
A unique experience
The experience of a stay in intensive care is unique and singular to each patient. It will depend on the pathology, the treatments put in place, the length of stay and the history of each person. However, we can mention a few elements that can help relatives to better understand the patient’s experience during this stay and to interact more easily with him/her.
Plunged into a world of his own
The sedated, comatose and/or confused resuscitation patient is in a state of consciousness that is difficult to understand and apprehend for those who have never experienced it. He is able to hear and, if his eyes open, to see what is going on around him but without integrating the information in a normal way: we can compare this to what happens when we integrate a sound, a word heard during our sleep to a dream in progress.
These mixtures of real elements and dreams can leave memories after the fact, often strange and difficult to understand for the patient. As a family member, writing a few words in the diary about what you talk to the patient about when you visit can help him or her sort things out when they wake up. Nadineone of the former patients of the One O One network, tells how she had the strange memory that one of her friends, although very maternal, had abandoned her children. When reading her diary, she will realize that this friend wrote (and therefore probably said) “I’m just passing by to see you, I left the children in the car”, thus allowing her to understand her strange memory.
Many patients report feeling like they have been on a boat, probably related to the ebb and flow of air in the ventilator hoses or in the air mattress that inflates and deflates to prevent pressure sores. Others will have more violent memories of persecution. It will sometimes be necessary to deconstruct these memories with the help of a psychologist in order to allow a serene life after the resuscitation.
The awakening
Contrary to what most films represent, the moment of awakening is not a short moment but rather a process. Depending on the sedative drugs used, the total duration of their use and the recovery of renal function (which allows them to be eliminated), recovery may take from a few minutes to several days.
Most of the time, the patient will still be intubated when the sedation is stopped because it is necessary for the patient to be fully awake to protect the crossroads between the airway (leading to the lungs) and the digestive tract (leading to the stomach). It is therefore often a relatively uncomfortable moment when the patient cannot express himself easily, when he is often lost because he has no memory of what happened to him, and when he is embarrassed by the intubation tube.
His memory may take some time to recover and his nycthemeral rhythm (day/night rhythm) will often be disturbed: it is often necessary to repeat things a lot when the patient wakes up. It will be necessary to frequently reorient him in time and space, that is to say to give him the date, the day, the hour, and to explain him where he is and why he is in resuscitation. Writing the day’s date and the names of the day’s care team on the room’s board can help him or her reorient himself or herself little by little.
The delirium
Intensive care delirium is a cognitive state where the patient is awake but experiencing hallucinations and delusions. Delirium can have multiple causes, such as certain pathologies, certain treatments, sleep deprivation, etc. and can be favored by age. This is a difficult state to live with, especially for family members, who may be particularly destabilized by the change in the patient’s personality or his unexpected and unusual reactions. Resuscitation delirium is a transient passage that may last a few days or weeks but will not persist once the causes are determined and removed or treated.
Comfort
The stay in intensive care is a difficult period. Many of the necessary treatments are often uncomfortable, worrying and even painful despite the multiple precautions taken by the caregivers and the painkillers (anti-pain) put in place.
Hygiene care and rehabilitation are difficult moments for patients. The use of a chair, for example, helps relieve back pain related to bed rest, and promotes breathing, transit and reorientation in time and space. However, this is a very important effort for the patient who has spent days or even weeks in bed, and this position, by stimulating the muscles, will quickly become painful itself.
However, it is necessary to go through this process and increase the duration of these efforts every day in order to allow for discharge from resuscitation. One of the roles of relatives during these mobilizations may be to entertain the patient from his pain and discomfortThe patient can be helped to tolerate the uncomfortable position a little more each day and to facilitate his rehabilitation.
