For some COVID patients, ICU stay comes with post-traumatic stress
Oscar still remembers the nightmares.
Glimpses of them come and go without warning — like the one that was triggered after hearing someone laugh.
"I started hearing this laugh in my head, and I couldn't point out where I recognized that laugh from,” he said.
For hours, Oscar racked his brain. And then, finally, he realized: It was the laughter of his beloved fifth grade teacher, who had appeared in a nightmare while he was sedated in the intensive care unit last summer with COVID-19.
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"She was laughing in this demonic tone,” he said. “It was really uncomfortable."
Now, nearly a year after his COVID-19 diagnosis, after spending a month in the intensive care unit, Oscar is still managing the long-term toll of the virus. He struggles to breathe at times, and uses an inhaler now — something the young, healthy now-27-year-old never had to do before.
And he's also still sorting through fear — fear of the terrifying dreams he had while he was in the hospital, and fear of getting the virus again.
But he says he's benefited from a new clinic at M Health Fairview that was created for patients who are grappling not just with the physical side effects of a severe care of COVID-19, but also with a type of post-traumatic stress disorder that can come from a long, disorienting stay in the ICU.
No concept of time
Oscar, who asked that his last name not be used in this story to protect his privacy and that of his family, came down with COVID-19 early in the pandemic.
He thinks he caught it at work.
He first noticed the symptoms on April 23 of last year, though a test didn’t confirm the diagnosis until several days later.
"Just throughout the day, I had two or three more coughing episodes. I didn't think too much of them,” he said. “They weren't persistent. They just came and went."
But a few days later, while trying to build a crib for his soon-to-be-born son, Oscar started coughing again. He was exhausted. His family said he looked pale and that he should rest. That night, he developed a fever.
In the days that followed, Oscar's health went downhill quickly. He locked himself in his basement to isolate from family. Just lifting a spoon to eat put him out of breath.
When his inability to breathe became untenable, he went to the hospital.
"About a week and a half [after my symptoms started], I was sedated because my symptoms got too severe,” Oscar said.
For the next month, Oscar was intubated in the ICU at Bethesda Hospital, which had by then become St. Paul's COVID-only hospital. His care team started to wean him off his ventilator at the end of May, when he started showing signs that he was getting better.
And as he was being slowly taken off the ventilator, he was also being slowly taken off the drugs necessary to keep intubated patients sedated.
When he came to on June 1, Oscar was disoriented and confused.
"I had no idea how much time really had passed,” he said. “When I was asleep, I went through dreams, most of them nightmares. The concept of time was fluctuating all the time."
In his dreams, time sped up and slowed down. He thought his son had been born and that he'd missed the entire thing. And he thought his doctors had been torturing him.
"A lot of my dreams, I had people burning my knuckles, people putting stuff in my mouth in these very hurtful ways,” he said.
‘What he was experiencing was PTSD’
Pulmonary specialist Dr. Sakina Naqvi treated Oscar while he was in the ICU. This fall, she helped launch M Health Fairview’s ICU survivorship clinic for COVID-19 patients.
Naqvi says Oscar's post-ICU symptoms are not unusual, and they're not unique to COVID-19.
"What he was experiencing was PTSD,” she said.
Doctors know that patients who spend a long time in the ICU often deal with a host of lasting, confusing symptoms once they're discharged.
"And it's a constellation of findings, which includes PTSD, confusion, cognitive delays, anxiety, sleep difficulties, and the longer-term effects of whatever illness brought the patient into the hospital,” she said.
So now, Naqvi and her colleagues meet with COVID-19 patients as they are discharged. They talk to them about what happened to them during their hospitalization. They find out what symptoms the patients still having, and determine whether they need adjustments to medication.
That plan, Naqvi said, is then handed off to a patient's primary care provider and, often, a mental health provider, too.
Naqvi said she and her colleagues had been discussing the possibility of establishing an ICU survivorship clinic for some time, well before the pandemic started. But COVID-19 — and the surge of ICU hospitalizations that came with it — put into sharp focus the need to better support patients after they are discharged.
Naqvi said that in some ways, the nature of COVID-19 puts people who get it at higher risk of having trouble once they leave the hospital.
"First, they've just been in the ICU longer. We don't keep people on ventilators for 90 days,” Naqvi said. “And I think the other is the isolation. No one is allowed to come and visit a COVID patient unless they are dying. I think that makes the PTSD much harder, and hard to put into perspective."
Dividing reality and fiction
Oscar said he was scared to talk about his haunting memories of the ICU, for fear that they might have been real. But Naqvi helped him rationalize his experience.
"One of the things she helped me with was creating a divide between reality and fiction,” Oscar said.
He learned that the drugs used to sedate him had also scrambled his brain's interpretation of the things his care team was doing to help him survive COVID-19.
"For her to talk about some of the things that were being done to me caused me a great sense of relief that they didn't actually happen,” he said.
As he approaches the one-year milestone of his illness, Oscar said things are getting better — due in no small part, he said, to the support he's gotten from his doctors.
He's back at his job after several months of physical and occupational therapy, he is busy finishing his master’s degree in mechanical engineering — and he continues to seek mental health support through M Health Fairview.
Oscar still gets out of breath, but his inhaler helps. And although those nightmares about being hospitalized surface from time to time, they aren't as intense as they used to be — and he understands them better. He now has the tools to help manage how they make him feel.
But his biggest achievement, Oscar said, was being present for the birth of his son, just weeks after he left the hospital. It’s something that still seems like a miracle after being so sick.
Oscar said this last year would have been so much harder without the joy of having a baby amid the chaos of his illness.
"I remember when he was first born, I was like, ‘I hope I make it to the day when I hear your first genuine laugh,’” he said. “I hope I make it to the day you open your eyes and you know I'm your father.”
His son, now 7 months old, is on the verge of walking. And Oscar’s big goal now is to hold his son's hand and walk with him across their back yard.
COVID-19 in Minnesota
Data in these graphs are based on the Minnesota Department of Health's cumulative totals released at 11 a.m. daily. You can find more detailed statistics on COVID-19 at the Health Department website.
The coronavirus is transmitted through respiratory droplets, coughs and sneezes, similar to the way the flu can spread.