Post-Intensive Care Syndrome (PICS) - Let's talk

Have you heard of Post-Intensive Care Syndrome? Sometimes it's called post ICU syndrome or PICS. PICS is defined as new or worse health problems after critical illness. These problems can affect your mind, body, thoughts, and/or feelings.

On Connect we would like to bring together people who have been affected by critical illness, and hopefully lighten the burden you bear. Patients and family members welcome.

Grab a cup of tea, or beverage of your choice, and let's chat. Why not start by introducing yourself?

Interested in more discussions like this? Go to the Intensive Care (ICU) Support Group.

Dear Rosemary. You are such a very kind person and I thank you for being understanding of my situation. I do feel bad about boo hooing however I cannot keep stifling these feelings. Many people are so much worse off than I am and I feel somewhat selfish but all I know is what I experienced and the terror and fear this has brought to my life. I barely made it home yesterday from forcing myself to do simple errands that I used to do without a second thought.

I did read the pages you sent the link for. The part most interesting to me was the Breakdown of Pics. Wow. I could hardly believe what I was reading as the cognitive decline due to pics hit home with me. I have problems with my memory, forming (or grasping) for words that at one time flowed easily. I feel some relief knowing I’m not alone with my soggy brain and fumbling about while doing simple chores or whatnot.

Thank you once again for helping me so very much. I realize now that I’m not unique or alone. My faith has grown in leaps and bounds.

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@rckj

I have had multiple ER to ICU admissions with adrenal and septic shock (infection overwhelming my secondary adrenal insufficiency). I didn’t know about PICS until I read about it here but I have all the symptoms plus fear of reoccurrence, which is not unlikely. I don’t have a specific question but am looking to feel better and in more control of my fears. I understand what is going on but that doesn’t always diminish the symptoms. I traveled from my home on the east coast to Mayo in Rochester and received wonderful care, including treatment plans to minimize a reoccurrence. So far, 10 months without hospitalization, which is a record for what has been a 10 year chronic/acute illness. I am hopeful but always concerned about another life-threatening episode. Any feedback would be helpful. Thank you.

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@colleenyoung, thank you for the connections. The repeated episodes of septic and adrenal shock as well as delirium have been hard. It will be great to share with others. I don’t know anyone who has been through these experiences.

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@muriel66

It has been ten days since my last statement about the way I am. I become more and more in touch with the ways I experience PICS after severe septic shock (2016) and septic shock (2017). I hope I am not repeating myself when I say that frankly I am cognitively and emotionally worse than I was before I experienced the second incident of septic shock. My concentration certainly is worse, as is my depression. Of course, depression can diminish concentration and diminished concentration can exacerbate depression.

It is positive that I finally accept that my depression is substantial and thus, I am more patient with myself and less judgmental of my cognitive disfunction. (Pat me on the back, please.) The uneasiness that I have is not knowing if in the future, I will return at least to the level of cognitive/emotional healing that I experienced before the second experience of septic shock. In other words, I am concerned about whether or not I will be able to function in a more 'normal' fashion. (Please pray for me.)

Tonight my brain is weary. I need to rest... and that is a subject about which I later will comment. My dreams seem long and complicated. I wish they were simple ones. Anyway, I continue to be thankful to be alive and as very-well as I am! My dear husband and I laugh about some of the silliness in my changes and our adjustments. Thanks for listening! M.H.

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@muriel66, I’m so glad that you have been writing and so sorry for your difficult experiences. I have had multiple episodes of septic and adrenal shock, all with delirium and ICU stays. I have only episodic memory of the illnesses and one blurs into the next. My wonderful husband helps to fill in the memory blanks as he was almost entirely by my side. I am just now recovering from the latest episode which was in late January to February. I often feel cognitively “foggy” and unable to focus, which troubles me. I do sometimes have troubling flashes of memory, particularly for painful procedures. Although, I also have some touching memories of my husband holding my hand and singing softly to me. It seemed to help call me out of the delirium and it is still so touching to me. I’m sort of just rambling a bit but am really just hoping to connect and share experiences. I hope we can be of help to each other. Thank you and best wishes.

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@muriel66

Almost two years after suffering severe septic shock and nine months after suffering septic shock, both because of the way my body responds to surgery, I again am reading about PICS. I continue to face struggles that affect my days. I finally am writing on this page. I wasn't able to write in the diary that was given to me while in and after I left Mayo intensive care (and went to a room on a different floor). My de-conditioning, my decreased cognitive ability, my immense fatigue, my emotional upset, and my schedule of very helpful medical care... such as dialysis, physical therapy, services entering the room... left me not wanting to do one more thing (not to mention that my physical de-conditioning meant that for a period of time, my hands could not write). I did pray almost continually, listened to all who provided me care, tried to eat, etc.. But my greatest expenditure of energy likely was to eliminate body-waste successfully and regularly; once the bladder catheter and anal "garter snake" (my expression) were removed. Ha, ha!

Almost two years after my 2016 hospitalization, I again am diagnosed with moderate major depression. And, I have sluggish cognitive ability. Because I again am at a point of accepting my emotional-mental state, and my fatigue, I hopefully will post regularly on this site. It helps me when I express myself in writing. Today started as one of my more difficult days. I awoke five hours ago and still feel like I am mostly asleep. Possibly this is because of a change in medication for the depression. However, the change occurred before last week when I gained more energy and even experienced happiness. (Note: I always am thankful... thankful for excellent, insightful, kind, inspirational, steadfast care from the entire Mayo personnel; from my husband, sons, friends, neighbors... and always thankful God's peaceful presence and amazing wisdom!)

Though my depression was less of a fog last week, today the heavy weight returned to my mind and body. I see a local psychologist and last week he cautioned me that this could happen. Writing about the way I feel is helpful, so I will give writing at this site another shot. Also helpful is reading and re-reading the Mayo online information about PICS. I did that earlier today and was reminded that the way I am today (physically, mentally, and emotionally) aligns with PICS. I also am reminded that I will continue to recover as fully as is possible...thankfully! Today is sunny and now it is a little bit warmer in northwestern Minnesota, so I am going outside. I hope that whoever reads this, has as healthy a day as possible. M.H.

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@andreab, I would like to write more but am still so foggy from my last episode (septic and adrenal shock, pneumonia, delirium, etc.). My brain doesn’t seem to want to clear and it seems to get worse with each episode, which worries me. Still, I have some memories of the ICU both good ones and troubling ones. I remember procedural pain but also remember my husband holding my hand and singing softly to me. The latter seems to call me back from the delirium. He’s a great person and a devoted husband throughout this protracted illness. I’m very fortunate in many ways. I’ve never met anyone who has had similar experiences so this forum is wonderful for me. I hope I can also be helpful to others despite my cognitive foggiest.

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@laci

I’ve been searching for a support group for ICU Psychosis (that’s what my doctors labeled it) and feel relief finding this group. February 4, 2016 I fell very ill. I don’t know to this day if I had flu or just became dehydrated. I had suffered two TBI’s back in 2013/14 so my brain was a mess to begin with. I have also suffered with depression in my life however I was doing well.

I was so sick at 3 a.m. on February 4 and my husband finally said we were going to the ER. Admitted with acute renal failure. I was already hallucinating from severe dehydration and was in acute respiratory and brain failure as well. Sigh. Some days I really wish God had taken me on that day as my life changed abruptly during hospitalization. I was placed in a coma and intubated for 12 hours. I came to on my way to the ICU and I was completely disoriented and though I was being pumped full of medication for electrolyte balance I was not given any pain medication. I was taken off all of my medications which was very difficult. I also smoked at the time so add that to the withdrawal of my regular meds I was now going through nicotine withdraw. I was transferred to general ward after three days. It was there that I became paranoid and started having the most wicked hallucinations to the point where I ripped a line out of my neck and all other lines in my arms. I guess I was violent and screaming but I really don’t remember. I felt badly though because somewhere inside I knew this was not me and I had the sweetest roommate who was moved to another room immediately. The doctors decided to do a series of tests for such medical conditions like menengitis. I was left for two days in a terrible state of hallucinations while I had spinal tap and other tests done to rule out medical conditions. My husband finally said that the doctors had to do something other than keeping me in restraints while I screamed at everything and everyone including him.

Doctor put me back into a coma and intubation for two days. I came too once again back in ICU. I was still hallucinating but not as badly as before. Moved back to a general ward and finally discharged on February 16. By this time I had pneumonia in my right lung. It was a harrowing time. I’ve never been the same. I can’t seem to get over the memory of the hallucinations and sometimes they come flooding back while I’m going about my day. I’ve pretty much become dependent on my husband as I can’t drive well and I don’t want to go out at all. The psychiatrist gives me pills. Nothing works. I did stop smoking and lost 60 pounds so guess that’s the silver lining. I am forcing myself to go out today not because I want to but because I have to make myself work through these terrible emotions. I’m now terrified of dying as I came so close. I never had a fear of death.

I know my circumstances were not as severe medically as some medicatl conditions that I’ve read here and I’m truly sorry to be such a wimp but I feel like I’m losing my mind. I sometimes don’t know if I’m dreaming or if this is real life. I did drink a lot to make the bad go away but it only made things worse so I don’t do that anymore. I have ptsd but I think because I’m 62 that the doctors don’t really care. My husband is this totally normal man who loves me and tells me to just get over it but of course no one understands if they have not gone through this. I know I’ll never be that kind and gentle person I was before. I miss some of the old me. Memory is shot. Can’t form words. Mind always racing.

Thank you for letting me ramble on. I’m going to go out now and try to make it through yet another day.

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@laci I am so happy you found this conversation. This is exactly where you belong! Sharing your story and listening to others will hopefully be a powerful experience for you in your healing. Your description above fits the definition of PICS nearly down to the word. I am sorry life has taken you on this journey, but am also glad it led you to this group. As you have already experienced, there are some wonderful people here ready to help!

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@muriel66

Almost two years after suffering severe septic shock and nine months after suffering septic shock, both because of the way my body responds to surgery, I again am reading about PICS. I continue to face struggles that affect my days. I finally am writing on this page. I wasn't able to write in the diary that was given to me while in and after I left Mayo intensive care (and went to a room on a different floor). My de-conditioning, my decreased cognitive ability, my immense fatigue, my emotional upset, and my schedule of very helpful medical care... such as dialysis, physical therapy, services entering the room... left me not wanting to do one more thing (not to mention that my physical de-conditioning meant that for a period of time, my hands could not write). I did pray almost continually, listened to all who provided me care, tried to eat, etc.. But my greatest expenditure of energy likely was to eliminate body-waste successfully and regularly; once the bladder catheter and anal "garter snake" (my expression) were removed. Ha, ha!

Almost two years after my 2016 hospitalization, I again am diagnosed with moderate major depression. And, I have sluggish cognitive ability. Because I again am at a point of accepting my emotional-mental state, and my fatigue, I hopefully will post regularly on this site. It helps me when I express myself in writing. Today started as one of my more difficult days. I awoke five hours ago and still feel like I am mostly asleep. Possibly this is because of a change in medication for the depression. However, the change occurred before last week when I gained more energy and even experienced happiness. (Note: I always am thankful... thankful for excellent, insightful, kind, inspirational, steadfast care from the entire Mayo personnel; from my husband, sons, friends, neighbors... and always thankful God's peaceful presence and amazing wisdom!)

Though my depression was less of a fog last week, today the heavy weight returned to my mind and body. I see a local psychologist and last week he cautioned me that this could happen. Writing about the way I feel is helpful, so I will give writing at this site another shot. Also helpful is reading and re-reading the Mayo online information about PICS. I did that earlier today and was reminded that the way I am today (physically, mentally, and emotionally) aligns with PICS. I also am reminded that I will continue to recover as fully as is possible...thankfully! Today is sunny and now it is a little bit warmer in northwestern Minnesota, so I am going outside. I hope that whoever reads this, has as healthy a day as possible. M.H.

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@rckj my apologies for the delay in my response. I have read through all of your posts in this conversation, and I am so thankful to you for sharing your story with all of us. Experiencing critical illness one time is often life changing and traumatic, but to have gone through this multiple times must seem surreal. I imagine one never gets "used to" being critically ill. You also have such a unique situation in that you are yourself a psychologist with expertise in precisely what you are dealing with. I hear you mention concern for your patients and how to manage and juggle the work/life/healing balance. Please know that it is very common for people who have experienced critical illness, to have a delay in returning to work. This is something that is not talked about that much, so often times people think they have to just "toughen up" and get back to work. But the reality is just exactly what you are describing. Even if your physical self has healed, the cognitive difficulties/"fogginess" and emotional wounds can just as easily prevent you from returning to life as it was. The fogginess that you describe is also reflected in what @muriel66 has shared with us as well. You can see you are not alone in this!

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@muriel66

Almost two years after suffering severe septic shock and nine months after suffering septic shock, both because of the way my body responds to surgery, I again am reading about PICS. I continue to face struggles that affect my days. I finally am writing on this page. I wasn't able to write in the diary that was given to me while in and after I left Mayo intensive care (and went to a room on a different floor). My de-conditioning, my decreased cognitive ability, my immense fatigue, my emotional upset, and my schedule of very helpful medical care... such as dialysis, physical therapy, services entering the room... left me not wanting to do one more thing (not to mention that my physical de-conditioning meant that for a period of time, my hands could not write). I did pray almost continually, listened to all who provided me care, tried to eat, etc.. But my greatest expenditure of energy likely was to eliminate body-waste successfully and regularly; once the bladder catheter and anal "garter snake" (my expression) were removed. Ha, ha!

Almost two years after my 2016 hospitalization, I again am diagnosed with moderate major depression. And, I have sluggish cognitive ability. Because I again am at a point of accepting my emotional-mental state, and my fatigue, I hopefully will post regularly on this site. It helps me when I express myself in writing. Today started as one of my more difficult days. I awoke five hours ago and still feel like I am mostly asleep. Possibly this is because of a change in medication for the depression. However, the change occurred before last week when I gained more energy and even experienced happiness. (Note: I always am thankful... thankful for excellent, insightful, kind, inspirational, steadfast care from the entire Mayo personnel; from my husband, sons, friends, neighbors... and always thankful God's peaceful presence and amazing wisdom!)

Though my depression was less of a fog last week, today the heavy weight returned to my mind and body. I see a local psychologist and last week he cautioned me that this could happen. Writing about the way I feel is helpful, so I will give writing at this site another shot. Also helpful is reading and re-reading the Mayo online information about PICS. I did that earlier today and was reminded that the way I am today (physically, mentally, and emotionally) aligns with PICS. I also am reminded that I will continue to recover as fully as is possible...thankfully! Today is sunny and now it is a little bit warmer in northwestern Minnesota, so I am going outside. I hope that whoever reads this, has as healthy a day as possible. M.H.

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@andreab thank you for following my posts and your kind and understanding response. It does seem very surreal and I agree that you never get “used to” it. I truly don’t know how many times I’ve been through this. My husband estimates over 20 times. I have severe adrenal insufficiency and am also susceptible to infections, hence pneumonia, sepsis, adrenal shock, delirium, etc., without warning symptoms, is the pattern. I feel so worried for my husband having to see this repeatedly and being frightened for my life (as am I). He is strong and supportive but I worry about the impact on him and other family and friends. The good news is I traveled from my home on the east coast to Mayo in Minnesota in the summer and now have action plans which are helping, both with daily functioning and in reducing the number of episodes. It has given me so much more hope and has made a difference. I keep thinking about the surreal nature of all this and realized something both good and sad. The closest hospital knows me very well. ER, ICU staff, MD’s, etc and I all know each other. They know exactly what to do for me in crisis. A huge comfort and relief but it is also sad that we should know each other so well under these circumstances. The standing joke is “ couldn’t you just come back to visit?”. But I am fortunate that their skill and kindness has gotten me through so much and I trust them even during scary procedures. I sometimes feel haunted with the memories of some procedures. I don’t want to spell it out further because I’m afraid it would trigger someone else on this forum. My memories are foggy but persistent. I’m trying to work on coming to terms with this. With regards to work, you and others here have given me some perspective especially that I can’t just tough it out. I have to care for myself first then judge if I’m truly ready to care for others as a psychologist. The needs of my patients pull on my heart but they are being well cared for by colleagues. Being in the trauma field is a unique position but perhaps I must tend to my own trauma first, given the circumstances. I thank you and all of the people on this forum for your amazing kindness and support. I hope I can also be of help to others as needed. Not being familiar with sharing in this way, I had held back my name. I see now that that was an unnecessary fear. Thanks to all, Rhoda

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My name is Paul, I am a Vietnam Vet serving at Phan Rang AF Base 1967-68. I was there during TET OFFENSIVE, my job was Weapons Specialist spending most of my time at the end of the runway on base loading weapons on aircraft. I also was a gunner during TET when extra people were needed. I am now retired and recovering from a series of surgeries that landed me in a hospital for 100 days straight. I have loud noises in my head that keep me from sleeping. I developed Asthma upon my return from Vietnam and being stationed in Arkansas. I got out of the service after my 4 year duty was up. I now have NET/MET to the liver and can not have anymore surgery on my abdomen, my initial surgery was due to a perforation of the colon and I am left with a permanent ileostomy.

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@carcinoid

My name is Paul, I am a Vietnam Vet serving at Phan Rang AF Base 1967-68. I was there during TET OFFENSIVE, my job was Weapons Specialist spending most of my time at the end of the runway on base loading weapons on aircraft. I also was a gunner during TET when extra people were needed. I am now retired and recovering from a series of surgeries that landed me in a hospital for 100 days straight. I have loud noises in my head that keep me from sleeping. I developed Asthma upon my return from Vietnam and being stationed in Arkansas. I got out of the service after my 4 year duty was up. I now have NET/MET to the liver and can not have anymore surgery on my abdomen, my initial surgery was due to a perforation of the colon and I am left with a permanent ileostomy.

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@carcinoid, Hello Paul

I appreciate your posts both in this discussion group as well as the NET discussions. Your input is very helpful to others! I appreciate your service to our country and I feel badly that you are experiencing these health problems. Do you think that the NET was due to exposure in Nam?

Teresa

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Very likely, yes I have thought about that an awful lot. I do have a 44 year old daughter who was born with redness on her hands and feet and I wonder if that is something I passed on to her because of Nam. I understand the VA is currently evaluating and possibly adding some more medical issures related to Agent Orange-however, carcinoid is not one they have put on that list. I was directly exposed to the point of saturation at least twice during my tour and left with no way to wash or even take what little clothes I had on - off. It was hot there !

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