Medical Examiner

The Cost of Surviving the ICU

I almost died of an illness like the novel coronavirus. People who survive the ventilators need to know that their recovery will likely be partially psychological.

ICU machines and wires
Justin Paget/Stone via Getty Images Plus

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We tend to make sense of sickness by ascribing levels to it, like medals in Olympic boxing: There’s featherweight “I’m under the weather,” a welterweight “ghastly ill.” And then there’s the super heavyweight, an opponent that actually scares you. Few people have to face off with this kind of illness. I have. Which may be why, as I scan through the daily news about the coronavirus, I tend to skip the stats on how many have died, the ventilators we don’t have, the politics, the quarantines, the jobs lost, even the bread-baking. Instead, I find myself drifting into the minds of those souls strapped to gurneys in the hallway, encased in a macramé of tubes and wires, fighting for each breath. These are the ones facing the super heavyweight. Some of them will die. But the ones I think about are the ones who will survive. Because I’ve been there. I know that getting off the ventilator won’t be the end of the story. And I know that not being sick doesn’t mean you’re well.

My illness started in a way that now sounds too familiar, though for me it happened early in the summer of 2013. A dry, coughing tightness in my lungs began to feel unnatural, followed by a 103-degree fever immune to ibuprofen or acetaminophen. By the third day, I woke up cloaked in an eerie dread that early man must have felt when he knew he had wandered too far from water.

By the time my wife, Tessa, drove me to the hospital, each breath felt like inhaling a propane blowtorch. Upon arrival, I was rushed to an intensive care unit bed. The next day, my chest X-ray was worse, and by day 4, I’d lost 75 percent of my lung capacity. I was attached to eight electrocardiogram wires and an IV dangling with 11 antibiotics and four antivirals. The finger oximeter showed my O2 levels plunge to 85 percent.

I should note that O2 levels are pass-fail—85 percent is not a B; it is a “You shouldn’t be alive,” because anything under 90 is a failing grade. They hooked me up to a rebreathing bag and put nasal cannulae up my nose that pumped in pure oxygen. The nurses said I was way too young to have pneumonia like this.

I was tested for SARS, MERS, Valley fever. My wife and 8-year-old daughter could only see me for a few minutes each day, and I began to stop making sense. In a haze, I remember one of the doctors tending my bedside and saying, “In medicine we are taught, ‘If you hear hoofbeats, think horses, not zebras.’ ” Meaning that 99 percent of illnesses are something ordinary, not exotic.

But they were running out of horses, and I began dreaming of zebras.

The head of the infectious disease department took my wife aside and said I was hours away from a possible intubation. That’s usually the last stop before the end, so he asked about contacting my parents and, further, making sure our affairs were in order.

That was life outside my body. Inside was a very different place. I’d begun a descent—or ascent, depending on your opinion of me—to the veil between life and death. Each day, I could feel more layers of self-definition drop away like old clothes. My feelings became more primitive, less complicated, more like a kid.

I sensed being reduced, losing years. In toddler English, I’d tell myself: “Breathe five minute, then take break, OK?” I was experiencing Corinthians in reverse: I spoke as a child, I understood as a child, I thought as a child, and I put away adult things. I promised myself I’d get a break after five minutes of breathing, you know, like getting dessert if you finished your meal.

Except you can’t take a break from breathing. So I’d restart, and restart, and I was getting tired, like a drowning victim you yell at to keep awake.

Chris Cuomo is right: The beast comes at night. Tessa would be in my hospital room until visiting hours ended at 10 p.m. She’d massage my legs the way we’d done to our kid when she was an infant. I was unable to speak, but my wife was seeking neither permission nor confirmation. It was one of the few moments of humanity I got.

But she’d have to go back home to our girl because she, too, couldn’t take a break; she would always be a mother. So she’d tuck me into my little hospital bed, which in my mind had turned into a dinghy, a tiny canoe. She would pull the curtains closed and leave the room, launching my little dinghy into the cold, dark ocean. My destination was morning, eight awful hours beyond the horizon, and there was no guarantee I’d still be afloat.

There was a night when I could no longer shoulder the unbearable heaviness of being. You have no idea how many things you do every moment to keep up the appearance of being a human, until you let it go. Being a husband left me. Then being a father. Finally, my sense of self began dispersing like powder. You’d think it’d be replaced by a sort of Buddhist calm, but that would be too easy. Devolving comes at a price. I began to suspect my doctors were trying to make me sicker. Through the rebreathing bag, I saw nurses talking to each other, and I knew they could only be plotting how to make me suffer.

I had visions of nightmarish sea creatures swimming around my bed, as the ICU waters began to rise. I would bolt awake because I thought a giant squid had attached its suckers to my face and was sluicing the life out of me. I ripped it off, only to find it was my rebreathing bag and nasal cannulae. I wanted real air, but real air meant death.

I kept giving up. But I also kept breathing. And the curious thing about breathing is that if you keep doing it, you stay alive! Stay alive long enough, and the tubes start coming out. Two weeks later, I limped home with my arm around my wife and my daughter holding my belt loop. Doctors did antibody tests and came up with nothing. Fifty percent of all pneumonia cases have no known origin.

I had recovered. But in some ways, the real illness was an emotional one. While in the hospital, I had suffered from “ICU delirium,” a condition marked by paranoia and hallucinations. Even as my body recovered, my own philosophies took a hit. Some things came back in a single breath: loving daughter and wife, my family, close friends. But I had been blanched clean of so many of my previous notions—everything else was suddenly optional. Many acts were simply a force of will, a joyless transaction.

This can be an amazing revolution. It can wipe clean all the detritus from your past life and allow you to rewrite all the rules. But sadly, recovering from trauma usually means you’re far too exhausted to do anything except binge Netflix (which is good, because everyone else is several seasons ahead of you).

In the months after I left the ICU, a numb post-traumatic stress disorder set in, punctuated only by bouts of crying when I’d see hospitals on TV or someone swimming underwater. I quit writing jobs because I no longer felt I had a point of view. It took six weeks before I could walk up a staircase without getting winded, but six months to start pitching projects again. It was another year before the nightmares went away. Even now, as I drive past the hospital to take my daughter to school, I look for the third-floor corner window, as though some tiny part of me is still there.

And now, during this pandemic, I can’t stop thinking of the desperate clutch of Americans clawing their way back to the shore like I had to. Many are in the throes of ICU delirium. When they get better, they need to know that their delusions are a thing known to science—they weren’t crazy after all. I recently spoke with one of my attending physicians (who asked to remain nameless given her proximity to coronavirus treatment and messaging) about what I went through and what some of the people she’s treated might expect to go through too. As clinical professor of infectious diseases at a huge university, she has seen the delusions up close.

“The patients are on so many meds. And there’s oxygen loss. They don’t know where they are, and they talk to people who aren’t there,” she said.

In order to help the person hooked up to the machine figure out what is happening, my doctor explained, “we use ‘alert and oriented times three,’ which is: Who are you? Where are you? And when are you?” The when question is usually “Who is the president of the United States?” For me, it had been Barack Obama, which acted as an analgesic. But now? “We still ask,” she laughed. “You get a very quick view of someone’s politics.” Assuming they know when they are, anyway.

When I went through my ordeal, I knew almost nobody who had been in the throes of where I was. In a few months, there might be a million. They will need to find each other, Alcoholics Anonymous–style. They may have to reintroduce themselves to a life they had to give up to survive. Visions of near-death, some awful, some gorgeous, all different, will seep into the public consciousness. They need to know their PTSD is well earned, and that it’s OK to lie fallow for a while. After that, they will need help jump-starting their passions.

The good news? I can only speak for myself, but death no longer has near the power it once had over me. Because it was demystified. Because I had a little more rope than I thought. Because I fucking survived.