2nd June 2023
“We know that many of our patients who survive critical illness will experience what is known as post-intensive care syndrome,” according to Dr Melanie Ryberg who was appointed as Principal Specialist Clinical Psychologist working in critical care at Tallaght University Hospital (TUH) in recent months.
“It occurs where patients who survive critical illness often go on to experience both physical and psychological difficulties.”
For patient Maria Finlay, her meeting with Dr Ryberg was to be hugely significant: “February 2021 was when I contracted COVID-19. By about the eighth day I became really unwell. I felt like I was suffocating. So we rang an ambulance.
“When I arrived at Tallaght Hospital, I met the nurse and she said she was getting in touch with ICU (Intensive Care Unit). When you get to ICU, you are surrounded by all these machines – the CPAP mask is on you and it’s really uncomfortable.
“There was a lady to the left of me who was very very ill. They were getting an iPad for her and then you could hear her talking to her daughters. The daughters were saying, remember mammy we love you, remember, we love you, keep fighting. And I remember the tears coming down my mask. I remember thinking, this is what my kids are going to experience.”
Fortunately for Maria, she recovered physically but faced significant psychological challenges.
Dr Ryberg explains:
“Maria attended the post-COVID-19 clinic here in Tallaght at the time, and for her specifically, there was an ongoing piece about that post-traumatic stress reaction that was having a significant impact on her.”
Maria felt very depressed, experienced nightmares and flashbacks, and was finding it difficult to cope. Sadly, the woman who shared the ICU with her died. For Maria, that was a difficult moment: “I had to tell myself, Maria, that woman didn’t make it but you did. So I thought I should be on cloud 9. But I wasn’t. I couldn’t cope with this part of the COVID-19 experience.”
In order to help Maria, Dr Ryberg explains that they were able to “draw on EMDR - eye movement desensitisation and reprocessing - which is an evidence-based treatment for post-traumatic stress disorder. Maria and I worked together over a relatively short period of time with really positive results.”
Maria acknowledges that she felt a “healing. We went through the process and ultimately it felt like everything was lifted from me. After the sessions, Melanie asked me how I felt and I told her I was happy – happy inside. And ever since then, I’m good.”
For Dr Ryberg, it was a positive outcome. Overall, her role is to identify and meet the psychological needs of patients and their families during an ICU admission. Her focus is on helping the 80% of patients in ICU who suffer from delirium, a condition that causes confusion and a lack of awareness of someone’s surroundings: “We know delirium is a significant issue in critical care and is associated with a range of bad outcomes including length of stay, cognitive impairment, and mortality.”
To improve the care provided to these patients Dr Ryberg has introduced a range of what she describes as “orientation and humanisation measures.” These have included the use of a digital whiteboard in ICU to give clinicians the flexibility and creativity to display key information for patients (and staff) relevant to the patient’s stage of recovery. This generally involves basic orientation information for the early stages of wakefulness, including simple things such as reminding the patient where they are and what day and date it is.
Watch Maria and Dr Ryberg on YouTube