ICU Trauma and Delirium: What Survivors Wish More People Understood
Based on a Medical Trauma Support Podcast conversation with ICU nurse practitioner and ICU Consultant, Kali Dayton, DNP
When we picture surviving a stay in the intensive care unit, we tend to imagine the story ending the way the movies do: the machines come off, the family exhales, and the patient goes home to pick up their life. But for a great many ICU survivors, walking out the doors is where a second, quieter struggle begins, one they are often not warned about.
On a recent episode of the Medical Trauma Support Podcast, I sat down with Kali Dayton, an ICU nurse practitioner and critical-care consultant who has spent her career trying to change that. What she shared was incredibly impactful to me and she helped me to better understand what happens to the body, the brain, and the sense of safety inside the ICU, and importantly what becomes possible when care is done differently.
An ICU where patients stayed awake
Kali’s story starts with a job interview. Newly back in the States after years of being abroad, she interviewed at a high-acuity ICU in Salt Lake City, and the nurse manager asked her something that, at the time, made very little sense:
“Would you be willing to walk intubated patients who were on ventilators?”
She said yes, she wanted the job, without really knowing what she was agreeing to. But in that ICU, it was simply normal for patients with breathing tubes to be awake right after intubation: writing on whiteboards, typing on their computers, communicating their needs, sitting in chairs, and walking through the halls. Kali didn’t question it. As she put it, her patients were human, and of course they would be awake during the day, telling the team what they needed during some of the most vulnerable and sometimes final moments of their lives.
She calls this an “awake and walking ICU,” and at the time she had no idea how rare it was.
The “conveyor belt” most patients are placed on
It wasn’t until Kali became a travel nurse that she discovered the rest of the world worked very differently. She walked into her next ICU to find the lights low and every patient lying still with their eyes closed. When she asked why one ventilated patient was sedated and whether she could turn the sedation off and get them up to a chair the nurse orienting her looked at her in shock. The exchange went in circles:
“She’s intubated,” the nurse kept saying. “Okay, but why is she sedated?” Kali kept asking.
That was the first time Kali encountered the assumption that a person should automatically be placed in a medically induced coma simply because they have a breathing tube. Most ICUs, she explained, run on what she calls a “conveyor belt”: the breathing tube goes in, the ventilator goes on, and the patient is automatically started on sedation and will not move a muscle. There is a whole spectrum of approaches, some teams use the most dangerous sedatives, others use lighter doses, but a patient who is fully awake, mobile, informed, and helping call the shots in their own care remains the rare exception. (In countries like Denmark, she noted, roughly 80% of ICU patients are kept off sedation entirely, and have been for decades.)
How sedation became the default
Kali traced the culture back to the 1990s. As ventilator technology advanced and teams began keeping much sicker patients alive, especially those with ARDS, the severe lung injury many of us heard about during COVID, clinicians reached for the medications they knew from the operating room to stop patients from fighting the ventilator. They knew those drugs caused a few hours of amnesia during surgery, so the thinking became: why not let patients sleep through the whole ordeal?
It came from a tender place. As Kali described it, clinicians genuinely wanted to protect patients from the trauma of the breathing tube, the pain, the environment, all of it. The trouble is that it was built on a misunderstanding of what was actually happening to the brain.
What sedation actually does to the brain
Here is the part that may shock you, I know it did for me, I had no idea. Those sedatives don’t produce real sleep. They disrupt brain activity so profoundly that the brain can’t reach the deep, restorative stages of sleep, so what looks like rest is closer to sedation-induced sleep deprivation. And a brain that is already under attack from critical illness (low oxygen, low blood flow, infection, inflammation, pain) and then deprived of restorative sleep is set up for severe delirium, which Kali describes plainly as acute brain failure.
The numbers are sobering. Delirium roughly doubles the risk of dying in the hospital, and regardless of the patient’s age it dramatically raises the risk of long-term cognitive impairment that Kali compares to mild Alzheimer’s or a moderate traumatic brain injury. None of this was understood in the 1990s. The patients’ eyes were closed and they weren’t moving, so the medical community believed they were peacefully asleep.
They weren’t. What survivors have since told Kali on her own podcast is that they could still hear and feel things around them but in their delirium, that sensory input got twisted into something graphic and morbid. They describe these as hallucinations or nightmares, but they’re quick to say those words don’t capture it. As Kali relayed it, what they lived through felt more real than the room you’re sitting in right now.
Survivors have described believing their deceased father was cannibalizing them, that they were being assaulted or kidnapped, that they were desperately trying to save babies from a fire and what is days to us can feel like years to them.
When the trauma doesn’t end at discharge
There’s a name for the cluster of physical, cognitive, and psychological impairments that survivors carry long after the ICU: post-intensive care syndrome (PICS). A person may have one of those impairments, or all three. And whether or not they had vivid delirium, many survivors wake to find they’ve lost weeks of time and lost control of a body that no longer moves the way it used to, sometimes too weak even to hold a cell phone or grip a pen, with a tube still down their throat and no way to communicate. As Kali put it, that alone, strapped to a bed, unable to speak, met with “calm down” or more sedation is its own deep trauma.
And then they go home, where the people around them often assume the hard part is over.
“There’s a name for what I’m going through”
Kali told me about a survivor who has become a close friend: a lawyer in his thirties who spent more than three weeks in a coma. When he tried to return to the courtroom, he experienced what he calls “time travel” his whole environment would snap back to the reality of his delirium, and he’d be lost. He didn’t dare describe what was really happening, terrified that if he spoke the truth he’d be institutionalized because it sounded so insane. He wasn’t getting better. He had written letters to his loved ones and was preparing to end his life when, searching online, he came across Kali’s podcast and found a single word: delirium.
“There’s a name for what I’m going through. I’m not the only one. I’m not crazy.”
He flooded her with emails, came on the show, and has since made enormous progress, speaking at conferences and pursuing a master’s in public health. Kali shared another survivor, too: a woman who had survived extraordinary hardship earlier in life and built coping skills to carry it, until a misread medical event landed her in a weeks-long medically induced coma.
During it, she vividly relived her life’s worst trauma; afterward, she couldn’t read a clock or a calendar, couldn’t use the coping tools she’d relied on for decades, and didn’t want to live dependent on her son. It had been two years and several crises before anyone gave her the words “delirium” and “post-intensive care syndrome.” Until that moment, no one had told her she wasn’t alone.
This is exactly why I do the work I do. When you finally have a name for what you’re carrying, whether it’s medical trauma, PICS, or medical PTSD, something shifts. It can move you from “there is something horribly wrong with me, and I’m the only one” to “this is a real thing, and there is help.” A name is often the doorway to getting the support you need.
A more humane kind of critical care is possible
Kali now works as a consultant, training ICU teams around the world to become awake and walking ICUs, units that reserve sedation for the times it’s genuinely indicated (seizures, certain brain injuries, and other specific situations), provide real informed consent about its risks, actively prevent and treat delirium, get patients moving as early as safely possible, and treat families as part of the care team rather than visitors. The transformation is hard; she described the hesitation, fear, and even resentment teams move through. But about six months in, once they’ve had repeated success, the feedback she hears makes her laugh:
“Why didn’t you tell us it’d be this fun? This easy? There’s no way I’d want to go back.”
Clinicians get to have human connection with the people they’re caring for. They get to watch patients walk out the doors, something that used to be rare. And there’s a quieter benefit, too. So much of what wears down ICU staff, the moral injury of providing care that feels like it’s prolonging suffering, of never knowing what a comatose patient would have wanted, eases when patients can be awake enough to say, here’s what I want, and here’s what I don’t.
What you can do to protect yourself or a loved one
One of the most practical things Kali shared was the idea of planning ahead. She described the very first survivor she interviewed, a woman who survived ARDS, endured a brutal recovery, and then had legal documents drafted protecting her from unnecessary sedation. Kali calls it being a “DNS”: alongside DNR (do not resuscitate) and DNI (do not intubate), do not sedate unless it’s truly essential to save my life. That survivor went on to have ARDS two more times and because her wishes were clear, she stayed awake and informed. At one point, with the room debating a risky test, she raised her hand from her bed, breathing tube and all, and made it known: I’m right here. I make the decisions. She signed the authorization herself.
Most standard advance directives are very generic do CPR or don’t, ventilator or no ventilator. But Kali pointed out that many of them include a free-text section, and she encourages people to use it to write something like: I don’t want to be sedated unless it is essential to save my life. I want to be awake, communicating, and mobile as much as possible. Talk it through with the people who would speak for you. It’s never too early.
For families who are in the thick of it right now, Kali also hosts a companion podcast, Walking You Through The ICU, made specifically to help loved ones understand and advocate during an active ICU stay.
You are not alone — and your voice matters
When I asked Kali what she most wanted listeners to walk away with, her answer was simple:
“You’re not alone. Surviving is part of it but you’re not alone in wanting to thrive.”
She made a point I feel deeply: you’re allowed to talk about how your experience affected you. Naming the harm isn’t being ungrateful, it’s being honest, and you can hold gratitude for being alive and a desire for things to change at the same time. Life is full of that kind of nuance. Kali calls the survivors and clinicians pushing for better care “revolutionists,” and she’s right that there is real power in it. So much of the healing I witness in our own community comes when people turn back toward the system that hurt them, not to relive it, but to help the next person have a softer landing. That’s post-traumatic growth in action.
If any of this resonates, please know there are others who understand exactly what you’re carrying. Connecting with people who’ve walked a similar road and learning, gently, how to feel safe in your body again can be its own kind of turning point.
Learn more about Kali Dayton’s work
You can find Kali’s consulting, resources, and contact information at DaytonICUconsulting.com. Her podcast for survivors and clinicians is Walking Home From The ICU, and her podcast for families navigating an active ICU stay is Walking You Through The ICU. She’s also active on Instagram at @DaytonICUConsulting, where she shares videos of patients awake and walking, worth seeing if it’s hard to picture.
Keep going from here
If this conversation stirred something in you, you don’t have to sit with it alone. The Medical Trauma Support Circle is a warm community for people healing from medical trauma, a place to feel understood. If you’d like to gently reconnect with your body at your own pace, the self-paced course Befriending Your Body After Medical Trauma walks you through it step by step. And if you’re just beginning to make sense of what happened to you, my free digital guide is a soft place to start.
And to the clinicians reading this: I keep hearing from you that you want training around medical trauma. A continuing education course built for you is on the way later this year. More soon.