In a diary kept for a patient in a British intensive care unit, nurses wrote:
“You suffered a seizure at home and woke up near the fire, switched it off and watched TV…. You phoned your dad because you noticed you had burned the right side of your face.”
Doctors “told you that you would need to be sedated and a tube inserted into your mouth and connected to a ventilator (breathing machine).”
“Your mum stayed with you…. A catheter was put into your bladder so we could keep a close eye on how much wee you are passing.”
In many critical care units in Europe, bedside diaries have been a fixture for more than a decade. Nurses use them to record the significant medical events and procedures that happen to patients. Sometimes, photos are included. Relatives may add entries that, for them, can be cathartic.
The diaries are given to the patients after their stay in the I.C.U. and can make for unflinching, sometimes shocking reading. But they can be powerful tools to help patients recover from hallucinations experienced while in the I.C.U. and to alleviate symptoms of post-traumatic stress.
Christina Jones, a British nurse-consultant and psychologist, found that at three months I.C.U. patients with pronounced symptoms of PTSD reported the most relief if given diaries, compared with those who were not.
It can be healing for families as well. “For a lot of relatives it’s a document that says, ‘This is what she went through, and look where she is now,’ ” Dr. Jones said.
When a patient dies in the I.C.U., the family is asked whether they want the diary. “Some families say all their goodbyes at the end of their diaries, and they ask for it early so they can put it in the coffin with the patient,” Dr. Jones said.
Gillian Colville, a psychologist in the pediatric intensive care unit at St. George’s Hospital in London, makes age-appropriate story books with line drawings for her young patients. The diaries aid parents in later explaining the ordeal to their children, she said.
Because parents, too, can experience post-traumatic stress symptoms — the I.C.U. siege can leave more lasting impressions on them than their child — the diaries may also be helpful for their recovery. “One father thought his son was in the unit for 48 hours, but it was only 12,” Mrs. Colville said. “People’s sense of time then is all over the place, colored by fear for their child.”
The diaries have been slow to take hold in the United States. Hospital lawyers fear they could violate American medical privacy laws.
Judy Martin, an intensive care nurse at a hospital in north central Texas, started an I.C.U. diary study this month. One patient, sedated and on a ventilator, was assessed and found to be alert and not confused. But when the patient was discharged from the I.C.U. and met with Ms. Martin, the patient admitted to having had terrible hallucinations.
Then Ms. Martin described how nurses had kept a diary of that stay, including photos. The patient brightened with relief and replied, “I can’t wait to see my diary.”