DALLAS Walking back into the intensive care unit at Baylor University Medical Center in Dallas is both frightening and therapeutic for Celina Montes.
'Brings back a lot of memories,' she said, choking back tears.
Some of those memories are fake.
On April 9, 2013, Montes was the very real victim inside a car crushed beneath a semi-tractor trailer during a freak hail storm outside Amarillo.
She was transported to Baylor Dallas, and spent 10 days in the intensive care unit on a ventilator clinging to life.
It while she was unconscious in the ICU that vivid nightmares of being on the open ocean and being pulled under water began.
'I knew I could see the waves,' Montes recalled. 'I thought there was somebody underneath my bed, because they were reaching for my feet. And they were trying to keep me here ... It was very frightening.'
'We call it post-intensive care syndrome,' explained Baylor Dallas clinical psychologist Ann Marie Warren.
Warren studies the condition known as PICS and its effects on patients and their families. She said sedation and changes in the sleep-wake cycle can affect the brain in strange ways. Bizarre hallucinations are often part of the syndrome.
Patients on a ventilator for more than five days are at highest risk of symptoms, which sometimes don't appear until after the patient is discharged from the hospital.
Research is scarce, though Warren says a quarter of such ICU patients may experience PICS. Many never mention their nightmares.
'I think the most important thing people can do is if they've had an ICU stay, and they get home and they're having nightmares... they're having depression... they're having trouble with their thinking... they're having anxiety... they need to see their provider to see what's happening to them,' Warren said. 'It's treatable.'
Warren said families and caregivers can help by keeping a diary of what's really happening to a patient during the ICU stay. It gives patients an accurate accounting of reality to compare with their memories.
Warren said getting a patient out of ICU quickly is a critical factor in reducing the impact of PICS. That includes 'getting them out of bed when they are ready; reducing the amount of sedating medications; and trying to get their sleep-wake cycle more normal,' she said.
What Celina Montes thought was someone trying to pull her under water, a counselor said, was more likely the feel of a compression cuff, worn on the legs to prevent blood clots. Her sensation of the rolling ocean might have been the air mattress she was on while in the ICU.
While she is still recovering from more broken bones than she can count, Montes' mind and her message to others thanks to counseling for post-ICU syndrome is strong.
'Don't be afraid,' she said. 'It's all right; just talk to somebody about it.'