The return to work following a critical illness and an ICU stay is an important outcome that has not received adequate attention when evaluating the long-term effects on survivors and their families. Researchers who have explored this outcome have found that just 33% of previously employed survivors returned to work after three months, 55% after six months, and 56% after twelve months (McPeake et al., 2019). Patients’ journeys returning to work are complex, and this data does not highlight the unique factors that influence each case. Various contributors, including age, educational level, length of ICU stay, and length of hospital stay, have been found to influence a patient's ability to return to work (Neubert et al., 2025). Further, individuals with post-intensive care syndrome (PICS) may experience difficult changes to their physical health, mental health, cognition, relationships, and sense of self and identity.
While returning to work is a major success for many survivors, it is not a simple marker of physical, mental, or cognitive health outcomes. Even when a patient can return to work, they may face unique health challenges. They may have new or exacerbated financial problems, even if they return to the same role they held prior to their critical illness. They may need to adapt their role or change their expectations for themselves. And while research indicates that a return to work is associated with better mental health and quality of life, this does not mean that individuals who have returned to work are not experiencing difficulties (McPeake et al., 2019). Data exploring return to work after critical illness is essential in understanding the needs of ICU survivors. However, it is important to understand the complexities that affect every patient, regardless of whether they return to work. Each patient has a story that highlights the immense impact that critical illness and PICS have on individuals, their families, and their communities. These stories are essential to fully understanding why some patients return to work and others do not, the unique struggles individuals with PICS face, and how healthcare professionals can best support their patients after an ICU stay.
Vanessa was working full-time as a speech pathologist and was a busy mother to a toddler when she started to feel sick in 2019. Within a week after her first flu-like symptoms, she was paralyzed in the ICU, unable to speak or eat. It was not until four months after her symptoms began that she was diagnosed with a type of Guillain-Barr syndrome. Her time in the ICU was difficult, but she entered rehabilitation expecting to bounce back to her previous state of health within a few months. About a year after her ICU stay, she finally felt ready to come back to work. The COVID-19 pandemic made working accessible for her. She could not climb stairs or carry things, so work from home orders allowed more flexibility in her return. She was slowly adjusted to working with more opportunities to rest. She says that without the COVID pandemic, she could not have returned due to her PICS and depression. Before she returned, she had a meeting with her boss, who asked her about her ability to climb stairs but not about her mental health. Vanessa wants employers to recognize mental health as an important part of health and a key factor in returning to work.
The nature of Vanessa’s work as a speech language pathologist in a school meant that she was engaging with the health system at work. Reading reports and working with children with a similar medical history or medical trauma was very difficult for her. Some students used their eyes or a phone to communicate, taking Vanessa back to her experience being unable to communicate in the ICU. The constant reminders of her traumatic medical experiences made returning to work very difficult. Vanessa needed to go back to work to contribute to her family’s income, so she had no choice but to manage these difficulties. She felt her heart race and stress in her body when at work. Vanessa’s experience was extremely difficult, and she has found healing through advocacy. She seeks to educate speech language pathologists and other medical professionals about PICS and how they can support people with PICS. Vanessa’s story highlights how simply collecting data on whether someone returns to work as a measure of success is not enough. Individuals with PICS need additional support, especially if they work in a field that reminds them of their trauma and difficult experiences.
David is another ICU survivor who attempted to return to work after his ICU stay. Prior to his critical illness, he worked in intelligence in a communications and IT role. He loved his job and could imagine himself staying in his position until retirement. In 2009, he contracted H1N1, or swine flu, which progressed to double viral pneumonia and severe acute respiratory distress syndrome (ARDS). David spent six weeks in the ICU on a ventilator and ECMO. David was a former track and field athlete in excellent health and had high expectations for his recovery and ability to return to work. His employer had an active mental health and welfare team who would visit him and communicate with his medical team. They were optimistic about a gradual phased return to work.
However, David’s recovery plateaued, and after eighteen months of holding his job open, he was forced to medically retire. This was a huge blow to David, as he had to quickly shift from fully expecting to return to the career he loved to accepting that he could not. He experienced cognitive deficits related to PICS and had difficulty understanding and retaining information. David felt a loss of his identity as his ability to work and participate in the sports he loved so much were gone. The possibility of returning to his job had given him hope in his recovery, and he struggled when this was taken away. The loss of his career also led to significant financial stress, especially because he was a single parent to three children and the only source of income in his household. David’s experience shows just how difficult it can be when one is unable to return to work, not just financially, but because of a shift in identity and sense of purpose and self.
Marie worked as a customer service representative for a large bank when she tested positive for COVID. She was very busy and had to keep up with serial numbers, inventory, invoices, ordering, shipping, spreadsheets, and communication. Marie began feeling sick, then was unable to breathe, and a friend told her to go to the hospital. She ended up spending five weeks in the ICU and one week in inpatient rehabilitation. During her time in the hospital, she was so weak she could not talk on the phone and experienced vivid visions that made her question what was happening around her. In rehab, she could not walk five feet without needing to sit down, and she was worried about how she would work and move around her office. Marie needed to return to work; she had used her vacation and sick time and needed to pay her bills.
She started with computer work and worked part-time from home for four weeks. She had no energy to sit up and was living alone without help. She went back to work full-time about four months after her ICU stay but couldn’t think straight, struggled to find the right words, and typed words incorrectly. As she was assigned more demanding work, she began making mistakes. She was initially able to catch and correct these mistakes, but her employer implemented a new accounting system that required others to fix mistakes. Her cognitive challenges resulted in more mistakes, and her anxiety was extremely high. She was invoicing hundreds of thousands of dollars each month and was anxious about her ability to keep up without making mistakes. She struggled with depression and spent a few days in an inpatient mental health hospital to find support. Marie eventually approached her boss and told him what was going on, saying, “I’m not doing the company any good.” Her concern about making mistakes and the challenges of navigating her health needs made working too difficult.
Marie left the company nine months after she contracted COVID. She contracted COVID again a few weeks later and returned to the hospital, asking them not to let her leave because she was losing her insurance in a few days at the end of the month. When her unemployment ran out, she did not have any income, which forced her to stop taking several medications. Her house was almost foreclosed. She utilized her hospital’s financial assistance program to restart her medications and was eventually approved for Social Security Disability Insurance (SSDI). Now, Marie helps others who are struggling with the impacts of critical illness and PICS. She knows that navigating the system and locating resources can be challenging, so she spends her time helping others.
As these three survivor stories illustrate, returning to work with PICS is not simple. It is often an unpredictable and difficult journey, no matter the outcome. It is essential that we better understand how to support people who return to work. Vanessa’s story shows how a specific workplace can be difficult to return to because of trauma. Marie’s story shows that measuring an outcome of returning to work in the months after an ICU stay is not capturing the true experience and impact of PICS. David’s story highlights that we must do more to support those who never can return to work, as well as how difficult it can be to lose that part of oneself.
All three of these survivors emphasized the need for greater support and resources for people upon discharge from the hospital. Providers and employers must have awareness of the potential impacts of PICS. They each brought up the benefits that have come from finding a support group. The understanding and support from others helped them navigate their experiences with PICS and attempts to return to work. Survivor stories show us the complexity of returning to work with PICS that simple statistics cannot capture. Returning to work is a complicated and emotional journey for survivors that warrants much more research and attention.
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References
McPeake, J., Mikkelsen, M. E., Quasim, T., Hibbert, E., Cannon, P., Shaw, M., Ankori, J., Iwashyna, T. J., & Haines, K. J. (2019). Return to employment after critical illness and its association with psychosocial outcomes. A systematic review and meta-analysis. Annals of the American Thoracic Society, 16(10), 1304–1311. https://doi.org/10.1513/AnnalsATS.201903-248OC
Neubert, A., Hempe, S., Bieler, D., Schulz, D., Jaekel, C., Bernhard, M., & Windolf, J. (2025). Return to work after major trauma: A systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 33(1), 44. https://doi.org/10.1186/s13049-025-01351-0
