Table 1.

Illustration of positive response shift in an intensive care unit survivor

Case: Janice is a 58-yr-old woman with hypertension who developed pneumonia and acute respiratory distress syndrome. She was mechanically ventilated for 6 d and spent 2 wk in acute rehabilitation after hospital discharge. Before her hospitalization, she worked full time as a media relations specialist and was very physically active, jogging or swimming almost daily. Six months later she is no longer working, cannot run a mile, has short-term memory impairment, and reports that she is consistently too fatigued in the afternoon to go out for dinner or participate in evening social events. Despite these changes, she reports no change in her quality of life compared to before her illness.
Form of Response Shift	Definition	Janice’s Description in Conversation
Recalibration	A change in a person’s internal standards	“I walk a couple miles with my neighbor and her dog most days—as long as the weather’s good—and I’ve started doing yoga on Tuesday mornings. I’m very conscious of what I eat, too. That’s pretty good for someone nearing 60.”
Reprioritization	A change in personal values	“Being sick made me think about how I want to spend my time. The way friends and family rallied around me was just incredible. I decided I wouldn’t go back to work—retire early—even before I left the ICU. Next month I’m meeting childhood friends in Florida for a mini-reunion, and I’m going to my niece’s graduation in May. That’s the good stuff.”
Reconceptualization	A change in how quality of life is defined	“Last month I started volunteering at a women’s shelter, and some of these women, they’re handling so much, trying to keep their kids safe, to keep custody of them, find housing, work, everything… every time I’m there it drives home again just how lucky I am.”

Definition of abbreviation: ICU = intensive care unit.