THERAPY-Magazin
A different perspective
Bernd Tittel shares his journey from intensive care to recovery after COVID-19. Discover the challenges of early mobilisation, the role of bed cycling therapy, and how technology supported his rehabilitation.
Tobias Giebler
Intensive care medicine and neurosurgery expert, Tübingen University Hospital
Interview with Bernd Tittel: Insights into the world of a critically ill ICU patient
In an exclusive interview, Bernd Tittel, who contracted COVID-19 in autumn 2021, provides insights into the course of his illness and his impressive journey back to normal life. The interview was conducted by Tobias Giebler, our clinical specialist for early mobilisation in the intensive care unit, and provides a unique perspective on the challenges and successes during treatment.
Tobias Giebler: Thank you, Bernd, for taking the time to allow us to shift our perspective and see through the eyes of a critically ill ICU patient. Let’s recap what you went through. In autumn 2021, you caught COVID between your first and second vaccinations – is that right?
Bernd Tittel: I’d already been COVID-positive once in spring 2021. I had my first vaccination in August 2021 and was just about to have my second vaccination. Then I got infected with the Delta variant. I think it was 17th November. I became increasingly unwell and was taken to the hospital in Überlingen by ambulance. The situation there got so bad that I was transferred to Tübingen on a ventilator.
Tobias Giebler: What do you know about that time? What did you notice? How was it?
Bernd Tittel: I’d already been COVID-positive once in spring 2021. I had my first vaccination in August 2021 and was just about to have my second vaccination. Then I got infected with the Delta variant. I think it was 17th November. I became increasingly unwell and was taken to the hospital in Überlingen by ambulance. The situation there got so bad that I was transferred to Tübingen on a ventilator.
Tobias Giebler: What do you know about that time? What did you notice? How was it?
Bernd Tittel: I remember getting into the ambulance at home. In the emergency department, I must have sent a few organisational text messages somehow – after that, I don’t remember anything.
Tobias Giebler:Nothing? No sights, no sounds?
Bernd Tittel: No, nothing at all. I can tell you today that I was apparently transferred to Tübingen by road. It wasn’t possible to have me flown in. From what I hear, it was touch and go. I got to Tübingen not just at the eleventh hour, but pretty close to the twelfth!
Tobias Giebler: When I first contacted you, you were already connected to the ECMO (extracorporeal membrane oxygenation) machine, taking over from your lungs. Then you were regularly placed in the prone position for at least 16 hours, following the recommendations. You woke up in the meantime. What were the first things you noticed? What happened next?
Bernd Tittel:During this time I had near-death experiences, and very confused dreams. I kept dreaming I’d been flown to the army hospital in a military helicopter. So I woke up thinking that I was lying in the army hospital in Ulm, for some reason. Then I was told where I actually was and what had happened to me.
Tobias Giebler: Do you remember who explained it to you, and how that went?
Bernd Tittel: No, they all looked the same – blue gowns, masks, visors.
Tobias Giebler: Did it bother you that you couldn’t see who you were talking to?
Bernd Tittel: No, that didn’t worry me. I was just grateful that someone was talking to me, taking the time to tell me were I was, and being there for me. It felt like I was drunk. I couldn’t communicate properly.
Tobias Giebler:Because of the breathing tube? It must have been comforting to wake up and feel like someone was taking care of you. Did you feel understood despite not being able to speak?
Bernd Tittel: No, nothing at all. I can tell you today that I was apparently transferred to Tübingen by road. It wasn’t possible to have me flown in. From what I hear, it was touch and go. I got to Tübingen not just at the eleventh hour, but pretty close to the twelfth!
Tobias Giebler: When I first contacted you, you were already connected to the ECMO (extracorporeal membrane oxygenation) machine, taking over from your lungs. Then you were regularly placed in the prone position for at least 16 hours, following the recommendations. You woke up in the meantime. What were the first things you noticed? What happened next?
Bernd Tittel:During this time I had near-death experiences, and very confused dreams. I kept dreaming I’d been flown to the army hospital in a military helicopter. So I woke up thinking that I was lying in the army hospital in Ulm, for some reason. Then I was told where I actually was and what had happened to me.
Tobias Giebler: Do you remember who explained it to you, and how that went?
Bernd Tittel: No, they all looked the same – blue gowns, masks, visors.
Tobias Giebler: Did it bother you that you couldn’t see who you were talking to?
Bernd Tittel: No, that didn’t worry me. I was just grateful that someone was talking to me, taking the time to tell me were I was, and being there for me. It felt like I was drunk. I couldn’t communicate properly.
Tobias Giebler:Because of the breathing tube? It must have been comforting to wake up and feel like someone was taking care of you. Did you feel understood despite not being able to speak?
Bernd Tittel: Communication was a big problem. All the technical terms, and I couldn’t ask questions, couldn’t make myself understood. It felt as if I couldn’t be heard.
Tobias Giebler: For us, you were a patient who quickly regained consciousness and was able to communicate. The ventilation tube was manageable because we could read your lips, and we were also able to use an alphabet board and a writing pad to assist you. I rarely had the feeling that I didn’t understand what you were trying to say. Did making yourself understood get any easier with time?
Bernd Tittel: It was very much dependent on the person I was interacting with, and their willingness to engage. Particularly when boards and writing were involved. It was made even more difficult when I experienced bleeding into my arm. Then I couldn’t even point and write any more. That was a barrier for me, but it was good to know that someone was always there.
Tobias Giebler: Were you in pain during this time?
Bernd Tittel: No, I can’t remember any pain.
Tobias Giebler: What did you notice about the technical equipment, alarms and so on?
Bernd Tittel: There were constant alarms and signals that were to do with me, yes!
Tobias Giebler: Can you describe that in more detail?
Bernd Tittel: You’ve got time, in that situation. At some point you try to make sense of the sounds. Each sound means something different. Something is empty – the food or a medicine. You try to find out what it all means. Not all of it is obvious, but some things got clearer over time. The really tough thing was that the noises were there all the time. You never really got to rest, so you never had a proper night’s sleep. That was something I found quite hard.
Tobias Giebler: I remember that you mostly slept during the periods when you were lying in prone position. That set a certain rhythm. Do you remember anything about this time?
Bernd Tittel: No, nothing at all.
Tobias Giebler: What do you remember from the periods when you were awake?
Bernd Tittel:I was always tired, right through this whole phase. I always wanted to sleep, but sometimes it just wasn’t possible because it was either too bright or too loud. So tiredness was my constant companion.
Tobias Giebler: You also underwent therapy during the times when you were awake. We had speech therapy, occupational therapy and physiotherapy 1–2 times a week. I assume that was exhausting for you?
Tobias Giebler: For us, you were a patient who quickly regained consciousness and was able to communicate. The ventilation tube was manageable because we could read your lips, and we were also able to use an alphabet board and a writing pad to assist you. I rarely had the feeling that I didn’t understand what you were trying to say. Did making yourself understood get any easier with time?
Bernd Tittel: It was very much dependent on the person I was interacting with, and their willingness to engage. Particularly when boards and writing were involved. It was made even more difficult when I experienced bleeding into my arm. Then I couldn’t even point and write any more. That was a barrier for me, but it was good to know that someone was always there.
Tobias Giebler: Were you in pain during this time?
Bernd Tittel: No, I can’t remember any pain.
Tobias Giebler: What did you notice about the technical equipment, alarms and so on?
Bernd Tittel: There were constant alarms and signals that were to do with me, yes!
Tobias Giebler: Can you describe that in more detail?
Bernd Tittel: You’ve got time, in that situation. At some point you try to make sense of the sounds. Each sound means something different. Something is empty – the food or a medicine. You try to find out what it all means. Not all of it is obvious, but some things got clearer over time. The really tough thing was that the noises were there all the time. You never really got to rest, so you never had a proper night’s sleep. That was something I found quite hard.
Tobias Giebler: I remember that you mostly slept during the periods when you were lying in prone position. That set a certain rhythm. Do you remember anything about this time?
Bernd Tittel: No, nothing at all.
Tobias Giebler: What do you remember from the periods when you were awake?
Bernd Tittel:I was always tired, right through this whole phase. I always wanted to sleep, but sometimes it just wasn’t possible because it was either too bright or too loud. So tiredness was my constant companion.
Tobias Giebler: You also underwent therapy during the times when you were awake. We had speech therapy, occupational therapy and physiotherapy 1–2 times a week. I assume that was exhausting for you?
Bernd Tittel: For the physiotherapy, I was supposed to wiggle my toes. But after such an effort, I was usually happy to go back to sleep. You try your best, but you can hardly do anything when you’re so tired.
Tobias Giebler: I found you to be a very positive person who was incredibly committed during these therapy sessions. You always asked the speech therapist to practise with you a little longer. Why was that?
Bernd Tittel: Well, on the one hand it was the need for movement and normality. On the other hand, at the beginning I actually found it motivating that I could divide my day into two halves. Then there was time for me again.
Tobias Giebler: The psychiatrist started seeing you very early on. So you had psychological counselling during this time. How did you feel about that?
Bernd Tittel:That was very important. Sometimes I missed those conversations. Particularly on days that were tough.
Tobias Giebler: How did you feel about the helpfulness and dedication of the nursing staff?
Bernd Tittel: The nurses were all very dedicated and looked after me, but that’s their job after all. I was particularly pleased with the student nurses. Some of them were my age and simply took a bit more time with me.
Tobias Giebler: What was it like when you were able to stand up for the first time?
Bernd Tittel: That was a huge step forward. I remember the first time I was able to stand up after 3–4 weeks. My legs still felt weak, though. It was a huge step, but it was very shaky. Standing just didn’t feel all that safe.
Tobias Giebler: I found you to be a very positive person who was incredibly committed during these therapy sessions. You always asked the speech therapist to practise with you a little longer. Why was that?
Bernd Tittel: Well, on the one hand it was the need for movement and normality. On the other hand, at the beginning I actually found it motivating that I could divide my day into two halves. Then there was time for me again.
Tobias Giebler: The psychiatrist started seeing you very early on. So you had psychological counselling during this time. How did you feel about that?
Bernd Tittel:That was very important. Sometimes I missed those conversations. Particularly on days that were tough.
Tobias Giebler: How did you feel about the helpfulness and dedication of the nursing staff?
Bernd Tittel: The nurses were all very dedicated and looked after me, but that’s their job after all. I was particularly pleased with the student nurses. Some of them were my age and simply took a bit more time with me.
Tobias Giebler: What was it like when you were able to stand up for the first time?
Bernd Tittel: That was a huge step forward. I remember the first time I was able to stand up after 3–4 weeks. My legs still felt weak, though. It was a huge step, but it was very shaky. Standing just didn’t feel all that safe.
I was just grateful that someone was talking to me, taking the time to tell me were I was, and being there for me.
Tobias Giebler: Were you able to walk straight away?
Bernd Tittel: No, I couldn’t walk yet. I made my first outings in a wheelchair. I was then offered a kind of rollator, but I didn’t feel that confident with it.
Tobias Giebler:In the last few days before your discharge, plans for your rehabilitation were arranged. You were then transferred to Kempten. What was that like for you?
Bernd Tittel:Kempten was a chance for me to recuperate at first. I was able to calm down a bit and gather my strength. It was quite a change to go from the intensive care unit to a rehabilitation centre like this. I also had occupational therapy, physiotherapy and speech therapy there.
Tobias Giebler: How did you find your time in rehabilitation?
Bernd Tittel: Overall, my time in rehabilitation was good. You could learn a lot. You could take a lot away with you. I also took advantage of the group programmes. You met a lot of people there who had been through the same thing.
Tobias Giebler:What were the most important successes for you in rehabilitation?
Bernd Tittel: I was able to get up on my own again, get dressed and walk a bit. These were all steps that helped me progress. In hindsight, the progress I made was huge.
Tobias Giebler: You were then discharged from rehabilitation. What’s next for you?
Bernd Tittel:I’m now continuing with outpatient rehab. I have occupational therapy, physiotherapy and speech therapy there as well. And I’ve now got an assistance dog to help me in everyday life.
Tobias Giebler: Do you feel like you’re back to your old self now, or has anything changed?
Bernd Tittel:No, I’m definitely not the old me. A lot has changed. Both physically and mentally. I’ve had a lot of time to think about myself. After all, I’ve spent a lot of time in bed.
Tobias Giebler: How do you deal with these changes?
Bernd Tittel: Some are difficult, others not so much. You just have to grit your teeth and make the best of it. You can’t just sit down and give up.
Tobias Giebler: Do you have any plans for the future?
Bernd Tittel:I haven’t got any definite plans for the future yet. I’m just taking things day by day and seeing what happens. There are a lot of things you can’t predict.
Tobias Giebler: Is there anything else you’d like to pass on to our readers?
Bernd Tittel:Yes, most importantly: Get vaccinated! That is the most important thing. This disease is not to be underestimated.
Tobias Giebler:Thank you, Bernd, for telling us so openly about your experiences. We wish you all the best on your road to recovery.
Bernd Tittel: No, I couldn’t walk yet. I made my first outings in a wheelchair. I was then offered a kind of rollator, but I didn’t feel that confident with it.
Tobias Giebler:In the last few days before your discharge, plans for your rehabilitation were arranged. You were then transferred to Kempten. What was that like for you?
Bernd Tittel:Kempten was a chance for me to recuperate at first. I was able to calm down a bit and gather my strength. It was quite a change to go from the intensive care unit to a rehabilitation centre like this. I also had occupational therapy, physiotherapy and speech therapy there.
Tobias Giebler: How did you find your time in rehabilitation?
Bernd Tittel: Overall, my time in rehabilitation was good. You could learn a lot. You could take a lot away with you. I also took advantage of the group programmes. You met a lot of people there who had been through the same thing.
Tobias Giebler:What were the most important successes for you in rehabilitation?
Bernd Tittel: I was able to get up on my own again, get dressed and walk a bit. These were all steps that helped me progress. In hindsight, the progress I made was huge.
Tobias Giebler: You were then discharged from rehabilitation. What’s next for you?
Bernd Tittel:I’m now continuing with outpatient rehab. I have occupational therapy, physiotherapy and speech therapy there as well. And I’ve now got an assistance dog to help me in everyday life.
Tobias Giebler: Do you feel like you’re back to your old self now, or has anything changed?
Bernd Tittel:No, I’m definitely not the old me. A lot has changed. Both physically and mentally. I’ve had a lot of time to think about myself. After all, I’ve spent a lot of time in bed.
Tobias Giebler: How do you deal with these changes?
Bernd Tittel: Some are difficult, others not so much. You just have to grit your teeth and make the best of it. You can’t just sit down and give up.
Tobias Giebler: Do you have any plans for the future?
Bernd Tittel:I haven’t got any definite plans for the future yet. I’m just taking things day by day and seeing what happens. There are a lot of things you can’t predict.
Tobias Giebler: Is there anything else you’d like to pass on to our readers?
Bernd Tittel:Yes, most importantly: Get vaccinated! That is the most important thing. This disease is not to be underestimated.
Tobias Giebler:Thank you, Bernd, for telling us so openly about your experiences. We wish you all the best on your road to recovery.
Bernd Tittel’s experiences with the bed bike in the intensive care unit
Tobias Giebler: Bernd, you also trained on the bed bike in the intensive care unit. Do you remember anything about that, what was it like for you?
Bernd Tittel:It was very motivating. To be able to move while lying down was a step forwards for me. I know this activity. It’s a popular sport. I found it amazing that you could do that in the intensive care unit. The great thing was that it was all explained to me clearly, and the training was adjusted to suit my performance. The therapists always took care of me. So I found the training to be very useful!
Tobias Giebler:Were you aware what the training with the bed bike was meant to achieve?
Bernd Tittel: For me, it was a kind of mobilisation. When I pedalled, my legs were bent and stretched – with some electronic support of course. And with resistance added, it became a workout for my muscles. It was clear that I wasn’t going to be standing and walking without leg muscles! The training helped get everything – my muscles, my circulation – back in shape.
Tobias Giebler: Bernd, you also trained on the bed bike in the intensive care unit. Do you remember anything about that, what was it like for you?
Bernd Tittel:It was very motivating. To be able to move while lying down was a step forwards for me. I know this activity. It’s a popular sport. I found it amazing that you could do that in the intensive care unit. The great thing was that it was all explained to me clearly, and the training was adjusted to suit my performance. The therapists always took care of me. So I found the training to be very useful!
Tobias Giebler:Were you aware what the training with the bed bike was meant to achieve?
Bernd Tittel: For me, it was a kind of mobilisation. When I pedalled, my legs were bent and stretched – with some electronic support of course. And with resistance added, it became a workout for my muscles. It was clear that I wasn’t going to be standing and walking without leg muscles! The training helped get everything – my muscles, my circulation – back in shape.
Tobias Giebler:A nice summary, and it’s great that you realised the significance of all this as a patient. It’s always important to me to explain why and for what purpose the individual therapeutic measures are used. The bed bike has the potential to accelerate strength gain and demonstrably improve walking ability.
The bed bike has the potential to accelerate strength gain and demonstrably improve walking ability.
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Cycling
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Intensiv- & Akutpflege
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Therapy & Practice
THERAPY 2024-I
THERAPY Magazine
Tobias Giebler
Intensive care medicine and neurosurgery expert, Tübingen University Hospital
Tobias Giebler graduated as a physiotherapist at the University Hospital of Freiburg
in 2013. Due to his several years of working as a paramedic in the emergency services,
he already brought knowledge in dealing with patients in the intensive care unit into
his physiotherapeutic training. He has been working intensively on the topic of early
mobilisation for 9 years. He works at the Tübingen University Hospital in the Therapy
Centre and has been the deputy area expert for intensive care medicine and neurosurgery
since 2023.
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