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I think Libby in the hospital was just Michael having a nightmare. I like your thinking though Queen. There were several differences in the Libby hospital room and the room he actually was in. Maybe he was dreaming about his first hospital stay when he walked in front of a car, but I still think it was a dream. I don't really like the idea that maybe Libby was at one time a nurse back during his first hospital stay, because he should have remembered her when he first saw her on the island.

yeah I think it was just a guilt induced nightmare with Libby and the main reason for the differences in the rooms was to let the viewer know that it was a nightmare and different from his vision of Libby in the freighter engine room.