Are Family Meetings Generally Helpful for Our Mom’s Care in ICU?
Published: Sat, 07/22/23
Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED” and in last week’s episode I answered another question from our readers and the question was
You can check out last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer questions from one of my clients, Emma, as part of my 1:1 consulting and advocacy service! Julius and Emma’s mom is critically ill in ICU & they are asking if family meetings are generally helpful for their mom’s care.
Julius: Yeah, just one
time, because … And it was actually kind of orchestrated at the time we were going to be there because of patient rights, really.
Patrik: Right. And they let-
Emma: Was it 9:00 or … Maybe it’s early. Maybe it’s just before 10:00 because 10:00 is visiting hours. So maybe it’s 9:00.
Patrik: Okay.
Emma: Was it early that day? I think it was early that day. Yeah. It could be just before visiting. We’re not a hundred percent sure, but that’s the only time we’ve seen that going on.
Patrik: Right. And they let you stay for the round?
Julius: They did.
Emma: That particular time.
Julius: Because of patient relations, I would say.
Emma: Yeah.
Patrik: Right. Okay.
Julius: No, seriously, I don’t … Because they pushed us out today when there were things going on with the rounds, it was like, “Okay, Sir, we got to go because they’re coming down and they want us out.”
Patrik: Well, again, what is it that they have to hide during a round? What is it that you can’t hear?
Julius: One of the nurses gave me a very cryptic notification, saying, “Hey, there’s been lots and lots of doctors here today. Did you get phone calls?” I’m like, “No.”
Let’s look at the computer, make sure this is your name and that’s your phone number. I’m like, “Yep.” He goes, “Because sometimes grandmother doesn’t know how to pick up the phone.” That kind of stuff. And he kept telling me this, but “Lots and lots of doctors were here.” So, I went and called patient relations and made sure that those lots and lots of doctors were there the next day for us to talk to.
Emma: Oh, tell him about the doctor that said he called you and she didn’t.
Julius: Oh, yeah, and then they lie and say they called you, left a message.
Ron: Left messages and they didn’t.
Julius: There’s a COVID police or whatever, I don’t … nurse practitioner that is the boss of everything, tends to really push the narrative of everything.
Emma: She pushes the COVID narrative hard.
Julius: And lies.
Patrik: Unbelievable.
Julius: You can make a movie on this. It’s like the same thing over and over again. I mean-
Emma: And when the questions get too intense, she reverts to, “Well, nothing we can do. It’s COVID.” That’s the answer you get. When you’re asking about, like, “Well, how can you treat her for pneumonia?” It’s bad.
Julius: I guess my main concern is to bring up this nitric oxide, what doctor
should be the … I mean they use so many of them.
Patrik: Yeah. Possibly a pulmonologist.
Julius: What? Say that again?
Emma: Pulmonologist.
Julius: Pulmonologist. Okay.
Patrik: But, look, a lot of ICU doctors are also pulmonologists. Not all of them, but there’s a reasonably large-
Julius: Yeah, seems like it.
Patrik: Right. Right. So hopefully your doctor in charge is an ICU specialist/pulmonologist. But you can’t tell me they haven’t heard of nitric oxide.
Julius: Okay. I know.
Emma: Okay.
Julius: Well, I mean, my nurse cousin definitely was like, “Interesting. Very interesting.” Because they must remember from that, they-
Patrik: Of course. Of course. I’d say anyone that’s nursed in ICU for more than 10 years would remember nitric oxide.
Julius: They do. You’re right. It’s a past knowledge of theirs. And
that-
Patrik: Look, yeah, it depends. As I said, I know here there are ICU still using nitric oxides. Yes, it has gone out of the window a little bit with other treatment options. And that’s what I mentioned yesterday, Julius. If your mom was 65 or less, I would’ve said, “Well, they need to get her on ECMO
(extracorporeal membrane oxygenation). But the cutoff for ECMO is usually at 65. And when you do ECMO, you don’t need nitric oxide. So, yes, to a degree it is a bit old-fashioned because ECMO has come in the last 10 to 15 years. But, again, it’s-
Julius: But we’re talking about the elderly.
Patrik: Correct.
Emma: Why would there be an age difference for some of these? Is it because it maybe affects the kidneys or something?
Patrik: You mean like for certain-
Emma: Why?
Patrik: No, I tell you why ECMO, for example, has an age cutoff. If ECMO doesn’t succeed, it often leads, or it can lead to a lung transplant or a heart transplant. And simply-
Emma: Oh.
Julius: Okay.
Patrik: Right. So, it has to be thought through before you put someone on ECMO, what’s the end game?
Emma: Okay.
Patrik: Right? In case it doesn’t work. And the end game is often a transplant. And when you look at transplants across the board, the cutoff again is usually around 60, 65.
Emma: Oh, I see. See, that makes perfect sense. Yeah. It’s
just amazing when nobody tells you anything, how you don’t know.
Julius: Yeah. That makes a lot more sense.
Emma: And you feel so
much better when you understand what’s going on. Yeah.
Julius: I really do think
I’ll probably have to have patient relations set up a meeting and maybe … they call it family meeting. The only thing I ever-
Patrik: So I was-
Julius: Yeah?
Patrik: Wanted to leave you with that, the family meeting. So, I’m expecting them to call you at some point and say, “You got to come in for a family meeting and you got to do this, and you got to do that.” And now-
Julius: I think it’s going to be tomorrow.
Patrik: Right. Okay.
Emma: Might be tonight.
Patrik: Okay.
Emma:
Who knows?
Patrik: So, what you need to do if they ask you for a family meeting, ask them to give you an agenda in writing and then you will see whether you want to go there or not.
Julius: Okay. Wait for them to say the family meeting.
Patrik: Well, let me ask you this, do you want a meeting?
Julius: Yes, I do.
Patrik: Okay. Well, then you should be asking for it. Then you should be asking for it.
Julius: Because I feel like I’ve asked for it and they kind of shuffle the … I don’t know, shuffle the doctor, is a doctor shuffle. “Oh. I’m so-and-so and I can tell you …” With patient relations. And then they do it so fast. I just want it to be really a family meeting. I really do.
Patrik: Right.
Emma: What was it, I mean-
Patrik: Because if they do it, they are in control. So-
Julius: Yes, I want to be.
Patrik: You want to be in control. And I think with everything that’s happening, you may want to ask for a meeting.
By the same token, if things are improving, well hopefully they are, then no need to make a big fuss. Let’s just carry on with what they’re doing.
Julius: Right.
Emma: Yeah. For that.
Julius: And the only reason why I say that is because I feel like they’re going to try … I don’t like this take control that it’s been all this time. I’m trying to take control and they’re not letting me. But I know that word, family meeting, you get
control.
Patrik: It’s a loaded word in my mind.
Julius: Word, exactly.
Patrik: In ICU, it’s, again, the family meeting is all about pushing a narrative.
Julius: Yes. But if I’m creating it, maybe we can get … My version of a family meeting is I get to see their whole rundown and then say, “Hey,
how about this?”
Patrik: Yep.
Emma: It also seems like everything that goes wrong always goes wrong when it’s not visiting
hours.
Patrik: Yeah. Look, there is-
Emma: It could just be my imagination. I don’t want to say anything.
Patrik: Look, there is a higher propensity for things to go wrong in ICU after hours. There definitely is.
Emma: Okay. All right.
Patrik: When I look at my time in ICU, sort of emergencies usually happens at 2:00 AM, not at 2:00 PM.
Emma: Okay.
Julius: Okay. That’s good to-
Patrik: That’s not to say there aren’t any emergencies happening at 2:00 PM, but there’s just … I don’t know what it is.
Julius: I don’t know what it is either. Yeah.
Emma: Yeah. Okay. I didn’t know if that was unusual or not. I just thought I’d bring it up.
Julius: So, would you suggest I do say family meeting or are you thinking, “No?”
Emma: Should we wait for them to bring it up, or what do you
think?
Patrik: What’s the movement of the doctors? And what do I mean by that? So, are they changing every few days? Have you only been dealing with one team so far?
Julius: Yes. Yes. It’s been-
Emma: It’s like we never really know who’s going to be there.
Julius: It’s every other day.
Emma: Yeah.
Julius: Even the doctors
are changing. But Elly, the nurse practitioner, MD, that she calls herself for the COVID, closed … Oh, wait, that is a closed unit. They’re a closed unit ICU.
Patrik: Again, they’re creating another narrative that just in case you wanted a second opinion, “We don’t want that.”
Julius: Yeah.
Emma: Right. Yeah.
Julius: Thank
you.
Emma: You got it.
Julius: Thank you.
Julius: That’s what I’m going with that. Yes.
Patrik: Yeah.
Emma: You got it.
Patrik: Yeah. That’s okay. Look for now, I think you’ve got enough to deal with just what’s at hand. You can look at things like getting a second doctor in, make your suggestions, get more information.
Emma: Right. We didn’t even know if we needed one. Just hitting base with you is helping us out.
Patrik: Of course.
Emma: Because we didn’t know-
Julius: Medically.
Emma: Yeah. We had no idea what to even suggest. Or even-
Julius: Yeah. My dad said, within that 5, 10 minutes, 15 minutes of talking with you, I calmed down.
Patrik: Yeah. Oh, definitely. No, no. It’s very easy to get sucked in, sucked into the negativity. And it’s very easy to lose perspective.
Emma: Yes.
Julius: Yes.
Patrik: Right? And-
Ron: Well, because they keep being so negative. They never once give anything positive.
Patrik: Of course. Of course.
Ron: It’s all negative.
Emma: Even when the numbers are improving. They were early on.
Patrik: Of course. I sort of keep saying to my clients, half-jokingly, they’re still negative by the time your family member is leaving ICU alive. They’re still saying, “Look, I told you … is whatever.”
Julius: Yeah. Well, apparently, the one guy told me that no one leaves the
floor.
Emma: She had a guy tell her, “Hey, it’s roach motel here, patients check in. They don’t check out.” I mean, that’s basically … I don’t know if you’re familiar with that commercial, but-
Ron: Yes.
Julius: Oh, my God.
Patrik: No.
Julius: I was by myself at the time then. I didn’t feel very good.
Patrik: No. And God forbid, even if you’re not getting the outcome that you
would like, it’s still important for you to have perspective, because otherwise you would just get sucked into this narrative without having perspective.
The 1:1 consulting session will continue in next week’s episode.
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