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

Why is the ICU Team Discussing End-of-Life Options for Dad When He Has Only Been in the ICU for 15 days? Help!

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, Iyah, as part of my 1:1 consulting and advocacy service! Iyah’s dad is in ICU with lung failure and she is asking if they can get her dad off the ventilator.

My Dad has Lung Failure in the ICU. Can We Get Him Off the Ventilator?

 You can also check out previous 1:1 consulting and advocacy sessions with me and Iyah here.

Part 1

Part 2

Part 3

Part 4

Part 5

Part 6

Patrik:  Right, because it sounds to me like you can’t come to an agreement as a family and it’s not good or bad, it just is, right?

Iyah: Yeah, and I’m torn.

Patrik: Yeah, for sure.

Iyah: I’m torn.

Patrik: For sure. And I do believe that strengthens the argument that he needs to make his own decision because you as a family can’t agree.

Iyah:  That sounds great. I would want him to make his own decision. I don’t want that to be placed on the children.

Patrik:  No, definitely not.

Iyah:  So, that is an option then that we can demand.

Patrik:  I think, Iyah, as long as you as a family haven’t appointed someone as a decision maker, I think the hospital will almost point you back to that. I think any reasonable and sensible person would point you back to that.

Iyah:  The next treatment needed would be tracheostomy and-

Patrik:  It would be.

Iyah:  And then, if he’s able to communicate on his own, he can let everyone know.

Patrik: Yeah, I think so.

Iyah: Yeah.

Patrik: I would not want anyone to make a decision about my life, I wouldn’t.

Iyah:  Likewise, yeah.

Patrik:  Put yourself in his shoes.

Iyah:  Yeah, yeah. Same with me, I would not want that either. Is this something that you can help us with tomorrow?

Patrik: Yeah, for sure. For sure. I think you’ve got the answer then that if you don’t want anybody to make a decision about your life, I think you’ve got your answer.

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Iyah: Yeah. And like I said, my other two siblings are not digging deeper for questioning anything. They want to go with dad is suffering too much. This needs to stop now. But my younger sister is adamant, end of life is out of the equation and I’m just torn, so we can’t come to an agreement.

Patrik: I think it’s very reasonable.

Iyah:  Okay. We have a call with a palliative staff doctor all tomorrow. Is that something you can help with?

Patrik: Yeah, definitely, definitely. Yeah. 2:30 tomorrow. That is around the same time now.

Iyah:  Excellent, excellent. I so greatly appreciate you, Patrik. I can’t express how much you’ve been able to help with the guidance, and experience, and knowledge. Before I contacted you, I was so torn. And watching your videos, it helped me so much to be able to think about questions that I need to ask and what can happen if A, B, C don’t happen, blah-blah-blah.

Patrik: Right. And you are still torn and that’s okay. I would be torn. Even though I’ve done this for many years, doesn’t mean I wouldn’t be torn if it was my dad. It’s normal. It’s nothing to be ashamed of or it’s very normal. I would be worried if people weren’t torn. The people who aren’t torn are the ones that come back one year later and say what if. They’re the ones that aren’t torn, and they get torn a year later and then it’s too late.

Iyah: Yes. I’m just going through my sister’s text. I appreciate your time so much, and I value it so much. I understand it’s almost 7:30, so I don’t want to take up too much more of your time. Just going to see if there’s-

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Patrik: Do you want to dial your sister in? We can dial your sister in.

Iyah:  If you don’t mind trying again.

Patrik:  Can you give me 15 minutes and I’ll get back to you and your sister? If you can give me 15 minutes, maybe that also gives your sister time to get ready.

Iyah: No. Actually, no, because I don’t know what’s going on with her. Bad reception, her phone, she’s saying her phone is not working, so it’s okay. She just texted me just a little more things. And she was asking cucumber flush to help the kidneys. Can that help his kidneys function again, his transplanted kidney function again?

Patrik: I am not sure about that. I think this is a question more for the nephrologist. From experience, your dad is at much higher risk of kidney failure than someone who has their own kidneys. I think your dad coming back from kidney failure is very, very slim because he already has a kidney that was a transplant. I think your dad coming back from kidney failure is very unlikely.

Iyah: And when you say that, does that mean dialysis is not an option for him or?

Patrik: No. Absolutely, dialysis is an option.

Iyah: Okay. Yes. Just not how it was before. Now, he needs to go back to dialysis.

Patrik:  That’s right. That’s right.

Iyah: Yeah. Another question was whether alkaline herbs and foods would help improve his  condition, question mark.

Patrik:  I doubt it at the moment. Not in the short term, but maybe in the long term.

Iyah: I’m just honoring his questions by asking.

Patrik: Yeah, yeah. No, no, sure. The reason I’m saying that is nutrition is important in ICU, right, but it’s not as important as other things. The importance for your dad at the moment is what do we do with the lung failure? How do we get him off the ventilator right? Those are priorities.

Iyah: That’s right. That’s absolutely right. The last question from her is what do you think about malpractice lawyer regarding neglect or misdiagnosis? So, my sister is on the extreme end, and she believes placing him on a ventilator was the wrong thing for him. She believes that he could have sustained his own breathing, even though the nasal oxygen, not the high flow oxygen cannula.

They didn’t try that at all. The nasal cannula, he was decreasing in saturation O2 (oxygen), and then the breathing mask covering his nose, and his mouth was still decreasing. And his ABG (Arterial Blood Gas) blood work was declining compared to hours prior and all.

Patrik: I’ll tell you what I think about that. So, I do believe that whenever there is medical negligence that you have a pretty strong case to sue a hospital. Okay. I do believe that. And what I don’t know is whether everything that she says is accurate, but this is something that can be found out.

So, what I mean by that is we could look at the medical records, and we could as a first step, look at the medical records and tell you whether you’ve got a case or not. Bear in mind, we’re not lawyers, but we are clinicians, and we can find out pretty quickly whether you’ll have a case there or not, and then you can refer it to a lawyer.

Iyah:  That’s who I would like to go towards, yeah, look into the medical

 records.

Patrik: Right. There’s absolutely a case for that if there was medical malpractice.

Iyah: If, I’m sorry, I didn’t catch that, if?

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Patrik:  I said there’s absolutely a case for you to go to a lawyer if you have evidence for medical malpractice.

Iyah: Got you.

Patrik: But by your sister saying what she’s saying, to me, is not evidence yet because you have a suspicion. Fair enough. But the question is, can that be substantiated through the medical records?

Iyah: Right. And along that line, when he went into ICU, he went in there twice. So, first was in the morning around 9:00 AM through an ambulance, and he complained of neck pain at first, and then he was unable to breathe. So, I called the ambulance, and they had him on an oxygen nasal cannula, which was going through the nostrils.

And his O2 (oxygen) saturation was 91 percent so, the ER (Emergency Room) doctor discharged us. And then, later on around 11:00 PM that night, we had to call the ambulance again because he couldn’t breathe, asking for his asthma  inhaler, gave it multiple times back and forth because he couldn’t breathe.

So, we called the ambulance again, and then at that time, my brother went with him, and I guess they probably tried the oxygen nasal cannula again. But I got there maybe three hours after he was admitted. He was on the oxygen mask with the… and I think I asked you this before, do you think that instead of the oxygen mask, because it dehydrated his mouth and he has food overload, he couldn’t drink, he was pleading for water. Would the high-oxygen nasal cannula have been a better alternative than the oxygen mask?

Patrik:  Potentially, yes. Potentially, yes. But again, in medicine, there’s always the fallback of it depends, right? The question to me would be rather around, okay, if he went into the emergency room, they sent him home, and then a few hours later, you had to call the ambulance. The question to me is would be more around what have they missed when he went into the ER?

And then, that’s number one, what have they missed in ER to potentially misdiagnose him? Number two, coming back to your specific question about nasal cannula versus high flow nasal cannula, I would need to look at the whole medical records, why they didn’t go with the high flow cannula. It could be as simple that they didn’t have it available in this hospital, but there could also be something else.

Iyah:  They do have it. The nurse did tell me they do have it.

Patrik: Right. I thought they would. Most hospitals have it, right? But I’m just thinking, what else? Is there something we’re missing?

Iyah:  Yeah.

Patrik:  For example, did they go from the cannula to the ventilator straight away because he crashed? That would be the first thing that comes to mind from my end. Did he crash?

Iyah:  And when you say crash, the O2 saturation, would that have dropped from below 85? Is there an-

Patrik:  Yeah, possibly, something like that. Something like that. Or did he stop breathing?

Iyah:  Nope. He never stopped breathing. But the whole time with the oxygen mask covering his nose and his mouth, his O2 saturation was like his 86 to 90, 91. Was that enough to warrant a ventilator?

Patrik: Oh, absolutely, absolutely.

Iyah: Okay. And that’s another thing that I was wrestling with in my head and my younger sister, is that the ventilator was the wrong thing to do. And with me, I was thinking I did not ask about an alternative instead of a ventilator. But if you’re saying when the O2 saturation is within the mid-80s, that is serious, unable to breathe on your own, correct?

Patrik: Very much so, very much so.

Iyah: And the longer that he cannot breathe on his own, his brain will lose oxygen and his heart. So, it would just continue to have him  decline and possibly pass away or eventually pass away-

Patrik: That’s right. That’s right.

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Iyah:   … without a ventilator. Okay. Thank you so much for your time. I really appreciate your time.

Patrik:  It’s a pleasure. It’s a pleasure.

Iyah: I would love to connect back with you tomorrow, like I said, at 2:30.

Patrik:  Yeah. Let’s aim for 2:30.

Iyah:  Thank you. Thank you so much.

Patrik: It’s a pleasure.

Iyah:  Okay, I’ll talk to you then.

Patrik:  I’ll talk to you tomorrow at 2:30 your time.

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Iyah: All right. Thank you so much.

Patrik:  Okay. It’s a pleasure. We’ll talk tomorrow.

Iyah: Okay. Have a good night.

Patrik: Thank you so much. Thank you. Bye. Bye.

Iyah: Thank you. Bye.

The 1:1 consulting session will continue in next week’s episode.

Kind regards,

Patrik

I only have one consulting spot left for the rest of the week, if you want it, hit reply to this email and say "I'm in" and I'll send you all the details.