Hi, it's Patrik Hutzel from INTENSIVECAREHOTLINE.COM , where we instantly improve the lives of Families of critically ill Patients in Intensive Care, so that you can 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!
In last week's BLOG I've shown you "The 5 QUESTIONS you need to ask, if the Intensive Care team wants you to DONATE your loved one's ORGANS in an
END OF LIFE SITUATION!"
You can check out last week's BLOG here!
In this week's BLOG I
want to show you
The 3 DISTINCT reasons the Intensive Care team DOESN'T WANT YOU TO QUESTION their approach or have PEACE OF MIND, control, power and
influence!
You've got a big problem and you know it!
You know by now that you've got a problem.
You know by now that if your critically ill loved one is in Intensive Care with a critical illness and is either
- very unstable and in a very critical condition
- in a life threatening situation
- in Intensive Care for long-term treatments and long-term stays
- having a severe(traumatic) head or brain injury
- approaching their end of life in Intensive Care
you know that you have a serious issue at hand and you know that PEACE OF MIND, control, power and influence in such situations are hard to come by.
Stress, overwhelm, vulnerability and challenge leave you without PEACE OF MIND, control, power and influence
In fact 99% of Families of critically ill Patients in Intensive Care have no PEACE OF
MIND, no control, no power and no influence during this "ONCE IN A LIFETIME" situation when their loved one is critically
ill in Intensive Care!
Those Families of critically ill Patients in Intensive Care tend be so stressed, overwhelmed, challenged, frustrated, paralysed by fear, vulnerable and out of their comfort zone that they are literally running around like "headless" chickens so to speak.
And even worse, their poor body language- implicitly or explicitly- is telling everyone around them, including the Intensive Care team, that they have no PEACE OF
MIND, no control, no power and no influence!
Those Families of critically ill Patients in Intensive Care don't even know that PEACE OF MIND,
control, power and influence is something they can achieve, if you know what to do, if you know what questions you need to ask and if you know how to position yourself and your critically ill loved one during this challenging and "ONCE IN A
LIFETIME"situation!
And you might say, "Patrik, I have no idea how to position myself, I have no idea where to start and I have no idea how I can get PEACE OF
MIND, control, power and influence!"
And the reality and the fact of the matter is that it's totally possible to get there so that you can turn things around in your favour!
The Intensive Care team doesn't want you to have PEACE OF MIND, control, power and influence!
Even though, even though the Intensive Care team doesn't want you to
have PEACE OF MIND, control, power and influence!
That's the last thing they want to have happen and having said that the Intensive Care team is so used to be running the show, to drive the bus so to speak and they tend to be so busy in driving their mainly hidden agenda whilst you are busy worrying and fearing for the very life and the very well being of your critically ill loved one!
As a matter of fact, if I have learned one thing in more than 15 years Intensive Care nursing in three different countries, where I literally worked with thousands of critically ill Patients and their Families, it's that if a Family had PEACE OF MIND, control, power and
influence, the Intensive Care team didn't like it.
The Intensive Care team doesn't want Families of critically ill Patients to have PEACE OF MIND, control, power and influence, because the
Intensive Care team then perceives you and your Family as "difficult" or "demanding"!
And that's good news, if the Intensive Care team perceives you and your Family as "difficult" or "demanding" you are on the right track!
Don't put the Intensive Care team on a pedestal and don't "suck up" to them!
The other 99% of Families of critically ill Patients in Intensive Care are
busy "sucking up" to the Intensive Care team and putting them on a pedestal. The result? No PEACE OF MIND, no control, no power and no influence!
However, the truth of the matter is that once you and your Family are on the right path to PEACE OF MIND, control, power and influence, especially if your loved one is in one of those challenging, difficult,
demanding and "ONCE IN A LIFETIME" situations, where
- very unstable and in a very critical condition
- in a life threatening situation
- in Intensive Care for long-term treatments and long-term stays
- having a severe(traumatic) head or brain
injury
- approaching their end of life in Intensive Care
that's exactly where the "rubber hits the road" so to speak,
because from the Intensive Care team's perspective there is far more at stake during those difficult, challenging, demanding and often heartbreaking situations than "just" the life or the well being of your critically ill loved one and that's exactly why the Intensive Care team doesn't want you to have PEACE OF MIND, control, power and influence!
"BEHIND THE SCENES" is where decisions are being made!
Once you and your Family understand what's happening "BEHIND THE SCENES" in Intensive Care, once you and your Family understand the politics, the dynamics, the power play, the intrigue, the psychology and most of all the hidden agendas in Intensive Care, that's when you will have PEACE OF MIND, control, power and influence!
Once you and your Family know and understand that what's happening "BEHIND THE SCENES" in Intensive Care impacts on the positioning of your critically ill loved one's
diagnosis and prognosis by the Intensive Care team and once you understand that what's happening "BEHIND THE SCENES" can impact on the care and
treatment offered or not offered for your critically ill loved one that's when you will have PEACE OF MIND, control, power and influence!
In fact there are three distinct reasons why the Intensive Care team doesn't want you to have PEACE OF MIND, control, power and influence, during those difficult, challenging and heartbreaking situations!
Let's shed some light on it!
1. The Intensive Care team's/ unit's financial interests
Let's face it. Intensive Care is a multi $$$ Billion Dollar industry per year. If your critically ill loved one is in one of those difficult and challenging situations that could cost a lot of money
with no guaranteed outcome, the Intensive Care team will be doing the maths.
The truth of the matter is that if the Intensive Care team perceives your loved one's treatment and stay in Intensive Care as too costly or if they think they are
not making any money, the Intensive Care team's calculations will inevitably impact on the Intensive Care team's positioning of your critically ill loved one's diagnosis and prognosis and also on the care and treatment offered or not offered.
Your job is to be aware that the Intensive Care team is counting Dollars $$$ and if you can't read the signs and the writing on the wall and if you don't question you will have no PEACE OF MIND, no control, no power and no influence!
2.Bed occupancy and other Patients waiting for Intensive Care beds
This is another big one and one that escapes Families of critically ill Patients as well! If your critically ill loved one is in a difficult, dire, challenging and heartbreaking situation and the Intensive Care team knows that they have other Patients waiting for scarce, precious and expensive Intensive Care beds and the Intensive Care team also thinks that your loved one might "block a bed" for a long time to come, the Intensive Care team once again, may "adjust" your critically ill loved one's diagnosis and prognosis and may also adjust the care and treatment for your critically ill loved one, according to their priorities.
Their priorities might change at any given time because they perceive other admissions to Intensive Care as "more interesting", more financially viable and therefore the minute the Intensive Care team suggests a "WITHDRAWAL"or a "LIMITATION OF TREATMENT" as being in "the best interest" of your critically ill loved one, you always need to question their approach! Because the very reason for this approach could be bed and financial pressures!
ICU beds are in high demand and often ICU's can't cope with this high demand!
3. Medical research interests
If I had a Dollar $$$ for every Patient in Intensive Care who is enrolled in a medical research study without their knowledge, without them or their Families being informed and without giving their or their Family's consent I would
be a Millionaire.
The fact of the matter is that Intensive Care Units heavily rely on funding from Universities or even government organisations to conduct medical research on real human
beings!
Therefore, the interests in Intensive Care besides treating critical illness are huge and once again, Intensive Care Units rely heavily on 5, 6 or even 7 figure Dollar $$$ funding per year in order to do medical research on real human beings!
The truth of the matter is that if your critically ill loved one doesn't fall into a research category and is
very sick, the Intensive Care team might once again suggest a "WITHDRAWAL"or a "LIMITATION OF TREATMENT" as being in "the best interest" of your critically ill loved one, you
need to ask the Intensive Care team whether they are not trying hard enough, because they have other competing interests.
The same applies if your critically ill loved one is inevitably
dying in Intensive Care, because the Intensive Care team might give you false hope for a "recovery" of your loved one and they want to continue treatment until they finished performing their medical research only to
prolong your critically ill loved one's suffering unnecessarily and you may find that the end of life of your loved one is all but dignified.
The bottom line is that you and your Family need to be on high alert and you can't really afford not paying any attention and you can't really afford not having PEACE OF MIND, control, power and influence during this "ONCE IN A LIFETIME" situation!
Also, check out our "YOUR QUESTIONS
ANSWERED" section
where I answer all of YOUR questions
http://intensivecarehotline.com/category/questions/
Hi, it's Patrik Hutzel from INTENSIVECAREHOTLINE.COM , where we instantly improve the lives of Families of critically ill Patients in Intensive Care, so that you can 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 one of our readers and the question of the last three episodes
was
"My Mum has been in ICU for three weeks now and she is on ECMO for ARDS! Will she survive?"(PART 1), (PART 2) and (PART
3)
As Ellie's Mum continues to be in Intensive Care for many weeks, Ellie had many questions so therefore we stayed in contact and it became a three part series where you can look up PART 1 here, PART 2 here and PART 3 here
Ellie has also been featured in our PODCAST in an interview that you can check out here.
In this week's episode of YOUR QUESTIONS ANSWERED I want to answer another question from one of our readers
and this week the question is
My father has been admitted to Intensive Care with a BRAIN CLOT! He had surgery and he's still UNCONSCIOUS! HELP!
Hi Patrik,
My name is Aatish and my father has been in Intensive care for 32 days. To start with on 24th May his right
side was unmovable so we admitted him to hospital on 25th May. Then hospital staff did his CT scan & MRI of his brain in which they found two blood clots.
He therefore had surgery on
his head around one month back, performed by neurosurgeons and he's still unconscious.
Now the Intensive Care team is saying that there has been a lack of oxygen supply to his brain, which is causing him to be unconscious. According to the Intensive Care team, they appear to
be at a loss and they are saying there is no medication, no medicine that can help him in this situation!
Therefore me and my family are anxious to wait and watch whether he will recover or
not. The Intensive Care team is not giving us any assurance whether he will recover and wake up or not.
I just wanted to ask what you think can be done in his case, whether there is any
medication or something else which will help my father to recover?
My father is 67 years of age and he has a history of high Blood pressure for which he is already taking medications and he
has Diabetes as well.
The exact MRI report is outlined below:
Subacute right frontal and posterior parieto-occipital SDH with max thickness of approx 7mm without significant mass-effect.
A large left fronto-parieto-ocipital acute on chronic SDH is seen with max
thickness of approx 2.6 cm with mass effect on the adjacent brain parenchyma with midline shift to left of approx 0.9 cm.
Then neurosurgery (Craniotomy) was done on 26th May. Before going to surgery & after surgery, my father was conscious but as he started getting convulsions, sedation was given to him & since
then he has not been conscious.
After surgery his CT scan was done on 28th May & on 31st May which has shown that both left side & right side clots were successfully removed.
Then on 31st May his Tracheostomy was done.
Meanwhile he has undergone many complications like having swelling to his kidneys, continuous fever, lack of urine output, lose bowel motions, complete body swelling due to non body movement.
The Doctors have done all possible tests meanwhile like checking infection in blood, stool test, cough test, etc.
Now his kidney swelling is getting worse, his creatinine is rising even though his urine output is still 100ml/hour.
On 21st June again we have done an MRI of his brain which shows nothing new.
The exact report is mentioned below:
- Post-operative status
- Subdural collections over right cerebral & left frontal convexities & right cerebellar convexity. There are likely to represents sequelae to trauma.
- Areas of gliosis in bilateral thalami.
- Haemorrhagic contusions in left parietal & bilateral frontal parenchyma.
- Haemosiderin staining over bilateral cerebral & cerebellar convexities.
- Diffuse axonal injuries in corpus callosum.
- Mild dilatation of the lateral ventricles.
- Subacute ischemic change in bilateral frontal & parirto- occipital parenchyma.
Possibility of global ischemic insult is likely.
Now on Monday the 23rd June the Doctor has done tapping & has removed approx
100 ml of liquid & again today i.e. 25th June tapping has been done & they have removed 2-3 cc liquid & Doctor had said that again on coming saturday they will do tapping.
Request you to kindly advise as what should be our next step.
Thanks & Regards,
Aatish
Hi Aatish,
Thank you for clarifying your query and sending all the details through.
I am also very sorry to hear what your father, you and your family are currently going through, as you would be experiencing one of the biggest challenges in your lifetime!
And we are here to
help. We can't cure your father and we can guide you in the right direction about what the next steps for you and your family might be so that you and your Family have PEACE OF MIND, control, power and influence.
There are a number of things that you need to consider in your father's case.
The first thing that springs to mind is that the CT/MRI reports shows
- Subdural collections over right cerebral & left frontal convexities & right cerebellar convexity. There are likely to represents sequelae to trauma.
- - Subacute ischemic change in bilateral frontal & parirto- occipital parenchyma.
- Possibility of global ischemic insult is likely.
You also mention a midline shift of 6 mm. I can also see that his initial diagnosis was set out as an "acute on chronic SDH(Subdural Haematoma)", suggesting that a bleed had been there prior to your father
being admitted to hospital.
The CT/MRI reports don't show glowing results in light of the fact that "subacute ischemic change" and the possibility of "global ischemic insult" is likely to cause your father not "waking up".
Again, in combination with
a midline shift of 6 mm it's not a good position to start off with.
However, it's not quite clear to me why the midline
shift hasn't resolved as yet, as midline shifts can either disappear completely or at least move in the right direction after the initial problems of having high intracranial pressures have been resolved.
The biggest
challenge however why your father hasn't woken up is that the initial SDH(Subdural Haematoma) has most likely caused the "global ischemic insult". Such an ischemic insult can be irreversible.
As a rule of thumb, the brain can only go for
3 minutes without oxygen supply, therefore any time > 3 minutes without oxygen can cause irreversible brain damage.
Check out this article for further clarification
What is the prognosis
after my critically ill loved one's brain has not had sufficient oxygen supply(hypoxic brain injury)?
Even though the Neurosurgeons removed the blood clots, the time for your father's brain without oxygen may have been more than 3 minutes, therefore the irreversible brain damage could be a real possibility.
Those are the facts and the clinical realities as they
stand right now and those are the facts and clinical realities as they are documented on paper.
I will address the other clinical issues such as kidney failure, infections, loose stools etc... later.
The fact and the truth of the matter is that on the one hand you are dealing with your father not "waking up" and not showing any signs of improvement as far as his neurological condition goes.
And once again, the CT/MRI as well as his current state isn't suggesting that anything is going to change anytime soon.
However, despite the clinical results and the current clinical realities, my experience in more than 15 years Intensive Care nursing in three
different countries have shown me that head/brain injuries and/or strokes take time to "wake up" and it's not linear and "waking up" is not an event and it's a
process.
Whether your father will "wake up" or not I can't tell, however given that after one month he is still in Intensive Care and given that you haven't mentioned that neither the
Intensive Care team nor the neurosurgical team want to give up, there must be hope.
I also want to quickly advise on the recent case of Michael Schuhmacher(the famous formula one world champion)
who had been in Intensive Care for basically six months after a severe and traumatic head injury and only now went on to rehabilitation, so they haven't given up hope on him either.
On the other hand, you and your Family need to think about and then decide what you want for your father, how much longer you want to wait and you also want to think through some scenarios for the future, such as what if he isn't waking up, what if he is deteriorating further or what if he's only slightly improving.
You also should ask yourself how your father has dealt with health challenges, setbacks and adversity in the past? Do you and your Family think that he will make a
recovery? Do you and your family think that he has a real chance of recovery?
Answer those questions for yourself, don't worry too much about what's written on paper and what the Intensive Care team says, you probably know the answer
already.
Many Families of critically ill Patients in Intensive Care often get too caught up in "experts" opinions such as the Intensive Care team and they often forget or neglect one of their deepest sources of wisdom which is their gut
feeling and the knowledge they have about their loved one.
Do just that and you will have PEACE OF MIND, control, power and influence. If you don't listen to yourself and if you are putting too much weight on what the Intensive Care team says you will have no PEACE OF MIND, control, power and influence.
As far as other issues go, such as the continuous fever, lack of urine output, lose motions, complete body swelling due to non body movement etc... those are the unfortunate side effects of being in Intensive Care for prolonged periods. I would assume your father is being fed either
via a PEG or a Nasogastric tube and often loose motions are a side effect.
Body swelling can be a side effect of the kidney failure and the non- movement.
You and your Family need to think about and then decide what you want for your father.
Also, it's very important that your father is getting stimulated and it's very important that your father is getting good nursing care such as
- Having regular washes and showers
- Getting out of bed regularly in a chair(there is no reason why he can't get out of bed)
- Having some natural daylight and fresh air
- Having his favourite music play
- Getting good and regular mouth care
- Playing his favourite
music
- Having regular and experienced nursing staff looking after him
And whatever else you think is good for your father!
Also, have you thought about home care as a possibility for your father? If he's not "waking up", taking your father home, with specialised services might be a good opportunity. There are specialised Intensive
Home Care services in India, check out http://healthcareathomeindia.com/. If you are reading this and your loved one is in a similar situation in Australia you might want to consider home care as well, check out INTENSIVECAREATHOME.COM.AU
Moreover, check out these two articles about kidney failure and kidney dialysis here
Also, I had a lady from Ireland enquire about her father recently in an almost similar case and I
urge you to check out the answer I gave to her question here, as you will get answers and insights there as well. I even recorded an interview with her.
Here are the links to her question and the interview.
My Dad is in ICU after a SUBDURAL HAEMATOMA, he's had MULTIPLE SURGERIES and he's NOT WAKING UP! Help!"(PART 1)
My Dad is in ICU after a SUBDURAL HAEMATOMA, he's had MULTIPLE SURGERIES and he's NOT WAKING UP! Help!"(PART 2)
Podcast with Laura who's DAD has been in Intensive Care since March 2014 with a SUBDURAL HAEMATOMA AND HE'S NOT WAKING UP! Listen to Laura's story!
I really hope that helps Aatish.
Please let me know if you have any other questions!
Thank you& Kind Regards
Patrik Hutzel
If you want your questions answered just hit reply to this email or email me at support@intensivecarehotline.com and I'll answer your questions!
Also keep an
eye out for our upcoming product launch in the next couple of months! We are NOW finalizing our first product that will help Families of critically ill Patients MASTER, take control, have power and influence in all of the most challenging situations in Intensive Care, even if their loved one is dying!
The product will be an "IN-DEPTH" education product for Families of critically ill Patients in Intensive Care and a SHORTCUT for Families to have PEACE OF MIND, control, power& influence! The focus of the education product will be on PEACE OF MIND, control, power and influence during the following situations in Intensive Care
- long-term stays in Intensive Care
- end- of- life situations
- Family meetings with the Intensive Care team
- withdrawal of treatment situations and/or perceived medical futility
- severe head and brain injuries
The product will be made available in Ebook, Video and Audio format so that our Customers
can consume the product in their chosen medium!
If you have any
questions about our upcoming products or if you have any suggestions
please let me know at support@intensivecarehotline.com
Your Friend
Patrik Hutzel
Critical Care Nurse
Founder& Editor
WWW.INTENSIVECAREHOTLINE.COM
