After I have introduced you to a real world example last week in how the Intensive Care team is SKILLFULLY PLAYING WITH YOUR EMOTIONS if your loved one is critically ill in Intensive Care and after I have shown you that you’re on dangerous ground every time you feel indebted and/or feel gratitude towards the Intensive Care team, because you feel like you want to or even need to return a favour when they ask you to do so, this week I want to dig in even deeper into the psychology and the dynamics at play!

You are on dangerous ground if you are feeling indebted or gratitude

Feeling gratitude or feeling that you and your family are indebted towards the Intensive Care team, because the very life and the very health of your critically ill loved one are in the hands of the Intensive Care team, makes you and your family very vulnerable and it puts you into a precarious and DANGEROUS position where you and your family are prone to make mistakes, make the wrong choice, give in to the demands from the Intensive Care team who is the “perceived authority” and who has the “perceived power”!

This makes it an EXTREMELY DANGEROUS situation for you, for your family and for your critically ill loved one, especially when you are in one of those difficult, challenging, heartbreaking and “ONCE IN A LIFETIME” situations where your loved one is

• 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
• THREATENED with an “NFR”(Not for resuscitation) or “DNR”(Do not resuscitate) order
• In a situation where the Intensive Care team suggests a “WITHDRAWAL OF TREATMENT” or a “LIMITATION OF TREATMENT” as being “IN THE BEST INTEREST” of your critically ill loved one
• approaching their end of life in Intensive Care

 the fact of the matter is that if your critically ill loved one is in one of those difficult, challenging, heartbreaking and “ONCE IN A LIFETIME” situations, the wheels that are in motion in a volatile, dynamic, highly political and intriguing environment that is driven by the Intensive Care team’s hidden agenda, that if you and your family are not on HIGH ALERT and if you and your family don’t understand the dynamics and the psychology at play, the Intensive Care team will push their agenda forward without you even knowing that it’s happening!

I can assure you that after more than 15 years Intensive Care nursing experience in three different countries and after I have worked with literally THOUSANDS of critically ill Patients and their Families that I’ve been through and witnessed many situations where the Intensive Care team has been SKILLFULLU PLAYING WITH THE EMOTIONS of Families of critically ill Patients in Intensive Care, only to find that the pressure the Intensive Care team is putting on to Families was driven by

• the financial interests of the intensive care team, e. will they make money $$$ or will they lose money $$$ and not meet their budget targets when continuing to treat your critically ill loved one

• The competition for scarce, precious and expensive Intensive Care beds, with other critically ill Patients waiting for admission to Intensive Care

• The medical research interests of the Intensive Care team, i.e. if your critically ill loved one doesn’t fall into a medical research category is the Intensive Care team even interested in continuing treatment on your critically ill loved one? Remember, medical research is generating multi- Million $$$ funding per year for Intensive Care Units and is used as a leverage and positioning tool for Intensive Care Units

• What’s happening “BEHIND THE SCENES” in Intensive Care such as the politics, the power play, the dynamics, the competing interests, the intrigue and the hidden agenda by the Intensive Care team

The fact of the matter is that if you don’t have an awareness and an understanding of what’s really happening in Intensive Care, the Intensive Care team will have an easy time to continue to play with your emotions SKILLFULLY!

Once again, your job, your task at hand if your loved one is critically ill in Intensive Care is to have PEACE OF MIND, control, power and influence!

And I can assure you that if you feel gratitude and if you feel indebted towards the Intensive Care team because you feel like they are doing so much for your critically ill loved one, you are walking on dangerous ground!

I’ll give you another real world example so that you really understand what I’m talking about!

Your 21 year old daughter has been in a severe car accident and she sustained severe and traumatic head and brain injuries.

On top of that she fractured her Hip, her pelvis and her ribs.

Your daughter has been very unstable and critical from the start and especially her traumatic head and brain injuries caused the brain to swell and it caused high brain pressures(intracranial pressures).

Your daughter therefore was placed on a ventilator and in an induced coma. It was difficult from the start to manage your daughters brain pressures and therefore the Intensive care team painted a “doom and gloom” picture from the very beginning.

After about three weeks in Intensive Care and after the Hip and pelvis fractures had been fixed, your daughter still doesn’t show any signs of life and still hasn’t “woken up” and still hasn’t shown any sign of life even though she has technically come out of the induced coma.

Related article:

How long does it take to wake up from a Traumatic brain injury or severe head injury?

You and your family know that your daughter is in a critical and dangerous situation and you are anxiously waiting to see whether your daughter will “wake up” or not!

So far your daughter has been mainly unresponsive to external stimuli, however you and your family are hopeful that she will come good and that she will wake up!

The Intensive Care team is now asking to have a “formal” family meeting with you.

Related Articles

• How can I be prepared, be mentally strong and be well positioned for a Family meeting with the Intensive Care team?(PART 1)
• How can I be prepared, be mentally strong and be well positioned for a Family meeting with the Intensive Care team?(PART 2)
• Family Meetings in Intensive Care or the Elephant in the Room
• How to be AWARE and PRESENT in Family meetings with the Intensive Care team

During the meeting the Intensive Care consultant suggests that given that your daughter isn’t “waking up” and given that the CT-brain results of your daughter are rather bleak that they would suggest a “WITHDRAWAL OF TREATMENT” or a “LIMITATION OF TREATMENT” as “IN THE BEST INTEREST” of your critically ill daughter!

You have shown gratitude and now it'll bite you...

The Intensive Care team knows that you and your family have shown gratitude and that you and your family have been thankful towards the Intensive Care team so far for what they’ve done for your daughter.

The Intensive Care team also feels the pressure from the Intensive Care administrators to not spend too much money $$$ on your daughter’s treatment as they know that continuing treatment for Patients with severe and traumatic brain injuries could cost tens if not hundreds of thousands of Dollars $$$!

The Intensive Care team also knows from experience that now might be the right time to bring up the topic of ”WITHDRAWAL OF TREATMENT” or a “LIMITATION OF TREATMENT” as being “IN THE BEST INTEREST” for your daughter.

The Intensive Care team also knows from experience that most Families of critically ill Patients in Intensive Care on a conscious or subconscious level feel gratitude and feel indebted towards them as so far they have tried to save your daughter’s life.

"The law of reciprocity" doesn't serve you and it may cost your daughter's life

They therefore know that Families of critically ill Patients in Intensive Care give in to their demands as the “law of reciprocity” kicks in.

What most Families of critically ill Patients in Intensive Care don’t know is that especially with severe and traumatic head or brain injuries, the recovery time can be extremely long and the critically ill Patients with severe head or traumatic brain injuries need time, lots of attention and tender loving care.

Many Intensive Care teams are not willing to put in the time, the energy and the financial and emotional resources that it takes to get Patients with severe head or brain injuries on to the road of recovery.

The many competing interests in Intensive Care is what’s driving the agenda

For Intensive Care teams who are dealing with many competing interests, with politics, dynamics, power play and always have a hidden agenda that Families of critically ill Patients have generally speaking no awareness about, the easy way out of their dilemma is to shrewdly and adeptly “sell” you and your Family on a ”WITHDRAWAL OF TREATMENT” or a “LIMITATION OF TREATMENT” as being “IN THE BEST INTEREST” for your daughter.

Related Article:  

The 5 questions you need to ask when the Intensive Care team is talking about “Futility of treatment”, “Withdrawal of life support” or about “Withdrawal of treatment”!

That’s how the Intensive Care team is driving their agenda home. That’s how Intensive Care teams manage their budget. That’s how they protect their turf so to speak.

And they know how to and when to “SKILLFULLY PLAY WITH YOUR EMOTIONS”!

That’s how the Intensive Care team manages their beds if they know that they have other critically ill Patients waiting for beds!

That’s what Intensive Care teams do, when they are not prepared to guide you through one of the most difficult, challenging and heartbreaking situations there can ever be in a Family’s life.

That’s what Intensive Care teams do, if they know that you consciously or unconsciously feel gratitude and you feel indebted towards them.

The trouble is that if you are not aware of your emotions and if you are not aware how the Intensive Care team might be “SKILLFULLY PLAYING WITH YOUR EMOTIONS”, you, your family and your critically ill loved one might be paying the highest price there is ever to pay in a situation like this.

Your loved one may die, because you’ve given in to the demands of the Intensive Care team and you’ve given in to their "perceived power" and the "perceived authority" of the Intensive Care team.

Your loved one may die, because you didn’t have a strong positioning and you didn’t pursue your agenda relentlessly.

The Intensive Care team is pursuing their mainly hidden agenda relentlessly and if you are not prepared, if you are not doing your own research and if you are not prepared to fight for what you believe in, then it might be too late…

Don’t say that I haven’t warned you!

Lung transplants for critically ill Patients are rising in numbers across the world and more and more critically ill Patients receive a life saving lung transplantation.

The major reasons to receive a life saving lung transplantation are

• chronic obstructive pulmonary disease(COPD), including emphysema
• idiopathic pulmonary fibrosis
• cystic fibrosis(cf)
• idiopathic (formerly known as "primary") pulmonary hypertension
• alpha 1-antitrypsin deficiency
• replacing previously transplanted lungs that have since failed
• other causes, including bronchiectasis and sarcoidosis

 most lung transplantations that I have seen over the many years while working in Intensive Care are straightforward and if all goes well they stay ventilated for up to two days, get extubated(removal of the breathing tube) and then get ready to go on to the ward and then go on to rehabilitation.

Lung transplant Patients are often on a clinical pathway and have certain boxes ticked

Critically ill Patients after lung transplantations often go on a clinical pathway, which means that certain conditions and certain preselected boxes have to be ticked in order to assess the progress of your critically ill loved one after having received a lung transplant.

This means that their vital signs such as Heart rate, heart rhythm, blood pressure, temperature and also vital signs for ventilation such as spontaneous ventilation- as opposed to mechanical ventilation- adequate oxygen levels, as well as good ABG’s(arterial blood gases) need to be prevalent in order for a lung transplant Patient to recover so that they can be discharged from Intensive Care.

Furthermore other tests such as their blood results need to be in order as well.

So, overall, if all goes well and straightforward and if they follow the clinical pathway, most critically ill Patients after lung transplantation don’t stay in Intensive Care for much longer than a few days.

Lung transplantations are high risk procedures

 However lung transplants come with high risks attached and it starts with the pre-selection of suitable Patients, it continues with finding the right lung donor and right lung recipient(i.e. Patient).

After the pre- selection has taken place and the surgery has been performed and the critically ill Patient has gone into ICU, the wheels are in motion and the goal is to always get them off the mechanical ventilation as quickly as possible and as I have pointed out the goal is to follow the clinical pathway and get them off the ventilator within the first 24-48 hours after surgery.

However, as I have mentioned, lung transplantations come with high risks attached and sometimes things don’t go as planned, the donor lungs may not be a “perfect match”, there may be some bleeding and also the critically ill Patient will end up with a fair amount of new medications, specific to the management of lung transplantations.

You can find out all about the procedure of lung transplants and the medications required here in our clinical pictures section

http://intensivecarehotline.com/clinical-pictures/lung-transplantation/

Sometimes, when the lung donor- lung recipient match isn’t 100% and if bleeding occurs, ECMO for lung failure as a bridge to spontaneous breathing may be required.

This can go hand in hand with prolonged mechanical ventilation and it can go hand in hand with a Tracheostomy.

Sometimes, even after a new set of donor lungs have been transplanted in a recipient Patient, things may not go all that well.

Sometimes lung transplant Patients end up ventilator dependent with Tracheostomy

 Even after careful pre- selection and after matching the donor and recipient, things don’t go as planned and Patients end up on the ventilator with a Tracheostomy.

This is a less than desired outcome, because the goals after a lung transplantation is clearly to improve the quality of life for the Patients and their families.

After more than 15 years of Intensive Care nursing in three different countries and after I have worked with literally THOUSANDS of critically ill Patients and their Families, I have witnessed some lung transplant Patients who end up with rejection of the new donor lungs.

This sometimes happens in the first few days or weeks after a lung transplant so that Patients never really leave hospital or Intensive Care in the first place or it can happen anywhere between 6 Months and 5 years after a lung transplant from my experience.

In any case, whether the rejection occurs relatively quickly or whether it occurs after Patients have gone home and had an improved quality of life, the outcome appears to be the same from my experience.

The issues that those critically ill Patients are struggling with tend to be difficulties breathing, increased oxygen requirements often resulting in mechanical ventilator dependency, Tracheostomy and an inability to wean the Patients off the ventilator.

The Patients that I have witnessed over the many years working in Intensive Care who are in this situation often stay in Intensive Care ventilator dependent with a Tracheostomy for long periods of time with no or a limited quality of life.

The sad reality in those situations is that this slow process often inevitably results in the death of the Patient.

Sometimes Patients end up in ICU for up to 6 months on a ventilator

I have witnessed some lung transplant Patients to approach their end of life and ultimately die after a long 3-4 month struggle on a ventilator in a clinical, sterile and limiting Intensive Care environment.

I am not advocating to stop treatment earlier and I am also not opposing to stop treatment when critically ill Patients and their Families face the dilemma of being ventilator dependent with Tracheostomy with no quality of life in Intensive Care!

 It depends on what the Patients and their Families want.

What I do however, is to strongly advocate for Patients after lung transplants who end up long-term ventilator dependent with Tracheostomy then would be the time to look for a suitable alternative, rather than keeping these Patients and their Families in a limiting and inhibiting Intensive Care environment!

Suitable and proven alternatives to a burdensome long-term stay in Intensive Care

 A suitable and proven alternative in this situation would be Intensive Home Care.

For example in countries like Germany and Australia, Intensive Home Care nursing services for long-term ventilated Adults& Children with Tracheostomy have long proven their concepts to be a genuine alternative to a long-term stay in Intensive Care and to improve Patients and their Families quality of life and/or quality of end of life in a holistic and more Patient and family friendly home care environment.

Those services, like INTENSIVE CARE AT HOME (WWW.INTENSIVECAREATHOME.COM.AU ) are providing tailor made services for long-term ventilated Adults& Children with Tracheostomy as a genuine alternative to a long-term stay in Intensive Care!

They are also creating an opportunity for Families to stop spending day and night in Intensive Care in order to be with their critically ill loved one.

 INTENSIVE CARE AT HOME services are generally focused to provide a win-win situation and focus on the best interest for the Patients and their Families who are faced with the dilemma of long-term ventilation with Tracheostomy in Intensive Care.

INTENSIVE CARE AT HOME services also focus on the needs of Intensive Care Units and hospitals who generally have a shortage of precious and expensive Intensive Care beds and they tend to always have admissions waiting for those Intensive Care beds.

INTENSIVE HOME CARE is providing a win-win situation!

By freeing up those precious and expensive Intensive Care beds by taking long-term ventilated Patients with Tracheostomies home, a win- win situation is achieved.

Furthermore, a stay in Intensive Care is extremely expensive with costs around $ 5,000 per bed day. Therefore, Intensive Home Care is more cost effective, Patients and their Families are in a non-inhibiting and more holistic home care environment and Intensive Care units, hospitals and health care funding agencies pay less.

Again, it’s a perfect win-win situation.

For more information about INTENSIVE CARE AT HOME check out WWW.INTENSIVECAREATHOME.COM.AU

For more information about long-term ventilation with Tracheostomy, you can also find more information here in these articles

• Tracheostomy and weaning off the ventilator in Intensive Care, how long can it take? 
• How long should a Patient be on a ventilator before having a Tracheostomy?
• Why does my loved one need a Tracheostomy in Intensive Care? 
• Why do doctors in Intensive Care insert a Tracheostomy after an induced coma?

I hope this article helps and sheds more light on ventilation requirements after lung transplants.