How the ICU team is SKILFULLY PLAYING WITH YOUR EMOTIONS& "YOUR QUESTIONS ANSWERED" Episode

Published: Mon, 10/27/14

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 “How to MUTE your NEGATIVE INNER DIALOGUE whilst your loved one is critically ill in Intensive Care!”

You can check out last week’s BLOG here!

In this week’s BLOG I want to share with you

How the Intensive Care team is SKILFULLY PLAYING WITH YOUR EMOTIONS, if your loved one is critically ill in Intensive Care! (PART 1)

In today’s BLOG I want to address a very big issue for Families of critically ill Patients in Intensive Care!

It’s an issue that’s mainly flying under the radar for Families of critically ill Patients in Intensive Care!

It’s an issue that Families of critically ill Patients in Intensive Care are hardly aware of that it’s happening, because they tend to be so far outside of their comfort zone, they are overwhelmed, stressed, anxious, vulnerable and they often simply don’t know what to do and how to deal with this “ONCE IN A LIFETIME” challenge and frustration!

You really need to dig down deep into the psychology and the dynamics at play in Intensive Care

So in order to become aware of the issue and to really dig down deep into the psychology at play in Intensive Care, you and your Family need to understand that if your critically ill 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 Intensive Care team will adjust their behaviour, their positioning, the things they say to you and how they say it.

Let me say this again, because it’s so important!

The minute your critically ill 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 Intensive Care team is adjusting their behaviour, they are speaking a language that’s very guarded and they are speaking a language that’s designed to protect their interests and their interests only!

They are not talking to you as if your loved one is in Intensive Care for a couple of days and it’s all going well.

Too much is at stake for the Intensive Care team

Now if you have found yourself in one of those difficult, challenging and frustrating situations where your loved one is critically ill in Intensive Care or is even in a perceived or real end of life situation, if you don’t understand that the Intensive Care team is adjusting their behaviour and is

“SKILLFULLY PLAYING WITH YOUR EMOTIONS”

you haven’t fully embraced and you haven’t fully understood what’s happening here and you haven’t fully understood what dynamics are at play and the psychology behind it.

I’ll give you a few real world examples so that you understand what I mean by that!

Your 62 year old husband has been diagnosed with Leukaemia and he got admitted to Intensive Care after he developed Pneumonia on the ward after he had some Chemotherapy treatment.

It looks as if your 62 year old husband might require some invasive and mechanical ventilation, basically a tube down in your husband’s lungs in order to help him breathe, as the Pneumonia is leading to rapid decline in his respiratory(breathing) function!

The challenge with Leukaemia or cancer Patients in Intensive Care is often that they are extremely sick Patients and that mechanical ventilation in particular is an uncertain endeavour because Leukaemia or cancer Patients tend not to have many reserves left.

However in this particular instance you and your children know that your husband is a fighter and you and your kids are very positive that your husband will get through it.

The Intensive Care team has already put your husband on a ventilator and he is now in an induced coma to keep him comfortable.

You are now asked to attend a “formal” Family meeting

The next day you and your Family are asked to attend a “formal” Family meeting with the Intensive Care team!

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In the “formal” Family meeting the Intensive Care team is painting a “doom and gloom” picture and the senior Intensive Care consultant is telling you that he believes that a “WITHDRAWAL OF TREATMENT” or a “LIMITATION OF TREATMENT” would be “IN THE BEST INTEREST” of your husband!

The senior doctor/consultant also mentions that a continuation of treatment would be “futile”!

Your alarm bells need to go off!

I can assure you and I can tell 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 whenever the Intensive Care team uses the words “in the best interest of your critically ill loved one”, your alarm bells need to go off and you need to be on high alert!

The reality and the fact of the matter is that the dynamics and the psychology at play in such a difficult, challenging and literally life or death situation is very complex and if you are not aware of the dynamics and the psychology at play, you, your Family and your critically ill loved one are doomed and you will have no PEACE OF MIND, no power, no control and no influence!

The fact of the matter is that the minute your critically ill loved one has been admitted to Intensive Care and the minute you feel like the Intensive Care team is trying to save your critically ill loved one’s life, that’s the minute you feel gratitude and that’s the minute when you feel like you are indebted to the Intensive Care team.

The “Law of reciprocity” always says that whenever somebody is doing something nice for you or is doing you a favour that you want to return that favour!

The ”law of reciprocity” in Intensive Care doesn’t serve you

But in Intensive Care in life or death situations this “Law of reciprocity” is dangerous and it doesn’t serve you!

I have been in too many situations in Intensive Care, in family meetings, in “perceived” end of life situations, where the Intensive Care team skilfully and shrewdly “sold” families of critically ill Patients in Intensive Care on a “WITHDRAWAL OF TREATMENT” or on a “WITHDRAWAL OF LIFE SUPPORT” as “IN THE BEST INTEREST” of their critically ill loved one!

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 have seen too many situations where the Intensive Care team is highly aware, shrewd and adept at taking advantage of your emotions and is taking advantage of the tendency of Families of critically ill Patients in Intensive Care to “give back” because they feel indebted and they want to return some favours!

But you are on dangerous ground, because it’s the very life, the very health of your critically ill loved one and the very sanity of your Family at stake here.

And once you’ve gone down that path, once you have given in to the requests of the Intensive Care team, it’s too late for you and your Family to have PEACE OF MIND, control, power and influence!

Once you’ve gone down that path, it’s too late for you to do your own research, once you’ve gone down that path it’s too late for you and for your Family to understand that the decision making of the Intensive Care team goes way beyond your critically ill loved one’s diagnosis and prognosis!

Once you’ve gone down that path, it’s too late for you and your Family to understand that the Intensive Care team’s positioning of your critically ill loved one’s diagnosis and prognosis is directly related to

The financial interests of the Intensive Care team. I.e. do they think that they will meet their budget targets by continuing treatment on your critically ill loved one
The competition for scarce, precious and expensive Intensive Care beds. I.e. other Patients waiting and competing for Intensive Care beds
The medical research interests of the Intensive Care team. At any given moment medical research is being conducted in Intensive Care on real human beings, i.e. YOUR CRITICALLY ILL LOVED ONE, often without you or your loved one being aware of it and without you or your critically ill loved one giving verbal or written consent! The truth of the matter is that medical research is a multi- billion $$$ Dollar per year industry and a positioning tool for Intensive Care Units
The things that are happening “BEHIND THE SCENES” in Intensive Care. The things happening “BEHIND THE SCENES” in Intensive Care are so powerful that if you don’t understand that the dynamics, the power play, the politics, the competing interests, the intrigue, the psychology and most of all the hidden agenda of the Intensive Care team you will literally have a very hard time of having PEACE OF MIND, control, power and influence whilst your loved one is critically ill in Intensive Care! It’ll be easy for the Intensive Care team to keep you and your Family at “arm’s length”!

In next week’s BLOG, I’ll give you another example of “How the Intensive Care team is skilfully playing with your emotions!”(PART 2)

Until then make sure that you continue doing your own research and make sure that there is nothing standing in your way of you having PEACE OF MIND, control, power and influence, no matter how difficult or challenging the situation you are facing!

Remember, PEACE OF MIND, control, power and influence are possible and within your reach even if your critically ill loved one is dying!

Sincerely, your Friend
Patrik Hutzel

Also, check out our "YOUR QUESTIONS ANSWERED" section

where I answer all of YOUR questions

http://intensivecarehotline.com/category/questions/

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 last week was

“My father has been weaned off the ventilator and still has the Tracheostomy in. When can the Tracheostomy be removed?”

You can check out the answer to last week’s question by clicking on the link here.

In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer another question from one of our readers and this week Anna from Sydney, Australia asks

My father is in Intensive Care ventilated with LIVER FAILURE and KIDNEY FAILURE, I DON’T THINK HE WILL SURVIVE! HELP!

Hi Patrik,

My father has been admitted to Intensive Care two weeks ago with a chest infection that turned out to be Pneumonia.

The doctors put him on a breathing machine as his oxygen levels were quite low and he couldn’t sustain breathing by himself.

The problem is that my father has been a heavy drinker for most of his life and he only recently slowed down drinking.

He therefore has liver failure as well and he looks quite yellow, jaundiced and puffy.

When my father first got into ICU and on the breathing machine his kidneys also stopped working.

The doctor had a chat to me and he thought that putting my Dad on Dialysis for the kidney failure would be the right thing to do.

My father has now been on the Dialysis machine for 6 days and the doctor says that his kidneys have hardly improved.

He has also gone into an irregular heart rhythm and he required to be shocked to go back to a normal heart rhythm. His heart rate was up to 190 beats per minute!

Another problem is that my father is ventilated but is on no sedation or pain killers. He seems to be tolerating whatever they are doing quite well.

But he is also lifeless and he just doesn’t have any reserves left.

The doctors have ruled out putting in a Tracheostomy, as he is at high risk of bleeding due to his liver failure.

He is 68 years of age and I do think that the doctors will soon ask me what we think we should be doing next.

Can you give any advice on this and do you think he has a realistic chance of survival?

Thank you

Anna

Hi Anna,

I’m very sorry to hear what you and your family are going through with your father’s stay in Intensive Care!

I know how terrible you must feel given that your father has been ventilated for a couple of weeks and hasn’t really shown any improvement!

Worst of all, you seem to mentally prepare yourself for the worst case scenario!

But first of all, let’s look at your and your father’s situation from a few different ankles.

Your father is currently ventilated and on no sedation and on no pain killers.

This is of concern, given that most critically ill Patients on a ventilator require sedation and pain killers in order to be able to tolerate the breathing tube and the ventilator.

It is also of concern that the Dialysis machine is not doing what it’s meant to be doing, which is to get the kidneys back to normal.

Liver failure, kidney failure and Pneumonia with a ventilator is not a good situation for your father to be in.

Especially the liver failure may cause some of the swelling that you’ve described, because usually Albumin levels in the blood are quite low and despite the Dialysis, this may actually not be enough to get the swelling down.

The other issue is that if your father is apathetic and not showing any signs of life, then he won’t be able to come off the ventilator. Therefore a Tracheostomy could well be the right step, however your father’s liver failure puts him at high risk of bleeding and therefore it sounds like the Intensive Care team has ruled out a Tracheostomy for now!

Now, your father, you and your family are in a difficult situation and you are facing a big challenge, because you are correct to point out that the Intensive Care team will want to make a decision regarding your father’s future treatment.

If they have ruled out a Tracheostomy for now, they will most likely suggest a “one way extubation”, meaning that they want to remove the breathing tube without putting it back in.

If your father is dependent on the ventilator this will most likely mean that he will die once the ventilator and the breathing tube have been removed.

Related article:

How long will it take to die after life support has been removed?

I would imagine that the Intensive Care team will also suggest that Dialysis will be stopped once the decision has been made to remove the breathing tube and the ventilator.

But here is the crux. What do you and your family want and what would your father want in this situation if he had the power to decide for himself?

The only person who can answer this question is you, your family and your father.

If you think that you or your father wants a Tracheostomy, then you should be asking the Intensive Care team to give him some FFP’s(Fresh frozen plasma) in order to minimise the risk of bleeding.

They may also look at giving your father some Vitamin K(maybe they are giving it already) to minimise the risk of bleeding.

In any case, you, your family and your father should be crystal clear in what you want.

Would you, your family and your father be at peace if the Intensive Care team withdrew treatment?

Or do you feel more comfortable in having more time with your father until you come to terms with what’s happening.

What you also need to consider is that if the Intensive Care team suggests to stop or limit treatment, are they doing this because they sincerely believe that they can’t help your father or are they doing it because they need the ICU bed for other critically ill Patients?

If the Intensive Care team considers or suggests a “WITHDRAWAL OF TREATMENT” or a “LIMITATION OF TREATMENT” as being “IN THE BEST INTEREST” of your father, are they doing it purely on medical reasons or are they doing this because they think that a longer stay and longer treatment would be an unnecessary burden to your father or are they suggesting this because they think that continuing treatment would cost them money that they could spend otherwise?

It sounds to me like your father’s and your situation is pretty challenging, however you shouldn’t rush to make a decision and you should look at alternatives and you should be probing the Intensive Care team.

You should also be thinking about what an end of life situation should like if your father was to pass away soon.

You should give as much input as possible and you shouldn’t have the Intensive Care team directing the end of life situation, if that’s the path you want to go.

End of life situations in Intensive Care are often handled poorly, simply because the Intensive Care team has a lot of other priorities and interests that tend to go way beyond your grief and your vulnerability in those situations.

Therefore, you should have a say and you should direct the end of life situation as much as you can. If you don’t you might get disappointed and you might have bitter memories for the rest of your life.

You should check out this related article here:

A five step BLUEPRINT for DYING WELL and with DIGNITY in Intensive Care!

I hope this helps Anna and I wish you and your family all the best!

Sincerely,

YOUR FRIEND

Patrik Hutzel

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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
what to do if your critically ill loved one is THREATENED with an "NFR"(Not for resuscitation) or "DNR"(Do not resuscitate) order
severe head and brain injuries

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Your Friend

Patrik Hutzel

Critical Care Nurse

Founder& Editor