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 in this series of questions from my client Melissa and the question last week was PART 6 of
My 78 year old Mom has lung cancer and developed an infection! She’s in ICU on the breathing
tube, can she get off it or will she need a tracheostomy? (PART7)
You can check out last week's episode by clicking on the link here.
In this week’s episode of "YOUR QUESTIONS ANSWERED", I want to answer the next question in this series of questions from one of my clients Melissa, which are excerpts from phone and email counselling and consulting sessions with me and the question
this week is
My 78 year old Mom has lung cancer and developed an
infection! She’s in ICU on the breathing tube, can she get off it or will she need a tracheostomy? (PART 8)
Previous questions answered from Melissa, you can find here
PART 1, PART 2, PART 3, PART 4, PART 5, PART 6 and PART 7
After I started counselling and consulting Melissa earlier this year, her Mom eventually left Hospital after going from ICU to LTAC and then home eventually.
A
few months later her Mom presented back to Hospital and got readmitted back to ICU because of the lung cancer having come back.
The ICU team is adamant that Melissa’s Mom hasn’t got much time left and that she will die very soon in the next few days. They have suggested hospice and Melissa is having second thoughts about what else could be done.
Read the dialogue below so you can see how I
can steer the conversation in a direction to help Melissa to come to terms with the situation and how she can make sure that she looks at the situation from many ankles so that she can actually do what’s best for her Mom!
The reality is that when Patients die in Intensive Care, the sooner you can embrace the inevitable and the sooner you are in a position to talk to your loved one about it, the sooner you can make peace with the situation as
is showcased below!
Patrik: Okay, yeah, yeah. Okay and if that's for her blood pressure and I think there's a very high chance that she is on adrenalin or epinephrine, or norepinephrine, I think there is a very high chance she is on that. That and the oxygen are probably keeping her alive, right?
Melissa: Yeah.
Patrik: So that's what in ICU is designed for, to keep people alive, right?
Melissa: Yeah.
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Patrik: So the oxygen and potentially the norepinephrine or the epinephrine, they are life support. So if she is on the norepinephrine, and
basically what it's doing is it's maintaining a physiological blood pressure without that, your mother could pass away reasonably quickly. So then the question arises, okay do you want to keep that going for the next few days? Do you and your family need more time? Do you want to talk to your mom about what's happening if they stop the oxygen, if they stop the norepinephrine that she may die. Is that something you want to bring up with her? Have you considered that?
Melissa: Like I said, I was thinking about talking to her tomorrow. If they take that oxygen mask off and put the close clips in does that mean she's definitely going to die?
Patrik: No, no, no, not definitely. It could be the next step towards end of life, it could be the next step. The question probably is to really map this out for you from everything that you are describing
is you could, on what your mother is on you could probably keep your mother alive for a period of time and that could be two days, three days, it could be three weeks. I don't know I haven't seen the x-ray. I understand the tumour has been metastasized. Do you know how much oxygen she's on?
Melissa: I don't know.
Patrik: That's all right. So they
could potentially keep her alive for a number of days with the support that she's on now. Then the question is, is she suffering for example? Is she in pain? And also, is she conscious?
Melissa: She is conscious. Like I said, she wakes up periodically. And I think they're giving her morphine because she is in pain.
Patrik: She is in pain.
Where is the pain?
Melissa: I don't know that.
Patrik: That's okay. Okay, I really think Melissa that you, or your dad, or you mentioned your brother, I really do believe that you as a family as long as she is conscious should talk to her about what she wants. I really do believe that is the way forward.
Melissa: Okay.
Patrik: And get it from her.
Melissa: I think you're right, yeah.
Patrik: I really do. And look it's very confrontational, don't get me wrong. It's probably the most difficult conversation you will ever have with
your mom.
Melissa: Could it make her worse is what I'm worried about.
Patrik: Look I do believe that even if it's confrontational, especially if you know that your mom has mentioned to your family friend that she's ready to go? I think you should hone in on that, I think you really should.
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Melissa: Okay.
Patrik: That means it's on her mind.
Melissa: Yeah.
Patrik: It's on her mind.
Melissa: Okay.
Patrik: And I think you should hone in on that. And as I said do you, it's one of the most difficult conversations you can ever have with your mom most likely, but I do believe if you can have that ... Look 99% of families lose the family member without talking about this, and I actually think it's a shame. I think if you have the opportunity to talk to her about
what might be happening, I actually think it's a gift.
Melissa: I'm going to ask you another question, which is probably going to sound crazy but maybe you've heard it before.
Patrik: Please, no, no, no.
Melissa: Are there ever, I know you worked in the industry for a while,
there's no chance at this late stage of a miraculous remission, right? We're not going to walk in there ...
Patrik: Yep, look I for example, I don't agree with that the doctors have told you that she will never go home. I don't agree with that. I do believe in, I'm not sure whether miracles is the right word. I do believe in improvement, and I have seen people improving from very difficult situations. Cancer metastasizing
is not a good sign, there's no doubt about it. I really have no idea from what you're describing how big the tumour is, what the x-ray looks like, you're talking about a white out, and I know what a white out looks like and I know what it means. It's not good.
Melissa: Yeah it is a white out, that's exactly what ... They showed us the ...
Patrik: Yeah, yeah, yeah.
Melissa: I couldn't believe it. I could not believe it when I saw that picture. It was ...
Patrik: Yeah, it's not good. However, for example I don't agree with that your mother will never go home. For example, maybe you ask your mother tomorrow and you say hey mom, this is
what's happening, it doesn't look good, maybe you are going to die in the next few days. Maybe your mother will say to you hey, is there any way you can bring me home? I'm just making this up here Melissa.
Melissa: Yeah.
Patrik: But this could, that could be a response, couldn't it?
Melissa: Yeah we asked, my dad wanted her at home and they won't let us do it.
Patrik: Yeah, okay. But what I'm saying here is for example, what we are doing here in Melbourne, I have an in-home care nursing service INTENSIVE CARE AT
HOME, we're doing palliative care at home. Sometimes for patients who are on ventilators with tracheostomies, we do that. So I don't agree with whatever they're saying that she will never go home. She may only go home for a few more days.
Melissa: Oh, I see.
Patrik: But if that's her wish and there is somebody who can make that happen for you,
maybe a nursing service, or maybe even you as a family, I don't know, I'm just making this up now. But there are professionals out there who might be able to do that for you like we do at INTENSIVE CARE AT HOME. In that instance you almost need to ignore what the hospital is telling you. If there is a nursing service out there who is working with
GP's or with palliative care physicians, there may be an option for you. I don't know what's available in your area. So with cancer metastasizing, with a white out of the lung, in the long run it's probably a death sentence. However, nobody can put a time frame around that.
Melissa: Okay, why are they in such a hurry?
Patrik: Yeah.
Melissa: I know they want a bed but the Hospice people are very nice, I think it seems like it's really their belief that that's the best way to, I mean ...
Patrik: But they don't know it any different, they only know hospitals and they don’t know what we can do with INTENSIVE CARE AT HOME for example.. I mean I can tell Melissa we have done palliative care at home, I do believe that's a gift.
Melissa: Yeah.
Patrik: In hospitals they're all under pressure, they know
they've got other patients waiting and they're probably so close to the topic where they think I wouldn't want to live like that, but it's not about them. It's about you, and it's about your mother. And that's why I think it's so important that you ask her.
Melissa: Okay. What if she says she wants to go?
Patrik: Okay, what do you think your, and
your dads, and did you say there's a brother as well?
Melissa: Yeah.
Patrik: How many people would be the main decision makers? It would be you, it would be your dad, and it would be your brother, anybody else?
Melissa: No.
Patrik: Okay. So what do you think your response, what do you think your dads response, and what do you think your brothers response is when she says she wants to go. What do you think your response ...
Go and look out for the next episode of “YOUR QUESTIONS ANSWERED” where I continue the conversation with Melissa and help her to come to terms with what’s happening with her
Mom!
