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 8 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? (PART 8)
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 9)
Previous questions answered from Melissa, you can find here
PART 1, PART 2, PART 3, Part 4, PART 5, PART 6, PART 7 and PART 8
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 and other family members about it, the sooner you can make peace with the situation as is showcased below in the dialogue.
Patrik: What do you think your family’s response is, including your response if your mum says she wants to go?
Melissa: If she wants to go, I have to honour that and let her go.
Patrik: Hmm. Hmm. Do you feel that if you had asked her today, do you think you would have gotten an answer from her that would really be her will? Do you feel that she’s in a position that she could really verbalise her wishes?
Melissa: Yeah, I
do. She’s pretty lucid.
Patrik: Okay, good, good, good. I think it’s important to acknowledge. I think it’s very important. I really do believe the situation … Okay, I’ll tell you how many end of life situations in intensive care turn out. Patients are on ventilators, or they are in an induced coma and they die without a family having the option to ask their family member. I do believe you are in a privileged
situation. I really do believe that because you can talk to her.
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If she says she wants to go, you have an answer. If she says, “Look, I want another week,” that might be her answer. If she says, “I want another two weeks,” because maybe she wants to see a friend, I don’t know. Then you also have an answer and then you can go back to the doctors and you can say, “Hey, I know what you think, but this is what mum
wants.”
Melissa: Excellent. Yeah, how would you phrase it to her? Like …
Patrik: Yep, I would just like we talk now. In a calm way like, “Look mum, your chest X-ray doesn’t
look good, look mum, it looks like the cancer has metastasized and it looks like … ” You can talk about that she’s on life support with the oxygen and probably with the blood pressure medication.
I would really be very honest with her and I would say, “Look mum, we think that if we took the oxygen and the Epinephrine and the Norepinephrine away, there’s a very good chance that you may not survive this.” Then get your response, but I really think … Look Melissa, I do believe you’re a very compassionate person and I do believe your dad is, too. I haven’t spoken to your brother. When I had this conversations with your dad a while ago, look, you and your dad sound
like you are very compassionate people, right?
Melissa: We’re a very close family. She’s really the glue that holds us all together. We love her very much.
Patrik: Right. Just spell it out. Again, it’s very confrontational, don’t get me wrong, I’ve had these conversations many times with clients, with patients sometimes, and it takes effort. It’s not an
easy conversation to have, right? But-
Melissa: Let’s say she says she wants a few more days, I ask them to keep her on the meds? Or …
Patrik: Absolutely! Absolutely! Have you signed a DNR? Do you know what I’m referring to?
Melissa: I didn’t hear that, what?
Patrik: Have you or your dad signed a DNR? A do not resuscitate order?
Melissa: We keep changing it because they put that in the computer and I went nuts. I don’t know how
it got on the computer and they said it was a misunderstanding. They took it out of the computer and as of right now it says don’t resuscitate if her heart stops.
Patrik: Did you agree with that?
Melissa: I did once they described how they’d have to break her chest open and how painful it would be. I didn’t want to put her through that, so I found myself
agreeing with that, yeah.
Patrik: Okay, and what does your brother and your dad think?
Melissa: I think they’re of the same mind with that.
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Patrik: Okay. Again, have you asked your mother?
Melissa: No.
Patrik: I think you may. I really think you may.
Melissa: I think you’re right. I mean it’s-
Patrik: Melissa, you are in a privileged position. I keep repeating myself. You can talk to your mother. 90% of families in ICU need to
make decisions without being able to talk to the loved one. I really believe you are in a privileged position.
Melissa: Thank you.
Patrik: It may not feel like it, but hopefully when you can look back on this situation, you may understand what I’m referring to. I believe you will understand what I’m referring to once you’ve had those conversations with your
mum.
I don’t think that this is as bad for the person who’s in that situation as it is for family sometimes. Do you know what I mean? I do believe that when people are dying, I do believe they know that they are dying and they, to a degree, have made peace with that situation. I do believe it’s often the families that haven’t made peace, but you are in a position to make peace, because you can talk to your mum, because you can get it from her
what she wants and that will alleviate your grief.
Melissa: That’s true. Okay, I’m gonna do that.
Patrik: That’s what I mean by … Also, whatever she says, you will get the answer. If she wants more time, they will give her more time. That will also then give her time to recover, if she can. If she says, “Look, I’m ready to go,” then you should take her word
for it and you should support her in any way towards that decision.
If she wants more time, that’s also a sign she’s probably not quite ready yet, for whatever reason, maybe again she wants to spend more time with you, with your dad, with your brother. Maybe she wants to see a family friend, who knows. If she says, “Look, I’m ready,” no matter what she says, you should support her. I can’t stress enough, Melissa, that I believe you and your
family are in a very privileged position to have those conversations while you can.
Melissa: Okay. Just two more questions.
Patrik: Please.
Melissa: You said they can go on the oxygen masks indefinitely?
Patrik: Look, as
long … Okay. You can give up to 100% of oxygen. Now, that’s increasing the chances of keeping a patient alive, but it’s no guarantee. What I mean by that is, is it the left or the right side of the lung?
Melissa: What was that?
Patrik: Is it the right out on the X-ray, is it the left or the right side of the lung?
Melissa: It appears to be everywhere on the left lung and now almost everywhere on the right.
Patrik: I see, I see. Basically what that means is, there is a limited amount of oxygen going into the blood because of the restrictions in the lung because of the tumour. If they’re giving the maximum amount of oxygen, it will increase her chances to keep her alive, as long as there’s oxygen
entering the body, okay?
Melissa: Okay.
Patrik: They could do that for a period of time, but if the tumour is growing and metastasizing, 100% of oxygen at some point will not keep a patient alive, if a tumour is metastasizing and growing.
Melissa: It is, it’s in her bloodstream now I think. I didn’t tell
you that. They tested the fluid and it showed that there’s cancer cells all over … Apparently, the oncologist was stunned because it grew so quickly in such a short time that he couldn’t believe it.
Patrik: Yeah, yeah.
Melissa: I couldn’t believe it either, until they showed me the pictures and I-
Patrik: Right.
Melissa: Those lungs and-
Patrik: Right. The oncologist, what does he or she think? Have they got an opinion?
Melissa: Well, you’re not going to believe this, or maybe you will but the oncologist hasn’t been returning our phone
calls.
Patrik: Oh, that’s terrible.
Melissa: Yeah, I know. My dad who’s a very well-adjusted psychologist was so angry at him. He was going to tell him off but finally, after a week of us calling him daily, he promised to get back to us tonight.
Patrik: You see, Melissa? I’m
very disappointed to hear that, but do you remember what I said to you before? I said to you the conversation that we are having now, I believe, is a very mature conversation. I really do believe … I don’t want to do this oncologist any injustice, but I do really believe there are too many health professionals out there who are dealing with death and dying and yet are not brave enough to have a conversation like you and I are having now.
Melissa: Yeah. My dad … we went out for dinner tonight, he said, “I don’t get it.” He said, “He doesn’t even see fit to call us, she’s been his patient now for years.” It was unbelievable.
Patrik: It’s very disappointing, and that’s what I mean. You’re talking about the impatience of the doctors and the nurses. I have seen it over and over again. They can’t face what’s happening.
Don’t get me wrong, it’s not easy as a health professional, but it’s the reality and it’s the job that people have chosen. I do believe it’s their moral duty to talk people through these situations without putting pressure on them. I really do believe that.
Melissa: Yeah, I agree. I agree.
Patrik: I can’t stress this enough, Melissa, I
really believe you and your family are in a unique and privileged position because you can get it from your mum what she wants.
Melissa: Okay. Okay. Thank you for telling me about the oxygen mask because-
Patrik: You’re very welcome.
Melissa: I didn’t know
that.
Patrik: You-
Melissa: I don’t want her to be in pain, you know?
Patrik: Yes, of course. If they’re giving the morphine, there’s-
Melissa: Yeah, they’re giving her morphine, yeah.
Patrik: On that note with the morphine, and I’m not sure whether they’ve told you, the main side effect of the morphine Melissa, is respiratory depression. Do you know what that means?
Melissa: Difficulty breathing?
Patrik: Yeah, yeah. It basically inhibits your efforts of breathing. Morphine is a fantastic painkiller,
but it’s inhibiting the ability to breathe.
Melissa: Do you recommend anything else that has the same effects as morphine but not-
Patrik: Yeah. When pain for cancer patients is an issue, morphine works extremely well to manage that pain. There is probably no other substitution for … what’s the word? For decent pain management. It’s the best medication
that’s out there at this point in time. However, the main side effect is respiratory depression.
Now, the other issue is the more morphine they are giving, there is a very good chance that your mum might not be as lucid as she is today. I do believe that time is of essence.
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!
