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 9
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 9)
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 10)
Previous questions answered from Melissa, you can find here
PART 1, PART 2, PART 3, PART 4, PART 5, PART 6, PART 7, PART 8 and Part 9
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.
Melissa: Yeah. Well, my brother’s coming in tomorrow and we’re going to be down there all day, so I’ll have to talk to her.
Patrik: Also, as a recommendation, Melissa, I would not only tell her what we’ve discussed now, I would also ask her about the DNR.
Melissa: Okay.
Patrik: Do it
while she’s awake. Not many families can have those conversations with their loved oneS in ICU. Once she goes through a hospice, they will give her more morphine because that’s what hospitals are doing, especially when it comes to end of life.
Melissa: Yeah. My last question is you’ve never seen anybody recover at this late stage,
right?
Patrik: No, probably not. However, I do believe the possibilities around this situation is, again, get it from your mum what she wants, and then depending on the answer, either support her in an end of life decision maybe in the next few days, or help her buying the time she wants. That would be then, for example, by reversing the DNR, and by making sure they continue her on life support.
Number one the oxygen and number two probably the Epinephrine and the Norepinephrine.
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Melissa: Okay. When you say oxygen, you’re talking about the meds not the ventilator.
Patrik: Yes, I’m talking about an oxygen mask not about the ventilator and the breathing tube! Ask your mum. You should ask your Mom if she would want to go back on the ventilator if it prolongs her life. Ask her.
Melissa: Okay. Okay.
Patrik: Do you feel like you will be able to have that conversation with her?
Melissa: I think so, yeah, I feel … I could definitely have the conversation about the oxygen mask, but with the breathing machine, I feel a little helpless, nobody wants …
Patrik: You shouldn’t worry about other people. You really shouldn’t
worry about other people. You’re doing the right thing here. You worry about your mum. You have a different point of view compared to other people, but that shouldn’t worry you. It’s really nothing that should worry you. As long as you involve your mother in the decision-making process, I think that’s all you need to do.
Melissa: I think so, too.
Now, she was awake today, but if I go in tomorrow and she’s totally unconscious because that happened yesterday. Yesterday she was out of it all day, I couldn’t talk to her at all. Today, she was awake.
Patrik: It’s fluctuating.
Melissa: Yeah, it’s totally fluctuating. One day she’s awake, one day she’s not, basically.
Patrik: I’ll tell you what another strategy around that could be. Do you know when they started giving her morphine? Do you know how long she’s been on the morphine for?
Melissa: I’m not sure, I think like a week.
Patrik: Okay. Here is a strategy to potentially manage that. Let’s just say your mum won’t be awake tomorrow, that could be a side effect of the morphine. If you want her awake, to
have this discussion with her, they could give her a medication called Narcan or Naloxone and I will email that to you when we come off this call, so you have the-
Melissa: Okay.
Patrik:
Narcan/Naloxone is the antidote to morphine. If somebody, for example, overdoses on morphine, one way to wake them up is to give them Narcan/Naloxone. It doesn’t have to be for a long period, but it needs to be long enough so you can have that discussion with her.
Melissa: Okay. What’s that called? N-A-
Patrik: I’ll email it to you. Naloxone or Narcan, I’ll email it to you when we come off this call.
Melissa: Okay, okay. Should I email you?
Patrik: Yeah, you can email me. I will email you this drug name once we come off this call, okay?
Melissa: Yeah.
Patrik: Hopefully she
will just be awake. Obviously, as you’ve pointed out, it’s fluctuating. Yeah, that would be a strategy. If she’s awake, look, great, that’s the easiest way to handle it. I really do believe … and especially you’ve mentioned you are a spiritual person, so you must know that there is a … no matter what happens to your mum, you know that your mum’s body might leave soon, but you also know that her soul and her spirit will always be here.
Melissa: I know. I do believe that.
Patrik: Right? It’s very important that you look at those resources because your spirituality is a resource.
Melissa: Okay. When I get home tomorrow, can I just email you to let you know what happened?
Patrik: Please, please. I’d love to hear what’s happened, I really would.
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Melissa: Yeah, but I will email you to let you know what happened.
Patrik: I would really
like to know, but you are … I can’t stress it enough, Melissa, you are in a privileged situation. You can make decisions whilst still being with your mum.
Melissa: Yeah.
Patrik: In a year’s time, in
two years’ time you will be glad you did.
Melissa: I know. That’s what’s been bothering me all night is that I haven’t talked to her about it.
Patrik: Do it while you can, do it while you
can.
Melissa: Okay, okay. I’ll do that.
Patrik: Is that a way forward you think will help you?
Melissa: Yeah, I do.
Patrik: That’s good. That’s good.
Melissa: I think it will go a long way.
Patrik: I think so, too. I think it’s so important for your family to come to peace with whatever and however this situation turns out. You want to make peace with the situation, and I believe that the best way to find peace of mind in this is by talking to her while you can.
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Melissa: Okay. You don’t think they’re gonna say anything, they’re not going to push us to take the mask off, if we say we’re not ready.
Patrik: No, because you haven’t signed for anything. Look, I do believe that if they did that, in my mind this is murder. If your mum asks
them to take it off, then it’s a wish. If they take it off against your mum’s will and against your family’s will, in my mind that’s murder, right? Also, Hospitals, doctors and nurses have a duty of care for your Mum and also for you as your Mum’s family.
Families in Intensive Care keep forgetting about that! All families often care about is what the doctors or nurses
are telling them without pushing back! Do never forget that doctors and nurses have a duty of care for your Mum and also for you and your family!
Melissa: Yeah, I agree completely.
Patrik: That’s why you’ve
got to talk to her.
Melissa: Okay. Yeah, that’s what I want to do. I was taking notes while you were talking, so I’m going in tomorrow armed with at least some more information about-
Patrik: Yeah.
Also, if it helps you, maybe read it from a piece of paper. Make it as easy as possible for you, make it as easy and effortless. If you feel like you might be struggling for words at your mum’s bedside, don’t get overwhelmed, maybe write it down and read it off a piece of paper, that’s fine. Whatever helps.
Melissa: Okay.
Patrik: Whatever helps.
Melissa: Okay.
Patrik: Don’t be bound by what other
people think or … This is a very unique situation, Melissa, and it’s clearly a once in a lifetime unique situation.
Melissa: Well, I’m gonna do that tomorrow. I’m just trying to think if there’s … I have to hang up soon because I have to have something to eat, my blood sugar is down.
Patrik: Of course, of course.
Melissa: I just want to ask my dad if there’s anything.
Patrik: Yeah, please, please.
Melissa: Dad, I’m hanging up with Patrik soon, is there any questions you want me to ask him or anything? All right. He’s okay.
Patrik: Okay. Say hi to your dad. I really …
Melissa: I will.
Patrik: I really feel for you, Melissa, it’s very difficult. You probably won’t be
able to change the outcome in the long term, but you will be able to help your mum whichever direction she wants to go. That’s achievable.
Melissa: Thank you. Thank you …
Patrik: You’re very
welcome.
Melissa: … Patrik very much and thank you for all the good advice.
Patrik: You’re very welcome.
Melissa: I’ll keep you posted-
Patrik: Please.
Melissa: … don’t forget to email me.
Patrik: I will email you the drug name. I’ve got it in front of me here, I will email it to you in one minute.
Melissa: Okay, thank you so much.
Patrik: You’re very welcome. All the best, Melissa. Take care.
Melissa: Thank you, bye bye.
Patrik: Thank you, bye
bye
