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 shared another question in this series of questions from my client Veronica and the question last week was PART 9 of
My Dad (71) is in ICU with stage 4 lung cancer & stroke, he’s on the ventilator now and in an induced coma, what are his chances of survival?
(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 from one of my clients Veronica, which are excerpts from phone and email counselling and consulting sessions with me and the question this week is
My Dad (71) is in ICU with stage 4 lung cancer & stroke, he’s on the ventilator now and in an induced coma, what are his chances of
survival? (PART 10)
In the last 1:1 counselling and consulting session, I explained to Veronica what a “one-way extubation” means and how it ties in with an NFR/DNR order. We furthermore talked about what does need to happen to get Veronica’s Dad off the ventilator or whether she should prepare herself and her mother for an end of life
situation.
In this week’s 1:1 counselling and consulting session we talk about why her Dad “only” has single organ failure and not multi organ failure and why the distinction is important!
I
also explain to Veronica how the ICU’s bed occupancy is impacting on her Dad’s treatment and care.
Furthermore, I share with Veronica what advantages a service like INTENSIVE CARE AT HOME would have for her Dad!
Veronica:
Well, I’m hoping so much that my dad will be able to communicate with us and tell us what his wishes are, which would be so much better for me. For everyone.
Patrik: Yes, for everyone. For everyone. Absolutely. So, what I’ll do is I’ll send you a couple of links to articles about tracheostomies. What I can do tomorrow, if you want me to just listen in, what I can do if I hear something that I think you should
question, I can quickly send you a text while you’re in that meeting and while we’re listening. I’ve done this before where people just want me to listen in. If I think there-
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Veronica: Yes.
Patrik: … I can just send you a text. If you want me to speak, entirely up to you. If you just want me to
listen in that’s fine. And, I will send you some texts while they are talking, things that you should be asking. You can let me know tomorrow what you want me to do.
Veronica: Okay, I will.
Patrik: And, I can be available pretty much anytime. I know they might call the meeting for 4:00 PM your time, but I also know it’ll probably be 5:00 PM. You know,
because they won’t be on time.
Veronica: No, they probably won’t be and it depends if they can get the oncologist there at 4:00pm.
Patrik: That’s right.
Veronica: No, I think that would be fantastic.
Patrik: Yeah,
absolutely. And, it sounds to me like you now at least have more supportive doctors, even though this Dr xxxxxxx seems to be more caring but he still doesn’t give you the bigger picture. Maybe there wasn’t enough time, or you know.
Veronica: Yes, I think he didn’t want to go into it just because it was just me.
He really wants to talk to my brother and my mum and everybody
to be able to discuss it together.
Patrik: Okay, yeah.
Veronica: Maybe that’s why it was not discussed.
Patrik: Right, right. So, does that help so far in terms of what to expect and also, yeah he’s saying he’s not for tracheostomy. But again, ask your dad if you can.
Veronica: Exactly. And, if it’s something that we can have, then if dad wants it-
Patrik: That’s right, they should be doing it.
Veronica: And, like you said, it’s not like he’s got two or three organs failing.
He’s got one organ failing.
Patrik: Yes, and that’s a big one. Because, if he had two or three organs failing, they would rub it in your face, excuse my language. They would rub it in your face.
Veronica: Yes.
Patrik: Right? And, they would have more arguments to sort of move it in that direction that they’re already moving it.
Veronica: Yes.
Patrik: Right? But, they can’t really because it’s single organ
failure.
Veronica: That’s right, and they still don’t actually know why he’s not responding to the treatment and what is going on with that organ exactly.
Patrik: Yeah. Other questions, are they busy? And, I’ll tell you in a moment why I’m asking this. Do you feel like they’re busy? Is that unit, you know-
Veronica: Oh, okay. No. They’ve still got a couple of beds left in it.
Patrik: Okay.
Veronica: But, I must say, last Saturday it was very busy. They had car accidents and all sort of Patients coming in around the time that we were having the problems when they were sedating my dad and he was getting distressed.
Patrik: Right.
Veronica: At that point, it was very busy. But no, it’s quieted up this week.
Patrik: Okay, and that was started Easter Saturday where they were really busy?
Veronica: Oh, sorry I’m talking about the one before. The Saturday before.
Patrik: Right, so Easter weekend was really very civilised there?
Veronica: Yes, it
was.
Patrik: Okay, the reason I’m asking is if an ICU is fully occupied, alright? And, most ICUs are busy places and they might quiet down over Easter, Christmas, but not necessarily, but if they do quiet down it’s usually around that time of the year.
Veronica: It did really quiet down, yes.
Patrik: Right. So, but ICUs most of the time are busy, and the reality is people are waiting for beds. That’s the reality. So, you know, that’s why I’m asking how busy are they? Are they full? Because, that can be another reason why they want to move things in a certain direction.
Veronica: Yeah, I know what you’re saying. No, they’re not full.
Patrik: Okay.
Veronica: Because, they’ve even got another little private room and that one was empty again today. So, no. And, a lot of the patients that were sedated, that were in an induced coma, they’re slowly getting woken up as well.
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Patrik: Okay, so that means they’ll probably clear out a few patients in the next few days. And,
you know, you’ve also got to look at things like next week is another public holiday, Tuesday, ANZAC Day. So, they will quiet down again because it’s almost like another long weekend coming up.
Veronica: Yes.
Patrik: Right? And, looking at those things can often make a difference too, because they won’t be as busy this week as they will be in two weeks
or in three weeks when all the long weekends have gone. There’s still school holidays, so it’s not quite, so you know if they were full and it was in the middle of winter, right? There would be less room for negotiation I believe.
Veronica: Yes. I see what you’re saying. Definitely. And, I guess it’s not like
they’re, it’s up to us if we want dad to get woken up right now, and that’s
what he was saying.
Patrik: That’s right. And also, he says, “Oh, he’s not a candidate for a tracheostomy.” And, again that from my perspective is public hospital talk.
That’s public
hospital talk. He hasn’t asked you. You are at this point in time I guess you are the decision maker, right? Or, at least lay out the option what a tracheostomy can and can’t do, right? He’s in a private hospital. He’s not in a public hospital. Your dad’s health fund would still have some-
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Veronica: Yeah, and it will cover all of it.
Patrik: Yes, that’s exactly right. So, sometimes it’s a matter of using the right language, as well, from your end and sort of saying, “Hey, look I appreciate what you’re saying, but have we considered all
the options?”
Veronica: Exactly. They need to consider all the options.
Patrik: Yes, and they need to be transparent with you, which hopefully he will be tomorrow. But, he hasn’t been so far. And, it’s his first day. I understand that, but, you know, he needs to be more forward with what could be happening next.
Veronica: Yes, and that he hasn’t gone through and I guess be clear enough because I was the one who asked him have you got time to meet with me to tell me the results of the scan. So, I jumped the gun because I needed to know tonight before we all sat down as a family.
Patrik: Right, and did he ask for the family meeting tomorrow, or did you ask for the family
meeting?
Veronica: No, he did.
Patrik: He did, good. That’s good. Okay, alright. Is there anything else that you think we haven’t touched on that you wanted to know?
Veronica: No, I guess for me, just the fact that I know that dad had the swallowing, I’m thinking how on earth is he gonna
swallow his tablets and everything else.
Patrik: Okay, well that’s why they keep the tube in, the nasogastric tube in, because they will crush the tablet and then they’ll put it through the nasogastric
tube.
Veronica: Okay.
Patrik: And, I’m certain that he’ll probably get some intravenous drugs at the moment, but they would have given some tables through the nasogastric tube over the last few days.
Veronica: Okay.
Patrik: They would have. So, but with the swallowing keep that in mind as well. Once he’s got the breathing tube out and he can’t swallow, he will swallow his own saliva, and that will go down the wrong way. And again, the tracheostomy can help with that.
Veronica: Okay. No, that sounds good. But, if he needs to have, okay let’s say dad does make it home, and he has a tracheostomy. How on earth, we’d have to have a full-time nurse, wouldn’t
we?
Patrik: Look, and this is where we might be able to help with my in-home nursing service and I mean it would come down at the end of the day for us to hire staff, and it could well be whatever … Some patients that we look after here and we visit them twice daily with a tracheostomy, but it really depends on how mobile people are. It depends on a number of things. But, I think from my perspective, it’s definitely
possible to look after somebody at home with a tracheostomy with the right level of care, that is not an issue. We look after patients at home on ventilators with a tracheostomy. You can have a look at INTENSIVE CARE AT HOME
Veronica: Okay.
Patrik: Right.
Veronica: But, in Adelaide, can they do that?
Patrik: Yes we can provide INTENSIVE CARE AT HOME services in Adelaide. From our perspective, all we
need to do is hire staff. And keep in mind, from a funding perspective, INTENSIVE CARE AT HOME is less than 50% of the cost of an ICU bed and your Dad would be in an environment he’d feel more comfortable. Everybody wins!
Veronica: Yes.
Patrik: But, I wouldn’t think that far as yet. I’d say let’s have this meeting tomorrow and see what happens
next.
Veronica: Okay. Sounds perfect. I will have a look at the links that you send me.
Patrik: Yes.
Veronica: About the tracheostomy, and I’ll remember that one way extubation
is basically-
Patrik: It’s an NFR.
Veronica: It’s an NFR, yes. So, I need to have all that cleared up at him, what the next steps would be because yeah, if he deteriorates, I want to know are they going to accept him back in the
ICU.
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Patrik: That’s right.
Veronica: Put the breathing tube back in!
Patrik: Yeah.
Veronica: Okay, thank you Patrik.
Patrik: Oh, you’re most welcome. You’re most welcome. Have a good night,
and if you want to talk tomorrow before the meeting because things have changed or whatever, just give me a call. Or, I can call you.
Veronica: I’ll let you know.
Patrik: Yeah.
Veronica: Alright, excellent.
Patrik: Okay.
Veronica: Thank you bye.
Patrik: You’re most welcome. Buh-bye.
