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 from one of my clients and the question in the last episode was
A Family Conference revealing the hidden mistreatments and delayed management of a dying patient in the
ICU.
You can check out last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED“, I want to answer the next questions from one my clients Andrea who has her 34 year old sister
in Intensive Care with non-Hodgkin’s Lymphoma and is currently experiencing decrease in blood count as well as having second thoughts about the treatment her sister is getting and in the end also not getting.
The Intensive Care team is wanting to stop or “withdraw treatment” against Andrea’s and her families wishes and she’s not prepared to let her sister go without a fight!
My sister is gone, because the doctor had ultimately decided not to
resuscitate my sister without my permission!!
“You can also check out previous 1:1 consulting and advocacy sessions with me and Andrea here.”
PART 1
PART 2
PART 3
PART 4
PART 5
PART 6
PART 7
PART 8
PART 9
PART 10
PART 11
PART 12
PART 13
PART 14
Andrea: Yes, not
today but on Saturday, Sunday, Monday-
Dr. Charkow: No, not the blood transfusion.
Dr. Rosebud: It wouldn’t have helped.
Dr. Charkow: Would not have helped at all.
Andrea: How do you
know?
Dr. Charkow: Because that is not the pathology of what is going on. The pathology of what is going on here is her brain causing increased pressure. A blood transfusion will not
help in this situation.
Dr. Miller: Can I also address the other issues about the blood transfusion? There is a fundamental problem with lack of blood cells. White cells, red cells. The fundamental meaning behind them is her marrow is failing. Obviously, it’s quite evident without even having done a biopsy and you could say, “Well, how would you know if you haven’t done a biopsy?” But let me
explain.
Dr. Miller: She’s pancytopenic , she’s not producing any of these cells. These cells come from the marrow. The only reason, possible, plausible explanation for
this is that the lymphoma has overwhelmed her body’s ability to produce these cells. Either from tumour cells invading her bone marrow rather or what. If you give platelets or blood, it might produce a transient improvement in her numbers but it will continue to go down. I mean, how many transfusions has she had in the past month? This is just a reflection of her otherwise disease.
Dr. Miller: So, I didn’t feel it was
reasonable to give blood. So, I regret saying that, I’m sorry I said that to you. What I meant to say was that blood is a precious resource, okay. We have a limited pool.
Dr. Miller: In your sister’s case it was going to be the least benefit of anyone else in this situation because it wasn’t going to help her get better.
Andrea: How do you know;
did you even try?!
Dr. Miller: If she was here right now, of course I would give you a blood transfusion because you’d probably feel very unwell without it. Just symptomatically. When you’re anaemic, you’re tired, you don’t have energy so we give blood to help you improve your symptoms. Diana is unconscious, having suffered this brain injury whether it was a stroke or lymphoma, it wasn’t going to promote her health.
Dr. Miller: So, I don’t give treatment unless it’s going to promote health. All right? I do not do things to make people get worse and if I
did something that could potentially harm her, then you could easily turn around and say to me, “Why did you give that transfusion.” We give transfusions all the time in this hospital and cause harm. I deal with patients who come to critical care after they’ve had a blood transfusion on the ward or in the outpatient clinic because they suffered harm from it.
Dr. Miller: My daughter, I told you about my
daughter-
Andrea: I know-
Dr. Miller: She nearly died from a blood transfusion, okay. She nearly arrested in front of my eyes, from a platelet transfusion. So, if I had given her blood and she had arrested, you would have said, “You have now killed my daughter, my sister by giving her a blood transfusion.”
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Steve (Andrea’s husband): Who are we talking about?
Andrea’s Mother: We’re talking about why we needed….
Steve (Andrea’s husband): No, I don’t want to hear about your daughter…
Dr.
Miller: I know but I’m just saying, I’m just giving that as an illustration-
Andrea’s Mother: We’re talking about the pathology as to why we would give a blood transfusion and why we she needed blood.
Dr. Miller: I’m giving that as an illustration. I’m sorry, I just wanted to illustrate.
Steve (Andrea’s husband): I understand but we’re not talking about that.
Dr. Miller: No.
Steve (Andrea’s husband): We’re talking about my wife’s sister, use our personal examples if you want to illustrate a point.
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Andrea’s Mother: And we’re trying to talk
about the signs and the pathology and progression of the disease.
Steve (Andrea’s husband): That’s fine. Then let’s talk about the signs and the pathology.
Dr. Miller: So, look. That’s the reason for not transfusing, all right. It was for rational means and I’ve discussed this with a number of people, colleagues, even the director of ICU who has
not said to me, “You are doing the wrong thing. You need to give her blood.”
Andrea: What picture did you cling to get those results?
Dr. Miller: Look, she knew about the before I even discussed it with her.
Andrea: Did she know about the….
Dr. Miller: With all due respect, she had already got her own knowledge of the case. I didn’t tell her anything until I spoke to her.
Andrea: Yeah and she said to me, “I feel that Doctor is not treating me and has given up on me. I don’t want him anymore.”
Dr. Miller: We’re not expecting that from
her…
Andrea: You did, you changed. You were fantastic at the beginning. Like any other doctor, you’ve grown tired of her and then when she eventually…. She was grieving to me!! We don’t get all the medications that the US or the UK and Europe would get, okay. It’s always about cost. I understand, it all comes down to money.
Money makes the world go round. I get
that.
Related article/video:
Dr. Miller: That’s not the case.
Andrea: It is the case.
Dr. Miller: The best handle of care we
gave. Diana had the best care. She had a standard of care that she would have received at any institution she went to around the world. No, no… Around the world. She had the standard of care.
Andrea: Okay, I don’t worry much. I understand that. I don’t care.
Dr. Miller: I’ve been doing haematology for 25
years.
Andrea: I understand that.
Dr. Miller: This is the standard of care. It was in the standard of care for a long time.
Andrea: And if it doesn’t work?
Dr. Miller: If
it doesn’t work, this is where we end up. Modern medicine is fantastic. Well then… Stop! End the talking in circles. So, what you’re saying is the chemotherapy, she didn’t get the best standard of care. She did and standard of care killed her. That is not true. The lymphoma is killing her. Inevitably it is progressing. I spoke to Diana. I said she’s coming to the end. I’ve told you all along, she’s going to die from her lymphoma.
Andrea: What?
Dr. Miller: I chose to intubate her the night she had the seizure because she had a stroke and I thought the seizure and the stroke was reversible.
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Andrea: Okay. This was going throughout the whole treatment, no sedation.
She had her bone marrow she had no sedation. She said her wishes were no
sedation. She had a CT-scan no sedation. Every day, she said, “I don’t want to be sedated.” Okay. She was sedated and now look where she is.
Dr. Miller: She was sedated because she was having an uncontrolled
fit.
Andrea: How do you know?
Dr. Miller: Because the registrars dragged me up.
Andrea: They did not drug her up, they’re not.
Dr. Miller: They
are.
Andrea: How do you know??
Dr. Miller: They are fully qualified to recognize an uncontrolled epileptic
seizure and she had an EGR which showed epilepsy.
Andrea: Are they neurologists?
Dr. Miller: It was recorded by the two neurologist and was seen by two neurologists. A CT scan showed a brain injury. This seizure happened because of the stroke, all right?
Andrea: Then how come, now again back to my sister. How come she came into the hospital on a Friday, you guys did an MRI scan of her spine but not her brain, for four days
later.
Dr. Miller: No, she had a big hit right on the weekend. The MRI’s fine. At the time, I thought she had cord compression from the lymphoma because she had lymphoma in the chest and her initial symptoms were predominantly looked like cord compression rather than brain lesion. So, Friday afternoon at 4:00 or 5:00, the registrars organized an MRI on her spine.
Andrea: That’s not the brain though because if you’re going in the machine why not scan the whole brain?
Dr. Miller: In record, yes, it would have been good to get an MRI on the brain at the same time but at the time I was focused on the cord because the cord lesion needs urgent radiotherapy.
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Andrea: Why not take both in one go?
Dr. Miller: In retrospect,
if I had gone back I would have to do an MRI brain, MRI spine. It did not change anything. There’s no change to anything. We would have been struck with a stroke on Friday night, we would have been struck with a stroke now. It’s not going to
change-
Andrea: Nothing’s gonna change but I want answers.
Dr. Miller: Yeah, sure.
Andrea’s Mother: I feel, and I think but I suggested. I think today we need to work with where we are today. For you as a family, Diana’s dying and you as a family, we are happy
to sit down and answer any questions and go through it with you.
Find more information about providing dignity to a dying patient:
Dr. Rosebud: No, you’re happy to control it. You’re happy to control the question asking and you’re happy to manage, rather than
have the last having the last stand.
Andrea’s Mother: I can help them up…
Dr. Charkow: I think what this is what I say is, this discussion is preventing your family from going through appropriate grieving…. It’s preventing you and your family from going through appropriate grieving for her.
Andrea: Is that? Okay.
Dr. Miller: Listen, I can’t bring her back!!
Andrea’s Mother: In the event, okay…
Andrea: In the event you will honour family’s wishes. I order to resuscitate. Then I had to look on the computer
Sunday night. On the file and then not to resuscitate!! I don’t know who changed it on the computer or whether it was changed.
Dr. Charkow: No, I instructed my senior registrar to change it.
Andrea’s Mother: Okay, so you made a decision not to do it against family wishes.
Dr. Charkow: I did make the decision not to resuscitate and I stand by it. Following our discussion on Monday, I spoke with the senior registrar we will definitely change it that we would change it. Okay it’s gonna be… I respected your wish on that point that we would try to resuscitate her,
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Patrik: But you didn’t inform the family when you made that decision. You didn’t inform the family when you made that decision. That would be a point of criticism.
Dr. Charkow: No, I forgot. I did actually say, that we would resuscitate her and that I would give blood transfusions as appropriate.
Steve
(Andrea’s husband): Yes, but that’s not the question. The question is you spoke to the Russian to the Russian doctor and made the call.
“Look out for next week’s episode of YOUR QUESTIONS ANSWERED where I continue to help Andrea with this challenge of having her 34-year-old sister in ICU!”
Kind Regards
Patrik
