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 our readers and the question was
The ICU Team Is Stopping Treatment To My Dad In The ICU. Can I Transfer Him To Another Hospital?
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 succeeding questions from one of my clients Peter as part of my 1:1
consulting and advocacy service! Peter is asking if pulling his dad out of the ICU is a part of medical malpractice?
The ICU Team Just Wanted to Empty Their Beds and Get Rid of My Dad. Is this Medical Malpractice?
“You can also check out previous 1:1 consulting and advocacy session with me and Peter here.”
PART 1
PART 2
PART 3
PART 4
PART 5
PART 6
PART 7
PART 8
PART 9
PART 10
Peter: Yeah. I mean, I just don’t want to have him in a dead-end…
Patrik: Of course not.
Peter: You know, just sit there and watch him die, you know?
Patrik: Of course not. But what I’m saying, you know, it is possible, and just because they say no today doesn’t mean no tomorrow.
Peter: Yeah. Or you know what she meant … I had a good question for you. You might know this. This doctor refuses to use … what’s that antibiotic that begins with a V? I don’t know why I keep forgetting it.
Patrik: Vancomycin?
Peter: They will … vancomycin.
Patrik: Yep.
Peter: Because he’s got two or three different bacteria in the lungs they cultured out, but … they don’t want to give him vanco because … under what conditions do you guys down there in your hospital’s protocol?
Patrik: One of the major side effects of vancomycin is kidney failure. That’s one of the major side effects.
Peter: Oh, is that right?
Patrik: I would stay off the vancomycin if I could, that’s for sure.
Peter: Oh.
Yeah, well that’s … you know …
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Patrik: To me, staying off the vancomycin if your dad has the potential to go into kidney failure only makes sense to me.
Peter: Yeah. Well … I mean, the funny thing with him though is when he’s on vanco, a lot of times they don’t do cultures on his sputum because this is prior to him having a tracheostomy. They wouldn’t take the cultures from the mouth. But I mean, they would … or the doctors would always say, “no, we
aren’t going to do any cultures, and throat cultures or sputum” and instead they’d just give him vanco and … what is it, cefitine? Is that the one they use? Or … zoso? Or … you know, that one. Zo-, zosys, or something like that. It’s supposed to be a really good antibiotic
Patrik: What antibiotic did you mean, besides the vancomycin?
Peter: It’s either ceptetine or cefepine …
Patrik: Oh, cefepime. Yeah, cefepime. Yeah, yeah, yeah.
Peter: And/or the zosif or … I keep forgetting the name.
Patrik: I can’t think of that.
Peter: Anyway, right now he feels good, within two or three days he’s nice and bright, the congestion clears up. And I’m wondering, if you fix his lungs, I guess what you’re trying to say is it might knock his kidneys out trying to fix his lungs. He does respond well to vanco, as far as his healing.
Patrik: Yeah. But he’s probably not … yeah, yeah, but his kidneys will suffer. His kidneys will suffer.
Peter: Yeah, maybe that’s what they’re worried about.
Patrik: Yeah. Most likely.
Peter: What about vanco … and she said too that they don’t give vanco if it’s a gram negative … I want to say it’s a gram negative bacteria.
Patrik: That’s right.
Peter: Have you heard of that one?
Patrik: Yeah, absolutely.
Peter: So they didn’t, because she said that he doesn’t have any signs of gram negative bacteria anywhere in the sputum samples. So they didn’t give him vanco, she told me.
Patrik: Right.
Peter: But I hope it’s not anywhere else.
Patrik: Right. I really think, Peter, you should wait for the weekend, talk to the other hospitals, start talking to them, put yourself on their radar. That’s what I would do, so you have options.
Peter: Yeah. I have a funny feeling, though, that nobody … she says … “You know, she knows her field.” She goes, “I want to tell you something,” she says, “Nobody’s going to want him.” She goes, “Even the VA, they’re not going to want him in this state. Like this.”
Patrik: Peter?
Peter: I don’t think anyone’s going take him.
Patrik: Right. Peter, everything in life is negotiable. Everything in life is negotiable, right? So keep trying. Don’t say “they’re not taking him.” That’s not the language you want to use if you want him over there.
Peter: Yeah, well I’m just telling you what she said.
Patrik: Yeah, well, keep asking. Keep asking.
Peter: Yeah.
Patrik: Yeah, yeah, but I do believe you’re safe to wait for the weekend. I think he’s safe for now, from everything that you’ve shared. But if after this second opinion, if you feel like it’s not going anywhere, or if you feel like it’s going in a direction that you don’t want to, then I would definitely get the ball rolling.
Peter: Yeah, because it doesn’t hurt, I mean, if he’s going down a dead-end street, you might as well try to do something for him.
Patrik: That’s right. That’s exactly right.
Peter: The only things limiting, is if those … my concern, if he’s the way he is now, with the … who would … if there isn’t another ICU, nobody else can accept him. It is mainly because they’d try to throw him into a nursing home or something.
Patrik: No.
Peter: They couldn’t accept him like this.
Patrik: Well, if he … okay, so if he goes to another ICU, what will basically happen is, a consultant or a doctor at the ICU where he’s at the moment needs to refer to another ICU doctor. That’s what’s happening. But that’s not out of … okay, so here is the thing, Peter. If they don’t want to continue treatment for whatever reason, it’s a sign that they want to empty their ICU bed. Now if they empty their
ICU bed by letting your father pass away, or if they empty it by sending him to another hospital, it doesn’t really matter at the end of the day from their perspective. All they want is, they want to have their ICU bed empty. Right?
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Peter: Oh yeah.
Patrik: So that’s what I mean. Everything in life is negotiable. Right? So you’ve got to play your cards as they might. You know, I mean, it’s just a matter of negotiating, really.
Peter: Yeah, I know. I just … you know, just want to have a … it’s such a hard thing to get them to transfer him there, you know?
Patrik: I wouldn’t say that …
Peter: I have to take the mattress.
Patrik: Why do you have to take the mattress? Is that his own?
Peter: Oh no, no, no. Just that the … no, the air mattress is, they have to get one when they get to the new hospital. They have to order one. ‘Cause usually, unless they have them in all the ICU beds, and typically they do … yeah, it’s just that … no, I’m just saying, they’re going have to lose that.
Patrik: Okay.
Peter: Oh, I’m sorry. I’m a little …
Patrik: Yeah. Okay. I think you’re well on your way. I think you’re well on your way. Just, I would wait for the weekend, and see what happens next.
Peter: How long can somebody go without peeing? I mean, in general.
Patrik: Ah, probably a few days.
Peter: Yeah, like, they’re keeping the volume down, but … yeah, just … have you seen kidneys wake up after so many days not peeing?
Patrik: Yep. So about 90% of patients in intensive care who go on dialysis, the kidneys recover. But I think your dad has chronic kidney issues, doesn’t he?
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Peter: Yeah, and … I don’t know, the other thing too is like, even if they were able to, he was still sick and he keeps getting these infections. You know, I don’t know whether it’s the trach that’s causing all these infections. They’re always just having this humidifier running on his trache, you know? I mean, I don’t know why they can’t just leave the trache with a … you know, those HME valves, just letting things natural.
Patrik: No, You can’t do that. The HME filters are only effective for 24 hours, and they’re not as effective as humidified oxygen.
Peter: You couldn’t do that?
Patrik: No. No, no, the HME is not good. Giving humidified oxygen is the right thing.
Peter: Oh, I see. I was thinking all that humidity though might be instigating the growth of the bacteria.
Patrik: No. No. I tell you why. No. It’s set at the physiological temperature, and also … so when you and I breathe in through the nose, our air gets warmed.
Okay? With a trache, if you’re not giving humidified oxygen, you’re inhaling cold air. That’s causing damage. So the humidification is the right thing to do, Peter.
Peter: Yeah. I’m just wondering, you know, trying to get [crosstalk 00:47:01]
Patrik: Yeah, absolutely. Absolutely.
Peter: I mean, he’s just, poor guy. He was feeling good and he got another infection there. So I was even going to the urologist. They’re wondering about taking out the suprapubic catheter, and put in just a direct line.
Patrik: Right.
Peter: So I mean, it … I don’t know. I’m sitting here worried about him.
Patrik: Yeah, absolutely.
Peter: I don’t know what to do. What … anyway …
Patrik: I would wait. Wait for the weekend.
Peter: Yeah, and then … you know, it’s funny. Half of him is recovering. Half of him is recovering, like, he’s getting a little more awake, a little more … but the other half is a problem. Yeah. But I don’t know how much longer they’re going to let him wait there, and let him waste his kidneys. She talked like “we don’t think there’s going to be any improvement.” Now the dialysis, about this, the VA told me that a creatinine of 5 wasn’t concerning to him. He said “when it gets up to 14,” he says, “that’s when you going to worry.”
Patrik: Yeah. Absolutely. And I …
Peter: And he also said as long as he’s making urine. See, now dad’s not making urine, so …
Patrik: Yeah, and I agree. I agree. I agree with that. It’s too early.
Peter: Yeah, but the urine output is still down.
Patrik: Yeah, the urine output is probably down, because he’s dehydrated.
Peter: That’s my theory, yeah, ’cause they’re not giving him hardly anything.
Patrik: That’s right. That’s right. So you know, it’s …
Peter: And that’s probably why the creatinine’s elevated, right?
Patrik: Absolutely.
Peter: And the creatinine is elevated because it’s concentrated, right?
Patrik: Absolutely.
Peter: So what they have to do is maybe … I mean, I know we’re just talking here, and you know … we’re not doctors and all that, but in the end …
Patrik: No, we’re not doctors. But they have a very good … I believe I have a very good understanding of all of this.
Peter: Yes, that’s why I’m calling you, Pat.
Patrik: Yeah.
Peter: You know, I mean, I know you have a lot of experience with this. And you know what goes on and … you know, which is a lot more than just knowing … and plus you have a lot of good medical knowledge about what’s going on, you know?
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Patrik: Right, exactly.
Peter: That’s why I call you.
Patrik: Yeah, absolutely. I think they are doing the right things. What they may not be doing is the … he might be dehydrated, but I can see why they want to try and dehydrate him because of the risk of the lungs. I can see that.
Peter: But see, then he would be … the antibiotic … now, see, ’cause they don’t want to use the vanco but there are other medicines like the … they haven’t tried.
Like, the zoso, I think it’s called. Zosyl?
Patrik: Yeah, but Peter, you don’t want to overdo it with antibiotics either. You don’t want to overdo it either.
Peter: Well he might get better on his own maybe, I don’t know.
Patrik: He may. He may.
Peter: It happened before, you know. He had a bad lung infection, his white count went up to like, what is it … 18,000, and the doctor would not give him antibiotics.
Patrik: Right. Yeah.
Peter: And what happened is that a few days later, the white count turned right around and went right back down. He felt better on his own. He fought it off on his own.
Patrik: Right.
Peter: But his urine output was okay at that time.
Patrik: Right.
Peter: Let’s give him another chance.
Patrik: Right.
Peter: All right now. So, all right, I won’t hold you any longer.
Patrik: That’s no problem at all, Peter. I’m glad you’ve called. I’m really glad you’ve called and, you know, you’ve done your research, and I think now you can ask them better questions and I would recommend, talk to that other hospital if you are concerned. And keep knocking at their door.
Peter: Because I don’t think other hospitals in the area will take him, but the fact that he’s a veteran, they might take him.
Patrik: I think so. I think that as a veteran, he has a higher chance of getting a bed. But I wouldn’t use that language, Peter. I would say, if I were you, I would tell myself, “Yes, they will be taking him.” That’s the language that I would use. Try a much more positive language.
Peter: Well say that again?
Patrik: I wouldn’t use the language, “They’re not going to take him.” That’s not the language you want to use. I would use the language, “They are probably going to take him.” Positive self-talk, not negative self-talk.
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Peter: Yeah, that’s true too. In fact I should talk to them as though they have to take him.
Patrik: Exactly.
Peter: Maybe when I talk … you know, like, “Hey, I have a patient to be transferred to you, period,” you know?
Patrik: That’s exactly right. That’s exactly right. So use different language, because if you do, your whole body language, your thinking changes, everything changes.
Peter: Yeah, because this doctor at the VA, he was really one of the most … what I was told, he was one of the most brilliant doctors in the country. And he’s at the Boston VA as a kidney doctor.
Patrik: Right.
Peter: And that’s why … I had a supervisor that I worked for, and he told me that, “Peter, this guy is, he’s really well known all over the country.”
Patrik: Right.
Peter: His name is Dr. Hamburger.
Patrik: Yeah.
Peter: He’s supposedly pretty good and he told me to get him, and …
Patrik: Right, right. Okay.
Peter: Okay.
Patrik: Does that make sense? Keep watching, keep asking the questions, and keep talking to that other hospital.
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Peter: All right now.
Patrik: Give me a call if you need anything.
Peter: All right, I appreciate your input, and you helped me to clear up a lot of pros and cons. And the thing is I don’t know what to do though if they give me no choice but to let him go, and I don’t know how I’m going to do that. I mean, should I bring him home and he goes in the house? I’m saying, they might force me to take him home or take him to some nursing home place …
Patrik: I think …
Peter: My thought … what about this thought, take him home, and then the next day, call an ambulance and bring him to the VA doorstep?
Patrik: That could work. Yeah, could be tricky.
Peter: Right in the emergency room, and then they’d have to take him.
Patrik: Could be tricky taking him home without nurses.
Peter: Yeah. That’s true too. He needs some support.
Patrik: Yeah, he does. He does.
Peter: Well the hospital, can a hospital just pull the plug?
Patrik: No, no, no, that’s why I asked about the DNR earlier. You remember, I asked about the DNR?
Peter: No, but she’s giving me this line about how she says, “Well as his doctor, if I think this is cruel and unusual, cruel punishment to continue him … that this is torture, putting him through this,” she goes, “I can refuse to continue to treat him.”
She gave me that line.
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Patrik: Right, I would dismiss that as talk. I would dismiss that as talk. She needs to give you the evidence that she has the right to do that. She hasn’t given you any evidence that this is the right thing to do.
Peter: Well … all right now. Well you take it easy.
Patrik: Okay. And you, all the best, Peter. Give me a call if you need anything, okay?
Peter: All right now.
Patrik: Take care.
Peter: Thank you very much.
Patrik: You’re most welcome. You’re most welcome. Bye bye.
Peter: We’ll see you.
Patrik: Bye bye.
Peter: Bye.
The 1:1 consulting session will continue in next week’s episode.
Kind Regards
Patrik
