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
My Critically Ill Husband is in Dialysis and in ICU due to Septic Shock. He is not sleeping, is this another sign of deteriorating condition?
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 questions from one of my clients Eva as part of my 1:1 consulting and advocacy service! Eva’s husband had a
cardiac bypass surgery and stroke in ICU, he is delirious and is asking if her husband is in poor prognosis.
My Critically Ill Husband is on Dialysis and in Delirium? Is this because of the dialysis?
Patrik: You’d think that they would be selecting their staff potentially according to their faith, but I don’t know.
Eva: Well, or if you have a policy about it or not that’s … I mean the hospital policy needs to be followed whether you personally agree with it or not agree with it.
Patrik: Correct.
Eva: Generally, it’s something that people ask for, not that it’s put out there and people are forced to choose between one option and that option. So, in terms of mental health, I’m pretty sure that that is why he is now in delirium because he’s afraid to go to sleep, which is what the doctor said.
Patrik: Yeah. I think you mentioned in one of your emails that he is on Seroquel?
Eva: Yes.
Patrik: How much is he getting? Do you know?
Eva: I think … Yeah.
Patrik: 25?
Eva: It was 12.5, and so they popped it to 25 at night, but that was not … He’d slept for about an hour and a half and then woke up again, and then I think they maybe gave him a second dose and that didn’t work.
Patrik: Anything else he’s getting to “sedate” him?
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Eva: Paroxetine. That’s not to sedate. That’s again a minimum dose.
Patrik: When you were saying yesterday the counsellor was here, is that from the Ethics Department or is that from other department?
Eva: No, that’s their spiritual counsellor. But I did meet with the Ethics Department, and her as well, to talk about again my concerns about how we was being badgered about this.
Patrik: Yeah. And it sounds to me like if they apologised, the Ethics Department must have spoken to them because …
Eva: Yes.
Patrik: That’s good. I’m glad.
Eva: But it hasn’t fixed the problem.
Patrik: No, no. It hasn’t fixed the problem, but at least it’s good to stop, to them putting pressure on, for now.
Eva: Not really. No, that didn’t stop that at all. I had to send people away. They were all gathered around the foot of his bed again because he was still aware yesterday and there was this feeling of urgency for him to make a decision while he was aware; because when he’s not, then he cannot make a decision.
Patrik: Sure. But for now, in order to take the pressure away, it’s almost like … I mean what’s your feeling? I mean your husband has a strong will to live? Do you think he would even-
Eva: Absolutely.
Patrik: Right. We wouldn’t consider giving up?
Eva: Not that way. No. I didn’t even know that was what was being suggested. No, I don’t think so. I did say to them, because his speech is … now they’re taken his teeth out, so it’s even harder … I said his actions speak louder than words. He is cooperating and participating until last night when now he’s picking at things; they may use that as a sign; I’m worried about that.
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Patrik: A lot of patients in ICU can become delirious especially after sleep deprivation and especially after not being in natural daylight for weeks.
Eva: Yeah.
Patrik: So, it’s nothing unusual, unfortunately. At the same time, the delirium is often not being used to stop treatment. It’s other signs usually that would be … You know, it’s more like the organ
failure side of things when people might say yes.
Eva: Right.
Patrik: So, the delirium is definitely a concern because it’s torturous being in ICU without being delirious.
Eva: Anyway, yes. Yeah. I’m so sad because we only had two days where he was able to talk with his family and friends, and all he had was people stopping by not for positive things. I said, “Unless you’re coming by to just chat and have a positive interaction, go away.”
Patrik: Right. Good.
Eva: But I don’t know what they did last night and that’s … you know.
Patrik: Concerning.
Eva: Concerning.
Patrik: Yes.
Eva: I had a request on his file that I’d be present at any kind of procedures because he is very anxious, and so previous to this I’ve been there. So, they told me that he agreed to it and that it wasn’t a problem, but internally it is.
Patrik: Absolutely.
Eva: He doesn’t show it outwardly.
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Patrik: Any more talk about having a cardiologist involved in all of this? Or have you asked again?
Eva: No, but I will ask today.
Patrik: So you’ve got to keep asking for what we believe is appropriate, right?
Eva: Yeah.
Patrik: And this particular consultant that’s on this week, he won’t be finished for a while. Is that right?
Eva: I think he’s actually on for one week.
Patrik: That means he would finish when? By Sunday?
Eva: That’s what I heard. I can ask again. The other doctors were on for two-week rotations.
Patrik: Right. It depends.
Eva: Am I talking too much?
Patrik: It depends, but most of the time it’s one week.
Eva: Here it has been two weeks.
Patrik: Okay. Sure.
Eva: But I don’t know for sure. I can check that out.
Patrik: Your husband would have a catheter for the dialysis, right?
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Eva: Yeah.
Patrik: Where is that catheter? Is it in his shoulder or is it in his groin?
Eva: No. It’s in his neck.
Patrik: In his neck. Okay. The reason I’m asking is we were talking about getting your husband mobilised and potentially keeping him on the edge of the bed, and they should be able to do that as long as he’s got what’s called the vascular catheter in his shoulder. If it was in his groin, mobilisation
would be very difficult.
Eva: Right. He did have one to start, and then they moved it to the … The catheter wasn’t there; it’s always been up there.
Patrik: Okay. Good.
Eva: He has nothing in his groin.
Patrik: Okay. Have they tried to mobilise him this week at all?
Eva: No. Well, just the cardio chair.
Patrik: Okay, that’s good.
Eva: And today he’s too sleepy.
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Patrik: Is he tolerating that? Is he tolerating the cardio chair?
Eva: Yeah. Up all day yesterday. It was their plan to tire him up.
Patrik: Good.
Eva: Physically it tired him out, but…
Patrik: Right. And again, Eva, that is important information because if they were completely giving up they would not do that. That’s why I-
Eva: Well, I had to push, but yes-
Patrik: Yes you have to push for it and keep pushing.
Eva: Yeah.
Patrik: Definitely keep pushing, but I’m glad to hear that those things are happening. Is your husband on oxygen, a little bit of nasal oxygen?
Eva: No.
Patrik: Oh, good.
Eva: He only needed a little bit of that last week, and so that’s been off.
Patrik: Oh, good. That’s a good sign.
Eva: He’s back to being NPO again today just because he’s not staying very awake, which made me very sad. He ate way more yesterday than he ever had. Jessica came in, ripped the old one off and put NPO up. That’s a little heartbreaking, especially since they took his teeth out and can’t get them back in.
Patrik: You know, it’s those little things that really make a difference.
Eva: Well, sure.
Patrik: It’s not being to talk. Not being able to talk is just like …
Eva: And it’s only this nurse who can’t do it, and he refuses to ask anybody else to do it.
Patrik: I see.
Eva: Whereas other nurses just went and got someone else when they had difficulties with it.
Patrik: You think there’s a realistic chance he might get them back in with the right nurse?
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Eva: Yeah. It’s just a little difficult. Because he slipped right back there.
Patrik: Okay. How many days has it been now on this admission, on this ICU admission, two weeks did you say?
Eva: 10 days.
Patrik: Okay. This communication from there needs to stop and it really needs to go from end-of-life talk to, “How can we take one day at a time?” It’s all about one day at a time, and really
getting him through this day, and getting his through tomorrow, and look for the little signs. You are there pretty much 24-hours a day. You said you went home last night, which I think it’s good that you did that.
Eva: Well, not really.
Patrik: No, no, no… It was alright
Eva: No, no, no. Yeah, but it’s …
Patrik: Yeah, but you need to look after yourself as well.
Eva: Yeah, but it comes down to a … I have had people come and be here while I was not there; I’ve used them all up. With that being said, I have talked about hiring someone to come in just to provide that little bit of support while I’m not here, and especially them being here during the night when he is just left pretty much alone and is not sleeping. So, that makes it a very, very long time to be sitting, which does not help with delirium.
Patrik: No, not at all.
Eva: If you’re not being reoriented and talked to it’s a long time.
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Patrik: Absolutely. At the same time, your well-being is just as important.
Eva: Well, I can sleep during the day.
Patrik: Right. Having been a shift worker for many years, and done night shifts for many years, I know how tiring it is.
Eva: Can you hold just a minute? I just want to check with Graham here.
Patrik: Sure.
Eva: (silence)
I’m sorry.
Patrik: That’s okay. So, where to from here? I guess now that you also mentioned the euthanasia part, that is a real concern, and you really do need to watch them.
Eva: Yeah. Can I have you hold one more time?
Patrik: Sure.
Eva: (silence)
Hi. Thank you for staying.
Patrik: That’s okay. I think, from what you’ve shared so far today, it’s really a matter of, on the one hand, the clinical things seemed to stabilise, if not improve.
Eva: Yes.
Patrik: It’s really all about the communication.
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Eva: Yeah. I think perhaps what I need to do is to actually write something up and have it on his chart.
Patrik: Yes.
Eva: About what wishes we have discussed, and we can put that health care directive on there.
Patrik: Very good idea.
Eva: Yeah.
Patrik: Very good idea. And as I mentioned to you, you need to be repetitive.
Eva: Okay.
Patrik: You almost need to sound like a broken record until they get it, until they really understand you and your husband don’t want that talk about end of life while he’s here.
Eva: Yeah.
Patrik: Again, I can’t stress this enough, Eva. When you go into this place, into this unit, if you look around you would most likely see that most other patients are on a ventilator?
Eva: No, actually. No.
Patrik: Okay.
Eva: They’re pretty good at getting that off pretty quick.
Patrik: Okay. That’s good. But where I’m going with this is really a lot of patients in ICU would be on a ventilator, right?
Eva: Yeah.
Patrik: And your husband is not, and that’s good.
Eva: Absolutely.
Patrik: If he was on a ventilator and he was on the Norepinephrine and he was on the dialysis machine and everything was failing, maybe the
discussions need to be had, but that’s not the case.
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Eva: Yeah. Okay. That makes total sense. Can I let you go and give you a call back later?
Patrik: Absolutely.
Eva: Okay. Thank you so much.
Patrik: You’re very welcome. All the best.
Eva: Talk later. Bye-bye.
Patrik: Bye.
The 1:1 consulting session will continue in next week’s episode.
