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 Mother is in ICU for a Cardiac Arrest. What are the criteria for ventilation Weaning?
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 Stephanie as part of my 1:1 consulting and advocacy
service! Stephanie’s mother is on post-cardiac arrest care in the ICU, and is asking if the healthcare team is really putting her on LTAC with only 9 days in.
My Mother is in ICU for Cardiac Arrest. Is It a Good Decision for the ICU Team to Transfer Her in the LTAC? Help and Support!
“You can also check out previous 1:1 consulting and advocacy sessions with me and Stephanie here.”
PART 1
PART 2
PART 3
PART 4
Tonette: I see it.
Patrik: -but, I’ve seen patients in ICU for months, sometimes. You know-
Tonette: Mm-hmm (affirmative)-you right, Dr. Patrik.
Patrik: Right? I’m not a doctor. I’m not a doctor.
Tonette: Okay.
Stephanie: So.
Patrik: I’m a nurse.
Stephanie: Mm-hmm (affirmative)-
Tonette: Alright, Nurse Patrik.
Patrik: Alright. So, you know, they wanna make you believe it’s a long time, it’s not. You know, it’s not a long time. And the reports might be negative. But, the reality is, what Carmen will need is time.
Stephanie: Yes sir.
Patrik: She will need time. And she will need time in the right environment.
Tonette: Right! She had pneumonia. We forgot to tell you that. They cleared that up. I think they cleared that up. Right? Talk to me, Miranda.
Miranda: They got this weird doctor over here at night time. They got this little weird doctor here at night time, and I asked him, I was like, “Is the pneumonia,” I asked him tonight, I was like, “Is there any way you can verify if the pneumonia is cleared or gone?” and he was like, “Well, they haven’t said anything.” I was like, “Huh?” And he was like, “We put her on antibiotics and normally seven days clear it. And we haven’t done
another chest x-ray to look at the pneumonia.
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Tonette: What it was, it was the aspiration pneumonia. They said when she came in, before she came. Okay, what, the aspiration pneumonia was a result of the seizure that she had before she got to the doctor. That saliva, or whatever the stuff that she was drinking, the soda, she pretty much, choked off on it and that was what brought on the aspiration pneumonia.
Patrik: Right. Right. Look, the um, you see, it’s certainly not good that she had an aspiration pneumonia, but the reality also, is that in a situation like that, people do suffer from complications and one of the complications of it is pneumonia and that’s unfortunately part of being on a ventilator.
And that relates back directly to, that’s why it’s so important to get somebody off the ventilator as quickly as possible.
Stephanie: Mm-hmm (affirmative)
Tonette: Before I forget it, they said, something, Miranda, help me out. They said something about her liver, too, what did they say? Dr. Reynolds.
Miranda: Oh, I didn’t hear anything about her liver.
Stephanie: No, her liver levels were good. At one point they did not want to give her the stronger seizure medicine because it affected the liver, that’s what the doctor at St. Joseph’s, the neurologist told them, they didn’t want her liver levels to change to normal, just very close to
normal, they said it was no problem for giving her that. And they were supposedly taking blood draws to check that. So, they didn’t say, from that last I heard, which was probably a week ago, you know. Not more than a week ago.
Patrik: Right.
Tonette: They did do the blood samples. And I thought they had clots in it.
Stephanie: From her lungs. The area around her lungs, not in her lungs. So what does that mean?
Miranda: When did they have that? They told me she was fine.
Stephanie: Oh, that was a while ago, Miranda.
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Patrik: Yeah, look, if she had a heart attack there would have been some blood clots, there’s no doubt about that. Because a blood clot is what leads to a heart attack.
Tonette: Right, they said it was real big, Nurse Patrik. They said the first blood clot, they said it was so humongous, and then after that, they did a sample, and I thought, that they became small after a period of time.
Patrik: Right. So, the goal really is, to wake her up, or to try to wake her up, and if that fails, well, let’s look at what else can be done.
The goal is to wake her up, see whether she can realistically come off the ventilator if she can’t, okay, well, then maybe a tracheostomy is the next step, but
even then, you know, she should not go to LTAC. The reality is, chances that things go wrong are there, and the LTACs most of the time, do not have an ICU, which then again, if something goes wrong, she would have to go back
to another hospital, which is, you know, it’s ridiculous. Just the whole thought of going-
Tonette: I’m telling you. They’re driving that LTAC so strong, I’m telling you. That’s all they keep talking about.
Stephanie: I heard it.
Miranda: What’s LTAC?
Stephanie: That’s long-term acute care.
Patrik: That’s right.
Stephanie: That’s an acronym. The acronym for long-term acute care.
Patrik: That’s right. Because it’s their default position. Alright, it’s that default position, whatever they do, is they feel like they can’t meet their timelines around how long a patient should stay in ICU.
Stephanie: There we go.
Tonette: That’s it.
Stephanie: It affects their numbers.
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Patrik: Correct.
Stephanie: I worked in a place where, I work in the gas and electric facility, where we count the number of times that your power is out. We count the correlation of how long your power is out. We get paid off of that. Do you hear me?
Patrik: Yeah, oh yeah.
Stephanie: We get paid based on how long we keep a customer’s service out.
Patrik: Right.
Stephanie: But we do everything in our power to make sure that we get that service back on as quickly as possible, and the principal is the same in the hospital.
Patrik: Yes, yes.
Stephanie: They all have numbers. We all have metrics. We all have metrics that we try to meet, you know what I mean?
Patrik: With a difference with ICU in particular, now let’s just say that Carmen goes out of ICU tomorrow, that bed will be occupied in no time. Right? That’s one of the critical components in all of this. Because if there was no shortage of beds, you know, they would, potentially, have all the time in the world.
But because there is a shortage of ICU beds, they don’t have time.
Stephanie: Mm-hmm (affirmative)-
Tonette: You’re right. I mentioned it. I seen people in here 120 days with a breathing tube at one time. I mentioned that to the doctor.
Stephanie: Mm-hmm (affirmative)-
Patrik: Right.
Miranda: Will they try to put, do they have enough authorization to try to put her out or do something if we don’t agree with them?
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Patrik: Yeah, so. I wouldn’t, you know, nobody can force you to consent to a tracheostomy nobody can force you. And nobody can force you to send her to LTAC. Now the hospital will make you believe that they can force you. But, my experience is they can’t. You know, there’s no law, in this world, who says, you have to consent to a tracheostomy. They have a duty of care for Carmen as well as for you as
a family. You’ve got to remind them, if you think it’s necessary.
Stephanie: I hear you, yup.
Patrik: Right.
Stephanie: The duty of care.
Patrik: The-
Stephanie: You take an oath, to take care of patients. You take an oath.
Patrik: That’s right. And also, let’s just say, if she was to go to LTAC is that far away from where you? I mean, is that an inconvenience? Besides going to LTAC is
that an inconvenience to you in terms of travelling?
Stephanie: Mm-hmm (affirmative)-
Patrik: Is it?
Stephanie: Yeah.
Patrik: Because-
Stephanie: No there’s one in Burnham. Burnham, but still. That’s not what we want.
We want her, the best case scenario, which we haven’t attempted, which you haven’t followed through on very much, is to try to wean her off of the ventilator.
That is our goal. Our goal is to, and it’s your goal as well.
Patrik: Absolutely, that is the goal. That is the goal. You see the other.
Stephanie: That’s the terminology we want to use. The goal.
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Patrik: Yup. Yup. Exactly.
Stephanie: This is the goal we want for Carmen. We hope that your goal is the same as our goal.
Patrik: Correct, correct. And also, in LTACs for example, you know, at the moment you can see, there was a cardiologist putting in a stent, now there’s a neurologist dealing with, you know, the seizures and stuff, in LTAC there is no specialist
on site. There is no specialist.
Stephanie: Wow.
Patrik: Right? There are no specialists. In ICU, you have specialist input pretty much whenever you need it. In LTAC there may be specialist input, but they’re not on-site usually, they have to come in from external, and it’s just a mess.
Tonette: A mess.
Stephanie: If they had an emergency, yeah. But they would only come in if there is an emergency quote unquote.
Patrik: Exactly, and I can tell you, I can tell you because I talk to people, whenever I deal with somebody in LTAC and I get to talk to a doctor or to a nurse with
my clients, when I ask questions, especially the nursing staff there, they have no idea. They put on their website they’re specialised in weaning people off ventilator When I talk to a nurse, and I ask them very specific questions, they have no clue what they’re talking about.
Stephanie: We’re gonna keep you close to that. We’re gonna try to execute this and we are going to try to, and if we have any questions we’ll come back to you-
Patrik: Please.
Stephanie: And have another consultation. If we have to bring you in, and I don’t know how we could do, I know we can’t afford to bring you here. You know that’s $10,000. We can’t afford that, but we can have you in on a conference call, right?
Patrik: Yes, very happy to do that. Very happy to do that.
Tonette: And I will be-
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Patrik: If I was you, I would get that meeting agenda in writing, and I would only attend once you have it in writing so there’s no secrets on their end.
Stephanie: Right, right, right, right, right. And there’s no need to be upset, there’s no need to be anything, you know, this is what we need, are you able to provide it? Then we don’t need to have a meeting without this.
Patrik: You are-
Rebecca: Because I mentioned the third party. I said, “If you guys aren’t able to-
Stephanie: You were saying something, he was saying something, Rebecca.
What did you say? I’m sorry, Becca. Hold there, hold tight Rosita. I’m sorry Patrik, what were you about to say?
Patrik: Yeah, I was about to, just to reiterate that you can’t control other people, but you can control how you respond. And don’t let people pressure you. Don’t let people pressure you. If you feel pressure, it’s just your response. You’ll have to control your response, you know. And it’s easier said than done, don’t get me wrong, it’s easier said than done, because I know how vicious they can be, but you know you have to control your
responses.
And you have to, you know, I’m all for working with people, don’t, I have no interest in picking fights with people, but as you can see, this is potentially a life or death situation right? And you have to be
firm.
Stephanie: Yes, right. And this cool, calm and collected.
Patrik: Yes, yes.
Stephanie: That’s the thing. And I say that because, I will say this, when you’re up, and I’m a little excited speaking to you, but when you are confronting people that feel that they are better than you, or that they have a higher education because they have letters behind their name, because they’re doctors, they feel that you’re nothing. And if you come across excitedly, guess what? They value what you have to say even less.
Patrik: Yeah. Yeah.
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Stephanie: So you have to come across firm, but calm, like you said. You’re very good at that. And I want to commend you for that.
Patrik: Yeah.
Stephanie: And we all have to make sure that we come across like that, you know, to them.
Patrik: Yes. And I fell like, you are, I believe you are very determined in getting the best outcome for Carmen and you just, as far as I can see, you just, with this interaction, you seem to be all on the same page. Which is also important.
Tonette: Definitely.
Patrik: Right, which is also important. You know, don’t let them intimidate you, you know. And what you’re saying, what you were saying, Stephanie, like, you know people might think they are better than you or whatever, you know, all I’m referring to, you know, it perceived power, it’s perceived authority, but it’s only perceived. It’s not real.
Stephanie: Exactly. Right, because we give them the power, okay? We have the ability to either give it to them, or we keep it for ourselves.
Patrik: Correct. Correct. And do not go, if they talk about insurance potentially not paying, do not make this about an insurance issue. It’s a clinical issue. If the insurance has a problem, they will contact you. But unless they’ve contacted you, I would not worry about that, at all.
Stephanie: Sounds good, sounds good. Yup. If they try to say it to you, I’m sorry, it’s not about an insurance issue, this is a clinical issue. This is about Carmen’s care.
Tonette: Keep it clinical.
Patrik: Yes. Absolutely, keep it clinical. Because if they are making it about an insurance issue, they want to push her out to LTAC. You know, just don’t go
there.
Tonette: And that- That is their ultimate goal.
Miranda: He said that during a meeting. He said do not mention anything about the insurance.
Tonette: That’s right. Just don’t say a word. Don’t say a word about it. We’ll say that to them. Don’t say nothing about insurance or nothing. The social worker’s been talking to you, right, Miranda?
Miranda: They not really saying nothing, I don’t- Ms. Jean, she just be offish.
Stephanie: So she’s giving you offers for what? For facilitating rehab facility.
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Miranda: Offish, she like, all she been saying is, “the meeting, the meeting.”
Stephanie: Mm-hmm (affirmative)-
Miranda: She hasn’t been actually saying anything else. She just say she’s here to help me with the process, but, I mean, what process is she helping me?
Tonette: The process to get you out.
Stephanie: Mm-hmm (affirmative)-
Tonette: Okay. Well Patrik, I know you given us more than an hour-
The 1:1 consulting session will continue in next week’s episode.
