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 the ICU for a Post Cardiac Arrest Care. She will Have Tracheostomy but Should it Lead to Withdrawal of Treatment for Her?

 

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 had a cardiac arrest and is now in the ICU post CPR, and she’s  asking why the ICU doctors are insinuating Euthanasia as the only option for her.

 

My Mother is in the ICU for Post Cardiac Arrest Care. Is “Mercy Killing” the Only Option for Her Condition?

 

PART 1

PART 2

PART 3

PART 4

PART 5

PART 6

PART 7

PART 8

PART 9

 

Patrik: And here’s another thing Miranda, let’s talk again about end of life for a moment. Let’s just say you decide in the next few days, it’s enough, “I don’t want my mother to continue like this.” Let’s just say you then talk to the ICU and you prepare your mother for end of life. They could stop life support and they could “remove life support”, make your mother comfortable so she’s not suffering, but you’ve then got to keep in mind again, from my perspective that’s euthanasia. Do you know what I mean by that Miranda when I say euthanasia?

 

Sheila: Miranda are you there?

 

Miranda: Yes.

 

Patrik: Do you know what I mean with euthanasia?

 

Miranda: Say it one more time?

 

Patrik: Euthanasia. It’s basically painless killing of a patient, by giving them drugs and hasten death. Have you come across that term before?

 

Miranda: No.

 

Patrik: Right. Right.

 

Stephanie: Have you heard of mercy killing?

 

Miranda: Say it again, Stephanie … Mercy?

 

Stephanie: Yeah. Yeah. Why don’t you hear me well? 

 

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Miranda: I don’t know.

 

Stephanie: Okay, that’s all right. Mercy killing. You’re not asleep? Yeah.

 

Miranda: Nn-nnn. It’s the rain, we got this rain.

 

Stephanie: Okay. Yeah. Say what?

 

Miranda: It’s raining where I’m at.

 

Stephanie: Oh, it’s raining where you are. Oh, okay.

 

Patrik: Right.

 

Stephanie: So yeah, I got you. Yeah. So euthanasia is the same. It’s just a professional way of saying mercy killing. It’s like a Dr. Kevorkian or something like that. Making them comfortable. Like hospice. They mentioned hospice care, by the way.

 

Patrik: Very much so. Very much so.

 

Miranda: They explained the same hospital. I don’t remember what happened.

 

But the same ICU. The same situation with the mother. And they basically said, let’s just make her comfortable. And it’s the mother and she said her eyes opened up. Right before she passed away. It’s like, “Don’t do this to me.”

 

Patrik: Right. Right. That’s why Ms. Genevieve keeps reaching out to us and telling us not to listen to the doctors.

 

Stephanie:  I remember you telling me that I know this Ms. Genevieve that you’re telling me about. That’s a powerful statement, Miranda what you just said.

 

Patrik: Mm-hmm (affirmative) that’s very powerful.

 

Stephanie: And we have the power. Mm-hmm (affirmative)-

 

Patrik: Yup.

 

Stephanie:  And by that time they were already making her comfortable, right?

 

By that time they’re going to say. Ms. Genevieve’s sake they were already making her comfortable, right?

 

Miranda: Oh, they put morphine in there.

 

Patrik: Very much so. That’s exactly what happens.

 

Stephanie: I hate that morphine.

 

Patrik: That’s exactly what happens. They will give Morphine, and they will give Midazolam also known as Versed. It’s similar to Ativan, I know you mentioned Ativan in the last few days, Stephanie. And Midazolam is similar to Ativan, plus just stronger. Just stronger.

 

Stephanie: Oh, okay. Gotcha yeah. Yeah. You sent me a reminder of a name.

 

You typed to me Versed and that’s different.

 

Patrik: Midazolam. They’re the same. The same, just different names.

 

Stephanie: Got it. Gotcha. And you said that’s kind of like Morphine, but not as strong, or stronger?

 

Patrik: Morphine is a pain killer. And Midazolam is a very strong sedative.

 

Stephanie: Right, because it’s for seizures. 

 

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Patrik: Yes, for seizures but also to put people asleep, to put them in an induced coma.

 

Stephanie: I gotcha. Oh, okay. I don’t think they’re using that. They’re using Ativan. And, let me see what I put on my little note, they’re not using that. They’re using Vimpat … let’s see what they use? Here we go … that’s not it.

 

Patrik: Dilantin?

 

Stephanie: Dilantin, yes.

 

Patrik: They’re not sedatives. They are anti-seizure medications.

 

Stephanie: Mm-hmm (affirmative)- This is my question, now that they took the central line out they’re not able to control her blood pressure as much as they used to, is that right?

 

Patrik: Oh, they have taken out the central line? And they have no-

 

Stephanie: Yeah, it’s just because she was bleeding.

 

Patrik: And they have not replaced it?

 

Stephanie: No. She has a hematoma there.

 

Patrik: They would have put in a new one.

 

Stephanie: They must not have placed it right. Huh?

 

Patrik: They would have put in a new one. They must have done. If she was to have a trach on Monday she would need a central line.

 

Stephanie:  They took it out because she had a hematoma there. Is there another place to put it? 

 

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Patrik: Yes, they could put it in the groin. Other side or in the groin. Or sometimes in the elbow. Sometimes.

 

Stephanie: Okay. And so because see she was bleeding. She had a blood in her urine. So they were saying, and I think I read about this too, that the neuro storm was causing all of that. Because what happens to the body, they say in a neuro storm, it just throws all your organs off. It can make the bladder not constrict. So she’s swelling right now, Patrik. She’s swelling. On her hands and I heard her stomach is swelling, so you familiar with that?

 

Patrik: Oh absolutely. And there are a number of reasons why people swell in ICU. One of the reasons is because they are immobile. That’s one of the reasons.

 

The other reason is, do you know if her kidneys are working or not?

 

Stephanie: That’s what I was just wondering? I was thinking, if they are they didn’t tell us. Nobody told me that her kidneys shut down. I don’t know, is any urine coming out in her bag, Miranda hardly?

 

Miranda?

 

Miranda:  One second.

 

Stephanie: Oh, you’re at work.

 

Miranda: Mm-hmm (affirmative)-

 

Stephanie: You’re not having to pick anybody up right now, right?

 

Miranda: No.

 

Stephanie: Or you were sending a message.

 

Miranda: Mr. Patrik can you say it again please?

 

Patrik: Pardon? 

 

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Miranda: Can you repeat what you were saying please?

 

Stephanie: What did you hear so far?

 

Patrik: What was I saying a moment ago? I was saying…

 

Stephanie: Miranda…

 

Miranda: I’m trying to recall the last thing I remember him saying.

 

Stephanie: Well, we were talking about our mother. We were talking about the central line. About the hematoma, about her swelling. About whether she’s having good elimination from urine, or what?

 

Miranda: And you said that, blood in her urine is from … hold on a minute. The blood thinners.

 

Patrik: And the blood thinner.

 

Stephanie: That don’t sound right, does it Patrik?

 

Patrik: So then we were talking about the swelling. And the swelling can be a by-product, even if kidneys are working, just by people being immobile, they swell.

 

Right? But if the kidneys aren’t working, the swelling is exaggerated. There’s another reason why people swell, which is if they have a low albumin level in the blood. Those are the-

 

Miranda: A low?

 

Stephanie: Albumin. I know what that is A-L-B-U-M-I-N. And that has to do with … what is albumin, is it a mineral and is it a hormone? Is it…

 

Patrik: No, it’s basically an ingredient in the blood.

 

Stephanie: Exactly.

 

Patrik: It’s an ingredient in the blood. And it can be replaced with a transfusion.

 

Stephanie: Okay. They’ve already been giving her those. But haven’t given her anytime soon. Anytime recently. But I know…

 

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Miranda: Couple of days or so.

 

Stephanie: A couple of days ago they gave her some.

 

Patrik: Albumin?

 

Miranda: A blood transfusion.

 

Patrik: A blood transfusion. And there would be albumin in the blood transfusion as well.

 

Miranda: That was a couple of days ago. Why is she having blood in her urine?

 

Patrik: Well, she’s probably on a blood thinner, right because she’s immobile.

 

And the blood thinner … they might have to adjust the dose. She might get too much.

 

Stephanie: They are, because they’re gonna … before they do the trach, once Miranda says do the trach, then they’re going to cut back. They probably already cut back on the blood thinners. I think they already did.

 

Patrik: Right. They have to before the trach.

 

Stephanie: Yeah. Make sure it’s therapeutic, or whatever. I think you said her INR was therapeutic. ‘Cause she’s on a lot of thinners. The IRN.

 

Patrik: INR. Okay, but it’s also the APTT also needs to be in the normal range, as well as her platelets.

 

Stephanie: Right. The PTT and the platelets. Okay. We’ll keep that in mind. So yeah, because when you think about it, when you say the blood, who knows it could just seep wherever. You know, if it’s really, really thin.

 

Patrik: Absolutely. And if the blood is too thin, the risk for a trach is too high.

 

They have to correct that first. 

 

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Stephanie: Yes, and yeah, that has to be corrected. Yeah, he said that. That’s what Dr. Philipps said. He said that. That’s what Dr. Philipps said. They would have to take her off of the trach for a day or so. I think more than a day, don’t you?

 

Patrik:  Well, I-

 

Stephanie: We want that trach … We want that thing outta there, huh? What are you thinking? It has to be off for more than a day?

 

Patrik: It has to be off for more than a day and the blood has to be corrected. It could be one of the reasons why they gave her a blood transfusion, to correct some of that already.

 

Stephanie: Mm-hmm (affirmative).

 

Patrik: We don’t know at this point.

 

Stephanie: Right. Right.

 

Miranda: No, I know why. They … Hello.

 

Stephanie: We’re here.

 

Miranda: They done the blood transfusions remember, when her count just was down in the beginning, but, they really … Okay, I gotta go in the building. I cannot hear anything.

 

Stephanie: Okay. We can hold on. You have to … I can wait, and I can talk to Patrik while you’re doing that.

 

Patrik: Yeah, yeah. That’s fine. That’s fine.

 

Stephanie: At the meeting … go ahead.

 

Patrik: The trach, I believe, is the right next step especially if her Glasgow Coma Scale is so low, right?

 

Stephanie: Mm-hmm (affirmative). Yes.

 

Patrik:  The burden on anyone like Miranda or probably yourself or anybody who is sort of involved in the decision making, it’s a massive burden. 

 

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Stephanie: Yes.

 

Patrik:  You know? It’s huge.

 

Stephanie: Yes, it is.

 

Patrik:  You know the pressure-

 

Stephanie:  Mm-hmm (affirmative).

 

Patrik:  Whether real or perceived, the pressure to make the right decision is pretty big, but then at the same time, what the ICU is saying in terms of, “You have to do this, you have to do that,” forget about that.

 

Stephanie:  Right, right.

 

Patrik: You want to make sure that Carmen gets the best care and treatment.

 

Stephanie: Um-hmm (affirmative). We will definitely have some more feedback tomorrow when we get with the family, because you’ll have more input, and I understand Miranda … It’s tough. It’s very tough.

 

Patrik: Very tough.

 

Stephanie: Yeah, but I hope that even just from our conversation with us being able to talk about this, and hear other examples. You heard the example that she gave was really powerful, and that’s what I think is weighing on her too, that she don’t want to make the wrong decision and then she wakes up. You know what I mean, so to speak, and says … you know like the other girl’s mother, father, brother, whoever he was.

 

Patrik:  Mm-hmm (affirmative).

 

Stephanie: You know? No, we don’t want to … You don’t know what you don’t know.

 

Patrik: That’s right.

 

Stephanie: Bottom line is, though. 

 

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Patrik: That’s right.

 

Stephanie: Like you said, it’s too soon.

 

Patrik: Too soon.

 

Stephanie: We’re talking about somebody … You’ve seen a lot. Yeah, way too soon.

 

Patrik: Way too soon.

 

Stephanie: To make a decision like that, and they want to push us to make a decision like that, and I say we choose our words carefully, we don’t say a lot. Let us get where we want to get, to the next step, if Miranda’s in agreement with that.

 

That’s, I think … We’re having a family meeting tomorrow to rally around her, let her know we support her. When she’s with us, maybe she’ll feel more … not so alone. You know… You can still hear me?

 

Patrik: Because I think that that’s-

 

Stephanie: I think that’s what you’re saying.

 

Patrik: Yeah. That’s a big one. I feel like the burden would be big on anyone.

 

Stephanie: Yes.

 

Patrik:  It would be … Nobody wants to be in a life or death situation where you have to potentially make a decision for a family member.

 

Stephanie:  Yeah.

 

Patrik:  It’s a very difficult situation. Not having perspective around that-

 

Stephanie: Yeah.

 

Patrik:  I think is critical … No, no. Having perspective around that is critical.

 

Stephanie: It is. It is. 

 

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Patrik: You know?

 

Stephanie: It really is.

 

Patrik:  How-

 

Stephanie:  You have some perspective because you’ve seen other people. Go ahead.

 

Patrik: How big is this ICU? Do you know?

 

Stephanie: Yeah, they’ve got several rooms. My mother’s in room 4009. That’s only halfway through, so they’ve got at least another … I think they’ve got another 10 beds, at least on one side.

 

Patrik:  So about 20 beds?

 

Stephanie: Yes, probably. Yeah. Does that make sense?

 

Patrik: Yeah, it’s pretty big. Are they busy? Are they busy?

 

Stephanie: Oh yeah. Yeah. Yeah.

 

Patrik: So it’s pretty full?

 

Stephanie: I’ve seen people coming and going, huh?

 

Patrik: Okay.

 

Stephanie: They’re coming out alive, though, huh? Mm-hmm (affirmative).

 

Patrik:  Yeah, most people would survive.

 

Stephanie: Mm-hmm (affirmative).

 

Patrik: But they would also be dealing with some end of life.

 

Stephanie: Yes. 

 

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Patrik: There’s no doubt about that.

 

Stephanie:  You were trying to find out how large the ICU is to determine…

 

Patrik: Yeah. I’ll tell you why I’m trying to find that out. Number one, I’m trying to … The smaller the ICU, number one, generally speaking, the less experience and the less sick people they would be looking after. That’s number one.

 

Stephanie: Right.

 

Patrik:  And also the less space, the higher the pressure on the beds.

 

Stephanie: Exactly.

 

Patrik: Right?

 

Stephanie: Yes, yes.

 

Patrik:  Also, if you were telling me it’s 20 beds and half of the beds are empty, I would try to determine, okay, so they’re not full.

 

Stephanie: Why?

 

Patrik: Right?

 

Stephanie: Yes.

 

Patrik: How could you use that in your favour potentially, and now you’re telling me they are full, so I’m wondering, okay, they’re full, so there is pressure on beds.

 

Stephanie: Mm-hmm (affirmative).

 

Patrik:  Right? But if they-

 

Stephanie: I saw a couple of empty rooms. Mm-hmm (affirmative). 

 

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Patrik: Right. Okay.

 

Stephanie:  I’m going to walk through there now. Now that you’ve said that, I’m going to walk through there.

 

Patrik: Have a look. Have a look.

 

Stephanie: Mm-hmm (affirmative).

 

Patrik:  Whereabouts are you? You are in Cincinnati. Are you in a big city or-

 

Stephanie: Yes, Ivory Oaks.

 

Patrik: Oh, you’re in Ivory Oaks. Okay.

 

The 1:1 consulting session will continue in next week’s episode. 

 

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