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 Had Surgery and is in the ICU for Pneumonia. Why Does the ICU Team Push My Mum Towards Palliative Care?
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 Tim as part of my 1:1 consulting and advocacy
service! Tim’s mother had surgery, a history of COPD and in the ICU for pneumonia and is asking if the ICU is refusing treatment for his mum simply because of lack of bed.
My Mother Had Surgery and is in ICU for Pneumonia. Are Standards of Care in ICU Neglected?
“You can also check out previous 1:1 consulting and advocacy sessions with me and Tim here.”
PART 1
PART 2
PART 3
PART 4
PART 5
PART 6
Patrik: They wouldn’t. The only place who can wean patients is… The only place you can wean a patient off the ventilator is ICU. Or, we can do it at home, right?
But you need an ICU doctors, you need ICU nurses… ICU doctors. It’s not going to happen on a ward. There’s a very good change your mom will deteriorate big-time.
Tim: Oh. She’s come so far forward in five days.
Patrik: Yeah. Absolutely.
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Tim: It’s amazing. The she’ll pick up. Her face cross, and what the amazing thing is. She’ll pick up her glasses and put them on, and she’ll wriggle her feet, and she’ll lift her legs and move them around. It’s quite amazing, yeah? She was like a vegetable.
Patrik: Yeah. And that’s all part to the care that she’s getting there. One-on-one care.
Tim: Yeah.
Patrik: I would talk to the private if I was you, and get a feel for what-
Tim: Go to them.
Patrik: Yeah. Because then, even if you don’t have an admitting doctor, the private will take your mum.
Tim: Really?
Patrik: Yes, they will. In the private sector, she’s not a burden. She’s a customer.
Tim: Yes. I remember you saying that. I remember you saying that.
Patrik: Right? Your biggest challenge, Tim, is that you don’t know what you don’t know. That’s your biggest challenge.
Tim: Yeah. It just seems silly now that she’s come… When we last spoke, mum…
They put her in the respiratory ward because she had the aspirated pneumonia because on the floor. They took her too quickly out of ICU after a major operation. She wasn’t even in there 24 hours. She was down stairs.
Then they showered her, which is kind of nice. She was standing up. Then they laid her completely flat when she went to bed, and she aspirated. Upstairs, and then by all this rubbish. They didn’t want to do the trach, then they did the trach.
Now they’ve-
Patrik: And she’s not any better now. She’s worse, so imagine. She was better when she first was on the ward, but then she deteriorated. Now she’s not better.
Now she’s worse.
Tim: Well, she’s better now. I mean, but-
Patrik: That’s what I mean. That’s what I mean.
Tim: Yeah. I understand. Yeah.
Patrik: So, what I would do if I was you, is I would ring, I would touch base with the private. The private will take her if she has an admitting doctor, and what I would tell in the mean… What I would say in the meeting if I were you, is, I would tell them, “Look. I’ve spoken to the private. The private is happy to take her if I can get an admitting doctor. Can you help me with this?” That’s how I would approach it.
Tim: Okay.
Patrik: And even if you can’t get a hold of the private this morning for whatever reason, I would still say that to them.
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Tim: Yes, because they won’t know. It buys a bit more time, doesn’t it?
Patrik: Yeah. Absolutely.
Tim: Just, I find it fascinating. The change in tone, since you and I last spoke…
And mum’s improved dramatically. Like… Amazingly… Like… Before, she was falling asleep sort of sluggish and after just that she is moving her legs and stuff, and I was doing some physio… I was doing my own physio on mum, and then she’d get tired from it, but now she’ll do it. Now she sorts of shakes her legs to stop it, and-
Patrik: Right. Right. And don’t worry about what somebody’s saying with 31 days.
That’s rubbish.
Tim: Is it?
Patrik: HCF, I have not seen a big, private health fund declining ICU care where it’s needed.
Tim: Excellent. And I see… They got the… They’ve got the very, very, very… The highest cover you can get. That apparently can cover her.
Patrik: Yeah. I wouldn’t worry about any of that. What I would worry about is… If your mum was to go to a ward on a ventilator. That’s what I would be very worried about.
Tim: This ward. Can’t they try and wean her off it? Like…
Patrik: Well they can. They… They… No, no. They absolutely… ICU can wean her off. They just don’t want to give her the time because they’re full.
Tim: But the thing is, she’s been sprinting now for two days.
Patrik: Yeah. But that’s you know… I guess, when we last spoke- We’ve spoken about a couple of weeks ago, last time I think. Maybe a couple of weeks ago. I would have thought… I would have thought that… Because I hadn’t heard, I would have thought, “Oh. Hopefully she’s off the ventilator.” But-
Tim: Oh, no. I’ll let you know regardless, you know-
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Patrik: Yeah, yeah. No, no. No, no. It’s fine. It’s fine. So, I just thought, “Well, maybe she’s off the ventilator. That would be great.” But because it hasn’t happened, they can do as much sprinting for now. It might help in the long run, but she’s just not there
yet.
Tim: They popped her off a few times.
Patrik: Yeah.
Tim: They popped her.
Patrik: It’s often two steps forward, one step back.
Tim: Mum grabbed it and pulled it out the other day, and then there was no nurse.
Two of the nurses went on a break and one nurse was covering three patients but should have been with patient.
Patrik: Right.
Tim: But mum… She just threw her arm up. She didn’t care. She was just sitting there. I was watching the oxygen levels and everything and her heart rate, and it was the same. It went up to 97… 98. Without the sprinting.
Patrik: Yeah, yeah. Sure. Sure. It is-
Tim: Went on for about three minutes.
Patrik: Yeah, but it’s not long enough.
Tim: But can I just tell you… Say, they just turn it off?
Patrik: No, no. I would… I would need to see a picture of the ventilator again.
Right? To see where she’s up to… You know? To see where she’s going-
Tim: Excuse me for this, she was down to… I did take a photo the other day, and I was going to send it to you, but I didn’t send it. She was saying she’s been off the ventilator. She was down to… I think it was eight?
Eight. And ten. Right…
Eight, ten and… It’s hard not to be depressed with everything, hasn’t it?
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Patrik: Absolutely. It’s not just one number that’s important. What was the longest she’s been off the ventilator? What was the longest? Hours? Days? Do you know?
Tim: Now it’s been 2 1/2 days.
Patrik: Oh! She’s been off the ventilator completely for 2 1/2 days?
Tim: Oh, but she’s sprinting.
Patrik: Yeah, but is she going back on the ventilator?
Tim: No.
Patrik: Oh! Oh, okay.
Tim: Just sprinting, like I said. I was getting worried, yesterday. I was in the ward, but I didn’t leave.
Patrik: Oh! Okay. That changes… Okay, that changes everything. I didn’t… Okay.
No, no. Since-
Tim: Sorry. I probably didn’t make it clear.
Patrik: So, she’s been off the ventilator for 2 1/2 days, completely?
Tim: Completely. Just sprinting. Yep.
Patrik: So, does… She’s not on the ventilator? She’s not connected to a ventilator anymore, for the last 2 1/2 days?
Tim: On a ventilator, they call it sprinting. It’s a little machine that does… Blows hot air
and-
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Patrik: Blows hot air and oxygen. Okay… But not a ventilator?
Tim: No. No way.
Patrik: That changes everything. That changes… So, she’s off the ventilator?
Tim: Oh, okay. Well they said… They… They said-
Patrik: You need to-
Tim: They were-
Patrik: You need to clarify… You need to clarify… If she’s off the ventilator-
Tim: Yes.
Patrik: They might have… They might have an argument to get her to the ward.
That changes everything.
Tim: That’s probably what they know. That’s probably why they’re doing it.
Patrik: Yeah. That changes everything. If she’s off the ventilator, that changes everything. But I still would have concerns that on the ward, there’s nobody that is able to look after her on a tracheostomy. I would still have that concern.
Tim: What would be the suggestion for these guys, because… It’s funny… Before I had that meeting with that-
Patrik: Ask them… Ask them whether they have the nurses on the ward to look after tracheostomy I question it, but you’ve got to find out. But I’d ask.
Tim: Can’t get through to them.
Patrik: The first thing is… You’ve got to ask. They can tell you all sorts of things, of course. But the next thing is, if she’s off the ventilator, they have a valid argument to get her to the ward.
Tim: Well, that’s… Yeah. That’s why they’re doing it, because-
Patrik: Right.
Tim: They put the pressure on-
Patrik: Right. Okay. So, okay then the next thing you need to ask is NFR. You need to ask whether she’s got an NFR or not, which is a ‘Not for Resuscitation’.
Which they shouldn’t have. My understanding was you didn’t agree to that in the beginning. Is that right?
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Tim: I understand. Yes. But no.
Patrik: So, you’ve got to probably bring up that topic again. Okay? Because you don’t want that. You want her to go back to ICU if need be. The other thing that we could do is… If, for whatever reason, she can’t have the trach removed, right?
You could still take her home with my service, right? And HCF might… Hey, you know… Again, just because HCF said no, doesn’t mean it means no. It just means-
Tim: Oh. It was just a guy on a phone. Not being rude It was just a… You know…
He asks everything. It wasn’t even an office.
Patrik: Yeah.
Tim: And I said, “Can I speak to somebody that has some authority?” And he goes… I… Because… Because they haven’t got me down on their paperwork as someone, they said they can’t… They said… He was pretty rude. He said, “Oh, look. I’ll send an email.” Then he sent an email to my step-dad. And my step-dad… He’s a bit of a…He’s a b***, basically. He’s caused all the problems… I think he’s caused half the problems with… Trying to get rid of mum,
you know?
Because he wants the house and everything-
Patrik: Right, right, right. Okay, okay. Look, Tim. I really have to run.
Tim: Yeah. Sorry. I really appreciate it, Patrik. I’ll get my partner to text you and just let you know what’s going on, then.
Patrik: Right. Right. And I can be there in the meeting over the phone if you want me to, but if you want to block me out another hour of my time, I… You know… I do charge a fee for that.
Tim: Oh, that’s all right. I understand. Yeah… Look… We’ll talk about that later, having you talk to me now, I appreciate everything that you’ve done. You… I’ll be honest with you. You’ve kept my mom alive until now, and it’s a mum I used to know. She’s cracking jokes and all.
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Patrik: Right. That’s great. That’s great.
Tim: You know… She’s a bit depressed. I asked her if she’s fine. Yeah, because I think she’s going to because she-
Patrik: Absolutely.
Tim: On Monday, she realised what’s happened. Because she goes, “What is going on? What is going on really?”.
Patrik: Right. Yeah. Right, right, right.
Tim: And I said, “Well, you had the operation, but then they buggered it up downstairs and you ended up back here, and you went into a coma.” She started crying.
Patrik: Right. Right, right, right. Okay.
Tim: She started balling.
Patrik: Yeah, yeah, yeah. Yeah. Sure. Okay. You know what to do. I would still talk about the private sector. You want to keep your options open. I would still tell them about the private sector. Get a feel whether they would be able to help you with that. They will be able to help you. They just don’t… You just haven’t broached the subject yet. That’s all.
Tim: Hey. Because she’s off the ventilator and sprinting… What’s the next step?
Patrik: Basically, the next step… The next step is to get the trach removed, if she can. And if she can’t, go to rehab, you know? But… Or to go home. You know? I
always believe home care is the best, you know? I mean, why would you stay in a hospital if you can go home with the right service? That’s it. Right?
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Tim: So, then you’ve got to… You have nurses on that will have to come and visit you?
Patrik: Yes. Absolutely. Absolutely.
Tim: Okay. Well, that’s awesome. Okay. So, I told a couple of ICU nurses about you, and-
Patrik: Thank you.
Tim: I said, “You know. I could be a side-kick for you guys.”
Patrik: Yes.
Tim: You know?
Patrik: Absolutely.
Tim: Their eyes lit up, and… They were young up-and-comers-
Patrik: Yes. Yes. And you might like some of those nurses. We could look at employing some of them, you know?
Tim: Yeah. Well that’s it. Some of them just are really quiet when you ask questions and they’ll get cranky, and other ones tell you everything.
Patrik: Yeah, yeah, yeah, yeah.
Tim: Some are sleek like with 007, you know? Why are you asking questions like that? It’s like, “Well, I’m just curious, like… You know?”
Patrik: Well, you’ve got every right to ask questions.
Tim: Awesome. No. You’re a legend Patrik. Honestly. Like, thank you very much. What I’ll do is give you-
Patrik: You’re very welcome.
Tim: If they do lay the thick on, I’ll give you a call and arrange a time that’s convenient for you-
Patrik: Please.
Tim: And I have to get a hold of them and tell them, and then we can talk about consultant fee and all that and just whatever then. But I still… We’ll talk about all this stuff later regardless anyway.
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Patrik: Yeah. Okay.
Tim: You’ve been gold. Thank you very much.
Patrik: Okay. You’re very welcome. All the best, Tim. Cheers.
Tim: Thanks, Patrik. You have a nice day.
Patrik: And you. Bye. Bye.
The 1:1 consulting session will continue in next week’s episode.
