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 Mom is in the ICU for Septic Shock. Which Intervention Will Be Good for Her, Palliative Care or Outright Euthanasia?
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 Laura as part of my 1:1 consulting and advocacy
service! Laura’s mother is in the ICU for Septic Shock and is asking if it is possible for her mum to be weaned from the ventilator and be extubated.
My Mom is in the ICU for Septic Shock. Is it Possible For My Mum To Be Weaned From the Ventilator and Be Extubated?
“You can also check out previous 1:1 consulting and advocacy sessions with me and Laura here.”
PART 1
PART 2
PART 3
PART 4
Laura: Making up this policy, right?
Patrik: That’s right. Making up, potentially killing people around your Catholic values.
Laura: Yeah.
Patrik: So those are all the…
Laura: Points to bring up, yeah.
Patrik: Absolutely. What I can also do, if you like, I can send you the recording of this phone call, if you like. You can listen to it. Would you like that?
Laura: Sure.
Patrik: I think that will be helpful because then you’ve got the points. Was there anything else… I think you’ve got enough to run with for now
Laura: Yes.
Patrik: You know what to do next. And don’t be discouraged if it doesn’t happen at your first attempt. Don’t be discouraged if they just stare at you blank. They’re not used to getting resistance. They’re not used to it.
Laura: Yeah.
Patrik: What we could do, if you need that over the next few days, if you are going into another meeting, which I would not recommend because you know what you want. You don’t need a meeting for that. You know what you want. If you were to go into a meeting, I’d be very happy to be there over the phone because I could challenge them on a clinical level.
Laura: Yeah.
Patrik: Right? But I would almost recommend not to go into any meeting because you know what you want.
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Laura: Yeah, and I don’t want any more of their indoctrination.
Patrik: Correct. Correct. Yeah. And just with the platelets, you mentioned the platelets, potentially that they’re low and that there could be one of the obstacles to potentially not do a tracheostomy. Some thoughts on that. Yes, if platelets are low, it could potentially… it’s a risk for doing a
tracheostomy. There’s no doubt about that. However, what happens if you… somebody has low platelets and they need procedure where there’s a tracheostomy or something else, but the risk for bleeding is there. Usually what happens is before such a procedure, they would be transfused some FFPs, also known as fresh frozen plasma.
Laura: Fresh frozen platelets.
Patrik: No, no. Fresh frozen plasma. FFP. Or platelets. Pure platelet transfusion. Either/or. So that is an option, okay? Also, also if the platelets are low, that could be a risk for dialysis because your mom would need what’s called a vascular catheter. You know, to start the dialysis. And if she has low platelets, again, that could be a risk because she could be bleeding because of that. But again, in order to manage that, maybe she needs some platelets beforehand.
So, what I’m saying is you know, if you bring up the dialysis again for kidney failure they might say oh, she can’t have dialysis because of this, that, and the other, including low platelets. And then your response needs to be well, you could give platelets, or you could give fresh
frozen plasma.
Laura: Yeah. May I say something?
Patrik: Please.
Laura: Tripped my memory. At one point, in the daily morning blood draw, she was going to maybe get a transfusion because the platelets were low, whatever. I don’t know. But then I don’t know what happened, they somehow analysed the blood again, I don’t remember, but they said no, no, she’s at seven, she’s okay, we’re not going to do it.
Patrik: Sure.
Laura: Level seven, whatever that means.
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Patrik: Fairly low. But you know, in a situation like that, then, if she needs ongoing treatment, including tracheostomy, including dialysis she would most likely need that. Need some transfusion.
Laura: Yeah.
Patrik: But you could cross that bridge when it comes to that. Has quality of life been mentioned?
Laura: They talked about that, yeah. They said well, you know, she has dementia, she has swollen legs. And I said well listen, she came back three years ago from myxedema coma yes, she was in a bad way in a hospital bed, but she came back beautifully. We had music, she did her art in her bed, she had TV, she enjoyed food up until four, five, six weeks presenting stomach ache and the vomiting that was indicative of these infections, kidney
infection. And so, she enjoyed her life. But they bring it up, you know, quality of life.
Patrik: And again, Ann, quality of life is a perception. Some people would accept a quality of life that other people wouldn’t accept.
Laura: That’s right. And who should be in charge of that?
Patrik: Maybe the Catholics are.
Laura: Yeah. Yeah. I told the admitting doctor, who they call hospitalist, I said I am pro-life. And then when my mother had… this is just a side note… then when my mother had the respiratory event after the procedure for the stent, he said see, I told you. You said your pro-life, now look. Like we had this horrible set back. It’s not, you know… I told you so.
Patrik: Yeah. Yeah. Exactly, exactly. So, this is another good point that you’re making. So, are you saying your mom has been in ICU before? Is that what you said?
Laura: Am I saying that?
Patrik: Yes.
Laura: Yes, she was in ICU when she had the myxedema coma, the thyroid collapse.
Patrik: Yep. How long ago was that?
Laura: That was three years ago, and it was the other hospital that we’re trying to transfer over to. It’s called Mildred Hospital. And they did a good job with her, and she’s made a good comeback. Now, I know they say it’s apples and oranges, but that hospital over there didn’t pressure me so much as they are over here. DNR, DNR.
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Patrik: Sure. Sure. So, you should use that. You should use that to your advantage. Because, you know, you’ve seen her bouncing back.
Laura: That’s right.
Patrik: Okay. So, you can use that example for your advantage, saying, “Hey look, my mom was in ICU before and she came back”.
Laura: Yeah. That’s right.
Patrik: Right. And at that stage, she already had dementia as well?
Laura: Yeah. She had a small stroke in there and she had dementia, yeah. But of course, you know, when your myxedema coma and that is a big event that affects everything. But she made a nice comeback when the thyroid levels came up. She was coming back nicely.
Patrik: That’s great. That’s great. And while we were talking, Laura, I found what I was after. I found the law in Los Angeles. You give me… I’ll email that to you.
Laura: Great.
Patrik: Because now you’ve got it. I’ll quickly read this out to you. So, it says patients who lack capacity are entitled to have decisions made on their behalf.
Okay. When a patient lacks capacity to make healthcare decisions, the physician must ascertain both whether the patient has provided specific healthcare instructions, either written or oral and whether the patient has designated a surrogate decision maker, which is you. You are the surrogate decision maker.
Laura: Yes.
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Patrik: Right. It is important to note that a written document, while highly desirable, is not necessary. If no such information is available, the physician should identify the appropriate surrogate decision maker, which is you. The physician should provide the surrogate decision maker with the same information that he or she would provide to a patient with capacity of course. And here it comes. The physician must comply with the decision of
the surrogate decision maker. Right?
Los Angeles law generally requires healthcare providers to comply with the healthcare decision for the patient made by an appropriate surrogate decision maker. That’s it. That’s it.
Laura: Aha. Wow.
Patrik: I’ll email that. I’ll just save this to my computer and then I’ll email it to you.
Because I knew I would find it.
Laura: Yeah. Good. Thank you.
Patrik: It’s so important. And people don’t know about their rights, and it’s really sad.
Laura: Yeah.
Patrik: Really sad that people don’t know about their rights. And it’s also sad that the doctors completely ignore it.
Laura: Yeah.
Patrik: They’re just playing golf.
Laura: Yeah. And it’s like you said. It’s like you said in your materials, it takes you aback and you’re shocked when you come into this. You’re like what? What?
Patrik: Yeah. You don’t expect that, you know? You would…
Laura: Going to the hospital to get some help, right? You’re going to get help. And instead, you get slapped with all kinds of stuff.
Patrik: It’s shocking that a service like mine exists. It’s shocking. A service like mine shouldn’t exist. You know? Because they are health professionals that have a duty of care. And it’s not happening at times. Not saying it’s never happening, but not happening at times.
Laura: Right.
Patrik: So, I will email this to you. This is a 22-page document. However, it’s on page three and I will highlight that in yellow so you can… I will highlight that so you can find it straightaway. And please, if you could email me a picture of the ventilator, that would be great.
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Laura: Sure. I can text it too.
Patrik: Text it, email, whatever is easiest for you.
Laura: Yeah, sure.
Patrik: And text, email…
Laura: The blood gas?
Patrik: Blood gas. Blood gas, please. And a picture of the monitor as well.
Laura: All right.
Patrik: Okay.
Laura: By the way, I will just say one more thing. The infectious disease doctor said that today, this morning, that my mother had a 14-day course of antibiotics and that that’s it. I guess they’re not doing anymore. He said they would keep the anti-fungal because they did a urinalysis and they saw it was a fungal, but they stopped the antibiotic.
Patrik: Why? Why did they stop the antibiotics?
Laura: Well, I was trying to talk to him about that. He said, well, that’s the normal course of treatment is 14 days.
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Patrik: Okay. Okay. So, it’s not that they stopped it because they felt like they need to stop treatment and including removing antibiotics because… the finish of the course, which is fine, which is normal.
Laura: That’s what I was trying to ascertain and really, you know… but that’s what he said.
Patrik: Okay. Do you know what antibiotics they were?
Laura: Meropenem.
Patrik: Yeah. Sounds about right. Two weeks of the course sounds about right.
Laura: She has a penicillin allergy.
Patrik: Okay. Okay. Okay. All right.
Laura: Did they give you your albumin?
Patrik: Albumin? Yeah, that’s good. And I’ll tell you why it’s good. Albumin is… so your mom would have lost, especially with being jaundiced and with being so yellow, she would have lost a lot of albumin. So, her albumin would have been really low. So, it’s good that they’re replacing it. And also, with the leap of faith, if a patient loses… excuse me. If a patient loses albumin, their blood pressure would be low, which is another reason why
she needs to have that.
Laura: Okay. That makes sense.
Patrik: It does. So as long as they keep doing that, because albumin is very expensive. As long as they keep… that’s all a good sign. That’s a good sign.
Laura: Yeah, I hope they’re continuing. I tried to make sure. I said are we going to continue this? He said I have until Monday, are we going to continue? So, I have to follow up, make sure that they do, you know?
Patrik: Yeah, and it’s important that they keep doing things because the minute they stop doing things, that’s when it gets really concerning. But we like… if they’re keeping albumin, I see that as a very good sign because albumin is a very expensive infusion.
Laura: Yeah. There’s something else that I wanted to mention. You know, my mother… obviously she has malnutrition because she’s presenting with the nausea and the vomiting over the last month and a half. And then we finally got her in here, but she wasn’t eating, so they finally tried to do a feeding tube. And they got the one that doesn’t connect with the intestine, you know, just the one that hangs in the stomach. And they started giving
the protein shake kind of nutrition. They said that it was just sitting there, like it wasn’t… I don’t know what the word that they used…
like the food was just sitting there, not maybe digesting, something to that effect.
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Patrik: Oh yeah, it wasn’t absorbing.
Laura: So, they pulled it off. So, they pulled it off the feeding, not the tube out, they didn’t continue the food drip.
Patrik: Right. How long ago was that?
Laura: Well today, this morning, I said hey, where’s the food bag? And I guess the doctor and the nurse saw that it wasn’t… I don’t know what that word was, like it was just sitting there. So, they wanted to discontinue it. Like it’s not being digested.
I don’t know what, but…
Patrik: Right. Right. Okay. Yeah, and that often does happen as well in Intensive Care, that food is not being digested. And especially with the pre-existing… you know, full bladder issues, I’m not surprised by that. And again, that’s why I believe it’s so important that you speak to the GI doctor.
Laura: Yeah. Okay.
Patrik: Right? So, I have emailed you the end of life care guidelines there from Los Angeles. And I will also email you the phone call, the recording of the phone call, so you can listen to that. And if you can please send me a picture of the ventilator and the… the ventilator the monitor, and the blood gas, that would be great because then I can guide you.
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Laura: Awesome. Yes, I will do that. Thank you.
Patrik: Okay. We’ll talk soon.
Laura: Okay, sounds good. Thank you.
Patrik: You’re very welcome.
Laura: Thank you, thank you.
Patrik: All the best for now. Take care.
Laura: Bye.
Patrik: Bye-bye.
The 1:1 consulting session will continue in next week’s episode.
Kind Regards
Patrik
