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 Has Sepsis and Had a Code in the ICU. Will This Be Her First Stage to Withdrawal of Treatment?
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 she’s asking if there is a chance for her mum to get out of the ICU.
My Mom is in the ICU for Septic Shock. Which Intervention Will Be Good for Her, Palliative Care or Outright Euthanasia?
“You can also check out previous 1:1 consulting and advocacy sessions with me and Laura here.”
PART 1
PART 2
PART 3
Patrik: Yeah. Yeah. Exactly. But again, those are probably the things they need to hear because you know, that’s very contrary to what their Catholic principles are.
Laura: Yeah, that’s right. I see your point, yeah.
Patrik: You know.
Laura: Yeah, those things could have helped. Helped to solidify and all that.
Patrik: Yes. And really, don’t feel like… the hospitals often do that. Intensive care units often do that as sort of a real threat, sort of saying out by Monday, 12 o’clock or whatever the case may be, we stop life support. They can’t do that. They can’t do it.
Laura: I don’t know if they can stop the life support because she was basically saying here are your options. And
you have to decide by Monday what your option is. You can remove the breathing tube and then you have hospice come in and then she goes home, or you have her die here in ICU, or you could have her transferred to another hospital, but you have to have her physician, an admitting physician and a phone number that we can do that. Those are the three options they gave me by Monday to do so.
Patrik: Yeah. Yeah. And you know, again, I’m glad that at least they mentioned that she can go somewhere else, potentially, if you can find an admitting doctor somewhere else. I’m glad-
Laura: And that’s what I mentioned to them, yeah.
Patrik: Right. And I’m glad that they mentioned that. That is really good. You know, because I believe that is your best bet.
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Laura: You know, Patrik, I had this thought that I go over to the other hospital in person and I talk to some people, some high up people, and say look, and tell them I don’t agree with this Catholic situation. We’re not Catholic, and we just want to give her more time and they’re pushing us out, and I don’t feel like I was treated well, I was intimidated, bullied, I was told everything in the book can bully me down, and we want another shot
over here at this hospital.
Patrik: Exactly. Exactly. And I think that’s the way to approach it. And if, for whatever reason, they are still not in the ICU, not wanting to help you, you would have to go to an executive level. The other thing, I mean you know that too, with Christmas coming up, there could be a delay in things, but it’s important that you prepare for that because some hospitals may not necessarily have the capacity or resources to admit over the
Christmas period. So, you’ve got to be prepared for all of that too.
Laura: What do you mean, I’m sorry… oh that there would be a delay because of the holiday is what you’re saying.
Patrik: Yes, I think so. You know, I wouldn’t rule that out.
Laura: It could be a factor. Yes, I see.
Patrik: Right. So, you might go to this other hospital and they might say to you, yeah, we would be very interested in helping you, but we may not be able to do it until next Friday because… you know, who knows?
Laura: Right. So here we have this intimidating situation, but I have to pull myself together and say wait a minute, don’t just go that route, find out what your options are, and get the research, state laws, and keep looking for what we can do.
Patrik: Correct. Correct. And make them aware that state law will certainly overrule any Catholic principles.
Laura: Yes. Overrule, absolutely.
Patrik: I mean, yeah, people are entitled to their beliefs, but they’re not entitled to break a law.
Laura: That’s right. Yeah, exactly.
Patrik: Right. And if you think they haven’t provided you with… if you think they haven’t provided you with the end of life care policy, keep asking for it. Because what happens is in that end of
life care policy or in the withdrawal of treatment policy, there will be something in there that says end of life care decision cannot be made unilaterally, which means it’s not a unilateral decision, which basically means one party decides and that’s it. This is life or death. It’s not like are we going to dinner tomorrow night, this is life or death.
Laura: That’s right.
Patrik: So, I’m just trying to think… yes. Another thing you could do, I give you another hint. So, do you think when you’re going back in there, do you think you can send me a picture of the ventilator?
Laura: Absolutely. I’ll do it.
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Patrik: Yeah, and I’ll tell you why. Can you send me a picture of the ventilator and a picture of the monitor, and I’ll tell you why? So, I have so many clients. They’re telling me this and they’re telling me that, and I just go like hang on a sec, I really want to see some clinical data because it’s easy for me to interpret that you know, people say yeah, tomorrow they told me they need to stop the ventilator on my mom or my dad or whoever
and they’re probably going to die. And I said, hang on a sec. Tell me what’s going on. Send me a picture of the ventilator. I also asked you about sedation. And once I have a feel for what’s happening, and once I see the ventilator, I can actually have a good guess how much support is there, is it minimal support?
Patrik: You know, they’re telling you that if they stop ventilation, that your mom is most likely going to die. Now, I want to see that ventilator first because in my opinion.
Laura: Say that again?
Patrik: Yeah, so they might say if we stop ventilation on Monday, your mom may pass away quickly, okay? And I say hang on a sec. That’s what they’re saying, but is that actually true? I want to see the ventilator-
Laura: Exactly.
Patrik: And I want to see how much support she’s on. And once you send me a picture of the ventilator and of the monitor, I might say hang on a sec, your mom is on minimal ventilation support already. So, the likelihood that she’s going to die is not very high because she’s on
minimal support with ventilation. And by Monday-
Laura: Can I tell you something?
Patrik: Please, please.
Laura: Yeah. I’m sorry, what were you going to say? By Monday-
Patrik: Yeah, and by Monday, for example, she’s now off the Precedex hopefully she will be more awake because the Precedex will wear off.
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Laura: Yes, that’s right. Well, I hope I can get my train of thought here. Oh, yes. So, I was in the room there and the head ICU doctor interventionist comes in and he’s looking at her, he’s looking at the respiratory. He said oh, you know what, let’s… this is what he said. He said let’s try to wean her off the breathing tube today. That’s what he said. He said that she’s doing pretty good. Let’s try to wean her off the breathing tube today. Let’s turn off the Precedex or whatever. So, the nurse, she turned it down. My mom was opening her eyes just a little bit here and there. And then he said, although her volumes are a little low. Although her volumes are a little low, she’s doing better. It was almost sounding
positive there, and that was this morning around 9:30/10:00 and here we are at a meeting at 10:30, he’s like okay, chop everything off. It’s like what?
Patrik: Yeah, you see, Laura, this is the problem. And that’s why it’s so important to read between the lines. Look, imagine this morning you heard that potentially they could take your mom off the ventilator and then few hours later, in the meeting, it’s all doom and gloom again. So, no hospital, no intensive care unit, will go back to a family and will say yep, Laura, we’ll look after your mom for a few days and we’ll get her out of ICU and a week later she’ll walk again. Nobody will ever tell you that. Nobody ever. Right?
Laura: Right.
Patrik: Right, nobody ever right, whereas what they do tell you is they paint the picture for you so your hopes are low, right? Because if they did tell you, yep, your mom will be out of ICU in a week alive and another week later she will walk around again and another week later she will be at home, nobody will tell you that because if that’s not going to happen, you could potentially sue the hospital.
Laura: Oh, yes.
Patrik: Right?
Laura: Oh, yes.
Patrik: So, it’s so important to read between the lines that every communication is really about managing their liability.
Laura: Yeah.
Patrik: That’s all it is.
Laura: Yeah. Yeah.
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Patrik: Right?
Laura: Right.
Patrik: So, it’s so important to break down the information and understanding what it means. It’s so important to watch for people’s actions and not so much their words.
Laura: Yeah, because why would he come in and say at 10 o’clock in the morning when he’s making his rounds, oh, she’s doing better on the breathing, looking up at the respiratory screen and saying we’ll try to wean her off the ventilator today and we’ll take off this sedation. And then although he says the volumes are low. That’s what he said. And here we have the meeting, and the meeting of hatchet man meeting.
Patrik: Yeah.
Laura: Then it’s pressure.
Patrik: Yes, and make sure that you are in control of how you respond. So, you know, it’s really important that you don’t give into timelines. Anything that… you set the timeline. You say hey, I want this end of life care policy by tomorrow, five o’clock, you know, whatever. It’s important that you turn as much on its head as you can.
Laura: Yes.
Patrik: But your mom is in double organ failure, which is very common. Very, very common. Your mom is not any worse or any better than most patients in intensive care. What I’m looking for, and I’ll find it… I know I’ve got it somewhere. I’ll find you the end of life care law in California. I will also, if you can send me some images of the ventilator and the-
Laura: Monitor.
Patrik: Monitor. Because that can give me some idea. Have you heard of arterial blood gases? Have you heard of that?
Laura: Yes. That’s the Co2 and the oxygen, the blood gas, right?
Patrik: Correct. Correct. Do you… you don’t have any results that you know of.
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Laura: I can ask a nurse what some of the levels are. She can pull it up on the computer.
Patrik: I think so. I think that would be great. I’ll tell you why. The effectiveness of ventilation, you really can find out from a blood gas.
Laura: Yes, I learned that there.
Patrik: Right, right. If you can get me some results from the last few blood gases, in combination with a picture of the ventilator, I will have a very good idea in terms of how far away your mom from getting off the ventilator.
Laura: Okay. I will do that.
Patrik: Right.
Laura: So, when we say blood gas levels, is there a couple of names that I should write down
Patrik: Yes. Co2, like carbon dioxide.
Laura: Got it, okay.
Patrik: And Po2, which is the oxygen level. They are the most important ones. If I get those two, that will be enough for me to guide you.
Laura: Okay. Very good.
Patrik: So, I am still… yeah, yeah. And you said your brother is seeing your mom as well, regularly. Is that what you said?
Laura: Yes, it’s just the two of us children, my brother and I. I’m 55, he’s 50… I’m going to be 55, he’s going to be 58 in January. And he’s up there with her now. I’m over here in just a little conference room.
Patrik: Yeah. No, no, no, that’s great. So, don’t let them intimidate you. Argue on a policy level, argue on your values level, that your values are not aligned with the Catholic values. And make sure you get time to sort out a bed somewhere else. And I have no doubt in my mind that you will find a bed somewhere else. It might take a little bit of effort.
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Laura: Okay.
Patrik: But you will find a bed somewhere else.
Laura: And I will try to talk to high up people and really.
Patrik: I would talk to high up people if I was you. If you’re not getting heard.
Maybe it’s enough for you to just talk to the doctors and say hey, I want time. And maybe that’s enough. But if it’s not enough…
Laura: I don’t think it’s enough.
Patrik: Right, right, is that how you feel?
Laura: Yeah, because they are just determined and they will sit in this very conference room looking at me from the beginning, and it was no nothing from the beginning. No nothing. So, I definitely feel like I have to go to the high up and complain about I don’t agree with this, I’m not this Catholic value, and I was intimidated from the beginning, negativity, and the harassment and doom and gloom. Just a horrific experience. And we want a
chance and time to see if my mom can make a comeback. And I don’t think it’s going to happen here because you’re trying to blow me out of this place, my mom-
Patrik: Correct, correct. And, so today is the 21st of December. Your mom’s been ventilated now for 10 days, okay?
Laura: Yeah.
Patrik: So that seems like an eternity for you. Must feel like an eternity for you. It’s not.
Laura: It’s not?
Patrik: Why is it not? And again, that comes from decades of having worked in ICU. 10 days on a ventilator is an eternity for your mom, it’s an eternity for you.
But it’s not an eternity in intensive care terms. Right?
Laura: Yes, I agree. I agree.
Patrik: And that’s why it’s so important to put all that in perspective. Here is another thing that’s important. So, your mom’s been ventilated now for about 10 days. After about 10 days, sort of 14 days, there’s often this decision needs to be made. If somebody can’t come off the ventilator, do you do a tracheostomy or do you potentially extubate and let someone die, right? If there’s…
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Laura: Excuse me, but they were saying that before, something about the tracheostomy. And then I was talking with one of the nurses and they were saying that her platelets were low. You know, the clotting and all that maybe they were thinking that the cut in the throat maybe cause bleeding, something to that effect.
Patrik: Could be. Could be. Could be. But irrespective of that, you know, but sort of the day 10-mark, day 14 mark after ventilation is sort of a crucial point because the question is, if somebody can’t come off the ventilator, would they need a tracheostomy or would they be extubated and then potentially die? So those are all the questions. So now at this point, where they know they don’t necessarily want to continue ventilation, either do a tracheostomy or potentially extubate your mom and she may not survive. But that’s why it’s so important. Please send me a picture of that ventilator because it’ll tell me so much.
Laura: Yes, definitely.
Patrik: You know? And if you can do that as a next step, then I can guide you. And what I’ll also do is I’ll find that state law in Los Angeles about end of life or withdrawal of treatment. But as I said, I have not come across any state, really, where a hospital can just, on its own account, stop life support without consent. I mean, that is murder.
Laura: Yeah. And then what you were saying in your educational materials about asking, and you told me now about the end of life policy, when I asked for the policy of termination of treatment, they looked kind of like what? You know?
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Patrik: So, you know, you could almost then argue if they don’t have a policy, you could almost argue so you are potentially killing people without having any rules around it.
Laura: Yeah.
Patrik: Right?
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.
The 1:1 consulting session will continue in next week’s episode.
Kind Regards
Patrik
