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
CASE STUDY: Have They Moved my Mom out of ICU Too Quickly, she went into Fast AF (Atrial Fibrillation) and Now She Has Severe ARDS? (Part 2)
You can check out last week’s question by clicking on the link here.
In this episode of “YOUR QUESTIONS ANSWERED” I want to answer a question from one of my clients Megan, as part of my 1:1 consulting and advocacy service! Megan’s brother is critically
ill in ICU and Megan is asking if it is safe for her brother to get out of ICU quickly once he’s off the ventilator.
Is it Safe for My Brother to Get Out of ICU Quickly Once He’s Off the Ventilator?
Megan: It’s actually not too fast, sorry.
Patrik: No, it’s all right. That’s all right.
Megan: Yeah, weird, weird. Well, finally, if it did all go wrong and I felt that something had been hidden from me I can ask for all the records and they know that.
Patrik: Say that again, please. You can. You’re breaking up, I can’t hear you.
Megan: Hold on. Bear with me. Is that better?
Patrik: That’s much better.
Megan: Better?
Patrik: Much better.
Megan: Oh, lovely. If the worst thing happened, and I didn’t want to think that way, but they know that I could ask for all the records.
Patrik: Oh, absolutely. Absolutely.
Megan: So, if I found that they lied to me and they’re really sedating him.
Patrik: Oh, yeah.
Megan: That would be really a serious-
Patrik: Yeah, serious misconduct. Very serious misconduct.
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Megan: Yes, and I would probably get myself a solicitor.
Patrik: Yes, yes. And what you could… And I tell you where. So, let’s just say the nurse is telling you they’re not sedating him when you ask them, or the doctors, doesn’t matter whether you ask the doctors or the nurses. If they are potentially lying to you, and you would find out, you
could drag them to the nurses or to the medical board. They could potentially-
Megan: Yes.
Patrik: Be punished.
Megan: Lose their license to practice.
Patrik: That’s right, that’s right. So, I would be very surprised if-
Megan: That they were lying.
Patrik: Right. I would be very, very surprised.
Megan: There’s so many court cases, in this country. There’s lots and lots of things going on. Doctors being struck off and all sorts of things. And the Health Professional Council pays out quite a lot, I think each year, to people in compensation for one mistake or another. So, I doubt they would really want to create another problem over something as simple. Yeah, because if they are sedating him, telling me he’s not going to make it
because he’s sleepy, then they have a hand in all this.
Patrik: They would be liable.
Megan: Yes.
Patrik: They would be really liable. As I said, I really doubt that they would do that.
Megan: What is happening, yeah.
Patrik: But you’ve got to keep asking. You’ve got to nicely bring your point across that you are not trusting them 100%.
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Megan: I don’t think that they’re evil enough or wicked enough to do that.
Patrik: Say that again. Say that again.
Megan: You don’t think that they are wicked enough to do that?
Patrik: No, no, I think they could. I think they could but you’ve got to give them the benefit of the doubt to a degree.
Megan: Yeah. And he had that conversation with me saying, and he wouldn’t miss this, I would never have thought these things but since that conversation I’ve become much more vicious.
Patrik: Mm-hmm (affirmative).
Megan: Maybe wrongly so, maybe wrongly so. Thinking euthanasia and I’m thinking all the worst things which is really very unfair of me.
Patrik: Yeah. And look, we’ve certainly gone through all the worst things that can happen but then you’ve got to be prepared for that. And because in ICU recovery takes a long time, as you see by now, but the reality is a deterioration can happen very, very quick.
Megan: Very quickly.
Patrik: Right. So, yes, just like the ICU, to a degree I’m painting the worst case scenario because I’ve seen all of that. The other thing that’s probably important to know and I can’t remember whether we discussed that last month. About 90 to 93% of patients in ICU survive.
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Megan: Okay.
Patrik: Right? So, the question that I have for any client is why would your family member not survive?
Megan: Yes, because the odds are in our favor.
Patrik: That’s right. The odds are in your favor and because of that you should always ask the question why?
Megan: Why wouldn’t it be my relative?
Patrik: Correct.
Megan: Yes, yes, yes. So, from that point of view, you’re saying, “Try to keep positive.”
Patrik: Absolutely, absolutely. What those statistics are not talking about is quality of life.
Megan: No, they’re just saying that they were wheeled out alive.
Patrik: Correct.
Megan: That’s what they’re saying.
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Patrik: Correct. For example, it doesn’t say they get out of ICU alive and then potentially go on to a ward palliative care.
Megan: Okay. I really want him to come out. That’s the important thing, isn’t it?
Patrik: Yes, exactly-
Megan: Yes, as we were saying.
Patrik: The biggest goal at the moment really is, he needs to get out of ICU alive.
That’s the main thing.
Megan: That’s it. That’s all. The rest is all for another day.
Patrik: That’s right.
Megan: Waiting for another day. There is just one goal. Get him off the ventilator and get him out of that. Because I believe, if they can get him off the ventilator, they will want him out of there as quickly as possible.
Patrik: Absolutely. But-
Megan: I think I explained that concept. Not straight out, but as quickly as possible.
Patrik: But they also know it’ll take time.
Megan: Yes. They know that. This is why I wonder why they’re so negative. Well, we know why, probably.
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Patrik: Yeah, because it takes time. It takes too much time in their mind.
Megan: Yes, and they are not seeing… But then it gets finally to say, “CPAP is very positive”.
Patrik: Very positive. If he was on any other ventilation mode, I would say, “Oh my goodness, it’ll take another six months.” CPAP is the ventilation mode before somebody comes off the ventilator, so he’s ticking all the boxes. Bear in mind, it would still be good, if
you can send me a picture of the ventilator that would be good, but see how you go.
Megan: Yes, I’ll try. We crutch it down around it all the time. It’s so difficult. It’s just that moment, you get that second and you just click and you get it.
Patrik: Yeah. You could also for example say, “Hey, once Ryan comes home, I want to have some pictures of him”. You could make something up.
Megan: I’ll make up a story. That’s a really good idea. Or I could say some of the family want to have pictures of him or something. Yes, good idea. It doesn’t have to mean that I’m taking a picture of the ventilator.
Patrik: No.
Megan: Okay. I’ll try and get that this afternoon. There’s going to be a very new nurse looking after Ryan today, who knows Ryan well. But they are definitely giving Ryan the less experienced nurses.
Patrik: Right…
Megan: That may be because there isn’t that much to do.
Patrik: Yes, and also because he’s not as sick as other patients now. The more experienced staff would be looking after the sickest patients.
Megan: Yes, so that’s encouraging in a way.
Patrik: Yes, it is. But then, you’d also need an experienced nurse to drive the weaning.
Megan: To drive?
Patrik: The weaning, the ventilation weaning.
Megan: Weaning. Yes. These two that look after Ryan a lot are both brand new nurses on there.
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Patrik: Right.
Megan: Brand new.
Patrik: Mm-hmm (affirmative).
Megan: They seem very competent, but they are new. But the advantages of them being new is maybe I can read more information out of them. I might be able to read a lot more than the more experienced ones.
Patrik: Absolutely.
Megan: There is that as well. Ryan has had a mix of very experienced and very inexperienced. It’s not been all inexperienced.
Megan: Okay. So Patrik, I go in, I’ll talk about the shower. I’ll try and get a photograph.
Patrik: Yes, absolutely. Definitely. Also, have you asked about the DNR yet?
Megan: No, I didn’t have a chance yesterday. I’ll try today, yes. Because they seem to slap these things on everybody, it seems to me.
Patrik: No doubt about it.
Megan: It’s terrible.
Patrik: It seems to be across the board.
Megan: I probably had one on me as well.
Patrik: A lot depends on the culture. You’ve worked out the culture there. As I said, I do the odd shift in ICU. Actually, I did a shift last Sunday. I was looking after an 82 year old lady who had cardiac surgery. She had no DNR and they know anyway that if she had a DNR, I would have spoken up. I would have said, “What’s happening? Why are you ticking boxes without talking to people?”
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Megan: Yes. It does seem to me this is very, very common.
Patrik: It’s very common, very common.
Megan: A friend of mine’s father in law was in for a heart failure. Again, there was a DNR, she told me, on him. They made a huge fuss and got it taken off.
Patrik: Good.
Megan: Yes. I may try to. I may say, “No way”. They did the thing with her about the ribs. “Oh, we’ll break the ribs.” “Well, break the ribs, then. They’d rather have broken ribs than die. Thank you.”
Patrik: Yeah, absolutely.
Megan: Also, they say, “We may break their ribs”. Well, that time he didn’t even have a heart attack. I think it’s a bad reason.
Patrik: That’s right. And what they don’t say is some cardiac arrests don’t necessarily need CPR. All they need is an electric shock.
Megan: And that doesn’t break any ribs.
Patrik: That doesn’t break any ribs. So it really depends on the nature of the cardiac arrest. There’s two different natures of cardiac arrest. So it’s not accurate that they always have to do CPR.
Megan: But isn’t it interesting that they use it to me or to my mother as they used it to them, for their elderly father. Same reason, to try and make you feel very… To make you agree. That’s why they say it.
Patrik: Very much so.
Megan: My mother was hearing all of this and she was looking up at me and there wasn’t a way I was going to say, “Oh yes”. They said it right in front of her, just like they did with… It’s very poor.
Megan: Anyway, I’ll get to speak about that this afternoon, and ask what their hospital policy is.
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Patrik: Yes, do that, and gauge their reaction. Ask about the sleepiness and see what they say.
Megan: Yes.
Patrik: What do you want me to do? Do you want me to call again tomorrow night? Your time tomorrow night. Tonight, not tomorrow night.
Megan: That would be a good idea.
Patrik: Okay.
Megan: Tonight or tomorrow night, what do you think?
Patrik: When I get up in the morning, which will be 7:30, which will be 10:30 your time. They might know that I ring at odd hours. I can identify myself. That’s it.
Megan: Yes. Might be a good idea. Do you think tonight though, or tomorrow night?
Patrik: You know what you can do? Why don’t you go in there and just shoot me an email and let me know what you want to do in terms of, maybe there have been some changes, maybe you think it’s okay. I’ll be guided by you.
Megan: Yes. I’m wondering whether a call to them in the daytime, on their daytime cellphones, but I don’t know what time it is with you now. Is it coming up to midnight?
Patrik: I can tell you that if you want me to call you in the daytime, I will do that. You tell me what you need. It doesn’t matter. For me now it’s 12:30, but that’s fine. I’ll talk to people every day, all over the world. It doesn’t really matter to me. This is what I do, and if you want me to call during the daytime, I will call during the daytime.
Megan: I’m not sure my rationale for saying that… Thank you, they might even hand you over to a doctor. You never know.
Patrik: That’s right.
Megan: But at night, the ward will close down for the night. No doctors around. But maybe you could find the information you want from the nurses. Maybe you don’t need the doctors.
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Patrik: I think I can get all the information, because what’s a doctor going to tell me? The nurses know most of the stuff, right? An experienced nurse, they know what to look for. Obviously they’re not making the major decisions, but they certainly know about all the decisions.
Megan: Very true. Yes. Getting a doctor is not really that important at this point then, is it?
Patrik: Not at this point.
Megan: No. The other thing that’s warranting ringing them at night is of course they’ve settled everybody down for the night, so they may have more time with you.
Patrik: We may have more time. They might be a little bit less guarded.
Megan: Yes. Everybody’s gone, it’s just them and a couple of colleagues, the patients are hopefully asleep. Maybe we’ll stick with plan A, Patrik. It seems to work. Yeah.
Patrik: You let me know. You shoot me an email, what you want me to do once you’ve been there.
Megan: Yes, and then we’ll take it from there.
Patrik: Yeah.
Megan: Marvelous. The other thing is, a friend called, in fact my aunt called, I’d better put her on the list really, and they wouldn’t tell her anything about Ryan today. Nothing. So I’ll put her on the list.
Patrik: That’s terrible.
Megan: It’s terrible. That’s why she’s got terribly upset. She’s been texting me, “They won’t tell me a single thing about what he has”. I ought to put her on the list, Patrik, shouldn’t I, really?
Patrik: I think you should put anybody on there. You should put people on the list that you think want to know. You definitely should.
Megan: Yes. I’ve been a bit slow there. I think it’s a very good idea. Also, the more people that ring and the more people that information, you never know what new information we might gather as well.
Patrik: Yeah. Absolutely.
Megan: Yeah. I’ll put her on the list. She’ll drive them mad because she talks forever.
Patrik: That’s all right. Again, keep them engaged.
Megan: Yes.
Patrik: And make sure they know that there’s people worrying about Ryan.
Megan: Yes, because a lot of people were ringing at the beginning and getting nowhere, that sort of faded away. They all come to me. I think I should get them back onto them.
Patrik: Mm-hmm (affirmative).
Megan: Definitely. I’ll have that as one of my projects over the weekend.
Patrik: Mm-hmm (affirmative). Yeah.
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Megan: Lovely. Okay, Patrik.
Patrik: Okay, I’ll wait to hear from you.
Megan: Thank you so much.
Patrik: Thank you. All the best for now.
Megan: Thank you Patrik. Lovely. Thank you very much indeed.
Patrik: Thank you. Take care.
Megan: Thank you. And you. Bye-bye.
Patrik: Bye-bye. Bye.
The 1:1 consulting session will continue in next week’s episode.
Kind Regards
