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 Brother Is In ICU With Tracheostomy. Is It True That The Tracheostomy Is Not As Painful As It Looks?
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 in ICU with
tracheostomy and Megan is asking how she can prevent the ICU Doctor to sabotage her with bad news that her brother won’t make it.
How Can I Prevent the ICU Doctor to Sabotage Me with Bad News that My Brother Won’t Make It?
“You can also check out previous 1:1 consulting and advocacy sessions with me and Megan here.”
Part 1
Patrik: So that’s all right. It’s a good sign.
Megan: That’s fine.
Patrik: That’s fine. Just ignore. So, yeah. And I’m definitely getting all the information that I want and she was nice, but she did in the end… Because I don’t know how long we spoke. Maybe for five, seven minutes. And then I know she got busy. She said, “I have to leave now because the doctors are coming and doing their round.” And I said, “Yeah, go. Fine.” But I wouldn’t say she got suspicious, but you just said, “Oh, I’m not sure.” Because I
said, “Look, I’m an ICU nurse myself. We can talk about…” And then basically the deeper that I was digging, she said, “Oh, but I’m not sure how much I can share with you.”
Megan: Yes. But that is strange because she has authority to share everything with you.
Patrik: Correct. That’s why.
Megan: I don’t know. I’ve never met… We’ve got last night’s nurse. I hadn’t met her either. So we’ve got a new group of nurses coming on, which is a bit of a shame because the others I’ve got to know very well. They would have been more communicative, I think, but we have to deal with what we have. We can’t choose.
Patrik: True. When you say there’s a new group of nurses coming in like less experience?
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Megan: Well, I don’t know. All I would say is that it seems to me that there’s a… I don’t know how it works, the rotation or whatever, but I’ve never met last night’s nurse before. I’ve never met Shiela before. Whereas I’ve met every time when I rang and find out who was looking off to Ryan I know the person and they know me. It may be just one of those things, Patrik, just last couple of shifts…
Patrik: No. Here’s a question. If you haven’t met those nurses before there is a chance that they’re using agency nurses, do you know what I mean by that?
Megan: Yes.
Patrik: So there’s a good chance that they are short staffed and that they’re getting agency nurses in. The way you can probably find out if they’re using agency nurses or not, is they would wear a different uniform.
Megan: Okay. Because you know they wear the blue top and the blue trousers.
Patrik: Yeah. And if they are agency, they wear different uniforms.
Megan: Different uniform. And all I will say is because of where Ryan’s bed is positioned, it’s right next to one of the kind of hotspots where they do a lot of admin. And the sisters, I hear them talking about nurses that they need to ring up and I hear all this going on. So they definitely use agency nurses. There are big discussions that go on a lot of the time about this. Lots of calls go backwards and forwards. And I hear it all because
they’re right behind me, which is why I find it difficult to do the photos sometimes because I’ve got this desk area. Yeah. But I do hear them discussing with an awful lot. So, and I did notice another thing that Angie, who is an experienced bank nurse of the ward, has been back there a lot more frequently. So they are short.
Patrik: They are short. Yeah. They would be. Every ICU is short.
Megan: Everyone? Okay. All right.
Patrik: It’s a worldwide phenomenon. It’s nothing isolated to this particular ICU or to the UK or to any other country. There’s a shortage of ICU nurses because it’s such a highly specialized area.
Megan: Yes. And I must say I imagined such a stressful and exhausting job.
Patrik: Very much so. It’s a young people’s job.
Megan: Yes. It’s a young people job, when you’ve got bags of energy and…
Patrik: Yes. And you can put up with the night shift and the weekends and…
Megan: Do all of that.
Patrik: … and all of that.
Megan: Yeah.
Patrik: So, yeah. And why is this important? So I tell you what I think is happening. If Shiela didn’t know about the weaning plan that is really concerning, which is a sign to me that either she’s inexperienced or she is an agency nurse and she doesn’t know the weaning protocols of this particular unit. So, but I’m sure you can find out. So what’s happening on a bigger picture level. I believe, even though you may not think that’s the case. I do
believe that Ryan is one of the better patients in there now. He wouldn’t be as sick as he was four weeks ago, so.
Megan: No. He’s not.
Patrik: So the acuity for him would have gone down. Therefore they can send nurses in there who are less experienced.
Megan: Okay.
Patrik: Whereas they would have other bed spaces. When they have new admissions coming in, people would be very sick. So they have to have experienced staff in there and they would take them away, the experienced staff, away from Ryan.
Megan: Yes. No, Ryan is not.
Patrik: He’s not as sick as he was and that doesn’t mean an agency nurse isn’t experienced. They can be very experienced. But they don’t know the place.
Megan: They don’t know it. They don’t know the protocols. They don’t know.
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Patrik: They don’t know the ins and outs of this particular unit. So that’s the downfall of agency nurses that simply they don’t know the place. They might be experienced, but with agency you may have that combination of them not knowing the place and being inexperienced. You might have that combination too.
Megan: Yes. I must say I have never seen this Shiela, but I would say, from memory, that she was wearing the same outfit, but I’m not sure. But I just remember that she was rather flustered and not as, I don’t know, not as communicative as…and she didn’t know. I said, “Okay, I’m going now.” And she said, “See you, then.” I said, “No, you’ll hear from me. You know that I always call.” And she looked at me very strangely. And I said, “Yes, of
course I call. Ryan wants to know that I’ve got home safely,” that’s what I said. I tell you, what I want to know is how is Ryan. Then I said to her, “I ring to see how he is.” And as I say, I rang them three times last night.
Patrik: Yeah.
Megan: They must lost it. I think they must love me.
Patrik: That’s all right. Take it as a compliment.
Megan: Yes. It’s her again. It’s just that because he’d never had a night on CPAP, I just knew how important it was that he could tolerate this. It was big.
Patrik: That’s really good. The other thing you’ve got to keep in mind is, let’s just take Shiela because she’s there today. There are a lot of people in ICU that work part time. So, and some people, they might just be doing one shift a fortnight, one shift a week. So it could be that as well that she’s working there, but she’s not a real regular.
Megan: Yes. That sounds very likely. Because even the regulars, even though they’ve never nursed Ryan, they smile at me and when I want to walk in they say, “Hello.” They know me. And she didn’t know me.
Patrik: Right. And the regulars would also know what’s happening with Ryan even though they’re not working at the bedside with him, because the regulars would be mainly full-time people. They would know what’s happening.
Megan: What’s going on with the handover, I imagine, they know everything about every patient.
Patrik: That’s exactly right. How many beds in there? 13?
Megan: 13.
Patrik: Yeah. They would know what’s happening.
Megan: And as I say so many of them that I don’t really know. I just know them by the face, not the name. They say, “Hello,” and they smile at me and they say, “Goodbye.” And they know exactly who I am. Even the receptionist says, “Oh, Megan. When you’re coming? Are you coming?
Patrik: Do that. Make sure they all know you because it’s much harder to deliver bad news on somebody that they all know and like. They don’t need to like you, but they need to know you.
Megan: No. But they need to know me.
Patrik: And, also talking to Shiela, I didn’t sense too much negativity either about the whole situation.
Megan: Excellent. Good.
Patrik: But that could also be…
Megan: Changed. Oh sorry.
Patrik: That could also be her not knowing the bigger picture.
Megan: Yes. Very true.
Patrik: And I rang around 10 o’clock and then somebody picked up and they said, “Oh Shiela is this busy at the moment. Can you please call back?” And I did. I did, even when I had this other person on the phone, look, it was probably a 30 second conversation, but the vibe that I’m getting, generally speaking, is not too bad.
Megan: No. Good.
Patrik: But that’s the nursing staff.
Megan: Yes. Quite different to the doctors.
Patrik: Very different. Yeah. So that’s the nursing staff and we have to wait. Have you spoken to the doctors since we’ve spoken yesterday?
Megan: No. I didn’t see any doctors when I was there. And I was pleased with the progress and everything, and I thought, “Let sleeping dogs lie.”
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Patrik: Sure. And maybe…
Megan: I’ll go this afternoon and see, there’ll probably be some… aw, it’s the weekend. There won’t be so many doctors now.
Patrik: Yes.
Megan: And the weekend is very hard to find one. So probably I won’t see many doctors, they have much less. I don’t know why, but there’s just less doctors on the weekend.
Patrik: Oh yeah, for sure. There’s less of everything on a weekend.
Megan: On the weekend? And less physio as well.
Patrik: Yeah, yeah, there would be.
Megan: Like one physio rather than a team of physios.
Patrik: That’s right. Did you say yesterday there was a change in doctors? Did you say that was the case?
Megan: Yes, I forgot. I wish I’d taken the name off the board, I’ll get it this afternoon. It sounded like the woman who is the head of the unit. So I’ll check when I go this afternoon to see who it is, but it’s a doctor that I have not yet encountered, not consciously anyway. At the beginning, Ryan was so sick and I wasn’t seeing doctors regularly, or I was seeing junior doctors. It was such a haze.
Patrik: I think it would be good for you to pick the junior doctors out, because they are just the messenger, they’re not the decision maker.
Megan: Yes.
Patrik: Right. And I mean you know by now, in order to get to where you want to go, you need to keep the senior doctors in the loop, especially when you, next week potentially start talking about DNR again, it needs to go to a senior level.
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Megan: Yes. This is not something for a junior doctor.
Patrik: No, they wouldn’t have a clue, they just tick the boxes.
Megan: Yes. They’re not decision makers as you say.
Patrik: And also bear in mind they are at the beginning of their career, they might have to suck up to whoever is making decisions.
Megan: Yes, they don’t want to rock the boat.
Patrik: No, no.
Megan: This awful Doctor Gie… in fact, funny enough it’s why my father didn’t become a consultant at St. John’s, because he wouldn’t suck up to anybody. He was his own man and he just wouldn’t do it, and that’s why he went and was a consultant outside of USA. But you can see the dynamic that you just don’t rock the boat when you’re a junior doctor with some of these specialists. Because I said, I want to see the consultant, this was Doctor Gie,
this was right at the beginning, and she sent her junior. Oh, she’s too busy, and along came this junior.
Patrik: Yeah. But I really didn’t sense sort of any negativity, there wasn’t any talk about him dying, there wasn’t any talk about that.
Megan: There wasn’t.
Patrik: No. But you got to watch them, and the reality is, if you called them in half an hour, they would have done their ward round. And often, after a ward round, things sometimes change.
Megan: Yes.
Patrik: But you know, the reality is the course often change after a ward round. But then also the course may not necessarily change too much on a weekend, it depends.
Megan: Aah, very true.
Patrik: It depends.
Megan: Yes, it depends.
Patrik: Are you going back in there later today?
Megan: Yes. I should be going there earlier today. They allow us in at 2, so I’ll probably be there from sort of 2.30. I’ve got a problem with my car, we’re just waiting for the AA, they’re going to come and see my car. And then once that’s all fixed, I’ll go, and then I’ll probably be there between 2 and 3, and I’ll just stay all afternoon. I will nose around, and I’ll be asking questions, and I’m hoping I might see Ryan in the chair, if so,
I’ll take a picture for you, of Ryan in the chair, and I’ll try and get a picture of the ventilator.
Patrik: Yes. Take a picture of Ryan with the ventilator in the background if you can.
Megan: That’s the way, because it is right behind him. It’s every reason-
Patrik: If you can, if you can. So then when was the last time you’ve spoken to a doctor, Wednesday?
Megan: Yes. The last time I spoke was this terrible conversation, when was that? Where are we now, Saturday? Wednesday.
Patrik: So you haven’t really-
Megan: No, I haven’t spoken to one since, because of the way they basically sabotaged me with this bad news. So he was around Wednesday, and then Thursday, so I am not going to let this happen again. This will happen. If I talk to them, I want to know that I’m going to talk to them, they’re not going to pounce on me like that, that’s not fair.
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Megan: So that was Thursday. Oh, and also to say the strangest thing, is the plan for Ryan and all this kind of what they call, what is it, proactive, whatever plan, was put in place under this consultant who said, Ryan is not going to make it.
Patrik: Yes, that’s right. And that consultant has disappeared now because he’s not-
Megan: He’s gone.
Patrik: Yeah. When the next consultant comes now, that consultant may not even go there, they may have a completely different point of view. And you know that already that they may have a different point of view, so you got to suss that out, and see what happens.
Megan: Yes. It’s a bit like, you’re on shifting sand really all the time, because you’re at the whim of the opinion of a consultant. It’s not like having just one consultant or two, because they change, there’s so many of them Patrik.
Patrik: Oh yeah.
Megan: There must be about, I don’t know, six or eight of them there.
Patrik: Okay, I’ll tell, 13 bed unit, I would imagine there would be at least eight or nine, at least.
Megan: At least. That’s what it seems to me, and they vary so much. That’s what makes it so difficult for patients, for relatives I mean, because you’re dealing with a different opinion every three days.
Patrik: Very much so.
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Megan: One day we’ll try and get him out, next day he’s not going to make it. Next day they’re mailing a plan. I wonder if it’s deliberate to keep you off balance.
Patrik: Look, it’s difficult to predict intensive care for anyone, it’s very difficult to predict what’s going to happen. It’s hard. To a degree, yes, it’s deliberate. For them, it’s always to keep the worst case scenario in mind, and always to manage your expectations.
Megan: Yes.
Patrik: And, if I have to say one thing in fairness, they can’t tell you that Ryan is definitely going to survive, they can’t tell you that, because nobody knows.
Megan: Nobody knows.
The 1:1 consulting session will continue in next week’s episode.
Kind Regards
