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
Why They Keep My Brother in ICU on DNR (“Do Not Resuscitate”) Status When He Is Doing Well?
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 for help because the ICU doctor is hoping for her brother’s life to end.
The ICU Doctor Hopes for My Brother’s Life to End. Help!
“You can also check out previous 1:1 consulting and advocacy sessions with me and Megan here.”
Part 1
Part 2
Part 3
Megan: But the truth is, he’s the sweetest, most gentle person. And they’ve picked up on this. That he’s got a very sweet temperament and the nurses seem to have really honed in on that.
Patrik: Good.
Megan: Which is great, and he’s very compliant.
Patrik: That’s good.
Megan: He’s not scratchy or difficult with them. Yes, so this is good, as you say. Keep this and hope that this continues. That’s why, when we get new nurses like Shiela we lose a bit of that momentum, but the others come back.
Patrik: The others come back and the others will ask Shiela about, “Oh, how has Ryan been doing today?”
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Megan: Yes.
Patrik: Right. You’ve got to use those dynamics to your advantage, to keep reminding the doctors, “Hey, the nurses all like Ryan, he’s in the good books with everyone.”
Megan: He is too.
Patrik: “You better remove that DNR.”
Megan: Yeah, because the nurse won’t like it, they’ll be very upset. Yeah. It’s true, they say he’s the most lovely man in there. They say this and the nurses, they come on duty, I see them in the hall and they say, “We saw Ryan, I came to see him when I came on. I’m not looking after him, but I’ve seen him this morning.”
Megan: So they go to see him. So this is good.
Patrik: Yeah, this is positive. On the one hand, with the DNR, you might have to be a bit more-
Megan: Tough.
Patrik: …tough, But at the same time, now that we’ve spoken about the dynamics, if you can plant that seed with the doctors, “Hey, he’s very popular around this place.” And just use that to your advantage. The nurses who are in charge, what’s your feeling around the nurses who are running the show? Are they siding with the doctors only, what’s your feeling around that?
Megan: No, I don’t feel that. The nurses who are running it, there are two very senior nurses who love the stories about my parents, wanting to see pictures.
Patrik: That’s good.
Megan: They’re really, really nice.
Patrik: Great.
Megan: One of them, Joe, she calls me the best smelling relative, because she says I smell like fresh laundry. She says, “I brought in a bag of laundry for you. I’ll leave it.”And she says it every time she sees me, she went, “Oh, it’s a fresh laundry again.” So we’ve got a little bit of a rapport.
Patrik: That’s good. So you don’t think they’re necessarily siding with everything that the doctors say.
Megan: No.
Patrik: Okay, good. That often does happen too. There can be a rift between the doctors and the nurses. There can be, certainly worked in places like that. And that could also be like, they want to have to say.
Megan: Yes, because they’re very experienced, they’re very senior.
Patrik: Absolutely, I certainly wanted to have a say.
Megan: And they have their own opinions.
Patrik: Absolutely. I certainly wanted to have to say.
Megan: Have your say, yes.
Patrik: I’ve been around long enough.
Megan: Yeah, you’re not just there to do their bidding.
Patrik: I’m not following blindly.
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Megan: No.
Patrik: I want to help people, and if they won’t let me, I will tell them, and I have told people in no uncertain terms.
Megan: Yes. The senior ones are the ones I know the best and they certainly don’t look like they’re going to take any nonsense.
Patrik: Good.
Megan: It looks like a stressful job running that, oof.
Patrik: Oh, it is a very stressful job.
Megan: Running the unit, aah! But they always have time for me and definitely friendly.
Patrik: Good.
Megan: And I remember she came up the other day, Joe, and she said about the laundry again, and then she said, to ask the nurse, she said, “What’s Ryan’s CPAP?”
Megan: And then she said, “CPAP.” And she was putting her thumb up, “Great.” She was really-
Patrik: That’s good, they’re having an interest and they’re taking ownership. That’s what it sounds like. That’s what you want.
Megan: Yes. Good.
Patrik: That’s what you want. And also, now that you’ve told me that the doctors seemed to disappear. There’s no doctors in there, most of the time. Is that correct?
Megan: Yes.
Patrik: That sounds to me like when they’re not there, the nurses are pretty much autonomous.
Megan: Yes.
Patrik: That to me is a sign the doctors want to do a hands off job, but want to call the shots.
Megan: Yes. Absolutely.
Patrik: That gives, that gives the nurses a high degree of autonomy, and they will have their own point of view. Especially, so now that we talk about this, so then maybe you can even approach the DNR issue with the nurse in charge because she’ll have the closest communication with the doctors.
Megan: Yes.
Patrik: So maybe, if you think you have a good rapport there, maybe you can pull one of them quietly aside and say, “Hey, this is what’s happening there, what do you think?”
Patrik: Because then, if you bring it up with them, then you’ll also know, would they be prepared to stand up for Ryan?
Megan: Yes.
Patrik: So imagine, once you know they would take sides, potentially, then you can go back to them next week and you could potentially, with the nurse say, “Hey, look, this is what we are thinking.”
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Megan: Yes.
Patrik: And if, for whatever reason, the nurse in charge may not want to escalate this, okay, well then we can go down different-
Megan: Different route.
Patrik: That’s right. But I think that would be the most diplomatic way and would probably get you the outcome that you want, in the most diplomatic way.
Megan: And the other thing is, if I broached the subject with one of the senior nurses, then it’s said, and she will almost certainly pass it on whether I ask her to or not, she’ll say to the doctors, “His sister has been asking.”
Patrik: Yes, she will, no doubt about it. It’s her job.
Megan: She will. Yeah. And we’ve opened the discussion. They know that I’m interested now, in this.
Patrik: Correct. They probably know already, it just hasn’t been the right time to bring it up, but sometimes, as you know, it all comes down to wording it correctly and choosing the right time. All of that.
Megan: And the right approach, the right person. I just feel that if he continues to improve, if, then that is the logical moment to say, “Now, let’s have this discussion.”
Patrik: Absolutely, and sometimes, I can’t tell you how many situations that I’m dealing with, in situations like that, where we haven’t got a lot of time and we almost have to go in with a jackhammer, because it’s gone down a direction that nobody wanted it to go-
Megan: We don’t like.
Patrik: … we don’t like, people often come when it’s almost too late. Then we have to almost go in with the jackhammer. But in your situation, you’re playing the field there. You’re building rapport. You’re finding out the dynamics and use that to your advantage.
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Megan: Yes. I am friendly with the nurses but I also am not a pushover.
Patrik: No, I wouldn’t think that.
Megan: I will pick them up and I’ll say, “Look, the leg cuff things, they’re not working. Can you check it for me please? Ryan needs his mouth sponging. Can you please?
Megan: I’m very friendly with them.
Patrik: They know that by now, they know that.
Megan: Yes. And Patrik, how important are these leg compressors?
Patrik: I can tell you how important they are-
Megan: Because I would really appreciate it if you could speak to them about this because about six or seven times, when they turn him, they forget to put them back on.
Patrik: Yeah, they take them off when they turn him and then they won’t put them on. I’ll tell you how important they are. 20 years ago when somebody was immobile in ICU, they were giving Heparin and Clexane, and they are basically blood thinners. Now, that’s still to a degree given in ICU or on the ward when people are immobile. However, if you can avoid medication and you can use the compressors, you would definitely want to prefer
that.
Patrik: You want to reduce medication. So how important are they, they’re very important because Ryan’s been immobile for how long now? Two months?
Megan: No, wait a minute. To the day, five weeks.
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Patrik: Okay, but still five weeks is a very long time.
Megan: Long time.
Patrik: So, the minute somebody is immobile, the risk for a DVT. Do you know what I mean by-
Megan: It’s high.
Patrik: It’s high, and if you can avoid giving medication and you can use the calf compressors instead, you definitely want to do that. But that’s why you’re spot on there, they need to use them.
Megan: And they’re not. I can’t tell you, it’s every time. I sit down, I lift up the sheets. First thing I do, and I notice that they’re just not moving. These things are not moving.
Patrik: Okay. What could happen sometimes is he may be on Clexane or Heparin, and the calf compressors. He may. It’s unlikely, but you can’t rule it out either. It’s best to ask.
Megan: Patrik, they’re giving him the injection of Tinzaparin or something.
Patrik: Or Enoxaparin.
Megan: Ah, that’s the one. They give him this every day in his tummy or in his arm.
Patrik: If that’s the case, the calf compressor is almost complimentary.
Megan: Yes. So it’s not as important, but it’s important.
Patrik: It’s not as important but it’s definitely important.
Megan: It happens all the time, literally. I say all the time, a lot of the time. Put it differently, when I see that they’re on and working, I’m surprised. And I keep picking them up on it. And they say thank you, they press the button and it starts inflating.
Patrik: Also, bear in mind, that’s what you pick up during the day. You don’t even know what’s happening overnight.
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Megan: When I’m not there. So this is something that I think is a huge concern. Especially since Dr. Gie said, “I hope he gets a big blood clot and has a huge heart attack.”
Patrik: That is so inappropriate. When she said that, one of the nurses overhearing that too?
Megan: No. She said it to me alone. She had a meeting with me, with the nurse there. The nurse had to then go, because she had to do a handover or something. She had to do something. So she left and she left me alone with Dr. Gie. And then Dr. Gie said, of course, the other thing we can do is give them drugs, which finishes them off. But we have to be more careful these days.
Patrik: Are these the words she used, that finishing people off?
Megan: I’m trying to remember her exact words. She said, “Of course, these days, it’s much more difficult to…” Did she say finish off?
Patrik: Terrible.
Megan: I know.
Patrik: I’m absolutely shocked. To finish them, seriously, if those are the words-
Megan: Patrik, I’m not sure that was verbatim. She said, “Of course, these days, as you know,” I don’t know why she thinks I would know. But anyway, she said, “…. there are much tighter rules.”
Patrik: Thankfully.
Megan: Thankfully. She said, “We can’t just give drugs to…” Something like end or finish, I can’t remember, but I was in such a state.
Megan: I was horrified because she had just previously said, “Let’s hope he just has a big blood clot and it goes to his heart. He has a huge heart attack and that will be the end of it.”
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Patrik: That’s just so inappropriate.
Megan: It’s terrible. I left there, I went to my car, I just cried. I was in a state of complete shock. And then she said, “And as you know, we can’t…”
Megan: Oh, I think she said, “We can’t deal with this with large amounts of drugs anymore, because they’ve tightened the rules.” That’s it.
Patrik: Yeah, because it’s euthanasia.
Megan: It’s euthanasia. That’s what she said, we can’t deal.
Patrik: How old is this doctor, is she young, is she old? I’m just trying to picture this.
Megan: She’s very much of the old school type. She’s about, I would say coming up to retirement.
Patrik: So she would be very desensitized as well.
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Megan: Very desensitized. And she said to me, “My father died of prostate cancer. My father came into hospital with prostate cancer and he was dead within very short time.”
Megan: I was like, “Oh…”
Patrik: I’ve seen that over the years is where they always have a story to almost justify what they’re doing.
Megan: Yes! This was the story to justify, because he’ll be dead anyway, so let’s do it and let’s do it humanely. Let’s euthanize him. She said to deal with this. She said, “You know that we can’t deal with this like we were able to be before, they’ve tightened up the rules.”
Megan: And I knew exactly what she meant.
Patrik: I don’t think they’ve tightened up the rules, at all. I don’t think the rules have been tightened. I think the rules, if anything, especially in the UK, it’s going in the other direction.
Megan: Weaker.
Patrik: They’re getting weaker. They have more authority now to euthanize patients without actually saying so.
Megan: Yes. She was just saying that, because what she wanted to do was to obviously put him on a pump of Morphine, Propofol and everything else to collapse his whole system down.
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Patrik: That what was it.
Megan: That was what she wanted. Oh, the other thing, just to tell you, she said “The cancer’s everywhere. It’s in his lungs, it’s in his spine. It’s in his hips.”
Megan: I’d already looked on your website at this point, I said, “I want evidence of this.”
Patrik: Good.
Megan: So she took me across, I saw the report with his name. I said, “But it says lung cavity clear, there’s no carcinoma. There are no secondaries here.”
The 1:1 consulting session will continue in next week’s episode.
Kind Regards
