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 in ICU is Getting Better. How Can I Get Him Out of ICU to Avoid Another Infection?
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 and she
is asking why the ICU team prevents from giving information about her brother’s condition when it is all documented during handovers.
Why the ICU Team Prevents from Giving Information About My Brother’s Condition When it Is All Documented During Handovers?
“You can also check out previous 1:1 consulting and advocacy sessions with me and Megan here.”
Part 1
Part 2
Part 3
Part 4
Part 5
Part 6
Part 7
Part 8
Nurse Kim: Well, sorry about that. It was my first time to look after Ryan yesterday. It was just my second day.
Patrik: I see.
Nurse Kim: It wasn’t passed onto me about the password, so I’m afraid … Yeah, I’m not aware of it. Although I’ve spoken with Megan earlier, so yes. I’m just confirming what you said because yeah. We’ve spoken this morning and … Yeah, let’s just say yes.
Patrik: So, that’s really fantastic. I mean, after such a long time and it’s almost like a miracle that he’s pulled through and I believe he’s still in a fair bit of pain, from what Megan told me, but so be it.
Nurse Kim: Mm-hmm (affirmative).
Patrik: If I may just ask, because I’m an intensive care nurse myself. He still has a PICC line? He still has a PICC line?
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Nurse Kim: Yeah, yeah, yeah.
Patrik: But is he having IV antibiotics?
Nurse Kim: Yeah.
Patrik: Right, right. Okay. Okay. Okay, well, I mean that’s really fantastic that he can go to the ward. That is such a good thing and I really want to thank you and your nursing team and the doctors for doing such an outstanding job. That is really probably all down to your amazing care.
Nurse Kim: Mm-hmm (affirmative), yes. Yes. And your support and his family’s support as well.
Patrik: Family support, it is very important too, yes. Thank you so much, Kim.
Nurse Kim: Thank you, Patrik.
Patrik: Thank you. Have a good shift, thank you.
Nurse Kim: Yeah, thank you very much.
Patrik: Thank you-
Nurse Kim: Bye-bye.
Patrik: Bye. Bye.
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Megan: Hi Patrik.
Patrik: Hi, Megan. How are you?
Megan: Hello? Oh my gosh.
Patrik: Can you hear me?
Megan: I can hear you.
Patrik: Yeah no, I can hear you too. I was just talking to Nurse Kim.
Megan: I didn’t catch that last bit, Patrik. Sorry? I lost-
Patrik: I said … That’s okay. I said I was talking to Kim, the nurse.
Megan: Yes, yes.
Patrik: She have told me quite a bit.
Megan: Oh. Right.
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Patrik: She said it’s only been her second day with Ryan apparently, and she wasn’t handed over anything about identifying me with the password.
Megan: Oh. It’s all on the thing. It’s all on records.
Patrik: That’s what I thought, but she wasn’t going to entertain that. Now what I did find out though, I did find out he’s got the PICC lines still because of antibiotics. That, as far as I understood, is the only reason why he’s got the PICC line. She didn’t want to go into any of … When I asked about pain relief, she didn’t want to entertain that at all. I am very happy to call back, but I think it needs just that push to make her aware that
there’s a password. What else did you think? Have you seen him? You’ve seen him yesterday?
Megan: I saw him yesterday. Just to say, Patrik, they have these long handovers, and it is very disappointing when it’s all documented.
Patrik: Yeah, yeah. Yeah, yeah.
Megan: Yes. It is a bit. And the other thing, and it’s a very small thing, but I have to keep saying to them, “Ryan’s got his organic yogurt in the fridge. He’s got his vegetable juice. He’s got his smoothies. It’s all in …” I have to keep saying all these things. And the other thing is they keep switching off his iPad, and then they don’t know how to get it back on.
Patrik: That’s terrible.
Megan: It’s all small things, but they’re things that would make Ryan’s life just that little bit more bearable.
Patrik: Absolutely.
Megan: Yes. It’s a bit frustrating, because I’m not asking for an awful lot. And they just … It’s as if … I don’t know why they don’t … I don’t know. Every time I go into the hospital, they say, “Oh, can you help us? Can you help with his iPad? We charged it … We …” Ugh. And I say to them, “But I think it’s better that you don’t switch it off.” “Oh, all right.” “Well, hand that over.” Never mind, Patrik. Look, yesterday … Oh, how did I find him?
I found him a bit more delusional? Deluded? Is that the right-
Patrik: Right. Yeah, yeah, delusional, yeah, yeah, yeah.
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Megan: Yeah. He’s really become fixated on our parents, particularly, and he’s asking for them. I’m saying, “Ryan, Kurt passed away, da-da-da.” And he says, “Yes, I understand.” Yesterday they left him in bed because he’d had the tracheostomy removed, and he was fairly comfortable, very
comfortable, very dry. I left him watching Mary Poppins, okay? And he and the nurse were watching it together, and I rang later. They’re rather amazed by Amazon Prime. I don’t think they’ve come across Amazon Prime before. They love it. There are all these things on there. Yes, so he was fine, but a bit wooly.
Patrik: Sure. This whole morphine business, is this new?
Megan: The morphine, they’ve only given Oramorph to him once in front of me, and it knocked him out. But I had Oramorph when I had a perforated appendix. It didn’t knock me out at all. I didn’t have any … It just made me feel rather sick. And my mom had it loads of times, but she never seemed to get
knocked out like that. So I was a bit surprised. Yesterday, he was in good spirits.
Patrik: Right. Yeah, he might need something for pain, whether it’s Oramorph or … If he’s got a fentanyl patch and he’s using the Hydramorph, that’s a lot. Or the Oramorph. That is a fair whack, so I’m not surprised when you’re saying he’s a little bit deluded with all of that.
Megan: Yes, yes, yes. I understand. The strange thing, Patrik, is … The very strange thing is that the fall seems to have flared up the cancer pain, if that can make any sense, because on the 20th of April, or shall we say the 19th of April, before he took the fall, before he went into hospital, he was complaining of pains in his knee. He was complaining of pain in his buttocks. He was taking dihydrocodeine and … Can’t remember the other one. And
another one, another opioid. He said they didn’t touch his pain, but whether he was aware … Because he knew, Patrik, he knew about his raised PSA. He knew. Did he subconsciously know, perhaps? I don’t know.
Megan: But he was never screaming in pain. He was never in this kind of thing before he went into hospital, because I remember vividly they were trying to move him on the ward, and he was starting to scream out. And I thought, “Maybe he’s damaged his back.” That was my thinking, because I didn’t know he’d got cancer that had spread, et cetera, et cetera, at that point.
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Patrik: Sure, sure.
Megan: But it seemed odd, this extreme pain.
Patrik: Yeah, it is. Odd that he’s got all that pain, and I’m a bit worried that the morphine and the fentanyl might knock him out. That also leads me to the liver, that his liver’s off. That’s probably the Panadol, the paracetamol.
Megan: Okay. So they’d been dosing him with that paracetamol like there’s no tomorrow. Great big bottle. Bottles and bottles of it have gone on that.
Patrik: Yeah, they need to slow down. They need to slow down with the paracetamol.
Megan: Yeah. They’re really going for that in a … Yeah.
Patrik: Yeah, yeah. Have you arranged anything with this Dr. Maine yet?
Megan: Not yet. The nurse, as you know, is very kind of … She’s not very familiar with Ryan. I think it’s because Ryan is doing … well, compared to the other patients, is the most stable et cetera, so he’s been given … And she’s sort of … He’s getting nurses who share and things like that, so she doesn’t really seem to be very au fait with Ryan. She’s not one of his regulars, but I’ll push about Dr. Maine. I really wonder, Patrik, whether the
cancer really needs to be escalated now up the-
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Patrik: I believe so. I believe it needs to be escalated. From my perspective, there’s no doubt about it. I also now believe … Now that the pain is getting worse, I do believe it’s a cancer issue and not … It could be an immobility issue, but I do believe it’s more of a cancer issue now.
Megan: Cancer issue, yeah. Yeah. The strange thing is, as I say, you know more about that obviously, although I know cancer isn’t your specialty, but it’s a … And maybe it can move. It can change so quickly. But their opinion, the doctors on ICU, is that he has had this cancer for quite some time. That was what they said, and they said his PSA was reduced the last time I asked. And they said they felt it was a quite well-established disease.
That’s what they said, but they’ve got other things wrong, so we can’t say that.
Patrik: They’ve got a big thing wrong, so …
Megan: They got a big thing wrong.
Patrik: So yeah, we don’t know, but-
Megan: Yeah, we don’t know.
Patrik: What I can do if you like, when you’re going there, I’m very happy to call back.
Megan: That would be great, Patrik. That would be great. I’ll go in and I’ll say to her that this is all well-documented. Well, it’s supposed to be. There’s a list of people and I can’t understand where the list has gone.
Patrik: Yeah. And the only thing is, she said to me he probably won’t go this afternoon. That’s what it sounded to me like.
Megan: Good.
Patrik: And that would give me a little bit more time, because it’s midnight here now, to call tomorrow morning my time, if that’s all right.
Megan: Absolutely. It gives you the … Yeah, because we’re getting a bit late now, aren’t we?
Patrik: Yeah. Yeah. Got to get some sleep.
Megan: You’ve got to get some nice sleep. So yes, I will arrange it, Patrik, and I will text you.
Patrik: Yes please.
Megan: Not text, email you, yes?
Patrik: Please.
Megan: And then you can speak to the one that comes on in the morning with him, and I’ll update you a bit more on Dr. Maine, if I can get any information.
Patrik: Yes, yes. I think that’s the best-
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Megan: Thank you so much for … Sorry.
Patrik: You’re very welcome. I think that’s the best way to go, just reiterate with them that you’ve identified me, reiterate the password, and then I’ll call them back tomorrow morning my time, which will be night time there, but that’s fine.
Megan: That’s fine. That’s absolutely fine. You might get a nurse who knows Ryan better. There are nurses that are very nice, but if they can’t identify you, they’re not going to give you the information.
Megan: You know, Patrik, the interesting thing about those nurses is very few of them are good communicators full stop, really. You really have to push them, and I think things get lost in translation as well a little bit, to be honest.
The 1:1 consulting session will continue in next week’s episode.
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