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 Had A Stroke And Ventilated For 12 Days In ICU. The ICU Team Wants To Do A Tracheostomy. What Should I Do?
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 Isabel as part of my 1:1 consulting and advocacy service! Isabel’s husband in intensive care is
recovering from COVID-19 infection and she wants to know why her husband is not waking up.
My Husband In ICU Is Getting Better From Covid-19 But Why Is He Not Waking Up?
Isabel: Hey, Patrik. I’m here.
Patrik: Isabel, how are you?
Isabel: I’m okay. How are you?
Patrik: Very good. Thank you. Are we waiting for Helga?
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Isabel: Yeah. She just said she’s logging on right now.
Isabel: I also sent the link to two of my brothers and my mom.
Patrik: Yes. Great. Right. Hang on, there’s someone coming in.
Isabel: Okay.
Helga: Okay. I’m on the call.
Patrik: Hi, Helga. How are you?
Helga: I’m okay.
Helga: It’s hard you know?
Patrik: It’s very hard.
Patrik: Did you spend more time earlier on Zoom with Bern?
Helga: Yes.
Patrik: That’s good.
Helga: We were able to get another call.
Patrik: Good.
Helga: Yeah.
Patrik: That’s good.
Helga: I’m not sure who else she’s having on the call.
Patrik: There’s one more person.
Aurora: Hello?
Patrik: Hello?
Helga: I had asked about the plasma.
Aurora: I’m here.
Helga: The doctor did call me again.
Patrik: They did or they didn’t?
Helga: I asked her about the plasma. She said the plasma wasn’t going to help with his current condition. It was only going to help the COVID, which is already leaving his body she said. We’re dealing with the aftermath of the COVID and not the actual onset of the COVID anymore. It’s the aftermath of it. The plasma is not going to help with that.
Patrik: I don’t think-
Helga: Then I did ask her about transferring him. She said that because he’s on continuous dialysis that he wouldn’t be able to transport, because they don’t do continuous dialysis by transport.
Patrik: The transport, I don’t agree that he can’t be transported. I don’t know why she’s saying that. People are being flown to other countries on ECMO. So, I don’t buy that at all. But, I don’t think it’s… It’s something that needs to be discussed right now. But, it can definitely-
Helga: What is that music background?
Isabel: Oh, sorry. That’s my house. Sorry. Jake’s watching TV. I’m in the living room. Let me go somewhere else. Sorry. That’s the TV.
Isabel: Okay. Is that better?
Helga: Yeah.
Isabel: Okay.
Aurora: Helga?
Helga: Yeah. I’m here.
Aurora: I was just going to say about.
Helga: I can’t see you.
Aurora: Well, I’m here. Can you hear me?
Helga: A little bit.
Aurora: Okay.
Helga: You’re breaking up.
Aurora: I know. It’s my phone. I’m sorry. I don’t have a good connection here.
Aurora: On the article that I saw today, there was something called a plasma exchange. I don’t think it’s the same as the plasma treatment, because this lady she got COVID, but it attacked her brain. And, I don’t know. Apparently, when she was clear from the COVID, they started using her own blood to kind of like a reverse kind of thing. I just don’t really understand. I tried to send it to Isabel, but I don’t know if she looked at it or not. They used her own
blood.
Patrik: Like a plasmapheresis?
Aurora: And with it, it helped with what happened with her brain. She didn’t even get COVID like everybody else. It hit her on her brain. In other words, she ended up from it getting a stroke and something. They didn’t understand it. So, when they did her MRI, they had found that it had attacked her brain. They did
this thing with her blood and the plasma.
Patrik: I don’t think that the COVID is the problem at the moment. I think the main problem is the brain. I think the COVID can be taken care of, in that he’s now off ECMO.
Aurora: Okay.
Patrik: I feel like the COVID, it’s not the main issue. I believe he’s coming off the ventilator step by step.
Aurora: Okay.
Patrik: I guess the bigger issue at the moment is not waking up and the potential next steps because of that.
Patrik: The COVID, it looks to me like when talking to the doctors this morning Helga, he’s not going back on ECMO. He’s gradually and slowly improving on the ventilator. That’s a fact. I guess the challenge really is the not waking up part.
Helga: She did say something about the kidneys though too.
Patrik: Yup.
Helga: He’s going into renal failure, and that he’s not making urine anymore. His potassium’s really high and so that’s concerning me too. Like his kidney function, does that eventually get better at this point or?
Patrik: I don’t think they are clear on it. If you look at the studies and at the research out there, most patients in ICU do recover from kidney failure, and they do go back to not needing dialysis.
Helga: Okay.
Patrik: I believe it’s too early to say where he’s going.
Helga: Okay.
Patrik: I don’t believe that him needing dialysis for the rest of his life.
Isabel: So, he’s not like, I think Helga brings it up. Huh?
Patrik: I don’t believe that him needing dialysis for the rest of his life is necessarily accurate. That’s just my take.
Helga: Yeah. No, I agree with that too.
Patrik: And I don’t think it’s a make or break. A lot of patients have dialysis living at home, they go to a dialysis center three times a week.
Helga: Yeah. That’s what my doctor said, that it’s not the issue.
Patrik: No.
Helga: It’s the waking up part that’s the issue.
Isabel: I feel like when they bring it up, they bring it up to kind of use it to reinforce their argument of like, “Oh, there’s nothing else we can do because this is happening too.” So, we’re trying to separate that from the issue, right?
Patrik: Fair enough. Very much so.
Helga: Yeah. The issue is the MRI results. That’s the issue, and him not waking up.
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Isabel: Helga, since you spoke to the doctor, I didn’t know they were going to call you, and I didn’t get a call from you, did you ask them for the MRI report? The formal report?
Helga: No, but I did ask for a 2nd opinion. So tomorrow, we can request that result.
Isabel: Do you plan to ask? Can you ask the MRI report? Are you comfortable with asking for the formal report? Even Patrik said that we should verify it.
Patrik: Just to verify.
Helga: Yes. I could bring it up tomorrow. It slipped my mind because Nikolai got on the call, and had a lot of questions for her.
Isabel: Okay.
Helga: So, he kind of took over that conversation but I did ask about the plasma and the transferring. I wrote it all down. I’ll have to write down the MRI report.
Patrik: You’re right Helga, that they’re using every little thing to paint a doom and gloom picture. They’re using the dialysis, sort of if he doesn’t have any perceived quality of life going forward, if there’s no, what they referred to as meaningful recovery, the dialysis from that perspective just complicates things. Whether you agree with that or not, that’s not for them to decide. That’s for you to decide what options you want to pursue, if any. There’s no
right or wrong answer. There’s only a right answer for you as a family.
Helga: Yeah. I was talking to my doctor. He was on the call last time with you also.
Patrik: Yup. Yup.
Helga: He were talking for a long time. He just said, “On a clinical standpoint”, he’s like, “I want to say, just stop everything. Stop torturing him. And stop.” But he said, “My heart is telling me for you guys to wait a little bit longer. Just give it more time, a little bit more time. Like I’m not saying weeks or months, but just a little bit more time to just reassure yourself, and to see where he’s going to go, because they said he wasn’t going to be able to
come off the ECMO and he did.”
Patrik: Correct.
Helga: And so.
Patrik: There is plenty of time to talk about end of life. Plenty of time. It’s not running away.
Helga: What happened?
Aurora: I was going to say with the dialysis, there’s people that are on dialysis for the rest of their life, until of course they can’t anymore. But, I took care of my mother-in-law. I took care of my grandmother. I would take her three times a week to dialysis. So, she actually lived with it until she passed away. She was many years with dialysis.
Helga: Yeah.
Helga: I just wanted to clarify with Patrik because they’re making it like a really glim picture-
Aurora: But, that’s just you Helga. They keep-
Aurora: Hold on, let me finish. That’s the thing. The doctors are going to attack you that way, because you’re the most vulnerable. You’re his wife. They know that, how do I say it? They’re playing a game of convincing you to do that.
Aurora: Of course, I would say if he were to go into arrest or whatever, I wouldn’t want him going try to revive him. Why? Because he already has damage on his brain.
Aurora: The thing is that they want to put the worst picture in your mind and they do it to you because it’s kind of like you’re easy to convince, you know? We’re not convinced. I’m not convinced. I can’t give up on my son yet. I just can’t.
Helga: I’m not easily convinced. He’s my husband. How do you think I feel? It’s torture.
Aurora: No, I understand. But the thing is that every time they tell you-
Helga: I have to tell you guys what they’re saying. I mean-
Aurora: I understand that. You know what, I’m going to get off of this.
Isabel: Aurora, Patrik was on the call with us. Aurora? Did she already hang up?
Isabel: I was just going to tell her that Patrik was on the call with you and I, Helga. So, he got the same information that we heard, where they were, I think he agreed, where they were trying to use it, like stack all the chips. This is why this doesn’t look good.
Helga: Yeah. Yeah.
Isabel: Because of this, and this and that and I can sort through that. That’s why I said the renal failure to me, I talked to you about that, I said, “I don’t want to count that into effect, because like Patrik said, people can survive on it. People can be on it for a while and they could heal. Just like he responded right away the first time, and he was doing pretty good. Even his lungs are improving. That’s when you had said, “Well, those things can still
heal. Even if his brain isn’t working, that his kidneys and his lungs could improve and be okay. That doesn’t mean his brain is coming back.” Remember that earlier.
Patrik: Can I just maybe paint the picture again from what I can see?
Patrik: There’s basically two options from what I can see. Number one is, you could stop everything and he would probably pass away fairly quickly. And number two, you could keep going.
Patrik: The COVID I believe will take care of itself. Then number two to a tracheostomy. Wait for him to wake up. What that looks like, nobody knows there may be some improvements there may not. Then the question is, can you accept whatever might happen from that point? And that could be a gradual improvement. It could be no
improvement. Those are the scenarios that you might have in front of you. Whether you can accept that and take the consequences.
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Eli: I have a question.
Patrik: That’s I believe from my experience, what would probably happen here?
Eli: I have a question.
Eli: Can you guys hear me?
Helga: Yeah.
Isabel: Yeah, go ahead, brother.
Eli: What if this, where he’s at, I don’t know if he’s stable enough to move to another center or another facility, maybe they’re not as equipped as a place that specializes in neurological. Maybe he needs a 2nd opinion from a center that deals with the brain. Maybe. I don’t know. A hospital that has maybe different medicines or different things that I don’t know, new technology or new something. I don’t know.
Patrik: I agree with you that a 2nd opinion… I mean, this is all fresh. I’ll tell you what I didn’t like. I didn’t like that the neurologist is also an ICU consultant. You remember that Helga and Isabel?
Helga: Yeah.
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Isabel: Yeah. Was it Dr. Escueta?
Patrik: Exactly. He’s also ICU. There’s almost, I’m not saying there’s conflicting interests, but if you have a neurologist-
Isabel: There kind of is. –
Kind regards,
Patrik
