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
Can We Bring My Sister Home from the ICU Even If She’s On A Ventilator?
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 Joyce as part of my 1:1 consulting and advocacy
service! Joyce’s sister is unstable in the ICU on a ventilator. Joyce is asking if it is safe for her unstable sister with tracheostomy to be transferred out of the ICU.
Is It Safe For My Unstable Sister with Tracheostomy to Be Moved Out of The ICU?
“You can also check out previous 1:1 consulting and advocacy sessions with me and Joyce here.”
Part 1
Part 2
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Part 5
Part 6
Part 7
Part 8
Part 9
Joyce: Right. I guess my sister is going to determine where she’s going to go with it.
Patrik: Yes.
Joyce: Her body is going to determine where it goes, and we’re going to follow, or we’re going to fight tooth and nails.
Patrik: You have put her in that position where hopefully she has the chance to take further steps, hopefully.
Joyce: Right. Okay. All right Patrik. I’m going to get you the information. Let’s take it from there.
Patrik: Yeah. Please.
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Joyce: Okay, you’re listening? They’re just moving my sister right now. So okay, so right now, she’s in the ICU. I told you she’s at a 50. She’s now still at 50, still at a PEEP. They mention of rational law, whatever it is called, which means they can do whatever they want now, which means doctors can choose whatever they want to do. You know what rational, or rationale law means?
Patrik: Oh, because of COVID?
Joyce: Yes. I mean, I know I’m just going to tell you just so you can guide me something. First of all, here’s my sister, just before they disconnect the FaceTime. I want you to see her. Hold on. Can you see her?
Patrik: Yeah, just give me a second, I just want to … Hang on. I just want to zoom, if I can zoom in. I can-
Joyce: Yeah, yeah. Hold on, I’m going to click the …
Patrik: I can’t.
Joyce: That’s why I needed to use-
Patrik: Yes, that’s better. What does she have on her head? An EEG?
Joyce: No, nothing on her head.
Patrik: Can you show me again?
Joyce: Her head is right here.
Patrik: Oh, okay. Yeah, yeah, yeah, yeah. Yeah, no, no, I can see it now, yeah, yeah. Okay. Right.
Joyce: I just want to see where we’re at. I mean, I know it’s just a picture.
Patrik: Yeah, no, but she looks like she’s not moving at the moment. That’s what it looks like to me.
Joyce: She’s not moving. She has a 50% PEEP. They said every time they move her, she desaturates, okay. They took out all the medicine. They took out the steroids. She’s only on antibiotics at the moment. No sedation whatsoever. I literally just got word within last hour, that she is now
being moved to a step down unit. And I am disappointed. I said, “Under no circumstances do I agree to that.”
Joyce: I obviously left a message to the doctor. No one is ever going to call me back. Look, we are in a huge pandemic. I know what I’m going to say to you … I know that hospitals right now are doing whatever they want, okay. And I’m freaking out. I mean, I just have to talk it out with you to give me maybe something. I know these are unprecedented times, and I know that these are not … The nurse said, “Look, this are not normal times.” But
they need the bed. She straight out said, “We need the bed.” And now she’s moving to a step down unit. Now remember, she cannot get a CAT scan because she’s not stable to go to the machine.
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Patrik: I question that. I question that.
Joyce: Well, no, so she said, “Look, the CT is ordered.” But she said … Now, they’re not cheaping out on the CT. She’s like, “Look …” She goes, “If we transport your sister, we will have to put her on a table. She goes, “It’s just me. It’s just one ICU nurse.” Again, this is a small hospital. Only one ICU nurse, and one technician. He is coded as full code. So if something happens in the machine, or something, they will not be able to
save her.
Joyce: Now, she’s saying to me also, if finding out what’s going to happen to her, or the CT doesn’t help our situation of what … Basically it’s not treatable. You know what I’m saying? So we can find out what’s going on. Look, he has it ordered. They said to me, “It’s so risky that she’s going to have a portable ventilator.” It’s a portable ventilator.
Patrik: Absolutely. Absolutely.
Joyce: Right. She said they’re going to … She’s like, “Every time we move her, she desaturates.” Now, I don’t feel like … Yes, it’s a pandemic and they’re busy. She said, “It is a risky … It’s a risky thing that we would put your sisters harm.”
Patrik: It is. It is a risky thing. But you’ve got to manage it. I’m not disputing that it’s not risky. I’m not disputing that for a moment. But it needs to be managed. And if you’re saying it’s one technician and one ICU nurse, yeah, that’s not enough. I agree with all of that. You need two ICU nurses, one doctor, a technician, and you need a support person. But they don’t have it.
Patrik: They don’t have it.
Joyce: They don’t have it. They don’t have it. So she said, “It’s just me. It would be just me. And something happens to her in the machine, I can’t save her.”
Patrik: Yeah, sure.
Joyce: Okay. So and then let’s say we … Look, it’s seven days. I have never fathomed … I know you said to me, “Just wake up.” And I just did not think it would be seven days and she wouldn’t wake up. Okay, I know that the ventilator settings should have got better, should have not got better. I don’t know where I’m at. I know you said to me, “Make sure she gets up.” She’s not up yet.
Patrik: Yeah, that’s terrible.
Joyce: But she did say something profound. I told you that one day she was mouthing, and I felt it. She wasn’t doing it. Then last night, the nurse noted in the middle of the night, that her tracheostomy is leaking some air, she said. Because she said, “It’s typical. Whatever. It’s new.
Whatever.” So she said that when she was trying to do something to it, she was in a lot of pain, grinching really, really bad. And she noted that she was mouthing something to her, and even let out a squeak. Hold on, I’m …
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Patrik: Sure.
Joyce: I’m hearing what the nurse … She doesn’t want me to leave the camera on. They actually … I got in trouble because my 24 hour surveillance has been vetoed by the hospital, and-
Patrik: What do they have to hide? What do they have to hide?
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Joyce: Well, they said it’s against … And not only that, they didn’t even let me take a picture of the ventilator, so I had to secretly do it because …
Patrik: Again, what do they have to hide? That’s my question?
Joyce: A lot now. But okay, so anyways, so back to the thing. So anyways, she’s going to a step down unit, and I said to her, “That’s unfair. I don’t agree with this.”
Something happened now. Then she said, she straight out said, “We need the bed for someone who’s more critical Hold on. Hold on. Hold on. Oh, are you moving?
Okay, you moving her?
Nina: Yeah.
Joyce: Oh my. Well, I’m really against it. I just want that to be noted.
Nina: No, I want you to know, we’re moving her. Her condition changed, we will stop.
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Joyce: Okay, well I’m going to tell you … So I’m going to tell you something, because you are putting … Nina, this has nothing to do with you, but I want this noted, that if something happens to my sister, 100%, I want this noted that you are liable for my sister’s life, and I am completely 100% against this move for a step down unit. I don’t feel safe, and I feel like her life is in harm right now, and I’m completely against this. And it’s
not against you. I want it noted completely out and loud, because you are … It is a very risky procedure in my opinion. And I don’t have enough time to even get a second opinion, I don’t have enough time to consult the safety of this move. And I just want that documented, because I’m 100% against this move.
Nina: Okay.
Joyce: Yeah.
Nina: Honestly..
Joyce: No, no, I’m not threatening you, I’m not threatening you.
Nina: Yeah.
Joyce: No, this has nothing to do with you whatsoever, I just want it to be-
Nina: Okay, I promise you, if she doesn’t look good, any changes in her vital signs, I will let the doctor know, and then we cancel the transfer. How’s that? But if ever we don’t see her that she’s progressing well. So then we might have to give her a chance. It might be a sign she’s getting better.
Joyce: The only thing I’m confused about is that you guys literally said to me the last couple days that she desaturates any time you move. You guys made it so well known to me that she’s so unstable. And I understand the CT situation. But she’s so unstable to even be moved, that for this step down unit, does not make sense at all. You guys literally … I am on top of this. And you guys said to me, “Every time, Joyce, we move, she needs to go
to 100, she needs to go to this.” You guys told me that. I have my own documentation here. And now all of a sudden, you’re telling me that a step down unit. It doesn’t make sense. And not only that, but the portable ventilator, I don’t agree with it. I’m just saying.
Nina: The portable ventilators for transport. So as far as they take care of ventilator patients. And I promise you, if ever her condition change, we stop and we cancel. That’s what I told the doctor too.
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Joyce: And I wish that I had at least 24 hours to consult with somebody. You guys work as a vacuum, and I have rights too. And I need to make sure that I’ve been notified so I could have gotten a second opinion. Listen, my sister is my lifeline.
She is everything to me. And I’m going to fight tooth and nails to make sure she’s safe.
Nina: You remember I talked to you this morning, and let you know I only find out this morning.
Joyce: And I tried to call Dr. Monroe and left him a very urgent message, and he never called me back. This is a life. This is … Look, I get the pandemic, but right now, my sister’s life is number one. And this is … I can’t even believe that Dr. Monroe cannot even call me so I can debate or defute his decision. And I don’t know what else can be done.
Nina: I know your sister is your life. But unfortunately, there’s a lot of patients that’s more critical. I’m not saying she’s not important, but I promise you, if ever any changes, we stop and we cancel. That’s what I told the doctor too. I understand your frustration, she has been here for weeks. And then everything progresses so and then you have your concern.
Joyce: She hasn’t been stable. That’s the thing, see, I would have considered the minute you move her a little to the left, a little to the right, she desaturates. That’s not stable from my eyes.
Nina: That’s why she’s under control. The doctor, me, and the respiratory therapist, and another ICU nurse.
Joyce: I mean, listen, I mean-
Nina: I’m sorry it get to like this. But I’m the middle person.
Joyce: I know, Nina. And this has nothing … Listen, I respect what you do 100%. I want you to know this is nothing personal, God bless what you do. I appreciate you more than you could imagine. But have this conversation is … I get it, you’re the middle person. But I don’t know who else I can speak to, to voice my opinion, who has control over the stop of the move. I want to see if there’s anyone else I can veto this move at least 24
hours, because I’m telling you, there’s a liability here.
And it’s not to you, you’re not liable for any … I mean, you’re a nurse.
Joyce: But the hospital is liable for my sister’s life right now, and you guys are putting her in harm’s way. And I am very well, and got all the advocates in the world to tell me and educate me. So I don’t know if there’s anyone else I can speak to, to veto the move. Is there anybody I can speak to at the moment to veto the move at the moment?
Nina: You can talk to my charge nurse, but unfortunately, she is on another call.
Joyce: Okay, well then-
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Nina: If you want to, you can hang up and dial another number, and then you ask her.
Joyce: Okay. So then can you … Okay, then can you give me about 30 minutes not to move her so I have time to call?
Nina: You know, you can just call. But as far as the move, I cannot … I have patients coming. It is a problem.
Joyce: Okay, well, then I don’t know what else … You’re telling me to call the charge nurse, and you’re already-
Nina: Listen, these situation is unprecedented. You know..
Joyce: I get it. I get it.
Nina: There are new patients waiting.
Joyce: Okay. Well, I don’t know what else to tell you.
Jane: What is her vitals right now? What is her blood pressure?
Nina: Her blood pressure is normal. 142 over 59.
Jane: 142 is not high?
Nina: No, it’s normal. Okay, I think I have to get..
Joyce: All right, Nina, I’ll call the charge nurse. Okay.
Nina: Yeah, you can call her now if you want, yeah.
Joyce: Okay.
Nina: All right, sorry about that.
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Joyce: Bye. Can you believe that? I mean, you saw this live right now. This is something that’s infuriating. I don’t know what else I can do.
Patrik: Joyce, I just had a quick look online, healthcare laws. There’s nothing in there that I could find. There’s talk about it, but I can’t find anywhere that this has been implemented.
Joyce: I mean, she just … She probably just said it because it’s all over the news. I don’t know how fast they implement it. But you saw, she’s saying I have no … I can call the charge nurse, I’m going to say the same thing. They’re still moving her. I mean, look, they’re moving her to a step down unit. Look, she said they’re moving her to a step down unit. I don’t really know what that means.
Patrik: Probably, I’ll tell you what it means. It means high dependency unit. It’s a step down. You’re going from ICU to HDU, which is high dependency unit. It’s a little bit lower acuity. But your sister sounds very unstable. I mean, they’re making this big fuss, they can’t transfer her to CT, but they can transfer her to a step down.
Doesn’t add up.
Joyce: She’s saying the CT, they would have to change a bed. She’s not changing a bed right now, she’s taking the ICU-
Patrik: Yeah, I agree with all of that. I agree. But she’s too unstable to go for a CT scan, but she’s stable enough to go to step down? It doesn’t add up.
Joyce: Should I call the charge nurse? Patrik, will you be patient with me? This is moment by moment. I’m so sorry. Just right, you’re okay with this at the moment?
Patrik: I’m okay with this for the moment. I do have a next call at seven o’clock.
The 1:1 consulting session will continue in next week’s episode.
Kind regards,
Patrik
