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 is the ICU Team Pushing My Critically Ill Dad Out of the ICU Too Soon?
You can check out last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer questions from one of my clients Ella, as part of my 1:1 consulting and advocacy service! Ella’s dad suffered a stroke and is on a
ventilator in ICU. Ella is asking if her dad will be able to withstand a tracheostomy.
Will My Critically Ill Dad in ICU Be Able to Withstand A Tracheostomy?
Patrik: Yeah. Can you see him? Do they give you Face Time?
Ella: Yeah, that they do. Today, the first day actually I had that. That is why I was telling he was lifting his arm and doing like this-
Patrik: Yeah, sure. Going forward, Ella, I believe I can help you. The one way I can help you with, is certainly giving you a second opinion, talking to the doctors with you. I do believe that would be very helpful, because I argue that they always tell families only half of the story. Right? So, they’re telling you, he should go to palliative care. He should go to hospice. If you and I were on a call with the doctors, I would ask them a
series of clinical questions. And I would ask them, “Well, have you done this? Have you done that? So, at the moment, you are in a position where you can’t ask all the questions. I’ve worked in the environment for 20 years. I can just rattle off some questions and they know, okay, they have to tell you the full story. They have to be transparent. I would like to know what ventilator settings is he on? That’s just one example.
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Ella: There is one, 400 or something they said, I mean tidal volume or something. I don’t know what does that mean. The progress could be very slow also, but I just don’t want to take out of anything or take some drastic actions or something like that.
Ella: The other important point, Patrik is he’s not having any insurance.
Patrik: Right.
Ella: And then he has to go through some kind of a Medicare or something like that here. So the last time they provided. But they should also not be worried about that, in terms of providing the care. That is of utmost importance. So-
Patrik: Do you do think it’s of concern for them that he doesn’t have insurance?
Ella: No, I don’t think so, but they should provide whatever the care is needed for him. Let him get recover. It’s not a full recovery. Come in stages, but at least I’m thinking like COVID -free and then maybe or in parallel, off the ventilator, wean off the ventilator. Make progress daily basis. Maybe a couple of hours, two, three hours. Then he would go into the … Because they’re saying he … I don’t know. He’s not even in coma. They’re
saying in vegetative state. I don’t understand that.
Patrik: I can tell you the difference. So, a coma would be often induced by medications. Okay? A vegetative state is something that’s natural. Right? So if he’s off sedation and he’s a Glasgow Coma Scale of three, he’s not responsive. That would be a vegetative state.
Ella: He’s not responding to commands. But not totally unresponsive. He’s responding to pain, and then sometimes he is moving his arm.
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Patrik: That is not a vegetative state. Definitely not.
Ella: The word they’re using is like the palliative care. There is a lady who uses that word. I know whenever he talks like this I cannot shout. The thing is, the way they’re talking is … Because my husband saw me and then he said, “Why are you getting upset too much? You ought to go patient.” I also told it is a very slow and patient thing. And as the day progresses and even every hour or every six hours, the things are slowly, slowly,
little by little changing. I’m not rushing.
Ella: I could see some positive things. Whenever I talked to the nurse also … “Okay, this is positive.” Some nurses are saying, “No, I don’t see any improvement.” So, I’m reading your blogs and then I’m looking at other things also.
Patrik: Of course.
Ella: Yeah… That’s why I told them to start picking some good things. Are we just working? Are we just good? At least progress wise? So that he can move to the regular ICU and then maybe I can come and visit him. I’m going to make a much of a thing, but at least it will be a little bit-
Patrik: Yeah. Of course. What I would recommend as a next step for you, Ella, is really, I do believe you will benefit from having me on a call with the doctors. For example, you mentioned tidal volumes earlier. On a ventilator, there’s 10 different other settings that are important to work out what is exactly going on?
Patrik: If you do nothing, you should not be pushed towards hospice. They are at the mercy of your consent. Nothing happens without your consent. No hospice. Nothing. No tracheostomy. Nothing happens without your consent. So always keep in mind, you have some power.
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Ella: Correct. Because my husband was telling, “The doctors know everything. You are not God,” or something. So he’s telling. So I said, “I am not God. I’m saying I have to get the right care. But I have to say what I have to say. They cannot push me or force or whatever. The way you can talk to me or something like that, and agree something or something.” Right from the beginning, I’m telling that. But he is showing the stability and
progress at least to the extent, whatever is possible. And also I was asking him about the tracheostomy also. He’s 84 years old. Will he be able to withstand that?
Patrik: Oh, it’s not painful. I know you said in your email pain. A tracheostomy is much more comfortable than a breathing tube. Much more comfortable. It’s actually painless. The breathing tube in the mouth is very uncomfortable.
Ella: Oh, okay.
Patrik: But, the problem is with the tracheostomy, even though it doesn’t cause any pain, it takes a lot longer to get rid of. Right? It’s usually a device that is used for long-term ventilator weaning, which is why it would be good if he came off the ventilator now.
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Ella: Yeah, right. I think they took that stuff correctly. I think they were aggressive on that taking. Today he was longer out, the test also. So hopefully, maybe a few more hours or something as the goal, they will be improving. And then maybe I think that from what I could see is like he might take even a couple of weeks to get over the ventilator situation from-
Patrik: He might. Ella, I’m sorry, I need to move on. I am very sorry. I know it is very short. Again, I do believe you will benefit if you and I were to get on a call with the doctors. I also believe if you don’t want to do that, that’s absolutely fine. Even by me just setting you up with some questions would be very helpful for you. But I do believe the shortcut really is if you and I were to get on a call with doctors and really ask
through everything that’s happening, so you can, I believe, really make an informed decision what’s next.
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Ella: But one thing is, if you bring in some other person or something like a medical person and then, will that not offend them or something that should not be-
Patrik: Look, that’s a good question. Look, the way I often approach this with clients is you might say, “Hey, I’m a family friend.”
Ella: Yes.
Patrik: Right? Keep it friendly. And you, you could say, “Look, I’ve got a family friend.” And if I’m on the call, I can say, “Hey, look, I’m a family friend. I am a critical care nurse by background.” And they can know that. I’m not-
Ella: Hiding anything.
Patrik: No, not hiding anything. That’s the way I approach it. But you’re absolutely right. If you say to them, “Hey, I’ve got an advocate.” And they might get defensive.
Ella: Yeah. That is very natural. Right? In any profession. Anything, that’s a natural reaction, I think. And then there was a thing about, I saw your email about membership and all those things. That would be like a little better option. What is it?
Patrik: Yeah. With the membership, you have access to me online only, not via call. It’s really only via email.
Ella: Okay.
Patrik: But you can definitely do that, of course. But then I wouldn’t be going on a call with you, for the membership. It would only be via email.
Ella: Okay. So they’re saying four-day package, seven-day package and things like that. So I haven’t spoken with the doctors. Last week after that, because that is when they were more telling about quality of life and all those things and all this. But now, because there is more, they’re seeing no significant improvement in their term, no significant improvement. They are not contacting me.
Patrik: After five days. Five days is not a long time. Of course, there is no significant improvement after five days, after a stroke. There’s nothing new there.
Ella: So I was prodding and asking the question to the nurses. Some nurses are very able to tell me … Yesterday, one lady told that he is off for all the IV medications. They are completely off now. That is progress for me. And then off sedation for the last three days. That is progress for me. And then he is doing a little better on her SBT. So that is progress for me. His COVID things are all stabilized. There is a little bit of progress
for me, but that is what I’m thinking in that way.
Patrik: And progress I can tell you, in a situation like that, progress will be very slow. It’s like recovery in ICU is often like a marathon, not like a sprint. It can be very slow. Ella, I need to run. What I’ll do is I’ll send you the consulting options again. I always advise clients, no matter what you decide, it’s fine. You can also read our blog for free. The shortcut is to talk to me directly, of course. But if you do nothing, there’s
so many case studies on the blog that you can access for free. There’s videos and stuff.
Ella: Yes, what happens is, to be frank with you, we are juggling with so many things even, we don’t have even time to go through all the materials also sometimes. The report and everything.
Patrik: I know.
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Ella: But, I guess, whenever I see the video, I get the confidence and I get the positivity. And that’s how I started to have this interaction and everything. So at least I am a little bit more confident when I am talking to the hospital that I have somebody behind me. There is someone with knowledge behind me, so that I can be more confident and then sounding little bit better than saying yes or nodding to everything, whatever they say.
“Okay.” Because he also doesn’t want to be in this situation. Neither me. Or nobody wanted to be in this situation.
Patrik: Nobody wants to be in that situation. No, definitely. No, that’s good. I’m very glad to hear that you gain some confidence from what I’m putting out there. That’s really nice to hear. And as I said, if you decide nothing, just keep watching the videos and gain some confidence. The shortcut is obviously, by talking to me directly.
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Ella: Okay.
Patrik: I need to run. I’ll send you the consulting options again. Pleasure. All the best Ella, and hopefully we’ll talk soon.
Ella: Okay. Thank you very much.
Patrik: Thank you. Bye-bye.
Ella: Yeah. But one more quick thing.
Patrik: Yeah, very quick.
Ella: Very quick. So if I choose one option, I can switch to other option as needed?
Patrik: Oh, anytime.
Ella: Okay.
Patrik: Yep.
Ella: All right. Thank you.
Patrik: Okay. Thank you. Bye.
The 1:1 consulting session will continue in next week’s episode.
Kind regards,
Patrik
