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
Is it Possible to Bring Home My Critically Ill brother through Intensive Care at Home Instead of Being Neglected in ICU?
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 Arthur, as part of my 1:1 consulting and advocacy service! Arthur’s brother is with a
tracheostomy and is on a ventilator.
Arthur asks how will he know if his brother can already come off the ventilator.
How Will I Know if My Brother Can Already Come Off the Ventilator?
Moe: Yeah, both are closed down neither are allowing us to see him. But he did test negative for COVID after testing positive.
Patrik: Sure. Okay. Let’s start with the good news and then let’s look at the not so good news. So the good news is, I mean, he had some time off the ventilator, which means there is light at the end of the tunnel. The not so good news is that, as much as I would like to help you with taking him home, I can’t help you in your location yet. We’re not in your location yet. So I’m not making up things that I can’t promise.
Moe: Right. Where are you located?
Patrik: I am located in Melbourne, Australia out of all places.
Arthur: Oh, they just have two locations.
Patrik: The demand in your place for us is so big. We know we need to go and have our services available there. I’m talking to people like yourself almost every day.
Arthur: Really.
Patrik: It’s unbelievable. I mean, we are very busy here in Australia. But the demand in your place, just because the population is so much bigger than here, it’s just through the roof. But let’s just say, just so that you understand, even if I could help you, even if I could say to you, yep, let’s set up home care, no problem. It would take time. It takes time here. You know if I get an inquiry here, similar to your situation, it would take
four, six, eight weeks because it’s such a specialized skill, right? You got to find, you’ve got to have the right equipment, and right staff.
Arthur: Understood.
Patrik: And it’s not as simple as, we’re just hiring ICU nurses for a 24-hour roster in the next four weeks, it takes time.
Arthur: Understood.
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Patrik: Right. It’s doable. There’s a few things though that I can suggest for you. You could contact or you could look around in your area, whether you can find someone that can do what we do at INTENSIVE CARE AT HOME. I doubt it. I doubt that there is someone. There is one organization that you can contact
and I’ll quickly, there’s an organization called Bayada.
Arthur: Yeah, I’m familiar with them.
Patrik: Right, right. Have you contacted them?
Arthur: I have not contacted them yet, but I will.
Patrik: Contact them, contact them.
Arthur: Okay. Okay.
Patrik: I know that. I know that we have referred clients to them and they seem to be able to deliver. Depending on the location. But given in your location, I mean, that’s a heavily populated area, isn’t it?
Arthur: Right. Yes.
Patrik: Heavily populated. So I feel like if they can’t do it in a heavily populated area, you know, they can’t do it anywhere really.
Arthur: Right. Right. Understood. Understood.
Patrik: Because you have, there are access to resources, there are access to staff.
Arthur: Right, got you.
Patrik: But let’s go one step back though, then Arthur. So even if I was in your area, I would tell you the following. I would tell you, okay, he’s had two days off the ventilator. Is that something that can be built on? Is that something that can be moved forward? So Intensive Care at Home is great and it’s a fantastic solution, but it should be a solution for someone that can’t come off the ventilator almost indefinitely. You know, I see light, I see that your brother at 32, even though he only had two days off the ventilator, I believe he can come off the ventilator. So why do I say this? As much as you would like him to wean off at
home, if there’s any chance he can come off the ventilator where he is now, I believe he should. And then go home. So imagine going home after a prolonged critical illness, without a ventilator, without a tracheostomy, it’s difficult, right?
Arthur: Understood.
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Patrik: Now, put, put the added on complexity in there, ventilation, tracheostomy, and then going home. That’s even more difficult. Again, can be done, but it’s such a specialized skill, that I believe you are low hanging fruit at the moment is to find out why can’t they wean him off the ventilator now. What’s stopping them? Is it lack of skills? Is it lack of experience? It sounds to me like staffing is a big issue. If you’re telling
me there’s one nurse for seven, I mean, that’s just dangerous.
Arthur: Yeah, it is. And that’s the whole thing we were lied to before my brother even got to the rehab. They said its four patients per one nurse. And that’s not the case. And on a few occasions, it’s only been one nurse for the whole facility, for the vent unit.
Patrik: All right. And who are the doctors overseeing this?
Arthur: Well that’s the thing. I’ve always talked to a PA and they’re rude, they’re rude. So we’re not getting anywhere with this facility at all. Like I’m relieved that he’s even back over to the hospital, because at least I know he’s getting the care.
Patrik: Yeah. Yeah.
Arthur: You know what I mean? I don’t want him at either facility, but if he has to be there at least he’s getting the care at the group hospital. And I will call BAYADA, I’m familiar with them.
Arthur: They should be able to have, you know, we can talk to them about getting him weaned. See if they have the capability and the nurses to do it at home.
Patrik: Yeah.
Arthur: But…
Patrik: Go on, go on.
Arthur: So again, after hearing him talking and then everything today, I would hope that this antibiotic is working and can clear up the pneumonia or this bacteria. They said this bacteria in his blood can clear it up, so that when they’re doing a weaning it’s a faster process until
we can find a facility to do it from home.
Patrik: Is your brother COVID negative now? Is he over the COVID?
Arthur: Yes, he is.
Patrik: Okay, good, good, good. Okay. Is he getting mobilized? Is he getting in a chair?
Patrik: Do you know?
Arthur: So to my knowledge, they’re sitting him up at the edge of the bed. They have not started really. He does need to get a recliner he told us today. We have to get him a recliner. Yeah. So we’ll get the recliner. That way, I guess it’ll lift him out.
So we’ll get the recliner and lift him out.
Patrik: You have to organize that?
Arthur: Yeah.
Patrik: Oh my goodness.
Arthur: Yeah, we have to.
Patrik: That sounds horrible.
Arthur: Yeah, yeah. So we’ll do whatever it takes. You know what I mean?
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Patrik: Sure, sure. I understand. But that’s just… Okay. Who’s giving you updates for your brother? So if you call them, who’s giving you updates?
Arthur: Okay. So when I call over to the rehab, I have to speak to the nurse from medical. I have to speak to the occupational therapist for occupational and speech, for speech. His physical therapy for physical therapy. And respiratory for respiratory. The nurse does not give and update because they can only give medical. And that’s what I told them. I don’t understand why there’s not one system where you can look at it and tell us
everything that’s going on. We actually have to leave messages for other people to call us.
Patrik: And if you want to talk to a doctor, can you get a doctor on the phone?
Arthur: No, you leave a message. And most likely, because I’ve complained and we filed the complaint against them, what happened is that the unit manager will call back. And there’s never a doctor that ever has, that I’ve spoken to not one time. The PA basically told me that my brother’s not the only patient. We have to give a few minutes in between all the phone calls. And I’m like, okay, so you want me to give a few minutes when he’s about
to aspirate? I don’t think so. He’s in there choking on his vomit trying not to swallow it and nobody’s in there assisting him.
Arthur: We literally, for two hours straight, we had to keep calling, keep telling my brother, try to roll on your side to spit it out of your mouth. Because if not, he would have aspirated and the conversation would have been much different, but they don’t get it. They just think, oh, well, someone’s going to get in there when they can. Once, he’s been left on his own, with a soiled pad or whatever for two hours, and then they will say, when
we can we’ll get in there. Are you kidding me? When we can? We’ve been on the phone for two hours, when we can? And if you’re not the right person, then get somebody else that’s going to do it. And that’s what we said to them, you know?
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Moe: Have you asked for a case conference, like the doctor?
Arthur: I have. Okay so we went up there Monday, basically it was the unit nurse, the charge nurse, the social worker, and the administrator. There was no doctor at the table in the meeting. It was the four of them plus myself and my other child. We were there and basically even that same day after they told us, assured us that it was going to get handled and we shouldn’t have a problem. And I called back because I have my brother’s kids. At
that time I had them here with me and they were crying in the background. So the receptionist and says, after I ask for the vent unit, three times he claimed he transferred me and they didn’t answer. On the fourth time when he came back he had me on hold, so had the mute button pushed and said, I can’t hear with all those kids in the background. His kids are loud and hung up the phone. But he was talking to somebody else and thought I was on mute.
Patrik: Okay. Have they laid out a plan how they want to wean your brother off the ventilator? Have they showed a plan?
Arthur: They have not shown me a plan, no. They told me basically it’s every day around the clock they’re weaning him, which is not true because when I talked to the respiratory therapist before, the respiratory therapist said, they can’t wean him until this antibody works through his system. And I don’t know if that’s true or not, because again, I’m not a respiratory therapist.
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Patrik: Right, right. Sure, sure. Okay. Okay. Arthur, giving you a few options going forward. So Bayada, you should definitely contact them. If Bayada can’t help you, you might be able to find another nursing agency that can help you. What I can definitely offer you is two things. If you find another nursing agency that can help you, but they don’t really have the expertise, but they’re still interested in helping you, we can train them. We
have programs to train.
Arthur: Oh really? Okay.
Patrik: Okay. We can do that. Again, it’ll take time. But in the meantime, what I can do for you, if you can set up another case conference, if you see any value in that, if you can set up another case conference, I could definitely be part of the case conference, right? And find out, what they are doing, what they are not doing. I believe they need to know that you are talking to someone that understands the area very well, to get some
accountability. The other thing is, God forbid, let’s just say he would deteriorate. Have they sort of told you he could go back to the other ICU? What sort of, what’s the backup plan, do you know?
Arthur: No, there is no backup plan. They haven’t, you know, because that’s not an option. He’s already told them he wants to come off the trach, he wants to come off it. Like he can mouth words, now you’re able to hear him speak some of the words. And he said, whatever you can do, help me do it aggressively. Like he’s told them, we’ve told them.
Patrik: And he’s not depressed.
Arthur: No.
Patrik: He’s in a good mental state?
Arthur: Yeah. Because we talk to him and that’s why we have the iPad for.
Patrik: Good, good.
Arthur: And I pray a lot, you know, I pray over him. I pray for the staff to get better but…
Patrik: Of course, of course. So those are the things that I can offer you that if you can get, for example, regular, either case conferences or I could also get on the call with you with the nurse or whoever you want to talk to. I can definitely get on a call with you to find out a bit more, for example, at the moment, or I believe where my expertise comes in is, okay, what are the ventilator settings? What are the arterial blood gases? What are the chest x-rays? Those where I can really break it down and try to explain to you, okay, this is how likely it is for your brother to get off the ventilator.
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Patrik: If I was to have the ventilator settings and the blood gas results, I could tell you within five minutes, okay, it’s likely for your brother not to come off the ventilator in the next three weeks or it is, right? That’s what I can help you with from a distance just by interpreting off what’s going on clinically. And that I do believe if you can set up another case conference and have me there, I do believe we will get a lot of
information. I also believe it’s good for you and for your brother that they know you’re talking to someone who understands this area very well, to have some accountability for them. Because it sounds to me like they’re not accountable.
Arthur: They’re not, they’re not. Okay. Okay, I can do that. So what I’ll do is, once he’s back there, hopefully Bayada can help us. But you know, if he has to go back there, I’ll figure it out. I’ll set some time up and then I’ll go back on and schedule that time slot on the calendar.
Patrik: Let’s do that. Please do know that if you wanted me to come on to a case conference or to some focus, I do charge a fee for that.
Arthur: That’s fine. That’s fine-
Patrik: I’ll send you some options when we come off this call and then you can go from there. But I do believe that is very valuable for you. I also believe that if you do ask for another case conference, Arthur, I do believe you should keep asking for a doctor there.
Arthur: I am going to keep asking.
Patrik: Keep asking.
Arthur: I am.
Patrik: When you had the case conference, was there a respiratory therapist there?
Arthur: No, there was no therapist there. It was literally the administrator of the building, the charge nurse, the unit nurse, and a social worker, the manager of social work. That’s it.
Patrik: It’s terrible. How many patients are in this building? Do you know?
Arthur: For the vent unit there’s 20 beds, 16 of them are full. And at one time it was one nurse for all 16. Now they won’t confirm it is 16, but I found that out from the liaison before I even sent my brother there because they said that there’s four nurses and four patients per nurse, and there was 16 beds full. But they lied.
Patrik: That’s terrible.
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Arthur: But it’s not the case. Yeah.
Patrik: Right. Okay. Okay. Look…
Arthur: But definitely I will set something up…
Patrik: Set something up, set…
Arthur: I will talk to them and I’m going to call Bayada.
Patrik: And definitely called Bayada. Definitely. I know they have helped a lot. I can’t remember which locations.
Arthur: Okay.
Patrik: Yeah definitely. We have inquiries from rural areas all the time. Bayada can’t help rural, but they can help metropolitan.
Arthur: Right. Right. I’m going to place a call hopefully today…
Patrik: Yes.
Arthur: … and see if I can get administration, at least leave a voicemail, or send the email to the appropriate source and go from there.
Patrik: Yes. Yeah. Go from there. All right Arthur, I need to go.
Arthur: Thank you so much.
Patrik: I’ll send you an email…
Arthur: Okay, awesome.
Patrik: Then we’ll go from there. All the best, all the best for now.
Arthur: Okay, thank you. Thank you, God bless you. Thank you.
Patrik: Take care. Thank you. Bye.
The 1:1 consulting session will continue in next week’s episode.
Kind regards,
Patrik
