Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So currently, we’re working with the client, and the ICU initially did not want to proceed with the tracheostomy even though the client would need one to prolong his life and get a chance for him to wake up after a hypoxic brain injury. Then after the family put some pressure on with asking the right questions, the ICU agreed to do a tracheostomy.

But before they are doing the tracheostomy, they actually sent a letter to the family and I’m going to read out this letter. It’s completely anonymous. I’m not going to mention any names. You don’t need to worry about it, but I’m going to read out the letter.

“Mr. so-and-so is in ICU, and he sustained a severe hypoxic brain injury as a result of an out-of-hospital cardiac arrest. There is general medical consensus between all intensivist at such-and-such hospital and with the neurologist that the patient’s neurological recovery prognosis is very poor and is unlikely to make a meaningful recovery to a functional baseline.

Furthermore, the patient has a life limiting illness with a recent diagnosis of metastatic cancer. The medical advice is that he will not benefit from further life sustaining measures with intubation and ventilation, and the most ethical way forward is to shift to full palliative care.”

Now, bear in mind, this man has been living with metastatic cancer for quite some time, so this is not a new diagnosis. The family has said he’s been living with that for quite some time, and they know it’s there, but that won’t stop him from wanting to live. Also, the family has been saying that their father has been waking up more and more and there seems to be progress in terms of his neurology.

The letter continues, “After extensive discussions with the family, as a compassionate measure, agreeance has been achieved to do a tracheostomy with the aim of weaning of the ventilator setting. This is mainly to facilitate to discharge the patient to the ward and to provide more patient time with the family. The patient’s ceiling of care from then on will be forward-based care only. The patient will not be for CPR (Cardiopulmonary Resuscitation), intubation, ventilation, defibrillation, inotropes, or dialysis and not for any ICU level of care. In the event of any further deterioration of his clinical condition, then the hospital team would be moving for full comfort measures.

This is presented to the family to sign and approve to confirm their full understanding and comprehension. Once the document is signed in due course, the tracheostomy can be performed.”

Now, it’s interesting that that was never mentioned to the family before the hospital agreed to do a tracheostomy. So, we advise the family not to sign anything. The only thing that we advise them to sign is for the tracheostomy procedure.

Now, again, I’m not mentioning the jurisdiction here where the client is in, but we have clearly shown the client that the hospital can’t make those decisions and it’s up to the family or the patient to make those decisions.

What has also been interesting is that the hospital changed from no tracheostomy to giving consent to a tracheostomy only then to throw in conditions that they have no right to put on a patient. This is self-determination and whatever the hospital perceives as no meaningful recovery might be very meaningful for the patient or for the family. I’m not here to make any judgment one way or another. I’m here to ask questions and whatever the hospital might say is unethical, the family might perceive as unethical. 

It’s about having a discussion and it’s about what does the family perceive as meaningful. What does the patient perceive as meaningful? Is this an exercise to empty their ICU bed? Why would they want to wean this patient off a ventilator if they thought there was no chance of progress because that’s what it looked like in the last few days after working with the client one-on-one that there is some progress and the family finds it very meaningful by their father opening eyes, and looking around, something the ICU team said a couple of weeks ago would never happen.

So, you have to take one day at the time, and you have to advocate for your loved one because otherwise ICU teams may want to do their own thing that may or may not be ethical, that may be driven by managing their beds, and by trying to almost blackmail families because that’s what I’m reading in this letter. You agree to this, then we do a tracheostomy that’s blackmail in my books and that’s not how patients and families should be treated in ICU.

So, that is my quick tip for today.

I have worked in critical care for nearly 25 years in three different countries where I worked as a nurse manager for over 5 years. We’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. We have saved many lives for our clients in intensive care. You can verify that in our testimonial section at intensivecarehotline.com. You can verify that on our intensivecarehotline.com podcast where we’ve done some client interviews. 

Now, I’ve also worked as a nurse manager in ICU for over 5 years so I know the system extremely well and I know how ICUs try to position cases and try to create narratives that may or may not be accurate. You can create your own narrative and that’s exactly what we’re helping you here, creating your own narrative, getting outcomes, and so forth.

That’s also why we created a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com if you click on the membership link or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours of the day, in the membership area and by email and we answer all questions intensive care related.

In the membership, you also have exclusive access to 21 e-books and 21 videos that I have personally written and recorded, sharing all my vast experience in intensive care nursing with our clients, making sure you make informed decisions, have peace of mind, control, power influence so that you can influence decision making fast, making sure your loved one gets best care and treatment.

I also do one-on-one consulting and advocacy over the phone, Zoom, WhatsApp, Skype, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation when you have a loved one critically ill in intensive care that you simply can’t afford to get wrong. I also talk to doctors and nurses directly on your behalf or with you. I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one in intensive care. Now, I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

All of that, you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected] with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care, click the like button, click the notification bell, comment below what you want to see next, what questions and insights from these videos, share the video with your friends and families.

I also do a weekly YouTube live where I answer your questions live on the show. You will get notification for the YouTube live if you are a subscriber to my YouTube channel, or if you are a subscriber to my email newsletter at intensivecarehotline.com.

If you want to leave a small donation on the super chat button, we welcome any donations to support our work so that we can make as many videos for families in intensive care as possible.

Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.

Related Articles:

Quick Tip for Families in Intensive Care: Ventilator Settings and Arterial Blood Gas Results! Quick Tip for Families in ICU: My Loved One’s Not Getting Better and ICU is Adding More Machines and Treatments While on Ventilator! Quick Tip for Families in Intensive Care: Pressure from ICU Doctors for My Husband to Pass Away or Do a Tracheostomy After Only 7 Days in ICU! Quick Tip for Families in Intensive Care: When Should a Tracheostomy be Done for Acute Respiratory Distress Syndrome (ARDS)? Quick Tip for Families in Intensive Care: Grandpa had Cardiac Arrest at 84, ICU on Ventilator 12 Days! Tracheostomy Induced Coma! Can He Recover, Help!