CASE STUDY: My 65 year old Dad had a heart attack & a cardiac arrest and he’s not “waking up” after the induced coma! How long will it take?

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 in this series of questions from my client Sue and the question last week was PART 4 of

My Dad has end-stage HIV and is on ECMO in Intensive Care! Can he have a lung transplant? (PART 4)

You can check out last week’s episode by clicking on the link here.

In this week’s episode of “YOUR QUESTIONS ANSWERED“, I want to answer another question from one of my clients Michael, which is an excerpt from a phone and email counselling and consulting sessions with me and the question this week is

CASE STUDY: My 65 year old Dad had a heart attack & a cardiac arrest and he’s not “waking up” after the induced coma! How long will it take?

This week I want to feature another great CASE STUDY where I help one of my clients to take the first steps in understanding why his 65 year old Dad hasn’t woken up yet after the ICU induced him into a coma after a cardiac arrest.

Go and read the dialogue and the excerpt of the 1:1 phone counselling and consulting session here.

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Patrik: Patrik speaking. How can I help?

Michael: Yes, hi. Good afternoon, Patrik. It’s daytime in Dubai. I don’t know what time in Melbourne.

Patrik: It’s 11 PM.

Michael: It’s 11 PM? Oh, okay. So it’s night over there.

Patrik: Yeah.

Michael: Sorry.

Patrik: That’s okay. No, no, that’s okay. As a paying client you have 24/7 access to me.

Michael: That’s fine. I would be coming to you on Skype, but at this moment I’m really very worried, so that’s why I thought I’ll just give a quick call to you on this.

Patrik: Yeah.

Michael: Well, I just let you know that we are based in Dubai.

Patrik: Yep.

Michael: And there are … my dad, he had a bypass around eight years back, and he’s 65 years old, and definitely is an old man. And quite weak, health-wise. He’s a hypertensive patient. He’s having a high blood pressure and around seven days back … and plus he’s on dialysis for two years and a half. And around seven days back, he had a heart attack and we took him to the emergency. And as of now, his heart rate is perfectly fine. His sugar level is perfectly fine. I believe he’s on a little bit of oxygen. That’s the reason why they put him on the ventilator. And as for the doctor, they’re saying he might need some more time to come back to his senses. So I’m not really sure over here … Is it normal to be on the ventilator for more than seven days?

Patrik: It can be. It can be. So when you say he had low … Do you know whether he’s got pneumonia?

Michael: He did not have pneumonia type. But as the doctor said, he had a small infection that could be one of the reasons why he was having a breathing issue. But he’s on antibiotics, which has already cured the infection. He said he doesn’t want any more antibiotic. And now from last three days, he has said there is no more antibiotic. He is a normal dialysis Patient, going twice in a week, but I’m only concerned he doesn’t open his eyes. He has some body language whereI can see that he’s not moving his leg or head, but he doesn’t open his eyes.

Patrik: Yeah.

Michael: So this is something I was really worried.

Patrik: Yeah, absolutely. So here is what I think might have happened. So he’s had the cardiac surgery eight years ago. Now he’s probably had a minor heart attack, is that what you said?

Michael: Yes, I believe so. Yes.

Patrik: Yeah, yeah. So what happens in a heart attack is that the heart can’t pump enough blood around the body, because you know, the heart is weakened. And that often pushes fluids back into the lungs. That could lead to an infection, but it also leads to difficulties breathing. So then often patients end up on a ventilator, right? When patients end up on a ventilator, they are induced into a coma. Now when people are induced into a coma, strong sedatives are given. Strong painkillers are given, because ventilation is not comfortable, as you would’ve seen by now, right?

Michael: Yes.

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WHAT IS AN INDUCED COMA AND WHY IS MY CRITICALLY ILL LOVED ONE IN AN INDUCED COMA?

Patrik: So that’s one of the reasons why your dad is probably not opening eyes yet. So the strong sedatives, strong painkillers. But the other thing, as well, is that your dad is critically ill, right?

Michael: Yes, he is.

Patrik: And that in and of itself knocks people out, right?

Michael: Okay, right.

Patrik: It doesn’t mean your dad is going to die, even though he’s in intensive care and is critically ill. It just knocks … a critical illness knocks people out, right?

Michael: Yes.

Patrik: So the biggest problem in intensive care is that no matter how much families, how much health professionals want to speed up the process of recovery, people will take their own time. Right?

Michael: Okay.

Patrik: If your dad is, okay, if your dad is not waking up, well, yes, I would want to know, what medications have they given, right, for … to put him in a coma. I would want to know that, because there’s different medications being given in an induced coma that could either delay waking up, right, or that could speed up waking up, right? I don’t know what they’ve given-

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HOW LONG DOES IT TAKE TO WAKE UP AFTER AN INDUCED COMA?

Michael: Okay.

Patrik: Yeah?

Michael: Okay, I don’t know the name of the medical drugs. That’s why I’d prefer my brother to call you back.

Patrik: Yeah, of course he can call me back.

Michael: Now when I called him, he said he’s busy, so I said no problem, I will just have a word with Patrik, and then eventually we come back to you.

Patrik: Sure!

Michael: What medicine, I’m not really sure on that. But as now, from the last three days, when I had a word with the doctor, as their thing, they are not giving him any kind of painkiller or any kind of a sleeping pill or something. They said they have stopped giving from last three days.

Patrik: Yeah. That’s fine. That’s fine. The problem is that … often that the drugs that are given during an induced coma often long-acting drugs. Now, you’re talking about your dad being on dialysis, so that means long-acting sedatives might have been given, plus your dad’s kidneys are probably weak in the bigger scheme of things, right?

Michael: Yes, they are.

Patrik: And that means, with the kidneys being weak, that means the medications take longer to be metabolised in getting out of the body, because you know, most of the drugs are being excreted through the kidneys.

Michael: Yes.

Patrik: Right? So with the kidneys being … or with the kidneys not working 100%, there’s probably a delay in all of those drugs getting out of the body’s system.

Michael: Okay, okay.

Patrik: Right? That could be one reason-

Michael: Okay.

Patrik: And, but-

Michael: I-

Patrik: Yeah? Go on.

Michael: Yeah, yeah. And I think on yesterday, you can see around 24 hours back or 48 hours back, my brother noticed while he was on dialysis, he just opened his eyes for a second, and again he closed it.

Patrik: Yeah, yeah.

Michael: So I don’t know what it means. It looks like he was awake. Yeah, he was awake.

Patrik: Yep.

Michael: He opened his eyes, and then within a second again he closed his eyes, and that’s it.

Patrik: Yeah. And that’s just probably, if you think about when you’re sleeping at night and you might occasionally open your eyes and you close them. It’s nothing dissimilar to that, right? Waking up-

Michael: Okay.

Patrik: Waking up after induced coma is like switching on a light with a dimmer, not with a switch.

Michael: Okay. Oh, okay.

Patrik: Right? So waking up after an induced coma is not like you’re waking up … You know, when you get up in the morning, you get up and it might take you ten minutes to be fully awake, but waking up after an induced coma might take days. It sometimes might take weeks.

Michael: Oh, okay.

Patrik: So waking up after an induced coma is like switching on a light with a dimmer, not with a switch.

Michael: All right. Okay, so this is considered as he is in coma? Because I asked the doctor what I asked. He said, “I can’t say he is in a coma because I can see when you try to prick him or when you try to pinch him, he just shows the action.” So I do not ask for the doctor. Honestly, I don’t know how good the doctor is. But what he’s saying, “I don’t think he is in coma,” but again, he said, “I don’t have a right answer to let you know why he is not opening his eyes, or why he is not coming back to his senses.” So it’s complicated-

Patrik: Look, they’re always … yeah. They’re always trying to be guarded, what they say. And I’m not guarded, because I’m not affiliated with the hospital, but I’ve worked in intensive care for nearly 20 years, right?

Michael: Oh, yeah.

Patrik: I know for a fact that patients, most patients, after an induced coma, they will wake up, right? The other thing that you’ve got to know is the statistics confirm that 90 to 94% of intensive care patients leave intensive care alive, right? So the problem often is, you have not seen this situation before, I would assume.

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Michael: No.

Patrik: Right, right, right.

Michael: Never.

Patrik: So I’ve seen it in my practise for 20 years, so- So what you see is a big shock for you, and that’s understandable.

Michael: Yes it is.

Patrik: Right?

Michael: Yes it is. Again, being my father, it definitely does. It does.

Patrik: Yeah. Absolutely, absolutely. But in intensive care, your biggest asset is being patient. It’s often two steps forward, one step back.

Michael: Okay.

Patrik: So keep in mind, 90 to 94% of patients in intensive care leave intensive care alive. Right?

Michael: Okay, okay.

Patrik: And that … and you look at your dad now and you think, “Oh my God, he’s sick, will he survive?” You know, I don’t know whether he will survive, but the statistics are in his favour.

Michael: It is. But I can see the doctor explain me, his heart rate is normal. His Blood Pressure is normal. His sugar level is perfectly fine, and his dialysis as normal as has been, and the calcium comes to around 4.22, 4.5, then that’s exactly where he is due for his dialysis.

Patrik: Yeah.

Michael: His urine, he’s been urinating. It’s perfectly … he said it’s fine. So when I see medical records, it shows he is fine, but they have done a scan for his head or his brain, what you say is that we don’t find anything in his scan. So when I see the record, I believe medically … I cannot say he’s perfectly fine, but what the medical report shows to me, he is okay with it. Like blood pressures and all this what I mentioned are okay.

Patrik: Yeah.

Michael: But that makes me more worried why he is not coming out of his sleep. That’s really concerned both me and my family.

Patrik: Absolutely, absolutely. But again, you’ve got to be patient and it’ll work. Normally, it’ll work itself out. What I can do from my end is, I’m very happy to speak to the doctors directly if you want us to, or we can … in a follow-up call, I could give you all the questions you need to ask to make sure they’re doing all the right things. But I would also be very happy to speak to the doctors directly if you want me to.

Michael: I really … in case it is the same channel, only I can … But the issue is, I don’t know if you’re aware of Dubai… Have you been to Dubai, Patrik?

Patrik: I have, actually. I have been to Abu Dhabi in 2003, which is a long time ago. And I have-

Michael: A very long time.

Patrik: I have been to Dubai, so I was on a day trip to Dubai when I was in Abu Dhabi, but that was the only time.

Michael: That that you’re talking about is quite some time back.

Patrik: Yes.

Michael: The point is, why did I mention Dubai? The point is, right, now where my doctors, it’s like xxxxxxxxx hospital, and they’re … I don’t mean to say that they don’t speak English, but the point is they are Arabic-speaking doctors.

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Patrik: Right, okay.

Michael: They do, they do, but not like the way how we speak. Because I’m from Canada, I’m from Calgary, but not the way how we understand. They do understand, but sometime maybe they are not able to explain in that way.

Patrik: Sure, sure.

Michael: But I will definitely … I will consult with the doctor. The ICU head doctor, his name is Dr. xxxxxxxxxx, or Dr. xxxxxxxx I don’t know exactly what his full name. So I will definitely, I will try to speak to him, and then I can try to contact you if it is possible, whatever the way we can, and even I will find out what kind of medication he is under.

Patrik: Yeah.

Michael: And I will call you again tomorrow. And really, I appreciate if I can get some support from you so that I know exactly-

Patrik: What’s happening.

Michael: Not exactly, but at least I know what’s happening with my dad.

Patrik: Yeah, absolutely. If you do want us to be involved in whichever way, either speaking to the doctor directly if they speak English, if they don’t, I could definitely give you all the questions that you need to ask to find out what’s exactly happening. One thing that I would want to know is, what medication has he been given?

Michael: Yeah.

Patrik: How big was his heart attack?

Michael: Okay, okay, okay. And how … the other thing is, Patrik, how can I … To be honest with you, I 100% trust you, what you said to me, because that’s one of the reasons why I’m making a long-distance call

Patrik: I’m not … Just to clarify, I’m not a doctor. I’m an intensive care nurse.

Michael: Oh, okay. All right. Okay.

Patrik: I have worked in intensive care for 20 years.

Michael: All right.

Patrik: I also believe that on the website intensivecarehotline.com, there’s enough evidence in terms of the work we have done and we are doing for our clients.

Michael: Yeah, that’s fine, that’s fine.

Patrik: Absolutely.

Michael: And as it, yeah, as you mentioned, if a person is on a ventilator, usually you think it takes a long period to come out of it? Or is it safe to be on the ventilator for a longer period? I don’t know.

Patrik: Yep. The short question to that is that it depends. It really … With increasing age, usually, the longer it takes, and especially with kidney failure, there’s a higher chance of waking up being delayed because of the drugs staying in the body for longer than with healthy kidneys.

Michael: Okay. And is ventilator one of the safe way to keep him alive, or there is another way? Like a test tube, or I don’t know.

Patrik: That, I would need to find out with a series of questions from the doctors. That, I can’t answer to you without getting some information through the doctors. For example, I would want to know what does his chest x-ray show? Why have they put him on a ventilator in the first place? You’re talking about an infection, but I would really want to know-

Michael: He was … no, no. When we took him to emergency, he was given CPR. He was not breathing. He fainted out, like he was dying-

Patrik: Oh, he was given CPR. So he had a cardiac arrest?

Michael: Oh, yes. He had a cardiac arrest attack, and the doctor said, “Fine, we lost him,” but I think they gave a CPR and some shock, and then they realised, okay, heartbeat, and started breathing, and that’s how they put him back on the ventilator.

Patrik: I see, I see.

Michael: It was very serious…

Patrik: Oh, yeah. No, no. Then the question is answered why they put him on a ventilator, because if he had a cardiac arrest, he would’ve stopped breathing.

Michael: Yes, yes. He did, he did, he did. He did stop breathing. And now he’s getting 40% on the ventilator. I can see the machine is showing that 40% oxygen is been given by the ventilator!

Patrik: Right.

Michael: Yeah, but I guess our question is like, he has been not given any painkiller or something like that which makes him sleep, but again, how long? How long will it require to open his eyes? That’s something that’s very difficult for us to digest.

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Patrik: Yeah, yeah. No, no, that’s fine. I can’t … I can answer you that question once I know what medications he’s had and once I know what the CT of his brain shows. Once I know that, then I can give you a much better answer.

Michael: Because I need to know the answers. That’s more important for me as of now.

Patrik: Absolutely. I agree, I agree.

Michael: Because we do visit the doctors here, and they give you answers. It’s not that they deny you, but sometimes you don’t understand their language, or maybe I’m confused to understand their language-

Patrik: And they’re very … They would be very guarded, you know? Their job is … They assume that you don’t understand. That’s what they assume. Whereas I assume you do understand, if I explain to you in a language that you can understand. That’s what I assume.

Michael: Yes.

Patrik: Right? People do understand if you take the time and if you explain to them. But the problem in hospitals often is, they don’t have time. They might only tell you half of the story, and that’s why I think you need to start asking the right questions.

Michael: Oh yes, and as you said, for him, it needs time to open. Now when you say time, you’re saying maybe it takes a week, maybe ten days, or maybe fifteen days, you never know. Depending on his condition, right?

Patrik: That’s exactly right.

Michael: That’s exactly what I understand, and which honestly makes me feel, okay, fine, if seven days have passed, it doesn’t mean that it’s not going to happen.

Patrik: Yeah.

Michael: It might happen under the seven days.

Patrik: Absolutely. And that’s why I also think it’s so important that you keep reading our free email newsletter, because with that email newsletter, basically what we do is we answer questions from our readers and you get a lot of what I believe good information there, just by reading the newsletter. But obviously nothing can replace if you talk to me one-on-one, I believe.

Michael: That’s more easy, because when I talk to you, I come up with more questions, and when I have more questions, then I have more clarification on it.

Patrik: Absolutely, absolutely.

Michael: Yeah, okay, fine. That should be fine, Patrik. Honestly speaking, thank you very much for your time.

Patrik: You’re most welcome.

Michael: And yes, my brother will definitely have more questions.

Patrik: Yep, you and him can call me anytime if you have any questions, given that you have signed up for the 7 day unlimited 24/7 counselling and consulting session. And as you know, you and your brother can also email me with your questions.

Patrik: Thank you so much.

Michael: Thank you.

Patrik: You’re most welcome.

Michael: Thanks, Patrik.

Patrik: Thank you. Take care.

Michael: Bye for now.

Patrik: Bye-bye.

Michael: Bye.

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