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 and CASE STUDY last week was Part 1 of
CASE STUDY: My 77 year old Dad has been in ICU ventilated for a week and he’s not “waking up”! The doctors have made him NFR without my consent and they want to switch off the ventilator, help! (PART2)
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 our clients which is an excerpt from a 1:1 phone counselling and consulting session with me and the question this week is PART 3 of last week’s CASE STUDY and we continue today with
CASE STUDY: My 77 year old Dad has been in ICU ventilated for a week and he’s not “waking up”! The doctors have made him NFR without my consent and they want to switch off the ventilator, help! (PART3)
This is another great case study where you can see how I can help a very concerned and very distressed client how to quickly make sense in a situation where the Intensive Care team hasn’t been open transparent with her and her family!
As a matter of fact, the Intensive Care team threatened to take her Dad off the ventilator by a certain date, without the client’s consent!
It’s also another great case study to show families in Intensive Care that you simply don’t know what you don’t know and that you getting informed quickly so that you can turn the dynamics in your favour is crucial!
If you do what 99% of the families of critically ill Patients in Intensive Care are doing you won’t do your own research and you will just silently nod off everything the Intensive Care team is telling you and you will be intimidated by the Intensive Care team…
If you do that, you will not being able to make informed decisions, get peace of mind, control, power and influence…
As a matter of fact, if you don’t ask the right questions and if you are not arming yourself with crucial insider and “BEHIND THE SCENES” knowledge, your critically ill loved one and your family may be doomed!
In our case study with my client Denisa, you can see that only in one phone conversation I can empower her and show her what questions she needs to ask and I can also show her what information the Intensive Care team has been hiding!
It’s also another great case study how to counteract the negativity of the Intensive Care team, if you only know what questions you need to ask and if you can interpret information correctly!
The number one complaint we’re getting from families in Intensive Care is that Intensive Care teams are negative!
We know that and in our hundreds of “YOUR QUESTIONS ANSWERED” episodes and in our hundreds of case studies we always show our clients how to stay positive and how to position your critically ill loved one’s diagnosis, their prognosis as well as their care and their treatment in a light that doesn’t allow Intensive Care teams to be negative!
This is also another great CASE STUDY how we can help our clients to not only get the best care and treatment possible for their critically ill loved one, it’s also a great CASE STUDY how we can PREDICTABLY and RELIABLY help families in Intensive Care to reverse an NFR (=not for resuscitation) order or a DNR(Do not resuscitate) order that was issues against their wishes and without their consent!
Because we know the hospital system and Intensive Care so well, we can get predictable results for you and for your critically ill loved one really quickly! We can help you position your critically ill loved one’s diagnosis and prognosis and therefore help you to get the best treatment for your critically ill loved one!
If you don’t know how to position your critically ill loved one’s prognosis and diagnosis, the Intensive Care team will do it for you and they do so with their own self-interest at top of their mind!
Enjoy the case study and enjoy the excerpt of the phone counselling and consulting sessions!
Denisa: Okay, all right. Thank you, yeah. So, I’ve got one more question for you. I wanted to change the Do Not Resuscitate order like you said. Can I do that? How do I go about that?
Denisa: Because I want to do that right away.
Patrik: Have you signed something? Have you signed –
Denisa: I’ve signed nothing.
Denisa: I’ve signed nothing.
Patrik: Good, okay. So what you have to do is … There’s two things. Number one, with the NFR (=Not for resuscitation) forms there is usually a section where a family member needs to sign.
Patrik: Okay, so if you are confident that you haven’t signed there and are you confident that nobody else signed there from your family? You were talking about your –
Denisa: I will check with my auntie, but she told me … I mean her consent and my dad’s consent when he was awake was only verbal.
Patrik: Okay, good, good. So, number one there should be a section where family member or next of kin should be signing. That’s number one. Number two, they have a policy about NFR(=Not for resuscitation). Basically, what it means is they have a Not for Resuscitation Policy.
Patrik: And there’s a very high chance that this policy actually says something along the lines of that family members need to consent.
Patrik: Okay? And there would also be a section in that policy that says something along the lines of that if either party is changing their position on this, that you need to notify … That either the medical team needs to notify you if they change their position or if you change your position.
Patrik: That’s what … As the first step, what I would do if I were you, as the first step you just ask them to take it off because you don’t want this and you should probably also tell them that you felt under pressure yesterday. You should probably also tell them that you asked them about the purpose of the meeting and they didn’t tell you. You can tell them that you felt mislead.
Denisa: I’m just writing this down.
Patrik: Yeah, yeah, sure. Tell them that you felt mislead by you asking them about the purpose of the meeting and they … Then they were telling you oh, it’s just about an update. Well, it clearly wasn’t. It was about making some major, major decisions.
Patrik: That you had no time to prepare for because we’re talking about life and death decisions.
Denisa: Yes, yeah.
Patrik: Right? That would be one argument. The other argument would be that you have changed your mind in retrospect, right? And if they then, don’t want to take it off you will need to ask for their policy, okay? Ask for the NFR Policy. Now, with both of those things taking off the NFR as well as if you need to ask for the policy, always ask with deadlines. If you talk to them first thing tomorrow morning, tell them I want to have this NFR taken off by 12 p.m. today or whatever time you choose.
Denisa: I’ll go in there tonight.
Patrik: Well, yeah, yeah, by all means. It changes … Once they realise you are speaking … You will be speaking differently compared to yesterday.
Denisa: Yeah, definitely.
Patrik: Right? Once they realise oh, what’s changing here? But something has to change and you are already realising that. You have to speak differently. You also got to be very short and concise. Don’t go overboard. Just tell them matter of fact. Look, I want this NFR off by, you know, whatever it is tomorrow 8 a.m. If they are not doing that, the next step is for you to ask for the NFR Policy and again if you do that ask them with a deadline. Tell them I want this NFR policy tomorrow by 12 p.m., always ask with a deadline.
Denisa: Do I need to give them a reason of why I want?
Patrik: No, no, no, no reason. Well, you can tell them about the NFR that you felt …
Denisa: Yeah, but I mean legally I don’t need to explain to them why I want to change it?
Patrik: You don’t need to explain anything. You are the next of kind. You are your dad’s medical power of attorney as far as I understand. You are representing him in the absence of his decision making capacity and you are advocating for him. You as the advocate for him, you have come to the conclusion that this is not what you want. It’s as simple as that.
Denisa: Yeah, okay, assuming they will ask me what I want to change it.
Patrik: Yeah, you can give them a reason, but even so …
Denisa: I don’t have to convince them what made me do it.
Patrik: No. Have you … Have they mentioned things yesterday like … Have they mentioned things like oh, it’s in the best interest for your dad?
Denisa: Oh, that’s all they mentioned.
Patrik: Yeah, yeah. It’s all crap. It’s all crap. What’s in the best interest is something that you should decide and not them.
Denisa: Yeah, especially I think when we were talking about in the best interest of him as far as all the negative things, they were not actually following up all these negative things with actual, like factual explanation.
Patrik: That’s exactly right and they haven’t told you things … They haven’t told you things like with … They might have touched briefly on the sedatives, but the reality is if he had some Midazolam and I believe he would have had some, it can take a long time to get out of the system and hopefully the dialysis, hopefully that will get rid of some of the sedatives.
Denisa: Yeah, okay, yeah, hopefully. He’s got … He has also developed a big lump on the right side of his chest. It’s huge. I asked what it is and they said it’s a blood clot and that it’s normal, but it’s huge.
Patrik: You can actually see that?
Denisa: Oh, it looks … When I first saw it, the position I had him in, it looked like it was his shoulder. It was that big.
Denisa: It like a tennis ball huge. They said it’s from the blood thinners he is on and it’s normal and it’s not.
Patrik: It’s not.
Denisa: No, I didn’t think it was either.
Patrik: It’s not. That’s very strange. I mean I’m sure he’s getting blood thinners. Most patients in ICU do. I’m just trying to think. So, it’s around his shoulder is that what you are saying?
Denisa: It’s on his chest, just above … Oh, how do I explain. Where his arm pit is, if you just move across, sorry, yeah, just on chest pretty much.
Denisa: It’s huge.
Patrik: Right. I can assure you that it’s not normal.
Denisa: I didn’t … I thought not either and when I asked they said he initially had one I think they said somewhere else and it’s normal for patients to have this and they move around. That’s pretty much what they said.
Patrik: That doesn’t make sense to me.
Denisa: I didn’t think so either. They sort of make you feel a bit like you are stupid for asking.
Patrik: Yeah, yeah. Keep asking, keep asking, keep asking. Don’t be intimidated. Again, be very short and concise with what you’re saying, but certainly don’t be intimidated…
Denisa: Sorry, I can’t even remember the names of the nurses because I talk to a different doctor every time I’m in there I think.
Patrik: Right. There is no consistency in terms of who’s talking to you, okay.
Denisa: Not, when I’ve been there. When I was in there last Saturday night, there was a nurse in there. I was in there until about 11 p.m. and she has been the best out of all of them. She answered my questions and actually explained things to me, but she is the only one that has actually, yeah, yeah.
Patrik: Look, I don’t know enough about this particular ICU to know their culture in terms of how do they operate. From what I get from you now, it’s not … It sounds pretty much like most ICUs because that’s unfortunately what happens in most ICUs, you know the way you are being dealt with is how most people are being dealt with, which I think is horrible. You also … The other thing that I can … One of the biggest threats that I can see at the moment is not so much that your dad is not waking up, that I consider as normal, at his age, being in an induced coma for 13 days he needs time. What I do see as a major threat, is that they only want to give him until the 27th of April, which is why I think it is so important that you start working on this NFR straight away.
Denisa: Yeah, I’ll go there tonight.
Patrik: Right? Because if you have this NFR sort of lingering in the back it’s another almost like it’s another argument for them to say we’ll stop on the 27th of April, right? And that’s not a good position to be in. Your dad will need time.
- THE 5 THINGS YOU NEED TO KNOW IF THE MEDICAL TEAM IN INTENSIVE CARE WANTS TO “LIMIT TREATMENT”, WANTS TO “WITHDRAW TREATMENT”, “WITHDRAW LIFE SUPPORT” OR WANTS TO ISSUE A “DNR” (DO NOT RESUSCITATE) OR “NFR” (NOT FOR RESUSCITATION) ORDER FOR YOUR CRITICALLY ILL LOVED ONE!
Denisa: Yeah. They sort of made me feel a bit guilty as well for even wanting to continue this week with him on the ventilator I think.
Patrik: Yeah. They’re pretty good at trying to make people feel guilty. They’re pretty good at that, right? Because that’s just another … They’re playing on … On a psychological level to a degree, no matter how difficult the situation is, to a degree you feel grateful to them to a degree because they kept him alive up until this point, you know? So, to a degree you’re giving in to them because to a degree you’re feeling grateful for what they have done so far.
Denisa: Yeah, I think too … Hard to think that they would not be doing what’s best for him I think? Yeah.
Patrik: Look, that’s hard to think that they may not, but as I’ve said to you, you can rest assured that their biggest … What they have in the back of their mind is oh, my God, what if he’s occupying our ICU bed here for the next four weeks. You know? Because they have other patients knocking at that bed, right? That’s not your concern. There’s plenty of ICU beds…
Patrik: You know?
Patrik: Go on.
Denisa: One other thing too that I found extremely odd, especially hearing about it now, because they were saying after they took him off the sedatives, they were saying he was taking an extra amount of time to come off it, but I don’t know what day it was … One night this past week, earlier this week, they decided to put him on sedatives again for the night because they said he was in pain. They then said the next day he hasn’t … He’s coming off sedatives, so.
Patrik: There’s a difference. There’s a slight difference between sedatives and pain killers.
Patrik: Sedatives are the Propofol and the Midazolam that we mentioned. Pain killers are morphine and Fentanyl. You know, those are the main drugs that are bing used in ICU. Now, the morphine or the Fentanyl will have a sedative effect too.
Denisa: They specifically said that this night they sedated him again.
Patrik: Right, right. How long ago was that?
Denisa: Oh, I’ve got it written in my file. It was … Sorry, it was Sunday or Monday night.
Patrik: Sunday or Monday night.
Denisa: I think it was Monday night, yeah.
Patrik: Okay and have you noticed a change in his responsiveness since then?
Denisa: Yes, actually comparing … After he was 12 hours coming off the sedatives the first time, I was with him, he was holding my hand very tight. I was getting cramps in it. He seemed aware when I was touching him and things like that compared when I was there not last night, the night before, getting him to even … It looked like he was having trouble even trying to move his fingers, that he was aware. It looked like he even could open his eyes a little bit. It was like he just didn’t have the energy to do it. He really seemed like he was wondering if you were there, yeah.
Patrik: When they re-sedated him and you said that was for pain, is that correct?
Denisa: That’s what they told me, yeah.
Patrik: Did they tell you … Could they localise the pain? Could they say oh, he has pain his chest? Could they point … Could they give you details?
Denisa: I didn’t specifically ask. I don’t think, but I remember them saying he was showing signs of being agitated, so they thought he was in pain.
Patrik: Sure, sure. The other thing that you can use, you know, especially with the NFR again, if they were telling you yesterday that he had a heart attack that might have occurred like ten days ago, I think that’s highly inappropriate. That’s highly inappropriate. I mean …
Denisa: Yeah, I have specifically, even the first time I spoke to a doctor there, every time I speak to a doctor I always move away from him or other family members and say to them, I just want to know … I don’t want to know he might be okay, I want to know specific facts of what has happened or what is happening.
Patrik: Yeah, yeah. For now, I would be very short with them, you know? You have questions and you are expecting an answer and that’s how I would handle that for now.
Patrik: You know, until you’re sort of more clear … You know, the other thing, the other question I would have, especially with the heart attack, I would ask around … You know, they are telling you ten days down the line, but then the question is when they first found out what have they done? How were they treating the heart attack?
Patrik: That would be … You know, they are telling you about the heart attack ten days down the line, but from my perspective what should have happened is that the day they diagnosed him with a heart attack, they should have come back to you and said okay, well, unfortunately your dad had a heart attack and this is how we managed it.
Denisa: Yeah, okay.
Patrik: That would have been appropriate wouldn’t it?
Denisa: Yeah, yeah, I think it is significant enough.
Patrik: I think it’s very significant.
Denisa: Yeah. Is there ongoing management needed after a heart attack?
Patrik: Well, that depends. Number one it depends on what have they done when they first diagnosed him with a heart attack. Let’s just say if somebody has a heart attack and gets found on the street or at home or wherever, the first thing that often happens is they have an angiogram. Have you heard of that?
Denisa: I have, but I don’t know what it is.
Patrik: Right. Basically what it is, is they put a catheter, a small catheter to the heart and see what arteries are blocked, because in a heart attack a minimum of one artery gets blocked during a heart attack reducing oxygen supply to the heart. Now, your dad might have been … When they first diagnosed him with a heart attack, your dad might have been too unstable to have an angiogram. I’m not disputing that, but not telling you that most patients after a heart attack have an angiogram, I believe that’s just negligent. It’s withholding crucial information.
Denisa: Yeah, okay.
Patrik: The next question that have with the heart attack is have they referred him to a cardiologist?
Denisa: Okay. They have mentioned a cardiologist to me once.
- PEACE OF MIND, CONTROL, POWER AND INFLUENCE EVEN IN THE MOST CHALLENGING OF CIRCUMSTANCES THAT YOU, YOUR FAMILY AND YOUR CRITICALLY ILL LOVED ONE COULD POSSIBLY FACE IN INTENSIVE CARE
Denisa: Probably about a week ago give or take a few days and when they mentioned that it was the doctor telling me that the next day they were going to assess him with the ICU doctor, the cardiologist, and a respiratory doctor, but that’s all that was said about that.
Patrik: Right, right. I believe they’re withholding very … Now, that you know that he had a heart attack, well, now you know, but not giving you that information for ten days I think is highly inappropriate.
Denisa: Yeah, I did actually ask in the meeting when she told us that, I actually asked why we hadn’t heard about this until now and she answered me saying pretty much a heart attack for someone in his condition or how he was is pretty much just like, I forgot how she said it, but not a big deal.
Patrik: Look, I can tell you that patients in ICU have, what’s the word? Yeah, they have a higher likelihood of sustaining a heart attack. There’s no question around that, but it’s very significant.
Denisa: Yeah, yeah.
Patrik: Just because they see it all the time doesn’t mean they don’t have to tell people. I agree with that people see it all the time in ICU it happens, but that doesn’t justify withholding that information from family.
Denisa: Yeah, okay, yeah. I thought that was a bit odd. All right, yeah. Thank you very much for all the help.
Patrik: You’re most welcome.
Denisa: Oh, and I will definitely give you a call tomorrow.
Patrik: Yeah, give me call tomorrow, as you know you have at least 7 days unlimited access to me as part of the 1:1 counselling, consulting and advocacy package!
Denisa: Okay, thank you. Every day that passes with him ventilated or everything sounding like it is significantly damaging his recovery chances and everything?
Patrik: Yeah, so look every day, you want to minimise time in ICU. You want to minimise time on a ventilator as much as you can. There’s no question about that.
Denisa: Yeah, yeah.
Patrik: But what I mentioned to you earlier, I and neither do the doctors, we don’t know what patient’s lives look like six months down the line after ICU. I don’t know.
Patrik: The real … And they don’t know either. Yes, studies have been done, what quality of life looks like, but it’s very different for different people, okay? So, I … Look, to answer your question yes, you definitely want to minimise time spent on a ventilator. There’s no question around that, okay?
Patrik: But, at the same …
Patrik: I don’t think much will change until … Unless something significant happens. I think at the moment it’s really a waiting game.
Denisa: How long would dialysis … Does it usually take to show anything or if anything changes?
Patrik: Look, it depends how aggressive they are going to dialyse him, all right? It also depends on how damaged the kidneys are, so when I say how aggressive are they dialyzing him, it really depends on how much fluid they are removing, whether they are removing 100 mL an hour or 400 mL an hour, okay? It also depends on how much sedation did he have over the last couple of weeks, you know? Was he on a lot of Midazolam? Was he on a lot of morphine? It depends on all of that.
Patrik: Right? So …
Denisa: If I ask them for this information, do I … Do they …
Patrik: They do.
Denisa: Can they give it to me? They have to give it to me?
Patrik: So, what can do, you know, you can ask for your Dad’s medical records.
Denisa: Yep, okay.
Patrik: You can do that.
Denisa: All right, okay. I was unsure of that as well.
Patrik: You can always ask for the medical records. They don’t have to give you … When you are at the bedside, they don’t have to give you access at the bedside, but they do have to release the medical records to you either in print form or electronically, they do.
Denisa: Can I ask for a timeframe for that too?
Patrik: I would always use the timeframe. For anything that you ask for, I would always use the timeframe, always. Number one, it changes the way you communicate with them and number two it changes the way they look at you and number three it makes them realise, hang on a sec, you’re advocating for your dad and you’re serious.
Denisa: Yeah, yeah. If I … Is it unrealistic for me to ask for his medical records by 12 tomorrow?
Patrik: Yeah, yeah. I can tell you what they will probably tell you. They will probably tell you that they can’t release the medical records over the weekend. That’s probably their response and that might be realistic. The reason, I am saying that is because when they release medical records they usually have to get admin people to do that and admin people are not there over the weekend.
Patrik: So, that … But you can use whatever timeframe you like and then gauge their response, you know.
Denisa: Okay, yeah, all right.
Patrik: You don’t know they need an admin person for that, you just want the medical record, you know?
Denisa: Yeah, yeah, all right. All right, I’ll do that. Okay, thank you. I feel a bit better after speaking with you. Thank you.
Patrik: You’re welcome, you’re welcome. Yeah, give me a call tomorrow or anytime you need to talk. My phone is always on!
Patrik: And let me know what you want to do and we’ll take it from there.
Denisa: All right, I’ll give you a call in the morning,
Denisa: Thank you very much.
Patrik: You are most welcome. Take care.
Denisa: Okay. You too, thank you.
This is PART 3 of the
CASE STUDY: My 77 year old Dad has been in ICU ventilated for a week and he’s not “waking up”! The doctors have made him NFR without my consent and they want to switch off the ventilator, help! (PART3)
This was another great case study where helped Denisa how she can take the NFR(Not for resuscitation) order off her Dad so that he’s in the best position to get out of Intensive Care alive!
Tune in next week for another of our case studies, it’ll come out in a few days where I’ll show another client how they need to position their family member’s diagnosis, prognosis as well as their care and their treatment so that families like you can get what they want, need and deserve!
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Sign up and download your FREE “INSTANT IMPACT” REPORT now by entering your email below! In your FREE “INSTANT IMPACT” REPORT you’ll learn how to speak the “secret” Intensive Care language so that the doctors and the nurses know straight away that you are an insider and that you know and understand what’s really happening in Intensive Care! In your FREE report you’ll also discover
- How to ask the doctors and the nurses the right questions
- Discover the many competing interests in Intensive Care and how your critically ill loved one’s treatment may depend on those competing interest
- How to eliminate fear, frustration, stress, struggle and vulnerability even if your loved one is dying
- 5 mind blowing tips& strategies helping you to get on the right path to making informed decisions, get PEACE OF MIND, control, power and influence in your situation
- You’ll get real world examples that you can easily adapt to your and your critically ill loved one’s situation
- How to stop being intimidated by the Intensive Care team and how you will be seen as equals
- You’ll get crucial ‘behind the scenes’ insight so that you know and understand what is really happening in Intensive Care
- How you need to manage doctors and nurses in Intensive Care (it’s not what you think)
Thank you for tuning into this week’s YOUR QUESTIONS ANSWERED episode and I’ll see you again in another update next week!
Or you can call us! Find phone numbers on our contact tab.
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This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
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- The 4 ways you can overcome INSURMOUNTABLE OBSTACLES whilst your loved one is critically ill in Intensive Care!
- How to get PEACE OF MIND, more control, more power and influence if your critically ill loved one is DYING in Intensive Care!
- The 5 QUESTIONS you need to ask, if the Intensive Care team wants you to DONATE your loved one’s ORGANS in an END OF LIFE SITUATION!
- MY PARTNER IS IN INTENSIVE CARE ON A VENTILATOR! THE INTENSIVE CARE TEAM WANTS TO DO A TRACHEOSTOMY AND I WANT TO HAVE HIM EXTUBATED! WHAT DO I DO? (PART 1)
- How MEDICAL RESEARCH DOMINATES your critically ill loved one’s diagnosis and prognosis, as well as the CARE and TREATMENT your loved one IS RECEIVING or NOT RECEIVING
- WHAT WOULD YOU DO if you knew that you COULD NOT FAIL, whilst your loved one is critically ill in Intensive Care
- How the Intensive Care team is SKILFULLY PLAYING WITH YOUR EMOTIONS, if your loved one is critically ill in Intensive Care!
- My father is in Intensive Care ventilated with LIVER FAILURE and KIDNEY FAILURE, I DON’T THINK HE WILL SURVIVE! HELP
- HOW TO GIVE YOURSELF PERMISSION TO HAVE PEACE OF MIND, CONTROL, POWER AND INFLUENCE WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
- My father has been weaned off the ventilator in Intensive Care and still has the Tracheostomy in. When can the Tracheostomy be removed?