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 Veronica and the question last week was PART 6 of
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 the next question from one of my clients Veronica, which are excerpts from phone and email counselling and consulting sessions with me and the question this week is
My Dad (71) is in ICU with stage 4 lung cancer & stroke, he’s on the ventilator now and in an induced coma, what are his chances of survival? (PART 7)
In last week’s counselling and consulting session, we have spoken about treatment options for Veronica’s Dad going forward and we discussed briefly if tracheostomy will be an option for Veronica’s Dad going forward or not.
In today’s counselling and consulting session we talk about tracheostomy in more detail and evaluate the options going forward.
Patrik: Oh, look I mean no matter if patients are in a coma or not, they can certainly recognise the nuances of whether somebody’s providing good care or not.
Patrik: You know, there is no doubt about that.
Veronica: No, cause I’ve been bringing creams in and stuff, cause during the week they said, “It’d be really good if you could bring something in and put it on his dry skin.” So, that’s what I was doing and then when those nurses were on they were not happy with that at all. They just did not want me to touch him.
Patrik: Do you think they were inexperienced or just-
Veronica: No, I asked them. They said they’ve been doing it for a long time and their belief was that it was irritating him, me touching him, and I don’t think it was because every time I’d touch him his blood pressure goes down, his heart rate goes down. But-
Patrik: You’ve got all the evidence on your side.
Veronica: But, they were right in the fact that yes, when I do talk to him it makes him cry. So, I try not talk to him because yeah.
Patrik: Sure. Must be difficult for you to sort of-
Veronica: But, they did say that they did say the doctors said the steroids make him extremely emotional. So, they said it’s expected that he will cry because it messes up with your mood and everything else and makes you very emotional. And, he wasn’t like that as much today, which was really good.
Patrik: Yeah, do you know what he’s getting in terms of steroids and how much? Do you know … hydrocortisone?
Veronica: It was hydrocortisone, but they called it mesa-
Veronica: Yes, that’s the one. [Methylprednisalone, yes. They’re weaning him off of that now slowly. He said it’s gonna be very gradual, but he said he doesn’t want dad to be on that too long. Cause, dad’s lost a lot of weight too, and he said he’s worried about him being too weak.
Patrik: Okay. What’s your, and let’s ask another question, you will probably be discussing this with your mother as well or whoever else, you’ve got a brother?
Veronica: My brother, yes.
Patrik: So, you will be discussing that with them as well, of course, what you want to decide as family I would imagine?
Patrik: Where do you think they sit with all of this?
Veronica: Well, I’d have to be honest. They’re not very strong about anything.
Patrik: Okay. That’s fine.
Veronica: My mum … and my brother both don’t really go see dad that much because they don’t like to see him that way.
Patrik: Yeah, that’s fine.
Veronica: And, my mum has already said, because my mum has got her own issues with her health and stuff, that she would prefer if dad didn’t come home the way he is because she can’t care for him.
Veronica: And, so I’ve said that I would look after dad because I would like him home if at all possible.
Patrik: Yeah, no understood. So, you are basically you’re gathering the information. You probably will also be the main decision maker because sounds like you know your brother and your mom they might be overwhelmed by all of this. And, that’s fair enough. It’s not easy, you know, I mean you can see it now. And, you’ve probably known it all the way along. It’s not easy. You’re shouldering a lot responsibility there to number one make decisions that they’re probably not in a position to make. Also, taking the responsibility to potentially take him home.
So, and that’s all, it sounds to me like you sound very level-headed and it sounds to me like you can shoulder all of that, but at the same time you’re still living with all of this and also potentially calling the shots for whatever the next step might be.
Veronica: I’m still making sure they’re involved, but it’s been pretty hard. I feel like I’m, it’s terrible to say, but I feel like I’m having to force them to make sure they’re there tomorrow.
Patrik: Yeah, I hear you.
Patrik: No, no, no, no. It’s okay. This is a very difficult situation and I feel for you. You are shouldering all of this responsibility and it’s, yeah I’ve seen it over the years that there’s often one person in the family that’s shouldering all of that responsibility and it’s pretty hard on them if they don’t feel like there’s a lot of support from other family members because they just can’t face it.
Veronica: No, they can’t. And, that’s really sad that they can’t face it, you know. But, I can handle it. I know I can, but then maybe it’s because I’ve spent so much time in the hospital myself having treatment. It doesn’t bother me, you know, the nurses said, “Does it bother you if we do the suction on your dad?” And, I was like, “No it doesn’t bother me at all. I can hold his hand.” It doesn’t bother me, none of it, because I don’t want him to go through things by himself.
Patrik: Yes. And, is there anybody else within the family. Are there any, does your brother have siblings? Is there anybody else close who might want to have a say or have some thoughts around the whole situation?
Veronica: We really trust my dad’s oncologist. He, you know, and at the same time we also, my mum and my dad are very close to their GP. So, he’s like a family friend. My mum is consulting with him as well. So, she’s keeping him up to date, which is great.
Patrik: Yup, no that’s good.
Veronica: Sorry, yes.
Patrik: Well, what’s the GPs, what are his thoughts? Do you know?
Veronica: Okay, so the GP himself, he’s still thinks dad’s got a lot of strength in him to fight all of this. So, yeah. He was really surprised at how quickly dad went downhill since he had the procedure, the bronchoscopy, because he was shocked because my dad is just so strong.
Veronica: And, my dad’s cancer specialist, Dr. Bishnoi, also has the same view. Let’s keep giving our dad the best shot that we can.
Patrik: And, that was pretty clear when we last spoke, that he was definitely advocating for your dad. Now-
Veronica: But, it’ll be interesting to see him tomorrow, what Dr. Bishnoi now thinks, now that they’ve done this re-scan.
Patrik: Yes, now are you anticipating that the respiratory physician will be in the meeting too?
Veronica: No, because the respiratory physician is a professor that they consult with, but he doesn’t actually go there.
Patrik: He doesn’t…
Veronica: He is, let’s have a look, he’s a special, top professor in respiratory that they all consult with and I forget his number, not his number, his name’s somewhere…
Veronica: But, they are consulting with him tomorrow, as well, to make sure that they get his opinion on this scan.
Patrik: Right, right.
Veronica: But, if you remember he was the original guy who said that he believed that my dad had the fibrosis for six months-
Patrik: Yeah, I know. I remember that.
Veronica: As much as he’s like a bit of a god to them, I don’t know.
Patrik: Right, okay. So, you know again it’ll probably come down to also thinking through is this something that has ever been discussed with your dad in terms of tracheostomy?Probably not.
Patrik: Never. It hasn’t been discussed. Okay.
Veronica: Never. And, you know, I don’t think dad was ever fully informed of the side effects of the treatment that he accepted as well, you know? Cause he was never told all of this and what is expected. He wasn’t, so he went into all of this blindly or he didn’t want to know. I’m not sure what happened there.
Patrik: Sure, okay. So, what I might do is, you know, a tracheostomy, just briefly talking about this I think you should definitely know a tracheostomy, the main advantage is yes you can keep people alive. The main use in ICU is usually for patients who need prolonged ventilation for their recovery, because you can take them out of an induced coma relatively quickly. They don’t need sedation because it’s not painful. Okay, and you can wean patients off a ventilator probably in their own time because you can pretty much connect them and disconnect them from the ventilator as patients can tolerate that, right?
Patrik: And, that’s the main advantage that you can really-
Veronica: So, it doesn’t have to me on your face, it goes straight through the trachea.
Patrik: That’s right. And, the other advantage is you can suction more comfortably, right.
Patrik: So, yeah. Absolutely.
Veronica: And, that’s what they might be able to do, which is why the doctor said he’s gonna need dad to try to be strong enough to be able to cough.
Patrik: Exactly right, I’m sure he would have mentioned that, because with a trache, you know, no matter whether you need ventilation or not, at least you can suction if somebody is not strong enough. Right? You have an airway.
Veronica: That’s always a benefit, yes.
Patrik: The question really is that if your dad wakes up and eventually, hopefully he won’t need a tracheostomy. But, then the question is if he’s not strong enough and he can’t get rid of the secretions, well there’s only so many options you have. You can suction it through the mouth or through the nose, but that’s number one very uncomfortable and you often don’t get as far down as you need to to get rid of all the crap.
Veronica: No, and so far the doctor said dad will probably have to stay on the feeding tube.
Patrik: At least until they’ve made an assessment on whether he can eat or drink.
Veronica: That’s right.
Patrik: So, a tracheostomy has a lot of advantages. The question really is as well, that if they are correct in their assessment that nature will take it’s course if your dad comes off the ventilator, right? The question comes up, well what would your dad want? Would your dad want a tracheostomy and maybe go home? Or, would your dad rather take out that breathing tube and let nature take it’s course. And, we even don’t know whether that’s going to be correct or not. It’s just an assumption they’re making.
Veronica: And, that’s exactly what the doctor said himself. He said, “Don’t know. He could breathe.” He doesn’t think he’ll improve at all because of the damage in the lungs, but he said he’s not worried about anything else. Definitely just the lungs and yeah.
Look out for next week’s counselling and consulting session, where we talk more about what else needs to be done to get the best care and treatment for Veronica’s Dad, including whether an NFR/DNR or a withdrawal of treatment should be considered or not.
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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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