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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
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 Melanie as part of my 1:1 consulting and advocacy service! Melanie’s sister is critically ill in the ICU and is asking why do they want treatment limitations for her.
My Sister is Critically Ill in the ICU. Why do They Want Treatment Limitations for Her?
“You can also check out previous 1:1 consulting and advocacy sessions with me and Melanie here.”
Patrik: … how are you?
Melanie: Good, how are you?
Patrik: Very good. The reason I’m contacting you back again is I’ve had a phone call now from the ICU Consultant at St. Matthew Private. Is this all happening, as far as you’re aware? The reason I’m asking was..
Melanie: Yes, yes.
Patrik: Okay, it’s happening, that’s the main thing I wanted to know.
Melanie: That’s as far as I’m aware.
Patrik: Okay, because she’s calling me. Basically telling me what my role was in all of this. And I said, “Look, I’m a nurse consultant and Patient advocate. I’ve tried to arrange a bed.” Which it sounds like, to me, it’s happening.
Melanie: Yes.
Patrik: Basically, her gist was, you know, who I was and what my role in this was. And then I said to her, “Look, I’m a nurse consultant and Patient advocate. I’m trying to arrange a bed, blah, blah, blah.” And basically, her response to me was, “Well, as you’re well aware, if you’re an intensive care nurse, a handover always takes place between intensivists.” And I said, “Yes, and I’ve never disputed that. All I was trying to do was trying to arrange a bed. Which it sounds like to me, it’s happening.”
Melanie: Yes.
Patrik: She was very upset, right? But she didn’t go into detail. Because I said to her, “So you’re calling me to tell me what I should, and what I shouldn’t be doing? All I’m trying to do is help the family.”
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Melanie: Yes.
Patrik: So, she was very upset that because I asked for her phone number in the ICU. I said, “Can you give me the phone number so the ICU consultant can contact her.
She said, “Oh you shouldn’t be asking for the phone numbers and blah, blah, blah.” And I said to her, “Look, all I’m trying to do is making sure there is a bed.” She didn’t like that at all. So that’s why I’m asking you, what’s been the latest you’ve heard about is there a bed or is there no bed? Because it wouldn’t.
Melanie: So, there is a bed, as far as I’m aware.
Patrik: Okay, great.
Melanie: He’s handed over to her apparently, so he must have mentioned that we’ve been talking to a department.
Patrik: Most likely.
Melanie: So, she’s spoken with you, and that’s probably made the connection. So in the handover, he probably said they been talking to someone, and wanted to speak. I don’t care about that.
Patrik: No, likewise. That’s pretty much what I told her, I said, “You must have a lot of time on your hands to call me and tell me what I should and what I shouldn’t be doing.”
Melanie: Yeah.
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Patrik: And because the other thing that could be on their radar, I had a client not too long ago at St.Matthew Public, she’s also covering St. Matthew Public, so they may have spoken. They may remember in the back of their mind, “Oh, there was a Patrik that we’ve spoken to a few weeks back with his client.”
Melanie: Well, that’s my prerogative. If I don’t want to engage in consulting-and I told the respiratory specialist, I said I have to engage an external consultant to help me look into beds and things like that. Yeah.
Patrik: Yeah, so I was just wondering what was the communication and …
Melanie: The last we got was, I’ve handed over to Eric. He’s a piece of work, isn’t he? He’s a piece of work.
Patrik: Who is Dr. Eric? Oh!
Melanie: Pardon? And he said he knows him very well.
Patrik: No doubt about that. No doubt about that they know each other.
Melanie: Yes. Yes. Yes. And so, she’s out of line for calling you anyway ’cause she should be asking me that.
Patrik: That’s exactly right. That’s exactly right. And I’ve just said to her, look, you must really have a lot of time on your hands if you’re calling me. It looks like we’ve got the outcome that we’ve want. Right? You know. And she’s worried about which phone calls to make this happen.
Melanie: Yeah. But that’s okay.
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Patrik: Of course!
Melanie: Because we knew that’d happen.
Patrik: Oh of course.
Melanie: And Dr. Malcolm is 100% behind us and he’s my sister’s physician.
Patrik: Absolutely. So he’s..
Melanie: I want him there.
Patrik: Right. And he is the admitting consultant now, Dr. Malcolm?
Melanie: Yes, but he’s away till Wednesday so he’s handed over to Dr. Anthony, I think his name was.
Patrik: Right. That’s okay as long as there’s a doctor who can admit. Everything else, as long as he’s in ICU he probably won’t have much input anyway.
Melanie: Yes, yes, but he’ll be coming in as the- because my sister will be admitted under him so he’ll be coming everyday I assume like the consultant does here.
Patrik: Yes, he would but the reality is that in ICU, yes you have the admitting doctor which will be Dr. Malcolm but in ICU, the ICU is basically taking over and deciding 95% of what’s happening.
Melanie: So, the thing is if we go in now and say we want all orders listed she’s gonna play hardball because he would have told her that we weren’t happy with her.
Patrik: He would have told her for sure but I also believe, okay, if she would think that the NFR is appropriate, right, she might have said I’m not going to take this patient. She might have said that from the get-go right? And maybe they’ve had discussions between Malcolm and her already in where this is going in terms of treatment limitations probably something you may want to find out from him. Have you told Malcolm about this whole NFR?
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Melanie: Yes, and he said it’s a load of hogwash. He said tell them to take it off or you should go to the police.
Patrik: Right, they all want to go the police do they?
Melanie: Hm? It’s up to Malcolm.
Patrik: They all want to go to. They all making to go to the police.
Melanie: I know. Only him. Only him. It was just him.
Patrik: Right. Yeah, okay.
Melanie: He was the one, yeah.
Patrik: Right, okay, well that’s good. And so the next step is that they’re going to transfer her with the ambulance?
Melanie: Yeah, so he said, “I’ve handed over to Minette, the last thing he said. I handed to Minette, I’ve put in a request for a, he called it something specific, didn’t sound like a transfer but something he said, “Oh it could take a while though,” and I said, “Will it be today,” he said,” I don’t know,” and he walked about.
Patrik: Right, it really may not happen today mainly because of the ambulance issue. I don’t think it’s debatable to do at St. Matthew but just be aware that it may not happen today. But I think the main thing is, it is happening.
Melanie: Yeah.
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Patrik: Right. The other thing that, especially with private hospitals, when I couldn’t get hold of the bed managers this morning, I rang exec straight way. And because exec wants to fill their beds because they were very helpful, very friendly, they said, “Yep, we’ll get the bed manager to call you straight away,” and I told them that I’m trying to make this happen on the family’s behalf and they have no concerns whatsoever.
Melanie: Yeah. So I’ll just, you know, roll with that. He’s a family friend and even if you had a client, we could still be family friends. I’ve worked a lot out of Melbourne and we met at an event once. Didn’t we?
Patrik: That’s right but even if you are a client from my perspective, I could still do that work, you know? There’s nobody.
Melanie: But how upset? What was she saying? Was she angry?
Patrik: Oh, she was very angry. I sort of said to her, you can stop now because I just basically then hung up because I’m not listening to her rant about what I should and what I shouldn’t be doing.
Melanie: Yeah.
Patrik: Right.
Melanie: Really?
Patrik: Doctors tend to be busy people and I just said to her, “Look, you must be very busy if you’re making phone calls like that and you’re worried about who’s making referrals to whom.”
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Melanie: Well the thing is, I have a cousin who’s a surgeon at that hospital as well and I could just phone him if she starts to play games. Hopefully, they have a similar roster system where she won’t be on for too much longer and they will get someone else.
Patrik: They most likely will have a similar roster system and there’s probably a good chance that on Monday there will be a new consult. Now if there aren’t I need to find out, I had a client at St. Matthew Public probably at the end of March and I would imagine the same consultants are at St. Matthew Private than at St. Matthew Public. It was not that similar to your experience at Victoria ICU, but again, this is the private system now. So in the private system you have a lot of more bargaining power. A lot more bargaining.
Because you are a paying client, you are not a burden. You are paying, or your sister is a paying client and you basically bringing revenue to the hospital.
Melanie: Yes, okay.
Patrik: Right.
Melanie: So, when we get to that hospital, should I be talking to her about removing the orders and the limitations or not yet?
Patrik: I think so because that’s part of the whole purpose.
Melanie: Yeah.
Patrik: And they would have to issue those orders themselves anyway because they have different paperwork, right. So they would have rewrite the whole orders. You probably need to be very keen with them that this part of the exercise. But also probably need to mention that Malcolm’ seems to be supportive of taking her in as..
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Melanie: Will his word hold credence with them or are they just going to go, “Well we’re the ICU blah, blah, blah,” like they do here?
Patrik: Could be, could be but, again, in the private sector it’s a much more collaborative approach and it’s more like, the admitting position has a lot more power than in the public eyes.
Melanie: Okay, okay.
Patrik: Right, and I’m pretty certain that this whole situation has gone up to an exact level as well in the meantime and they would know that discussion have been around and if are, actually we’re proving that part of your reason why you want this patient somewhere else. If the St. Matthew Private felt like we don’t want the patient like that they would decline. They would.
Melanie: Yeah.
Patrik: Right.
Melanie: Yeah.
Patrik: So, because the doors are opening there you are now in a different field. You’re in a different environment and the dynamics are different. The St. Matthew, they view you, or your sister, as a customer not as a burden. Otherwise they would have said, “No, we said no.” And I’ve seen that too.
Melanie: Yeah. I hope that they don’t change anything now because for now that she has a hand over and she knows that, she could very well turn and say well, “No, I’m not going to accept her now.”
Patrik: It sounds to me like he’s made the call. When I called them, starting with the bed manager, I left a message, then I went straight to the Director of Nursing. Because they did ask the situation and I said, ” Seven weeks ICU with trachy, cardiac arrest,” and I would have understood straight away if they weren’t interested but I realised they are interested. They would have told me straight away, “Oh, we got to check with the ICU, seven weeks ICU is too long blah, blah, blah,” they would have told me that straight away. That all wasn’t the case. So they were pretty keen from the start and she may not have the final say and that’s maybe why she is maybe calling around and upset or who knows.
Melanie: Yeah, okay.
Patrik: You got to be very firm with them probably too. Especially if she’s sort of already…
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Melanie: Inquisitive to the other one?
Patrik: Yeah, inquisitive or a little bit upset or whatever the case may be and did you end up sending the email to Victoria CEO?
Melanie: I did. I’ve heard nothing so I don’t even know, because I rang the executive office, she gave me an email address, she wouldn’t give me the director’s email address, she gave me a general management one. And I don’t know if that was the right address so I’ve heard nothing. I just want to leave it for now. I want to get my sister to St. Matthew and just put my energy there.
Patrik: Yeah, absolutely.
Melanie: Yeah, if we get her out today then, I’m hoping we can get her out today, then yeah. I’d rather put the energy there and then wait later and wait make a formal complaint.
Patrik: I think so. I think so. Put the energy where it’s more important. And have you asked him that, let’s just say for argument’s sake, it’ll take another 24 hours until you can go, have you asked him to lift the NFR in the meantime?
Melanie: No, no, I’m having minimal to do with her. As little to do with her as possible.
Patrik: Understood.
Melanie: Because whatever’s done with her, I’m just trusting in God that we’re gonna get her there. I’m glad I could be on the front foot with this Sophia. I’m going to play it cool.
Patrik: Yes.
Melanie: Very, very cool. Like I don’t know anything and like you haven’t said anything thing and then we’ll see where that goes. Continue to refer back to Dr. Brick’s. He’s her physician, we wanted her here, we’ve heard great reports, we know other doctors here. My cousin’s a surgeon here.
Patrik: Yes, that’s the card you need to play.
Melanie: Okay. I’m not going to be hung-up over it and I’m just going to let it go and in terms of the fact of that they’re friends, hopefully we won’t have to deal with her for too long. She might not even be on this weekend.
Patrik: She might not even be on. As I said, all I can say is with my previous experience from St. Matthew Public and I’m almost certain that 90% of the consultants at St. Matthew are working at St. Matthew Private and I don’t want to go into detail what happened there with terms of family and what the situation was. It was fairly similar to your experience but again you are in private land now and you can play the cards very differently, and they will play cards differently too.
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Melanie: So, if she’s problematic should I again just go to the exec level?
Patrik: Probably. Either that or Brick’s.
Melanie: Yeah, but he’s away so…
Patrik: No, I get it.
Melanie: Whoever he’s handed over to here.
Patrik: I get it. Even over the weekend, we can talk of course, but if there are issues over the weekend, for example, in a hospital there’s always an executive member on call. So hopefully you can negotiate with them but if you feel like it’s not going anywhere you can always escalate it and in the private system you will get a very quick response.
Melanie: Okay, alright. Okay. Okay. Thanks, Patrik.
Patrik: You’re most welcome.
Melanie: I’ll keep you posted. I’m just praying that we’re gonna go soon. We’re gonna get out of here soon.
Patrik: Absolutely.
Melanie: And I’ve said to my sister I’m not moving. I’m not moving from that bedside until we’re gone even if I stay all night. I’m not moving until we go.
Patrik: Given where it’s at now, I think it’s probably a good idea. But maybe because you’ve been running off your feet, maybe you find another family member who can do that for you?
Melanie: Yeah, yeah. Apparently, it’s corridor conversation too at the moment. The doctors are all whispering about in the corridors and you’d think these things at St. Matthew are private.
Patrik: That’s okay don’t be worry about it. Really, none of your business what they think. This is not about them.
Melanie: No, I don’t care. And I don’t care what Sophia thinks. If she’s not okay in a professional standard in the way she deals with us then I will be escalating because I am not going through that again. And I have more support in that hospital.
Patrik: You have more support in the hospital and the more this was coming to a head, I really felt very strongly that it needs to be taken out of a clinic level because you have, from my perspective, you almost have nothing else to lose but to move forward and be proactive about whatever it was because it was just getting unbearable.
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Melanie: Yeah, it is unbearable so hopefully it’ll be different. So, I’m praying. Just praying. You were going to say something else…
Patrik: I was going to say something else, just for tomorrow, I do one shift a week in ICU still and that’s tomorrow afternoon, right? But if you need anything definitely available in the morning, definitely available after 10 o’clock tomorrow night and if you need something tomorrow afternoon I can definitely step out. I mean I see her from 1pm till 9:30pm. I still do one shift a week just to keep my fingers on the pulse and know what’s happening and that stuff. So, yeah, that’s just for tomorrow but anything you need today or tomorrow morning, always around.
Melanie: Thanks so much actually.
Patrik: You’re most welcome.
Melanie: Thank you. Okay I’ll keep you posted. Bye bye.
Patrik: Okay, take care, bye bye.
Melanie: Bye.
The 1:1 consulting session will continue in next week’s episode.
How can you become the best advocate for your critically ill loved one, make informed decisions, get peace of mind, control, power and influence quickly, whilst your loved one is critically ill in Intensive Care?
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- 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 interests
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- 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!
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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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