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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 one of my clients and the question in the last episode 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 the next questions from one of my clients Natasha whose father passed away in the ICU. Natasha is eager to know exactly the cause of death of her father while he was a dying patient in the ICU.
No one ever told me in the ICU about these complications my Dad was having. Was there any medical negligence?
Natasha: Hello?
Patrik: Hi Natasha how are you?
Natasha: Hello? I’m okay. I was actually headed outside getting the mails when you called.
Patrik: That’s okay.
Natasha: I didn’t get the mail.
Patrik: Right, Sunday mail.
Natasha: Yeah I didn’t get it on Friday. How are you? I hope everything’s okay.
Patrik: Yeah, I’m very good. How are you and your family?
Natasha: Okay. Could be better you know. I’ve been actively reading all of your posts, very informative, very informative reading a lot of … I really wish that I … God I wish we did it differently, I’m so angry and upset. Some new news, Friday I actually did, I got the medical records from the hospital but not the films. They didn’t give me the films, they told me to come back on Monday because they didn’t know that I wanted the films even though I checked off entire chart. I have been going, so it actually is 1189 pages of actual pages. I am on 430 so far. Some of the things, I don’t understand everything but I have, there are things that I am confirming myself from what I’m looking at. A lot of things that you and I had discussed and just things that I didn’t … Even when I was there that I felt were off. Just talking about it is making my heart race. I was really, really upset.
Patrik: I can only imagine.
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Natasha: There’s a lot of discrepancies. I started writing emails to my sister about … It just really, really upset me just reading some of the stuff here. God, just really … I really wish that I bought … I just wish I told that ambulance to bring my dad to … There’s a place called …It’s actually rated number one by US News and World Report. Rated number four by US News and World Report in the New York, New Jersey area. That hospital where they actually saved his life. I wish I just told the ambulance to go there. It would have been an extra 10, 15 minutes.. He would have had a better outcome. It’s a university hospital. I wish I did that.
Patrik: What’s the name of the hospital that your Dad was at?
Natasha: Valley Hospital in Ridgewood New Jersey. They actually get pretty good reviews online but its all bullshit. I’m not joking it’s bullshit.
Patrik: Sure.
Natasha: The awards they get for example like there’s this thing called a Beacon Award. You actually have to apply for that. It’s just a lot of it is total bullshit. It’s just … Because sometimes if you go online and the patient … When you go on Facebook or something, patients say really nasty things.
Patrik: Of course. Social media is where you get the real gist-
Natasha: Yes.
Patrik: Right?
Natasha: Yes.
Patrik: No matter what they print on their website it’s really all about what people say on social media.
Natasha: Because when you go to Hackensack University’s medical … The good hospital, the excellent hospital which is renowned. Hackensack University Medical Center in Hackensack New Jersey, that one when you go on their social media website on the reviews you get overwhelmingly excellent reviews, patients giving detailed reviews. When you go on Valley you really do get shitty reviews. Let me just tell you something. Do you want to hear about some of the things that I … I wasn’t … I’ve been with my dad every single day, I’m going to tell you. Taking detailed notes myself when I was there. A lot of things and the hunches I’ve been having just from what they’re doing and comparison to Hackensack University Medical Center comparing to what my sister … My sister is a rheumatologist. She’s very smart. Comparing it to just what I read online, I have friends who are medical professionals, and talking to you as well. I’m a smart person. I know what is right and wrong. Let me just cut you some of the things that I’ve seen, some things. Do you want to hear it?
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Patrik: Go, go.
Natasha: Just a couple of things. All right that I noticed. Let me look at some of the things I wrote to my sister. Hold on. In the beginning … I don’t even know where to begin. What’s really interesting is … I guess I’ll start from the top part. I’ll start from here. Do you remember … I told you that my dad when he … They were saying how when he was … At the last moments when he was having his oxygen levels in the 60s after the nurse had changed him, when they did a chest x-ray the pulmonologist came and he said that on the chest x-ray it looked like his endotracheal tube was too high up. When he went in with bronchoscopy, the flexible tube he was, “No it’s okay it’s in the right location.” Then I remember he had said it’s going up into the 70s now but then it wouldn’t go up more than that and then it … He said no it’s in the right place.
Then when I was looking in the record this is what he writes. There’s another thing about that. He writes in his notes on the day my dad died, first in ETT and confirmed placement with Ambu aScope? What?
Patrik: That was after the bronchoscopy.
Natasha: This is what he wrote in the notes.
Patrik: Did he write that after the bronchoscopy or before or after?
Natasha: No, this is after.
Patrik: After yeah.
Natasha: So he writes pushed in ETT and confirmed placement with Ambu aScope, tube in adequate location, continued to bag patient, unable to achieve SAT above 70s. He pushed in the ETT and confirmed placement with Ambu aScope, tube in adequate location continued to bag patient, unable to achieve SAT above 70.
Patrik: I think we’ve-
Natasha: Why did we have to push in the ETT?
Patrik: Well it depends on what they … This is why it’s so important. I believe you need to get the films as well. Now when you’re referring to the films you are referring to … Well I would refer to chest x-ray film, CT films whatever.
Natasha: Yes everything.
Patrik: Yeah everything. I think we discussed this last time or on previous times. I can’t believe the bagging. I give you another quick example with the bagging. I still do one shift a week in ICU.
Natasha: Yah, you mentioned.
Patrik: I was actually doing a shift on Saturday. I was looking after a patient who was 75, 80% of oxygen. We put him up to a 100% occasionally. He was very unstable but bagging somebody you would get slapped on your fingers and rightly so. You know what I’m saying?
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Natasha: Yeah.
Patrik: Bagging a patient is just like … I’m laughing and I shouldn’t laugh but that is laughable to me. That is not best practice. You bag a patient when you … You remember last time we spoke about, you bag a patient when you can’t ventilate it or before you bag you paralyze. This is actually what this patient had on Saturday. He was paralyzed so that you don’t even bag in the first place. I really don’t know what they’re doing there.
Natasha: Yeah because it just didn’t … Then I’m going to tell you another thing that I caught. Again I’m not being very … First I’m not skimming, I am reading through the notes. I am reading. I caught some things and I just thought it was interesting how he wrote pushed in ETT and confirmed placements with Ambu aScope -_tube in adequate location, continued to bag patients – unable to achieve SAT above 70. Then in the room he said the tube is in adequate location. Then in this report he’s making it seem like it was not in adequate location. Then let me tell you something else, then when I was reading through the notes … When he was admitted into the emergency room and I was reading about the tube placements, a clinical care doctor. Dr. Sharma. He was this Indian guy. When I was reading his notes they used the word capnometry is that to make sure that it’s in the right place. All these methods in capnometry..
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Patrik: Okay. Here is what I can tell you about … There is … To keep this okay, sorry.
Natasha: Because there are different methods to make sure that it’s in the right place.
Patrik: I can tell you what the methods are from my experience. It does happen that the tube according to either chest x-ray or bronchoscopy it’s deemed to not be in the right place. Either too far in or either too far out. Once that’s been established either through a chest x-ray or through a bronchoscopy you as the bedside nurse or as an experienced physician you might get the instructions to either pull the tube out by a couple of inches or pull it back in, whatever the case may be. Once that’s done the simple follow up on that is a chest x-ray. There’s nothing else. I don’t know how he can say the tube is in the right place. Yes he’s done the Ambu aScope, fair enough but it’s still from my experience should be followed up by a chest x-ray. Obviously there is the discrepancy between what he told you at the bedside and then what he then documented. There is another obviously discrepancy.
Natasha: That too right, exactly. Then in another time around … On April 4th … There’s more. On April 4th 2017, four days before my dad died there’s a couple of things. The endotracheal tube from the carina something about … I didn’t right exactly the distal measurement … I don’t know how to say the medical … I didn’t write down exactly. It was written as a different type of … As a problem I guess. The endotracheal tube from the carina was about five centimeters or something. The distal measurement from the carina. I remember when the emergency room doctor when I was looking at the notes when he was at the ER; it was four centimeters from the carina or something. It was written as if it was a concern because next to it, it said chest x-ray, which they did not tell me about this either. It said small left pleural effusion and possible traced right pleural effusion. I was never told about either.
I was never told of the endotracheal tube from the carina distal five centimeters. In my notes I didn’t write that part. I was going to go back and write it, I never did. Then I remember in the ER notes in the beginning when I was going through the notes, the clinical care doctor, Dr. Sharma when he did the capnometry whatever it’s called, when he wrote the note about how far whatever 24 centimeters down but he wrote four centimeters from the carina and over here on four four 17 chest x-rays five centimeters distal whatever to the carina and then the small left pleural effusion possible trace right pleural effusion. They don’t believe there’s Pneumothorax or whatever the-
Patrik: Pneumothorax, yeah.
Natasha: No one told me any of this. No one told me my father has fluid in his lungs ever. Then it also said that they also made notes about on this day that my father was declining. There was more that his chest x-ray was cut … The infiltrates were covered in both lungs. I thought that it wasn’t that bad and that he didn’t get worse until, what is it? The fifth or the sixth. What is it? That the left infiltrate got worse in the sixth but he was really bad on the fourth. They noticed a decline. He was really bad but they didn’t do the bronchoscopy, so these are all these things I just told you.
Patrik: Here’s a few things. You know what the carina stands for? Have you done that research?
Natasha: I did and I-
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Patrik: That’s okay, can tell you in one sec. I can tell you very quickly. Basically when they intubate (intubation) the patient, it goes down in the trachea. When the trachea goes into the lungs there is a section, the carina that’s basically the sections where it goes into the two main bronchi basically left and right lung. It’s basically the intersection of the left and the right lung. That’s the carina.
Natasha: On the top part, the top part?
Patrik: The top part is the trachea. When it goes down probably maybe depending on the person maybe five, ten centimeters then there’s this five … What’s the word the bifurcation where it basically spreads into the left and into the right lung. That’s what is called carina. Because why this is important is in some cases … Again not very often, in some cases you do find that the endotracheal tube might be stuck into the right lung. Very few cases but it has happened. That the tube is that far down that it goes into the right lung. You can see that in the chest x-ray and you can usually see it very quickly on the ventilator itself because the numbers are way off, because you’re basically only ventilating one lung. That’s why this carina is a bit of an important spot that people tend to mention in chest x-ray reports and so forth.
Natasha: I was never told that … Then couple that with me telling you about … About the gargling and the cough. Remember how I told you he kept gargling, that’s not normal. Now I never knew this before and then when I read that report about the doctor and then how there’s that discrepancy with what he told us in person and then here, how he pushed it down and he did nothing else afterwards that my father … Then he got the hospital acquired … Then I read online too that the ventilator associated pneumonia can happen because that thing is not placed properly inside of you.
Patrik: Very much so.
Natasha: It happened because of them. Do you know what I’m saying? And on top about the bronchoscopy. You see why I’ve been so upset this whole time.
Patrik: Understandably. Now here is another thing. Can you show more light on the pleural effusion. What does it exactly say?
Natasha: I don’t … Let me just tell you. They did not give me … They told me to come back on Monday because the personal records she’s, “I didn’t even get that for you. I was supposed to ask you and I didn’t ask you, that’s separate.” she’s like you have to come back on Monday and I’ll get it for you on Monday. That’s all. I literally copied it word for word. That’s all that I remember because I wrote it for my sister. My sister lives in … She lives about 45 minutes away. She lives in Manhattan but she’s really busy. I just wrote an email because I was just really storming off. Writing emails … I wrote 15 emails to her. “My God they wrote this. This is what they wrote.” They just literally … I just called it to you verbatim. Small left pleural effusion and possible trace right pleural effusion.
Patrik: When they say small it doesn’t give an indication in inches or in centimeters, it just said small.
Natasha: No, I would have written it down because I literally … I didn’t really understand what that meant until I Googled it.
Patrik: Sure.
Natasha: But I want to put it in quotes.
Patrik: The reason I’m asking whether it’s small or big. In some pleural effusions, they put in a chest drain ( Underwater Seal Drain and Chest tube) to drain the effusion.
Natasha: I read that afterwards. I Googled it. You know what else, can I tell you something Patrick I kept insisting that they do a chest CT. They eventually brought him for an abdominal CT and I’ll get to that in a second. I kept telling them, “Are you guys ever going to do a chest CT? I mean he’s having all these problems. It just makes sense. They’re excuse was he … The protocol is going to be the same. The treatment they want to give him it doesn’t make sense and he’s unstable. I’m like, but you should do a chest CT. I don’t understand this makes no sense. They would just not want to do a chest CT. Now I’m thinking do they just not want the full … What the hell is wrong? Maybe his lung collapsed. Maybe he had fluid and they didn’t want to extract that fluid. Maybe they didn’t want to have that … To see really what was there.
Patrik: The only thing that I can think with the CT is if you’re sending a critically ill patient to a CT there is a risk involved in that. What I’m saying is you want be very quick because you basically-
Natasha: Patrik, hold on a second. She’s going to think the whole idea was he’s going to die anyway. I’m sorry I’m just really angry. Go ahead, okay, continue.
Patrik: The question is if you are sending a patient for CT, who’s already ventilated, who’s already in a coma who’s already on vasopressors/inotropes and multiple forms of life-support-
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Natasha: He wasn’t in a coma. He wasn’t in a-
Patrik: He was in a natural coma. That’s fair enough. You want to minimize the times in a CT scanner because of the risks attached to it. You got to weigh up-
Natasha: He was not on vasopressors/inotropes at that time.
Thank you very much for being a part of this series of 1:1 consulting and advocacy sessions. We hope you will find these new upcoming episodes informative and empowering.
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- How to ask the doctors and the nurses the right questions
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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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