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 replay a webinar from last week where I recorded an entirely free webinar for families in Intensive Care.
Therefore in this week’s episode you get access to a free webinar recording
“YOUR QUESTIONS ANSWERED” FREE Webinar recording
that you can listen to or you can read the transcript below.
In the webinar from last week November 22nd, 2017 you can listen to how I can help a very distressed family who has their 47 year old brother in Intensive Care after open heart surgery, a prolonged induced coma, has an open chest and the Intensive Care team wants to “withdraw treatment” and issue a DNR(Do not resuscitate) order.
This is a really good webinar recording, because you can see how I can help a family to think about their critically ill’s brother’s situation more positively and I give them strategies how they can turn the dynamics around so that they can get the best possible care and treatment for their brother!
Patrik: Hello, it’s Patrik here from Intensive Care Hotline. I can see Karen and Sandy are online. Can you hear me, Karen and Sandy? Can you type into your chat pad that you can hear me?
Oh, hi Karen. Is it Karen, or is it Sandy? Can you identify yourself? Or is it both? Karen. Thank you, Karen. And you can hear me? Can you just give me a clear sign that you can hear me?
Fantastic! Fantastic! Okay, great. That’s fantastic. So, at this point in time, you are the only attendees, and that’s absolutely fine. If other attendees join, you may have to change subject. There are other people who have signed up, but they haven’t turned up yet, so let’s just focus on you. Tell me about your … Okay, Karen, Sandy, and Jeannie. Fantastic, fantastic.
Just to give you a quick overview how we run those webinars in general, it’s really about you giving me your questions and detailing your situation if you can, and then we’ll work through that. We’ve got about an hour to go. We might be able to finish sooner, but I’ve got about an hour of my time that I can spend with you, and if you want to detail your situation, please go ahead.
And by that I mean you have to type into the chat pad. Sorry, I should’ve said that. I can’t get you online to speak. I can’t get you to talk. … Yes, about your brother, yes. I do remember that, and I just quickly need to get up that email again. Just give me one second, please. I just need to get that email. I’m getting quite a few emails. Just give me one sec.
So, is this your 47-year-old diabetic brother with MRSA in the sternum seven weeks after bypass surgery? Can you just quickly clarify that this is … Yes, okay. Okay, this is the situation. Okay, I’ll just quickly read out this email, so that we’re on the same page.
So, “My 47-year-old diabetic brother ended up with MRSA in the sternum seven weeks after bypass surgery. The infection weakened his heart and caused a small hole to develop in the wall of the right ventricle. They did emergency surgery to stitch the hole. 16 hours later, he coughed, and the stitches came loose, so back to emergency surgery.”
And you continue, “They did more stitches and glue but had to place him on bypass. He went a certain amount of time. No two people in the OR agree on the length of time with low pressures, and they said they hoped he would wake up. He was placed in a medically induced coma for three weeks so that his heart could heal, just kept open so they did want him to move.”
“Neuromuscular blocker, so he was paralysed and that’s another term for a neuromuscular blocker, Fentanyl Propofol, EEG and CT were normal after two weeks in. He is now been off all three meds for nine days. A second EEG two days after being off the meds showed abnormalities. MRI can’t be conducted because it’s too risky with the open chest. Omentum overlay has been placed on the chest, though they were originally planning on a muscle flap, but I’m sure they are now waiting to see if he starts responding.
“My brother is only yawning and opening his eyes, sometimes blinking, but not on command. The doctors are telling us that they’ve been assessing him neurologically on different scales, but he isn’t responding, and we need to decide when enough is enough. My family doesn’t want to give up just yet. All of this happened over the course of four weeks.”
So, this is your email, Karen, and I have responded to that briefly. I’m just quickly having a look at what else we said. Yes, he’s on a feeding tube and he’s got a tracheostomy. You’re trying to remain positive, and your sister and you sing to him, and I think that’s great. I think that’s really good that you’re doing that. They told you that a DNR would be best; we told them no.
So, with all that information, a few things that I can see. The first thing that you need to know is, I have seen many of those situations over the years in intensive care. Just to give you a little bit of background, I worked as an intensive care nurse for nearly 20 years, and I have seen many of those situations where people have been in a prolonged induced coma, and three weeks is definitely prolonged, and I have seen people not wake up for a long time. I’m really pleased to hear that they’ve done a CT scan of his brain, which basically shows nothing. That’s good. I understand they can’t do the MRI because of the open sternum, and I understand all of that.
What I don’t quite understand is that after three weeks they still haven’t closed it. That I don’t understand, but the reason I can see for that is you’re referring to a hole in the right ventricle, which really concerns me. The waking up part doesn’t concern me yet because, you know, what you need to understand there as well is, you’re referring to neuromuscular blockers, which is basically a paralysing agent. So, to explain this to you what it means, when people are in an induced coma, they are getting strong sedatives plus morphine or fentanyl for pain relief, right? That often is enough to knock people out, and then they’re not waking up for weeks. Okay?
Now, you’re also referring to the neuromuscular blockers which is a paralysing agent. So, sedation and morphine or fentanyl is knocking people out. On top, he’s getting, or he was getting, the neuromuscular blockers. That’s even worse, right? I understand why they were giving it because they didn’t want him to move with an open chest. I get all of that, but that’s even delaying waking up even more. So on that front, your brother is probably fighting an uphill battle on waking up because he was in an induced coma with a paralysing agent for a long time. Now, do you remember how many days he was on the paralysing agents? Do you remember that? Do you have a time frame around that?
Karen: Three full weeks
Patrik: Oh, my goodness. Three full weeks. Okay. So, I’ll give an example there so you can put this in perspective. A paralysing agent should always be a last resort, and it certainly has its time and its place in intensive care, but it shouldn’t be used for more than three or four days, right? So, I have rarely seen it being used for more than a week, rarely, very rarely, because, as I said, it’s a last resort, again, it has its time and its place, but it has a lot of negative side effects, and that includes not waking up. It also includes what’s being referred to as myopathy, which basically means a severe muscle weakness, right? So, that is certainly concerning. The other thing that I should have mentioned right from the start: your brother’s age, at the age of 47, is very young, and you’re right on track. He should not be given up on, and if people talk about a DNR, I think it’s highly inappropriate.
Will he be going through a long recovery? Yes, for sure. He’s probably embarking on a long road of recovery, but he’s your brother, he’s 47. I mean, it’s very young, and at the time of today, I’m 45. I mean, most people in ICU who are 60-plus years are not given up on, right? Why would you give up on a 47-year-old? So, just to put that in perspective, and I think it’s inappropriate to talk about a DNR or withdrawal of treatment for a 70, 75-year-old let alone for a 47-year-old. So, that’s sort of a little bit of what I can see, or it’s the bigger picture that I can see. The other important thing is, what do you know about the hole in the heart? Can you specify that? Do you know more about it? You know, a hole in the heart just doesn’t sound good to me. Do you know more about it? And if you do, how does it impact on his current situation?
Karen : they are saying also with the DNR because of the open chest. They are not wanting to do the muscle flap to close the chest because in all honesty they feel it is a waste to do it on someone that may have sever brain damage. The heart surgeon said the heart was still weak but healing nicely.
Patrik: Mm-hmm (affirmative). Okay. They’re saying, also with the DNR, because of the open chest. They’re not wanting to do the muscle flap to close to the chest because they feel it’s a waste to do it on someone that may have a severe brain damage. The heart surgeon said the heart was still weak but healing nicely. Okay. Okay. Okay. That’s good information. Oh, okay. So, there is no evidence that your brother has brain damage, okay? So, they’ve done the CT scan, and they’re saying there is no brain damage, so there’s no evidence for brain damage, okay? So, what’s also important to know for you is, what about the second EEG? Just let me go back with the EEG. Just give me one second. I might have just to quickly look at the email again.
Oh, yeah. EEG and CT were normal. A second EEG two days after being off the meds showed abnormalities. But abnormalities could be anything. They need to be more specific, right? Abnormalities could be all sorts of things. I would really want to see a report from a neurologist who can evaluate the EEG. Okay? So, abnormalities is too general. They need to be more specific.
So, going one step back, just talking about the open chest to begin with and the DNR, do you know whether the chest is still infectious? Do you know whether he’s still got the infection in the chest?
Do you know whether he still has the infection in the chest, Karen?
Because, depending on that, depending on whether he has the infection in the chest, they aren’t indicating in the chest, but says there is … Okay. Okay. That’s fine. One of the reasons they keep a chest open is often an infection in the chest, and you don’t want to close a chest when there is still an infection. Do you know whether, in the last few days and weeks, has he had washouts of his chest? Do you know whether they’ve done regular washouts in the operating room?
Karen: yes, they have been changing out the sponges in the chest
Patrik: Yes, they have been changing sponges. Okay. Okay. Because they’ve done that … Not in the OR. In the ICU. Okay, that’s fine. That’s fine. So, when they’re doing that, they must have an indication of whether there’s still an infection in the chest or not. But before I go into whether they should or they shouldn’t close the chest, I need to tell you something again, bigger picture, and to understand the bigger picture is really important for families in the intensive care, very important. So, the worst-case scenario for the intensive care unit really is to look after a patient indefinitely with an uncertain outcome. Okay? Let me repeat that one more time because it’s so important to understand.
The worst-case scenario for an intensive care unit is to look after a patient indefinitely or with an uncertain time frame and also with an uncertain outcome. That’s the worst-case scenario for an intensive care unit. Why is this? Because they don’t know the outcomes, it’s costing a lot of money, it’s occupying a bed they could use for another patient, it’s very emotionally draining for them, too, they’re dealing with an emotional family, and that’s all fine, but at the end of the day, they have no interest in doing that. So, that’s really important for you to understand that this is their worst-case scenario, and everything they’re telling you is framed around that worst-case scenario, so that’s why they keep hinting at DNR, and they keep saying they don’t want to close the chest.
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But the reality is that by closing the chest, it would take one issue away, right? As long as the chest is clear of an infection, that would be the first thing, and they would have an indication whether the chest is clear of an infection after they’ve done the washout because they can take swabs, and they would have an indication from those swabs if the chest is infection-clear or not.
Karen: This is what we said too!
Patrik: Okay. That’s what you said. Very good, very good.
So, the brain damage, to me, is not evidence at this point in time. The other thing that’s important to know is … There are patients in intensive care who have brain damage, and yet they leave intensive care alive, and the same discussions might happen, and yet they leave intensive care alive, right? There is no hard and cold evidences with the information that you’ve shared that there is brain damage. There is no evidence for that. They’re talking about abnormalities in an EEG, but what does that mean? It needs to be specific. So, from that perspective, again, given that patients are in intensive care with brain damage, and they leave intensive care alive and go on to rehabilitation, there is no reason why your brother can’t have the same.
Does it impact on his quality of life going forward? It may be, but if you’re not trying, you don’t know. I mean, the worst-case scenario could be that your brother is dying in intensive care, which it sounds like the intensive care unit is pushing towards, right? The best-case scenario is, your brother will leave intensive care alive, goes through rehab, and will have some quality of life down the line. Right?
Karen: They want us to talk to palliative or either to get him to a long term acute care facility or to take him off the vent. He had be functioning on CPAP but had to be put back on the vent today because of low respiratory moments
Patrik: Yep. I understand that. Yep. They want you to talk to palliative care to see or either to get into a long-term acute care facility. Okay. Yeah. Understand. So, with the long-term … To a degree, I like that they bring up long-term acute care. Palliative care, depending on your understanding of palliative care, palliative care can be assisting at the end of patients’ lives, but it can also be assisting in pain management, okay? Let’s talk about long-term care. Or take him off the vent. He had to be functioning on CPAP but he had to be put back on the vent today because of low respiratory moments. Okay.
So, okay. So, a few questions there. If he goes to long-term acute care, he would need to be off life support, not necessarily ventilation. They could look after him on the ventilator or on CPAP in long-term acute care, but he would have to be off life support with other mechanisms, so that keeps me getting back to the heart. So, the surgeon is telling you that the hole is healing, but do you know whether he’s on any life support for his heart? And I don’t want to get too technical here, but it would be important to know, so do you know whether he’s on any inotropes or vasopressors?
Karen: What exactly does that mean?
Patrik: … Yes. Yes, I’ll come to that. Do you know whether he’s on any inotropes or vasopressors for his heart? So, I’ll just type this in so you can see the terms in front of you, and I’ll type a couple of drug names. You may have come across them, but that would be really important to know. Just give me one sec.
Here are the drug names: inotropes/vasopressors Noradrenaline/Norepinephrine Adrenaline/Epinephrine, Dobutamine Milrinone
Have you seen any of those drugs there, drug names that I’m just sending through? Have you heard some of them during the course of your brother’s stay in ICU? So, the drug classification is inotropes or vasopressors, and the names of those drugs are put underneath. And this is really going to be important information going forward.
Karen: We haven’t heard them saying he is getting any of those right now they are saying he is only on antibiotics.
Patrik: You haven’t heard them saying he’s getting any of those. Okay, okay. And that’s a good chance he’s not, but can’t rule it out either. So, the reason this is … Right now they’re saying he’s okay. Okay, well, if that’s what … And insulin. Sure. If that’s what they’re saying, you know, I would still verify with them. You’ve got those names now in front of you. I would definitely verify with them. The reason this is so important is, you see, your brother’s on a ventilator. That’s life support. If he was on any of those drugs, inotropes or vasopressors, that’s life support, too, and if he’s on any of those, he can’t go to long-term acute care. He needs to stay in an intensive care environment until he’s off those medications, okay? So, that’s really important information for you to have.
Also, if he was on any other life support, like dialysis/CRRT for kidney failure … And I’m just trying to read through your email again. You don’t mention anything of kidney failure. Because he’s diabetic, there’s a good chance he isn’t. Okay. Good, good. Okay. So, if the only mechanism of life support your brother is getting is the mechanical ventilation or the CPAP, he can go to long-term acute care, but not with an open chest. Not with an open chest. Okay? That’s one thing they need to sort out before they’re even bringing up sending him to long-term acute care.
The other thing that’s important to understand, or another question for you. He’s off all sedation now, can you just confirm that? I think you mentioned that in your email.
Karen: Correct, he’s off all sedation.
Patrik: He’s off all sedation now. Yeah, okay. Okay. The other thing with the open chest, I tell you what needs to happen, so he’s got a tracheostomy now, which he’s had now for a few weeks, I understand. You see, one of the advantages of a tracheostomy … One week. Okay. One week. Okay. You see? One of the advantages of a tracheostomy, really, is to mobilize a patient, right? If your brother wasn’t having the open chest, your brother could get out of bed with a tracheostomy. It’s so much easier to do that, okay? But because he’s got the open chest, they can’t do that.
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Where I’m going with this is, really, your brother is not waking up. He needs stimulation. He needs to be moved around, he needs to get in a chair, all of that. I know it might sound impossible to you, but there are special chairs inICU where you can mobilise a patient, even if they are unconscious, so it’s definitely possible, and it helps patients to wake up. So, the problem is the open chest, and they need to fix that, right? And if the cardiac surgeon is telling you the heart is healing, or the cardiac surgeon should be the one advocating for closing the chest, right? Do you feel like the cardiac surgeon and the ICU doctors, do you feel like they’re on the same page, or do you feel like they’re saying different things?
Karen: I think they are now on the same page, but they don’t communicate with each other or us.
Patrik: So, just repeating that, they’re now on the same page, but they don’t communicate. Okay. Okay. All right. Okay. With each other, or … They don’t communicate. Yeah, yeah, yeah. I get it. Yeah, okay. So, taking practical steps to get the outcomes that you want, you know, I’ve given you the bigger picture for now, and I think you understand how ICUs operate, you have a much better understanding how ICUs operate, you have a much better understanding about their agenda, right? The bed that your brother is occupying now for the last four weeks they probably could have had five other patients in there, and high turnover, that’s easier for them, all of that. Potentially more money for them as well, you know, all of that.
So, with all of that in mind, taking practical steps to go forward. Can you just share with me, which state are you in in the US? You are in the US. Which state are you in? WV stands for West Virginia? Is that what it is? West Virginia, okay. Okay. So, I will find out from you what the law is in West Virginia, but the reality is, so when it comes to DNRs and end-of-life decision-making, most states, whether it’s in the US or in any other country, they can’t just issue a DNR or withdraw life support without your consent, okay? So, you know, they are pushing for a DNR, but at the end of the day, they can’t make this decision without your consent, okay? So, from that perspective, you will probably have all the time in the world, as long as the health fund keeps paying for your brother’s treatment. And on that note, I would just not respond to that pressure, and you haven’t, which is great.
Karen: They tell us the DNR is most important because his open chest won’t allow for them to actually do CPR.
Patrik: So, just, sort of, keep ignoring the talks about DNR, and just keep going is the most important thing for now. You’re saying because his open chest won’t allow them to do CPR. That’s not entirely accurate. What could happen if, God forbid, if your brother’s heart stops, God forbid, they could do CPR on an open chest. They can do that. Okay. I have seen this not many times, but I’ve seen it a few times. So, they’re telling you that, but your argument with that is, well, close the chest. That’s your argument. Your argument to them is, close the chest, and then you can do CPR. Right? That’s your argument. Right?
So, you see, one thing that I always try and educate people on is, you really got to change the dynamics in there, and I’m giving you the tools to do that, right? It’s really all about asking the right questions. It’s really all turning it upside down and telling them that you are doing your research, and telling them, look, you’re telling us a DNR is important because he’s got an open chest. Well, your response to that is, well, close the chest. That’s your response to that. Right? So, taking more practical steps, ask them to close the chest if it’s infection-free, ask them about the life support he’s on with the inotropes/vasopressors that I mentioned earlier, and the other thing that’s important to understand with long-term acute care …
So, a lot of people come to me, and they say, look, my loved one, brother, mother, sister, father, whatever, they’re getting a tracheostomy, and they then want to send my loved one to a long-term acute care. Okay. And they often say, they get a tracheostomy on a Monday, and they’re told, oh, on Wednesday they want to send my loved one to long-term acute care. So, putting some perspective and some real world experience around that, the best place to wean somebody off the ventilator is in intensive care. There is no doubt in my mind that the best place and the most skilled people to wean somebody off the ventilator is intensive care and not long-term acute care.
What do I mean by that? Intensive care, you have intensive care doctors, intensive care nurses, you have respiratory therapists, you have physical therapists, you have a really skilled and educated workforce, and they’re really experienced with weaning patients off the ventilator. Now, you go to long-term acute care, and you have none of that. You have one doctor looking after maybe 30 patients, and you’re going from intensive care nurses to not intensive care nurses. The stories that we get from long-term acute care are pretty, I wouldn’t say horrendous, but I would not send my family member into long-term acute care if I had a choice.
So, what’s important there to know as well … Again, intensive care beds are in demand. If they think they can’t get your brother out of this intensive care bed by letting him die, God forbid, but it looks like they’re pushing towards that, they will try and send him to long-term acute care to get him out of that intensive care bed. Right? That’s what they’re working towards, but if patients do go to long-term acute care, they’re also more awake, and they certainly don’t go to long-term acute care with an open chest. That’s unheard of. So, they will need to take care of that open chest first, and again, I can’t stress this enough, the best place to wean somebody off the ventilator is intensive care because they have the skills and the knowledge, and they also have the facility to deal with setbacks.
When patients go to long-term acute care and there are any setbacks, whether it’s an infection, whether patients need kidney dialysis/CRRT for kidney failure, or they need any of the drugs that I mentioned before, the inotropes or vasopressors, they go back to intensive care anyway, and you don’t want to have patients go back and forth. Your brother is way too vulnerable and way too fragile to be sent to long-term acute care. Have they given you a timeline around wanting to send him to long-term acute care? Have they given you a timeline?
Karen: No timeline.
Patrik: They haven’t. Okay. That’s good. That’s good. And can I just quickly zoom in? What I shared with you so far, does that make sense at all? Does that make sense from your end?
Okay. Good, good. So, we’re on the same page. That’s really important. So, you know, the situation that you’re dealing with is certainly not easy. There’s no doubt about that, but the simplest advice that I can tell you is, keep asking the right questions, keep advocating for your brother, ask them to close the chest, ask them about life support, do not give in to a DNR(=Do not resuscitate). I mean, you’re doing that already. You told them so. You told them already not to talk about DNR anymore, and that should your response. The minute they talk about stopping treatment, the minute they talk about DNR, just tell them, look, we’ve told you what we want, and you don’t even need to go there anymore because we’ve told you what you want. Just keep it like that. Right?
Often, pushing back on them is the simplest thing to do because they’re not used to it. They’re not used to it. Most families don’t question, so your simplest strategy is, really, to keep asking for what you want, and have that expectation. That’s really important.
Karen: They told us this evening that they feel nothing else can be done and that we have to consider his quality of life. Indicating we are being selfish
Patrik: They told you this evening that they feel nothing else can be done and that we have to consider his quality of life, indicating we are being selfish. You can just ignore that. You can just ignore that talk about quality of life. Quality of life is a very subjective experience, and I’ll tell you where this is coming from. I know how intensive care professionals tick. They’re exposed to very extreme things, and they view your brother’s case as extreme, and that’s fine. And being an intensive care professional myself, I just think, yeah, I have seen many things where I think, okay, maybe I wouldn’t want to live going forward, but that’s what I might think for me, personally, but that’s not what a family might think. Okay? So, it’s not for them to judge. Your expectation, or your future expectation of quality of life, that’s not for them to judge. Right? And let them indicate … You know, it’s not selfish.
Selfish, from my perspective, would be if you gave up on him. That would be selfish. Right? So, illustrating a little bit more about quality of life as well, I tell you what else we do so you understand how I feel about quality of life in those situations. We run an in-home care nursing service called INTENSIVE CARE AT HOME, and I don’t want to bore you with the details, but it’s important for you to understand. We take patients home on ventilators with traches, and we know it’s … We do it every day, and we send ICU nurses in the home for patients on ventilators. Now, we know our clients want to live, right, and, you know, it’s not for everyone, but people need to be given an option, right? And not giving people an option is inappropriate. So, does that …
I’m talking about quality of life here for patients on ventilators. People want to live, right? But your brother is not even in a position at the moment where he can make up his own mind. Your brother needs to come to a point where he wakes up, and where you can ask him, hey, this is the situation. What do you want? In the meantime, you are making decisions for him, and I believe you’re making all the right decisions. The reality is, if your brother is going to die, God forbid, you know, if he’s not surviving this, well, then you tried, but if you don’t try, you will know the answer anyway. But you will never know the answer if you don’t try. And, again, they are just referring to their own worst-case scenario without telling you, and their worst-case scenario is to keep your brother there for the next four weeks without knowing what’s happening.
So, you can just, again, ignore. Just ignore, and tell them that it’s not for them to judge about quality of life. You see, where I see you professionals falling down is, and again, that’s including myself to a degree, we have seen everything in intensive care, but we don’t know what the patient’s quality of life looks like when they leave intensive care.
We have no idea. I have a much better understanding now because we have this in-home-care nursing service INTENSIVE CARE AT HOME, but prior to that, I had no idea what a patient’s quality of life looks like once they leave intensive care alive. And 99% of ICU professionals don’t know that either, so that’s the answer you need to give them. You need to tell them that they have no idea what your brother’s quality of life will look like in six months time, in 12 months time. They don’t know.
There’s enough success stories out there where people were doomed to die in ICU, and they live, and they live good quality of life, and they’re sharing their stories, and there is no reason why your brother can’t be doing the same down the line. And you said in your email, you are positive, you are singing to your brother. I think that’s so important. Being positive is half of the battle, and staying positive will help you no matter the outcome.
Karen: Thank you Patrik we needed to hear this!
Patrik: So, yeah. I know. I know that you needed to hear this, and I know you needed perspective around this, and you can look up on our website, there’s hundreds of case studies where we help families in similar situations. Right? Your brother is 47, and I can tell you, I would have the same conversation with you if he was 74. I would have not changed the conversation that I had with you now if he had been 74. Right? And the simplest advice, really, is, keep pushing back, keep asking for what you want. Expect it, demand it, and keep asking all those questions.
So, we’re going to finish soon, but what other questions do you have? Was there anything else that you needed to clarify?
Yeah, please. Please let me know what else you need to clarify.
Karen: What should we look for to indicate that he may be waking up, we think he can hear us!
Patrik: Yeah. Okay. Yeah. Yeah, yeah, yeah. Yeah. Yeah. I’m sure he hears you. I have no doubt about that he hears you. Yeah. So, look, I will, when we come off this call, I will send you some links to articles and also some ebooks and videos where I’ve written extensively about what to do when patients don’t wake up after an induced coma, okay? So, I will send you some links there. What should you be looking if he is waking up, so the best advice that I can give you around that is, number one, keep looking, keep looking for signs. I do believe your brother is hearing you. And the next thing is, waking up after an induced coma is a process. It’s not an event.
- The 5 Mistakes you are unconsciously making if your critically ill loved one is in an induced coma and is not “waking up”!
- The 10 answers to the 10 most frequently asked questions when your loved one isn’t “waking up “ after an induced coma!
Families in intensive care often have the expectation that once people come out of an induced coma, they will wake up, and they start talking, and as you’ve see by now, that’s not the reality. So, waking up after an induced coma can be a very long process, and it’s more like switching on a light with a dimmer, not with a switch. So, it’s going to be a very slow process, and patience is your biggest asset in all of this, really being patient. It can take weeks. And if he does wake up he’ll probably be confused because of being in an induced coma for such a long time, so there’s numerous hurdles that you have to overcome once he wakes up, but it’s just what it is.
So, yeah, I will send you some articles around that, but give it time. Give it time. So, it may take another two weeks, it may take another three weeks, but that brings me back to why they need to close the chest, and why they need to start mobilising him, getting him out of bed, so he gets stimulated, and also, once the chest is closed, they can do an MRI. Okay? Because I think doing another CT of the brain would be important, but doing an MRI would be even more important. Okay? So, that’s another reason why they need to close the chest, right? So, there’s numerous reasons why they need to close the chest, as you can hear by now.
So, the other thing that I definitely would like to offer you is, you know, if you are interested, I offer one-on-one consulting where you have access to me 24 hours over the phone, if you want that. I do charge a fee for that. That also includes talking to doctors and nurses, if you want me to. If you want me to participate in family meetings with the doctors, if you want me to. I can certainly advocate for you in those meetings. You know, because I come in as an advocate, and I will not let them get away with any of that crap. Excuse my language, but I know what questions to ask, and as you’ve seen by now, I’ve already given you enough insight, you can take the first steps. You’re pretty well-equipped now to … Yeah. You know, you’re pretty well-equipped now to deal with them, but if you want that one-on-one hand-holding with me over the phone at any time, I offer that. And, again, that includes talking to doctors and nurses as well, if you want me to on your behalf, and also setting up meetings with them over the phone, like where you are there as well.
So, that’s something that I offer. Of course. I understand, I understand. I understand. I’m not … You know, I’m just very happy … I love what I’m doing, and there’s no obligation whatsoever. I want to help people, and if I do this free webinar, that’s absolutely great. I can see how I can help you. And just very quickly, what I do offer is, I offer a seven day, 24/7, unlimited phone support, and that is 24/7, you don’t have to use it seven days in a row. You can use this at your own pace, and that comes at a price point of $699. That’s just something really, but I understand you need to evaluate whether it’s the right decision for you. Totally understand.
And before we close off, was there anything else that you wanted to have clarified? I will send you some articles around waking up after an induced coma, and what else was there? Anything else you needed to clarify before we close off?
Okay. And I think you’ve covered it pretty well. I think you have a very good understanding.
Karen: Thank you
Patrik: You’re very welcome. You have a very good understanding of what’s happening, you have a very good understanding of what you need to do from now, and it’s quite simple, but it’s not easy, and by that I mean, the simple thing is pushing back on them and having demands and expectations, and not backing off from it. It’s easier said than done, but it’s good that there’s three sisters. I can already see you’re working together on this, and as long as you keep speaking with the same voice there, there’s not much they can do. So, just be very consistent with your message. Be very consistent.
So, I really hope that helps.
Karen: Thank you
Patrik: You’re very welcome. Been a delight. It’s been a pleasure. It’s been a pleasure. So, patience is very important, but it looks to me like you are patient, and just not taking no for an answer. Simple, but not easy.
Okay? So, we’re going to close off. Thank you very much for coming on and baring your situation, and I hope I could help you with that, and look out for the email where I send you some information around how long it takes to wake up after an induced coma. Okay? Thank you so much, and I will also send you a recording of the webinar so you can listen to it again, okay?
Thank you so much again, and have a good night. Take care.
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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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 interests
- 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!
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Also check out our Ebook section where you get more Ebooks, Videos and Audio recordings and where you can also get 1:1 counselling/consulting with me via Skype, over the phone or via email by clicking on the products tab!
This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
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