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 my clients Andrea who has her 34 year old sister in Intensive Care with non-Hodgkin’s Lymphoma and is currently experiencing decrease in blood count as well as having second thoughts about the treatment her sister is getting.
The Intensive Care team is wanting to stop or “withdraw treatment” against Andrea’s and her families wishes and she’s not prepared to let her sister go without a fight!
Therefore, this week’s topic is
The ICU doctors refuse to give my sister blood transfusions, will she die because of it?
“You can also check out previous 1:1 consulting and advocacy sessions with me and Andrea here.”
Amanda (nurse): She’s hyperdynamic (erratic). Her blood pressure is 200 one minute and then it’s 90 the next.
Patrik: I see.
Amanda (nurse): It’s the whole neurological response. So, sometimes the Noradrenaline is at 20 and then five minutes later the Noradrenaline is at two.
Amanda (nurse): Her blood pressure’s swinging all over the place.
Patrik: Okay, okay.
Amanda (nurse): I’m so terribly sorry about this. It’s just a horrible situation for everybody.
Patrik: Look, it is, it is. I’m not telling you what to do. I’m just asking, it’s difficult for you to be stuck in a side room with a patient who may die.
Amanda (nurse): No, don’t worry about me. This is what I’m here for. The doctors have just arrived so I’ll just say goodbye.
Patrik: Yeah, yeah, yeah, yeah, yeah.
Amanda (nurse): If you call back later, I can speak to you.
Patrik: Yeah. Thank you so much for your help.
Amanda (nurse): Thank you.
Patrik: Thank you. Bye bye.
Amanda (nurse): Bye.
Andrea: Did you want to stay on the line?
Patrik: I can stay on the line if you like. So, what she’s telling me, did you hear what she was telling me?
Patrik: Okay. So, I confirmed with her, she is in the side room because they are preparing for end of life care.
Patrik: Now, she’s telling me that giving platelets wouldn’t change anything. Now, I wasn’t going into an argument with her because there’s no point. It’s something that needs to be discussed on a medical level. There’s no point in me arguing with her whether she should have blood or not. That is something we need to bring up with the doctors, not with the bedside nurse.
Andrea: Well, the doctors are here now. I’ll put you on speaker if you want the news.
Patrik: If you want…
Andrea: They’re just going to put us into a family room.
Patrik: Mm-hmm (affirmative). I’m just listening.
Andrea: I’ll put you on speaker as well.
Patrik: Mm-hmm (affirmative).
Patrik: Yeah, look, if you have a minute, I might just explain to you what else I’ve got out of this conversation with Amanda a moment ago.
Patrik: So, she is now on noradrenaline (inotropes/vasopressors), which means her blood pressure is going down and that, again, is a result from my perspective of not getting any blood products.
Andrea: Right, yeah.
Patrik: Right. So, the combination-
Andrea: We’re just waiting for one more person, if that’s okay. Yeah. Sorry, Patrik.
Patrik: That’s okay. So, when did you say she had her last blood product? That would have been on Friday?
Andrea: It would have been on Friday.
Patrik: Right, right. So, she hasn’t had any blood since Friday. Her haemoglobin today might be in the 60’s, maybe even lower. Which, again, is what I mentioned to you in the email yesterday, that the lower haemoglobin goes, the more likely she will need inotropes/vasopressors like noradrenaline and that is life support, right. If they’re not getting her off the life support, it’s far less likely she will wake up. That is a vicious cycle, by them making this decision.
Patrik: So, today’s Wednesday. She’s now thrombocytopenic which basically means she has no platelets left, whatsoever, right. The platelets are six and under, total. Again, that to me is a sign of, well, her body is not producing any of it be we’ve known that all the way along , which is why she had blood products all the way along and then they stop giving her that.
Patrik: Right? Now, she’s got no platelets, she’s on Noradrenaline. I’m not surprised.
Andrea: Oh, she’s not on the Noradrenalin?
Patrik: No, she is, she is but as I said I’m not surprised because she hasn’t had blood products for five days.
Patrik: With every sign showing that the number of platelets, haemoglobin and everything else is going down
- “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!”
Patrik: Right? I guess that is the question you should be asking the doctors and what they will be probably telling you is, “Oh, yes. She’s not waking up. Blah, blah, blah. Her prognosis is poor. Blah.” That will be their most likely, their justification of everything that’s happening but it’s not in line with what they told you two weeks ago, that she is for full treatment because at the moment, they’re not treating her appropriately.
Andrea: That’s right. Yeah.
Patrik: Right? What is this family meeting all about? Did they give you a hint what they wanted to discuss?
Andrea: No, no. Just probably-
Patrik: Just a general catch up but I guess-
Andrea: No, I don’t think it’s that. I actually think it’s them explaining the situation to us and then pretty much, this nurse isolated her and is saying that she’s deteriorated. They’re pretty much going to say, take her off, cut her off.
Andrea: That’s what I think.
Patrik: Yeah, yeah and you’re probably right. When did they move her into this side room? Yesterday or overnight?
Andrea: This morning. Huh?
Patrik: When did they move her into this side room? Yesterday-
Andrea: This morning.
Patrik: This morning.
Andrea: Really just before I called you…
Patrik: Mm-hmm (affirmative), mm-hmm (affirmative). Okay, I think there’s two ways. The first thing is, did you see that I sent you this end of life care decision making policy? Did you see that?
Patrik: It’s a relatively large document and I know the sections that we can bring up in the meeting, where I believe they’re going totally against-
Andrea: Yeah okay.
Patrik: … totally against what’s in this policy.
Patrik: The other thing and that is something you need to decide, if they’re not treating her, if they’re not giving her blood, we can argue with the policy. The question is do you want to escalate this to a lawyer? That would be my question then. If you want to escalate this to a lawyer then she might get blood today. I don’t know, she may not. You’ve got to weigh that out, probably with your family.
Andrea: Right, okay.
Patrik: Whether you want to escalate this to a legal situation.
Patrik: Or whether you want to wait for the family meeting this afternoon.
Andrea: Well, no, no. The family meeting’s not happening this afternoon. Basically, they even got the other ICU doctor, that was looking after her yesterday and he basically said, “I’m really sorry.” So, they’re actually think she’s dying.
For more information about family meetings in Intensive Care you can check out the following:
- FOLLOW THIS ULTIMATE 6 STEP GUIDE FOR FAMILY MEETINGS WITH THE INTENSIVE CARE TEAM, THAT GETS YOU TO HAVE PEACE OF MIND, CONTROL, POWER AND INFLUENCE FAST, IF YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
Patrik: You must be joking. So, they’re basically just cancelling everything and they’re saying it’s all not happening, she’s dying.
Andrea: Yes, that’s what they’re doing.
Patrik: Oh my goodness.
Andrea: That’s what I think they’re doing because they just brought the other ICU specialist that was looking after her last week and he said to my sister, “I’m really sorry.”
Patrik: Mm-hmm (affirmative). Okay, okay. So, okay, right. So, with the Noradrenaline going at the moment, that probably could keep her alive for the next 24 to 48 hours but if she’s not getting any blood-
- INTERVIEW WITH MEDICAL FUTILITY LAWYER PROFESSOR THADDEUS POPE ABOUT MEDICAL DISPUTES IN INTENSIVE CARE REGARDING END OF LIFE DECISIONS
Patrik: … the Noradrenaline won’t save her, right. So, the question really will come down to are they prepared to give her blood or not? That is, from my perspective, from what I can see, that is the question, whether they she can continue to live or not because the only way to get Noradrenaline off is by trying to give her blood. They may argue, “Oh, it’s,” number one, they may argue, number one, to late, number two, she stopped the stroke, she will never wake up. That’s what they may argue.
Patrik: Now, I think it’s highly inappropriate not giving five days of blood transfusions and then all of a sudden saying, “Oh, we move her into a side room.” I think it’s, I’m speechless.
Andrea: Yes and so am I. It’s malpractice.
Patrik: It is.
Andrea: It’s malpractice.
Patrik: It’s so inappropriate, the way they’re going about it because they basically set her up for this, by not giving her blood products.
Andrea: Most definitely. It’s malpractice.
Patrik: Did you think, what do you think the next steps from the doctor, are they going to sit down with you?
Andrea: Oh, yeah, yeah. They’re just waiting to have that conversation now.
Andrea: The whole army of them.
Patrik: Okay. Where is that conversation taking place? Do you think it’ll take place in her room? Do you think they’ll take you aside?
Andrea: No, once my parents and my husband are here, it’ll be in a private meeting room.
Andrea: And they’re just waiting for us to, well, waiting for me really.
Andrea: I’m just waiting for my husband and my parents to come.
Andrea: I think it could happen now because my husband’s here.
Andrea: So, I’ll leave you on. So, I’ll leave you on speaker.
Patrik: Sure, sure.
Patrik: That’s okay, that’s okay.
Andrea: There’s a whole army of them.
Patrik: Sure, sure.
Andrea: Are you coming? Are you coming in now?
Doctor Cheen: Yes, yes.
Andrea: Sorry, just moving my chair around…
Patrik: That’s okay, that’s okay.
Andrea: All right Patrik. I put you on speaker.
Patrik: Mm-hmm (affirmative).
Doctor Cheen: My apologies for being late. Let me introduce you the team…
Andrea: Patrik, can you hear?
Patrik: Yeah, so, so. So, so.
Doctor Cheen: Doctor Cheen. Who is on the line?
Andrea: Patrik is a family friend and he’s listening in. Patrik.
Doctor Cheen: Yes, hello Patrik.
Doctor Cheen: Doctor Cheen here.
Patrik: Hi, my name is Patrik. How are you?
Doctor Cheen: I’m fine, thanks. What’s your position?
Patrik: I’m a family friend and I’m an intensive care nurse by background. I’ve worked in intensive care for nearly 20 years so, they’re just wanting some support and probably getting some more insights of what’s exactly happening.
Look out for next week’s episode of YOUR QUESTIONS ANSWERED where we continue with the family meeting with the Intensive Care team and where I continue to help Andrea with this challenge of having her 34-year-old sister in ICU!
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
- 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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This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
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