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
What is Considered as Maximum Life Support in the Case of My Mom in ICU?
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, Iyah, as part of my 1:1 consulting and advocacy service! Iyah’s dad has been in the ICU for almost two weeks and she is asking why they are being pressured by the doctor to decide between end-of-life or tracheostomy for her dad.
Why Are We Being Pressured by the Doctor to Decide Between End-of-Life or Tracheostomy for Our Dad in the ICU?
.
Iyah: Hi Patrik! I just want to tell that they’re talking about either end-of-life, or tracheostomy for my dad.
Patrik: Okay. So, how do you feel about a tracheostomy?
Iyah: I don’t like it, but if that’s the only way to save him, because he’s in critical illness right now, and if it may be temporary, then I’m okay with it.
Patrik: Right. Another question, Iyah, so they’re talking about end-of-life if they’re not doing a tracheostomy. My question is what makes them so certain that if they don’t do a tracheostomy that he will die? I mean, that’s a statement they’re making, but what makes them so certain, actually?
Iyah: Correct, yeah. I watched one of your videos. And even with allowing them to end their life, they may continue breathing. I understand what you’re saying, and without asking questions. Yeah. I don’t know.
Patrik: Right. I think that’s a question for you to ask, right? I mean, the other thing that I have often seen in ICU, they can help people die. That’s called euthanasia. That’s illegal, just throwing that in there. Most people, when you take them off a ventilator, they don’t necessarily die straight away. They might die eventually, but it’s not a guarantee.
RECOMMENDED:
Iyah: Yeah. I’m actually waiting on a call from the ICU doctor because I want to ask about a trial to see if he can do some breathing on his own because he needs to get off the ventilator. It’s very hard on him.
Patrik: Right. What’s stopping him from getting off the ventilator? Do you know?
Iyah: They’re telling me his blood to PCO2 (Partial Pressure of Carbon Dioxide), PO2 (Partial Pressure of Oxygen), ABG (Arterial Blood Gas) is not looking good.
Patrik: Yeah.
Iyah: His pH body level is just a smidge off. That’s what they said.
Patrik: Right. But why? I understand. I get all of that, but why? Is he in cardiac failure? Is he having pneumonia? Is there something else that you’re unaware of or that you haven’t shared yet?
Iyah: Oh, they treated the pneumonia with antibiotics for the first five days. And today I asked about the virus, and they said that it’s not a concern at this time. And then later on the nurse came back and said the recent cultures from his respiratory growth as gram-positive cocci.
Patrik: Right. Excuse me. And when was that first diagnosed?
Iyah: The fever he had was possibly Tuesday.
Patrik: Right, right. Excuse me. Are they doing daily chest X-rays?
Iyah: Yes.
Patrik: Right.
Iyah: Yep. Some, just a smidge of improvements, I guess, but it is looking better than when he first went in.
Suggested Links:
- YOU DON’T KNOW WHAT YOU DON’T KNOW WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE! (PART 1)
Patrik: Okay. Do you have access to the medical records?
Iyah: I have not asked for that.
Patrik: Right. I mean, the quickest way I can help you with the decision-making, really, is by talking to the doctors directly. That’s the quickest way I can help you.
Iyah: Yes, and I would love that. And I understand your rates, so yes.
Patrik: Right.
Iyah: I want to be in.
Patrik: Right. That would be the quickest way. And how do you get updates from them?
Iyah: Being there in person or calling.
Patrik: Right. And who do you talk to? Do you talk to the doctors? Do you talk to the nurses?
Iyah: I’ve never seen the doctor in person. The doctor has called me one time. Nurses, it’s just the nurses I speak to.
Patrik: And do you find the nurses to be knowledgeable?
Iyah: To an extent, that I know of, yeah. Seems like it.
Patrik: Okay, that’s good. Do you feel pressured by doing a tracheostomy or agreeing to end-of-life? Do you feel like they’re pressuring you?
Iyah: Yes, I certainly do.
Patrik: Right. And what does that look like specifically? Can you be more specific there?
Iyah: Oh, the two choices of either end-of-life or a tracheostomy, when I want to see if he can try to breathe on his own without a ventilator.
Patrik: Right, okay. Have you had an in-person meeting with the doctors?
Iyah: No. Just a couple of days ago I asked to speak to the doctor, and I was told he would call me. That was the 23rd, so I still haven’t gotten a call from the doctor.
Patrik: Okay. Look, and with those choices they’ve given you, are they sort of telling you, “You need to make a decision by tomorrow, 5:00,” or what does that look like?
Iyah: Yeah. The palliative staff, the doctor spoke to me and my brother a few days ago. And the palliative staff called me a few days ago and said on Monday they will call me to try to arrange to meet with the family and discuss the decisions.
Patrik: And what was your response to that?
Iyah: I just said, “Call me on Monday,” because she called me on Wednesday. And I said, “I want to give my dad more time.” She called me the next day after the palliative doctor spoke to me and my brother. The palliative doctor was urgent, saying, “We need to make the decision in the next few days.”
Patrik: I always find that very interesting, sort of that they’re putting people under pressure, and they’re working with their own timelines, but they’re not working with your dad’s timelines. But anyway, we can work with that.
Iyah: Everything’s so urgent. My dad has been in the ICU for almost two weeks, and then at that point, that’s when a palliative doctor came and spoke to me and my brother while we were visiting our dad.
Patrik: Is your dad awake when you talk to him?
Iyah: His eyes open a little bit. This morning his eyes were pretty open, and he was very scared and his mouth was moving up and down, and he was terrified. So, they had to give him some fentanyl, 50 mcgs of the fentanyl and two millilitres of Versed, or something.
Patrik: Versed, Versed. It’s called Versed.
Iyah: It’s Versed.
Patrik: If you explained the situation to your dad, do you think he would understand about choices?
Iyah: Yeah, I-
Suggested Links:
- YOU DON’T KNOW WHAT YOU DON’T KNOW WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE! (PART 2)
Patrik: And if, let’s just say for argument’s sake, let’s just say you gave him two choices, tracheostomy or end-of-life, he would probably choose the tracheostomy, or what do you think?
Iyah: If the tracheostomy may be temporary and not permanent, I think he may say, “Let’s try it.”
Patrik: Right.
Iyah: Even though he has a sweet tooth, and he would miss eating the foods that he loves, which are sweets.
Patrik: Of course. Does your dad have an advanced care plan?
Iyah: No, he does not.
Patrik: That’s okay. Have you and your dad or other family members ever discussed with him what he would want in a situation like this?
Iyah: No. On November 5th, his anniversary for his kidney transplant, I said congratulations to him. And my dad did mention if he had to go back on dialysis, it would kill him. But people say that kind of stuff all the time. If my dad can improve, I think he would want to live.
Patrik: Yeah, for sure. For sure. Okay, okay. Look, I mean, I probably should mention something else. So obviously, we’re talking about end-of-life here, and we’re talking about a tracheostomy. And without knowing all the details, I would argue, that I think, end-of-life is out of the equation, right?
Iyah: Oh, okay. That’s-
Patrik: Well, what I mean by that is, or when I’m saying that, I mean, if you don’t agree to end-of-life, it’s not an option. If your dad doesn’t agree to end-of-life, it’s not an option.
Iyah: Right, right.
Patrik: Right?
Iyah: Yeah.
Patrik: So that inevitably leads to the tracheostomy. However, the question that hasn’t been asked yet is, and this is a question I would like to ask, have they done everything beyond the shadow of a doubt to get your dad off the ventilator and avoid the tracheostomy? I don’t have the answer to that, but it’s something we can find out.
Iyah: I don’t believe so because I understand there’s a trial extubation, or whatever that’s called.
Patrik: Yeah.
Iyah: I would like to have that performed before proceeding to any possible next steps. And that’s why I wanted to talk to the doctor about it.
Patrik: Yeah, yeah. Look, a trial extubation, I’d advise for that. But a trial extubation also has some risks. But again, this is why we need to talk to them and find out, what have they done? What have they not done? What medications is he on? And find out a little bit more, that there’s, yes, you’ve given me very valuable information, but it’s not the full details.
Iyah: Yeah. Yes. I recall from your videos, the ICU nurses will give only half of what they know.
Patrik: That’s right.
Iyah: I totally get that.
Patrik: That’s right. That’s right. So maybe the next step, Iyah, is for you and for me to talk to the doctors or talk to the nurses. That would be the next step.
Iyah: I would love that. Yes.
Patrik: And you’ve seen what my options are?
Iyah: Yes, your rates. Yes.
Patrik: Right, right, right. You can choose from one of what works best for you, and then we can get a call organized.
Iyah: Yes. I would like the seven days.
Patrik: Yeah, it’s not-
Iyah: I understand it does not have to be consecutive days.
Patrik: Yeah, you could choose that at your own pace. Own pace.
Iyah: Yes. I think that would be very viable for us because right now it seems like in the next few days we need to make the decision. And I’m really pressured. My siblings and I, we’re all split. Four siblings, including me, and we’re split.
Patrik: Right. What do you mean when you say you’re split? Are you…
Iyah: Two are along the lines of, “We don’t want dad to suffer anymore.”
Patrik: Right.
Iyah: Sister and I are saying, “We want to give him every possible chance, and let’s not talk about end-of-life yet.” And so it’s not perceived and as real, end-of-life.
Patrik: Yeah. I see. I see. Yeah, yeah. Sure, sure. Yeah, sure. And that’s why I asked you earlier, are you the decision-maker? And it sounds to me like you are.
Iyah: Yeah. It sounds like I am from what the nurses told my younger sister. I am a guardian for my dad and make the decisions.
Suggested Links:
Patrik: Yeah. And your other siblings are not objecting to that, are they? They’re not objecting you being the guardian?
Iyah: Well, like I said, the other two are wanting in end-of-life. They don’t want him to suffer, so they will… But my younger sister, she’s with me.
Patrik: Look, I mean, yeah, as long as you are the guardian, you are the decision-maker. I also suggest that you should get your dad, excuse me, into the conversation.
Iyah: Yes. If he can get off the ventilator, yes.
Patrik: Well, but excuse me, not only to get him off the ventilator. If you feel like it’s appropriate, and I do believe it is appropriate. That is my personal and also professional opinion. If you think your dad understands what you are telling him, then you should explain the situation to him and should let him make his own decision.
Iyah: He’s been so sedated. He doesn’t have movements in his hands.
Patrik: Oh, okay.
Iyah: He can’t follow commands. He can only open his eyes slightly and just barely there.
Patrik: Right. I see, I see. Fair enough, fair enough.
Iyah: Yeah.
Patrik: Yeah, no, I hear you there. I hear you there. Yeah. No, that’s okay.
Iyah: His body’s not liking this at all. It’s really a struggle for him.
Patrik: Right. Yeah. No surprises there. I mean, nobody likes being on a ventilator in ICU. Maybe just on the suffering aspect, do you think he’s suffering?
Iyah: Right now on a ventilator, yes.
Patrik: Right.
Iyah: He is having his mouth up and down this morning trying to move, and his eyes are just pleading for help, tears and all.
Patrik: Right, yeah. Yeah, no, understood. Understood. Right. And unfortunately, when someone is coming off a ventilator, unfortunately, there is often an element of suffering. Yeah. It’s part of the process. Just because someone is suffering temporarily doesn’t mean you can’t help them in the long run.
RECOMMENDED:
Iyah: Yes. That’s how I see it.
Patrik: Yeah, yeah, yeah. Okay. Iyah, do you have any questions that have not been answered so far in terms of how I work or anything?
Iyah: I would like to ask your opinion on two things. With the new virus, the gram-positive cocci or something, can that be life-threatening?
Patrik: Oh, look, I guess any virus… If it’s a gram-positive, it’s not a virus. It’s actually a bacteria. Anything can be life-threatening, but when someone is in ICU, they’re often going from one infection to another.
Iyah: Yes. I do recall that from your videos. Yep. Two steps forward, one step back.
Patrik: Right. Two steps forward, one step back. So yes, anything in ICU can be life-threatening. There’s no question about that. By the same token, as I mentioned to you before, approximately 90% of ICU patients survive.
Iyah: That’s right. That’s right. I’m holding onto that. Yeah.
Patrik: Yeah. When I say survive-
Iyah: Holding onto it.
Patrik: You should definitely be holding onto that. But I should also be clear there that when someone… We’re talking about people leaving the ICU alive.
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?
You get to that all important feeling of making informed decisions, get PEACE OF MIND, CONTROL, POWER AND INFLUENCE when you download your FREE “INSTANT IMPACT” report NOW by entering your email below!
In Your FREE “INSTANT IMPACT” report you’ll learn quickly how to make informed decisions, get PEACE OF MIND, real power and real control and how you can influence decision making fast, whilst your loved one is critically ill in Intensive Care! Your FREE “INSTANT IMPACT” Report gives you in-depth insight that you must know whilst your loved one is critically ill or is even dying in Intensive Care!
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 you 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!
Make sure you also check out our “blog” section for more tips and strategies or send me an email to [email protected] with your questions!
Also, have a look at our membership site INTENSIVECARESUPPORT.ORG for families of critically ill Patients in Intensive Care here.
Or you can call us! Find phone numbers on our contact tab.
If you want a medical record review, please click on the link here.
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!
Related Articles:
- 5 Ways to have control, power and influence while your loved one is critically ill in Intensive Care
Related Articles:
Quick Tip for Families in Intensive Care: Weaning off VA ECMO and VV ECMO Simultaneously?
Quick Tip for Families in ICU: Extubation, Tracheostomy or Hospice? What is Best for My Loved One?
Quick Tip for Families in ICU: The Difference Between “Ending Suffering” and Continuing Treatment!
Quick Tip for Families in ICU: My Wife’s in ICU with Cardiac Arrest & Tracheostomy, Can I Make Decisions?
Quick Tip for Families in Intensive Care: My 28-year-old Husband had a Liver Stab Wound & His Heart Stopped! ICU Wants to Stop Treatment, Help!