My name is 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, control, power and influence, even if you’re not a doctor or a nurse in intensive care, making sure your loved one always gets the best care and treatment when you have a loved one critically ill in intensive care.

Today I have an email from Linda, who says,

“Hi Patrik,

My 55-year-old sister was in hospital for dialysis. She missed a few dialysis treatments and was sent from a skilled nursing facility via ambulance to the ICU. She had trouble breathing on or around the 29th of September, was intubated and sedated for a few days, but recovered and was pending discharge back to her skilled nursing facility, but didn’t want to go back there.

On or about the 13th of October, while still in ICU, she had just completed her dialysis and called me to tell me she was having trouble breathing again, but then hung up. I called the dialysis nurse and was told that my sister was en route back to her room and was okay.

Approximately two hours later we received the call that she coded and had to be resuscitated for 13 minutes and put on a ventilator and feeding tube. A few days later she was given a CT (Computed Tomography) scan and said she had mild brain injury with RSV (Respiratory Syncytial Virus) pneumonia when she wouldn’t wake up.

A week later she was given an MRI (Magnetic Resonance Imaging) and the prognosis of catastrophic hypoxic brain injury. She opens her eyes, moves her legs and arms, and was battling RSV pneumonia. Me and my mom, her healthcare proxy, made the decision to allow her to have a tracheostomy and PEG (Percutaneous Endoscopic Gastrostomy) in the hopes of her regaining full consciousness. As of today, the prognosis is still grim, but the hospital has moved her from ICU, then stepped down ICU, and now pending discharge to a long-term acute care facility or a skilled nursing facility, whichever her insurance will allow.

We understand if she goes to her mom’s home, it will be a huge commitment with her brain injury, dialysis, tracheostomy, PEG, etc. Currently it seems the hospital doctor is pushing palliative care. Her mother and I are not ready to give up hope. We are not sure where to go from here.

From Linda.”

Linda, I’m very sorry to hear what you and your family are going through with your sister. This is an incredibly challenging situation, and I want to walk you through what’s happening and what your options are moving forward.

Your 55-year-old sister has been through a traumatic medical journey. She initially required intubation, recovered well, but then suffered a cardiac arrest during or shortly after dialysis. The 13-minute resuscitation has led to what doctors are calling a catastrophic hypoxic brain injury, though she’s showing some signs of awareness, opening her eyes and moving her limbs.

The fact that she’s moving from ICU to step-down ICU and is now facing discharge is actually the ICU’s way of saying they believe she’s medically stable enough to transfer, but it doesn’t necessarily mean the prognosis is accurate, let alone final.

Here’s something critical, Linda. You and your mother need to obtain all of your sister’s medical records right now and immediately. This includes:

• The detailed code blue documentation.
• All doctors’ and nurses’ reports.
• All imaging reports and results, CT and MRI, chest X-rays.
• Respiratory therapy notes.
• Lab and pathology results.
• Dialysis records from that day.
• Vital signs chart.
• Ventilation chart.
• Fluid balance charts.

Leave no stone unturned. The devil is in the detail.

Why is this so important? Because the hospital’s prognosis might be based on incomplete assessments or might not be considering all factors. When we review cases here at intensivecarehotline.com, we frequently find that families aren’t getting the complete picture, and having all records allows us to identify gaps, inconsistencies, or opportunities that the ICU team might have missed.

You mentioned the hospital doctor is pushing palliative care. This is extremely common when hospitals want to discharge patients they consider difficult or resource-intensive. Your sister requires dialysis three times per week, has a tracheostomy, has a PEG tube, and has a brain injury. She’s what hospitals consider a high-maintenance patient, and it’s actually their worst-case scenario because she’s a patient who might stay indefinitely with an uncertain outcome, and that is the ICU’s worst-case scenario.

Here’s what you need to understand. Palliative care and giving up hope are not the same thing. The hospital may be pushing this because:

• They need the ICU bed.
• They believe, or want to create the narrative, that the prognosis is poor.
• They want to limit liability.
• They don’t have experience with long-term recovery from hypoxic brain injury.

However, brain injury recovery can take six to twelve months or even longer. The fact that your sister is opening her eyes and moving her limbs just a week after the injury is actually a very positive sign that should not be ignored.

This is exactly the type of situation where a consulting call with myself or with one of my team members can be life-changing for your family. Here’s what we can do during our consultation call:

• Review all medical records in detail.
• Identify what questions need to be asked of the ICU team and the ICU doctors.
• Help you understand the true prognosis versus the hospital’s discharge-driven prognosis.
• Participate in a conference call with the ICU team if needed.
• Advocate and question the medical team’s recommendations.
• Develop a clear action plan for your sister’s care.

We can challenge the medical team’s assumptions, ask the hard questions about why they’re recommending palliative care so early in the recovery process, and ensure that all treatment options are being considered. We’ve helped hundreds, if not thousands, of families in intensive care in situations just like yours get different outcomes by asking the right questions and by advocating effectively.

Right now the hospital is likely offering you two options, a long-term acute care facility or a skilled nursing facility. But there’s a third option that most hospitals won’t tell you about, which is intensivecareathome.com. So let me break down your options.

Option 1: LTAC (Long-Term Acute Care) Hospital. This is only available in the United States, and I know that you are in the United States. It provides more intensive care than a skilled nursing facility, can manage ventilation weaning, better staffing ratios, but may be better equipped for complex patients with tracheostomy and dialysis needs.

Option 2: Skilled Nursing Facility. This provides less intensive care than an LTAC, may not have adequate staff for tracheostomy care, dialysis coordination can be challenging, and it is often not equipped for long-term ventilated patients.

Option 3: Intensive Care at Home. You can find more information at intensivecareathome.com. This is the option that can keep your sister out of ICU predictably and permanently, even if she does need long-term ventilation with or without a tracheostomy, PEG tube feeding management, dialysis coordination, 24/7 intensive care nursing care, and brain injury rehabilitation.

Here is why intensivecareathome.com is the game changer. Instead of being moved around between hospitals, ICUs, LTACs, and skilled nursing facilities where she’s just another patient and another number, your sister can receive ICU-level care in a home care environment, whether that’s your mother’s home, her own home, or another suitable location.

This is especially important for patients who:

• Cannot be weaned off the ventilator.
• Need long-term tracheostomy management.
• Require ongoing dialysis.
• Are recovering from brain injuries.
• Need palliative care but the family wants to maintain hope and quality of life.

With Intensive Care at Home, your sister would have:

• Dedicated 24-hour intensive care nursing.
• Proper tracheostomy care.
• Ventilator management if needed.
• Coordination with dialysis services.
• A personalized rehabilitation plan.
• Family involvement in daily care.
• Most of all, dignity and quality of life in a home care environment.

This option allows you to maintain hope, provide excellent care, and give your sister the time and TLC she needs to potentially recover from the brain injury, all while avoiding the revolving door of ICU readmissions from an LTAC or from a skilled nursing facility, which we see over and over again, especially for tracheostomy and dialysis patients.

Keep in mind that most LTACs and definitely skilled nursing facilities do not have ICU nurses. That’s why patients don’t recover, why patients die, and why patients bounce back into ICU like a revolving door.

So here is also what most hospital doctors will not tell you when it comes to hypoxic brain injury, because recovery is unpredictable and can take many months, sometimes even years. The fact that your sister is showing signs of awareness just a few weeks after a 13-minute cardiac arrest is significant and encouraging. The medical literature shows that brain injury patients can continue to improve for 12 to 24 months. Early assessments within weeks are notoriously unreliable. Patients who show even minimal signs of awareness have potential for further recovery. The quality of ongoing care dramatically affects outcomes.

Your sister needs time to recover, excellent medical management, proper nutrition via PEG, aggressive treatment of infections like RSV pneumonia, consistent dialysis, proper tracheostomy care with critical care trained nurses, and rehabilitation as she becomes more alert. She cannot get this in a facility that is understaffed, like in an LTAC or in a skilled nursing facility where there are no ICU nurses, or in a hospital that wants her gone.

Your Action Plan

Here’s what I recommend you do immediately, Linda.

1. Get access to all medical records. Request complete copies of all medical records from all hospitalizations. You are legally entitled to these as the healthcare proxy or healthcare decision maker and support person.
2. Schedule a consulting call with myself on our website at intensivecarehotline.com or call me on one of the numbers on the top of our website.
3. Get the code blue documentation and all medical records, treatment plans, doctors’ notes, nurses’ notes, ventilation charts, vital sign charts, medication charts, lab results, MRI results, CT results. Leave no stone unturned.
4. Question the palliative care recommendation. Before any palliative care decisions are made, we need to facilitate a meeting with the medical team where we can ask:

• What is the basis for the grim prognosis?
• What specific MRI findings indicate catastrophic injury?
• Why is palliative care being recommended at only two to three weeks post-injury?
• What rehabilitation has been attempted?
• What is the plan for ventilator weaning?
• Has a neurologist specializing in brain injury been consulted?

5. Explore Intensive Care at Home at intensivecareathome.com as an option and learn about how this option could:

• Provide your sister with 24-hour ICU-level home care.
• Keep her out of hospitals and facilities permanently.
• Allow for personalized brain injury rehabilitation.
• Coordinate all her complex medical needs dialysis, tracheostomy, ventilation, PEG feeding.
• Give her the best chance at recovery in a dignified, private, home care, holistic environment.
• Provide palliative care if that becomes necessary and the only option, but on your family’s terms and timelines in your own environment.

Do not let the hospital rush you into anything. Hospitals have a financial incentive to discharge patients quickly. Don’t let them pressure you into making decisions before you have all the information, before you have consulted with me and our team, before you understand all your options, and before you have explored Intensive Care at Home as an option.

Linda, your sister’s situation is exactly why I started intensivecarehotline.com and intensivecareathome.com. Too many families are pressured into giving up hope too early, accepting inadequate care in understaffed facilities, or watching their loved ones suffer through a revolving door of hospital or ICU readmissions.

Your sister has multiple complex needs, tracheostomy, potentially long-term mechanical ventilation if she can’t wean off it, dialysis three times weekly, brain injury requiring rehabilitation, PEG feeding, and infection management. Traditional facilities are not equipped to handle these levels of complexity with the dignity and attention your sister needs and deserves. Hospitals want her out. Skilled nursing facilities and LTACs are understaffed. intensivecareathome.com is the solution that keeps patients like your sister out of ICU predictably and permanently.

You have more options than the hospital is telling you. The prognosis may not be as grim as they are suggesting. It is way too early to give up hope, and you need expert guidance and advocacy, especially with a view of Intensive Care at Home. Don’t make this decision alone. Contact me at intensivecarehotline.com now and book a call with me right now.

I have worked in critical care nursing for 25 years in three different countries, where I worked as a nurse manager for over five years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy, because of our insights, and you can verify that on our testimonial section at intensivecarehotline.com and on our podcast section where we have done client interviews. Our advice is absolutely life-changing.

The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for, they don’t know what questions to ask, they don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care. That’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always.

That’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives. That’s why I do one-on-one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once-in-a-lifetime situation that you simply cannot afford to get wrong. When I talk to families directly, I also talk to doctors and nurses directly, asking all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.

I also represent you in family meetings with intensive care teams. We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care, in case you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com and click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team 24 hours a day in the membership area and via email, and we answer all intensive care-related questions. In the membership, you also have exclusive access to 21 e-books and 21 videos that I’ve personally written and recorded. All of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets the best care and treatment, always. All of that you get at intensivecarehotline.com.

Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

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Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.