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Quick Tip for Families in Intensive Care: My Dad’s in ICU for 4 Days with Cardiac Arrest & Brain Injury, Can ICU “Pull the Plug” Without Consent?

Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

Today, I have an email from Deborah who says,

“Hi Patrik,

My dad was brought into intensive care after having an epilepsy seizure whilst in a canal boat and fell into the water. He was still seizing after they removed him from the water fairly quickly as he had no evidence of drowning in his lungs, but his heart stopped but was started again and then he got transferred to the hospital. They immediately didn’t think it was positive and they told us to say goodbye.

However, after being put into an induced coma, he became stable whilst we were there on the 4th and then on the 5th, his vitals recovered, he contracted pneumonia. About a day or so later, his lungs looked normal apparently. They reduced his sedation in the morning of the 5th, but he started feeding and so, they felt it was best to re-sedate him.

The following morning, they reduced sedation again. However, I felt he was still feeding as he was twitching in his face, and they didn’t seem to do anything about it. Until the following day, they gave him stronger medications for it. We were told again, doom and gloom, he won’t make it, and he hasn’t woken up yet. This was on the 5th as well.

The 6th, he started yawning and having small facial expressions but nothing consistent and opening one eye, but again, not consistently.

We get to Saturday, and they said they did an EEG (Electroencephalography) a few days before and the CT (Computed Tomography). They were going to give results but EEG that was clouded by the seizures, and the CT showed apparently a normal brain so they were lost to understand. We have no questions to ask. We didn’t know what to ask.

Now, it’s Monday and they have reviewed the images again and have said he’s unlikely to have any recovery or quality of life. They said that if he has a heart attack or has anything occurring between now and when we go in tomorrow, they won’t be resuscitating him.

My question is that what should we be asking? How can the same scan change? Are they allowed to just say it’s over to pull the plug? We are lost with what to even ask.

Many thanks for your website. I’m so glad I found it today.

From, Deborah.”

So first off, the timelines here are extremely short. You’re talking about a few days and you’re waiting for things to develop quickly, which unfortunately they won’t.

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. So, this is the biggest challenge for you. You haven’t seen a situation like that before, which is fair enough. You’re finding it incredibly difficult steering the territory, which is also fair enough.

I have worked in critical care nursing for nearly 25 years in three different countries where I worked as a nurse manager for over 5 years and where I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can confidently say we have saved many lives with our consulting and advocacy as is verified and documented on our testimonial section at intensivecarehotline.com. It’s also documented on our intensivecarehotline.com podcast where we interviewed some of our clients, verifying the outstanding work we’ve done.

So, in a situation like this, yes, there is a reasonably high chance that your dad has some brain damage and potentially irreversible brain damage. But you’re talking about only a few days since he got admitted to intensive care. Therefore, you are just scratching the surface here.

Most patients in intensive care survive. Approximately 90% of patients in intensive care survive and leave intensive care alive. That doesn’t talk about what their quality of life looks like, doesn’t talk about what their life looks like in six months’ time, in six years’ time, nobody knows. But I think your dad has a very good chance to get out of intensive care alive to give him a chance. It is quite usual that patients after an anoxic or hypoxic brain injury after cardiac arrest have some twitching or some seizures, that is nothing unusual.

So, what to do? He needs some anti-seizure medication and that might also help him to wake up. At the moment, it looks like he’s heavily sedated and you are sort of saying, “Well, today they stopped sedation and then he didn’t wake up by the end of the day.” That’s not how waking up after an induced coma works, especially not with a brain injury. With an induced coma, when patients are waking up, it’s more like switching on a light with a dimmer rather than switching on a light with a switch.

With the doom and gloom they’re telling you, don’t be dissuaded by it. The reality is that, if life support was stopped today, the outcome he’s probably going to die. By continuing treatment, you will give your dad a fighting chance to see what happens, but that you will only find out over time. He might need a tracheostomy to give him that chance. He might be able to be extubated and have the breathing tube removed.

Well, where we can help is look at the medical records, give you a second opinion, or talk to the doctors and nurses directly and find out exactly what’s going on. What ventilator settings is he on? What medications is he on? You are missing many, many critical ingredients here. What ventilator settings is he on? What medications is he on? What are blood results?  CT scan, MRI (Magnetic Resonance Imaging) scan reports, EEG reports? It’s like piecing together a puzzle to really get an understanding of what is happening.

Now, you’re saying here it’s Monday and they have reviewed the images again and they have said it’s unlikely to have any recovery or quality of life. What is quality of life? What is it? It’s a subjective measure, not an objective measure. What’s a good quality of life for you might be different to what’s a good quality of life in the perception of the intensive care team, it’s all based on perception.

So, they said, “If he has a heart attack or anything occurring between now and when we go in tomorrow, they won’t be resuscitating him,” well, that is not up to them. Intensive care teams are incredibly good at pretending to do whatever they want until you challenge them. They can’t just say we’re not going to resuscitate your dad that could be perceived as murder. You got to call things for what they are and not for what they’re not.

So, I don’t understand why families in intensive care are so naive and think, “Intensive care teams can just do whatever they want.” Think about that. Letting your dad die without you agreeing to a DNR (Do Not Resuscitate), that could be perceived as murder. Are they allowed to say it’s over to pull the plug? Well, think about that. Once again, Deborah, think about this logically. Can they do that? Well once again, that could be perceived as murder. Always use common sense when you have a loved one in intensive care. Don’t be dissuaded by the perceived power of intensive care teams. Your dad will need time and only time will tell you where this is going. Only time will tell you that. So always apply logic, always apply common sense. Give your dad time. He might need a tracheostomy to give him that time if he can’t come off the ventilator, but it’s early days. I can see you’re trying to jump to conclusions and you’re trying to rush to conclusions. The conclusions will come only over time, not in a short period here.

So, I hope that helps.

Because we get so many questions from families in intensive care, that’s why we created the membership for families of critically ill patients in intensive care and you can become a member if you go to intensivecarehotline.com if you 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 questions intensive care related. In the membership, you will also have exclusive access to 21 eBooks and 21 videos that I have personally written and recorded. The access to me and my team and the access to the exclusive videos and eBooks will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment so that you can influence decision making fast when you have a loved one critically ill in intensive care.

I also do one-on-one consulting and advocacy over the phone, Zoom, Skype, 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 can’t afford to get wrong. I also talk to doctors and nurses directly and I ask 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 if you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected] with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, comment below what do you want to see next, what questions and insights you have from this video, and share the video with your friends and families.

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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.