Question: September, 2021
What other options for recovery can I ask the doctor about? Cree D.
Thank you for your help. My mother has been in ICU in Georgia for 4 weeks now. She has been on the ventilator for 12 days now. They won’t put her in the prone position because they said she’s to sensitive and her oxygen levels drop when they turn her. They said she doesn’t qualify for ECMO and that they can not put her on a trachea now because she is requiring too much oxygen. What other options for recovery can I ask the doctor about? My mother wants to live. The last thing she said right before they put her on the ventilator was “I want to live.” Then the nurses said, well let us put you on the ventilator. Please help me. I need my mother to live also.
Doctor Response:
In some cases, it is true that prone positioning cannot be tolerated by the patient and their oxygenation actually gets worse. In addition, her lack of eligibility for ECMO may have to do with many other considerations as well, such as how long she has been ill, her other medical illnesses, age, and several other factors. Tracheostomy is in fact not an option for patients who require very high support levels on the ventilator.
Unfortunately, we still do not have a cure for this disease. What we have learned however is that we must manage the patients with safe ventilator settings, steroids, looking for blood clots, carefully selecting anticoagulation, and waiting. This disease takes a very long time to heal and the best that we have learned so far is to be patient and wait while we support carefully.
Kindly,
Negin
What strikes me most about your question is its sincerity, compassion, and logic. Having taken care of many people who’ve had COVID in an ICU (not that anyone is the same as your mother, of course!), I’ve learned a couple of things that I’ve passed on to patients and families alike in this situation…and they say it helped.
-First, it takes patience, because it takes a long time to get through COVID in an ICU setting.
-Second, it sounds like you are talking through treatments with the medical team in a straightforward, honest way—this is key. The topics you’ve talked about are very appropriate—and it also sounds like the medical team has thought through these too.
-Third, even though there are life support machines and smart people to manage them, there are still so many things that are out of our control—whether we are doctors, nurses, or family members. I wish I had specific advice on how to deal with uncertainty and stress better, but it seems that we each have our own way of coping. But it is important to try to cope with this. There are people in the hospital who can help you.
-Last, each day is different and I sincerely hope that your mom will have a better day tomorrow.
Chris
Negin Hajizadeh MD, MPH (Her, She) (pronounced Neg-in Huh-jee-za-deh)
Director of Decision Science
Center for Health Innovations and Outcomes Research (CHIOR)
Associate Professor of Medicine
Department of Medicine Division of Pulmonary Critical Care and Sleep Medicine
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Feinstein Institute for Medical Research
Christopher Cox, MD MPH
Duke University Medical Center –
Division of Pulmonary & Critical Care Medicine –
Clinical Faculty Palliative Care Medicine
Co-Director / Duke University Medical Intensive Care Unit
Director / Duke Program for Supporting People and Enhancing Recovery (ProSPER)
Box 102043 – Hanes Hall, Room 105c – Durham, NC 27710
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