Why does my loved one act different?
Most critical illness affects the brain and confusion is very common in
Critical Care. To ensure comfort, we often give sedation and pain medication
which could also make the patient seem sleepy or confused. If the patient
has a breathing tube in place, he or she will not be able to talk until
the breathing tube is removed.
Why isn’t he/she getting better?
Patients cared for in Critical Care are very sick. Improvement can be slow
and setbacks are common, and sometimes patients decline despite maximally
aggressive care. Things can change from day to day and it can be difficult
to predict the final outcome. The best way to deal with this is to get
daily updates from staff and to focus on the short-term daily goals.
What are all of these tubes connected to my loved one?
Your loved one may look different because of his/her condition and various
tubes and devices in place. Each device has a purpose. The endotracheal
tube in the patient’s mouth connects them to the breathing machine
so that they can breathe safely. A feeding tube in the nose or mouth allows
delivery of nutrition and medications. A catheter in the bladder allows
careful monitoring of urine output and kidney function. Large IVs in the
arm or neck, called PICCs or central lines, allow us to administer multiple
strong medications safely and at the same time. Please ask the nurse if
you have questions about other tubes or devices.
Why are the doctors always changing?
In order to ensure that there is a critical care specialist, or intensivist,
in Critical Care 24 hours a day, the doctors work in 12-hour shifts. Because
of this, the intensivist taking care of your loved one changes during
the day shift and night shift and every few days. Sometimes, it could
be challenging to see a new face after becoming familiar with the previous
doctor. Our group of intensivists are all well trained in critical care
and communicate very clearly about the patients so that care will remain
optimal when a new doctor comes on.
What can I do to help?
Talk to the bedside nurse regarding activities that you could participate
in such as passive range of motion, oral care, massage, reorientation,
calming techniques, helping them to fill out the journal, meal/menu selection
and feeding assistance. If your family member is confused, you can try
to help reorient them throughout the day. Please follow rules and visiting
hours so that the health care team can provide optimal care.
How can I get an update and communicate with the doctors?
A nurse is at the bedside for most of the day and can usually provide you
with an update. Intensivists usually make multidisciplinary rounds in
the morning, around 10 a.m., and can provide a brief update and answer
your questions at that time. With large families, it is much more efficient
to have one spokesperson get updated and pass on information to others
rather than the physicians updating everyone separately throughout the
day. If you are unable to make it to morning rounds for an update, please
ask your nurse to contact the physician so they could update you in person
or by phone. Remember that our intensivists are taking care of several
patients and often have unpredictable emergencies, so your patience is
appreciated. In special circumstances, the physician will try to set up
a formal meeting with your family to discuss the situation in more detail.
Where will they go after Critical Care?
Most patients who survive their critical illness and improve, will be transferred
out of Critical Care to a regular bed in the Hospital. Remember that they
will have a new doctor managing their care once they leave Critical Care.
The health care team will assess their condition on a daily basis to determine
what level of care they will need when they leave the Hospital. Some patients
are able to make enough recovery to go back home. However, some patients
will be too weak to go home and will need to be transferred to a facility
that provides extensive rehabilitation. In these situations, case managers
are available to provide you with information about the options of various
facilities where your loved one can go after their hospital stay.