This is the story of Michael
Michael is living an unusual life and at the time that I was privileged to be involved in his care, he
was in his prime years, in his early 40’s.
Michael is dependent on other people, as well as on equipment to keep him alive. Michael had
sustained a spinal injury in his late 20’s whilst playing sport and he ended up paraplegic(C4/C5), with
the ability to move his arms.
Michael had a good background, he was well educated with a University business degree and he had
a loving Family around him. His father was a successful Business man himself and Michael basically
inherited a car dealership from his father in which he was working in until his accident. Michael also
had an older brother and a younger sister.
Michael managed to get back to work after his accident, as he was able to do most of his work in a
wheelchair and he had the ability to drive a car. So he had a fairly good Quality of Life, considering
that he was working, earn a living and he was mostly independent.
A few years after his sport accident, Michael also sustained a stroke, which was a major setback for
him and this time he spent a prolonged period in Intensive Care that left him ventilator dependent
with Tracheostomy. Michael had difficulties to be weaned off the ventilator and after a few failed
weaning attempts, Michael had enough and all he wanted was to get out of Intensive Care. It was
obvious to the medical and the nursing team that he would require ongoing mechanical ventilation
with Tracheostomy, but it was even more obvious that Intensive Care wasn’t the right place for him
to be, as Intensive Care is a very limited environment to be, for somebody who is medically stable
and ventilator dependent with Tracheostomy.
In his first few years of paraplegia and ventilator dependency, Michael struggled to come to terms
with his ordeal. A young man, previously fit, healthy and active, all of a sudden bound to a
wheelchair and now he was even facing worse, as he was ventilator dependent with Tracheostomy.
Michael eventually got discharged home from Intensive Care and unfortunately he never managed
to be weaned off the ventilator and he ended up in the care of his Family, with his mother as the
main carer, but also with the support ofnon-family carers. Not an ideal scenario for somebody who is
ventilator dependent with Tracheostomy.
Michael and his Family struggled with his care. Especially the 24 hour ventilator dependency with
Tracheostomy became a massive challenge, with frequent suctioning required, as well as frequent
inner cannula changes, in order to maintain a safe airway. This left Michael’s and his Family’s Quality
of Life at a less than optimal level. Frequent readmissions to ICU with Pneumonia were a fairly
In his first few years at home, there were no specialised Intensive Home Care Nursing Services
available and Michael was unable to go back to work in his car dealership, something he was able to
do before he had his stroke and something that he dearly missed.
Not too long after Michael got discharged out of Intensive Care home, Michael’s mother became
very sick and weak, as the stress of looking after her son became all too much, and within less than
12 months after Michael came home from ICU his mother passed away.
After his mother’s death, Michael’s Family reorganised his care and now he was mainly left in the
hands of carers, who had no formal training on ventilators or Tracheostomy care, and like before, his
Quality of Life was not at an optimal level and he was always at risk to be readmitted to Intensive
Care- an environment Michael did not want to go back to.
It was around the same time, when Michael and his Family first heard about a new nursing service
that specifically offered Intensive Home Care Nursing services for mechanically ventilated Customers
with Tracheostomy and their Families. The nursing service was exclusively working with Registered
Nurses who had Critical Care Nursing experience and the staff employed by the nursing service, were
highly qualified with specialist skilled and also had the right mindset to take care of Michael in a way
that would improve his and his Family’s Quality of Life.
Fast forward, a 24/7 roster got organised and funding was also arranged, in order to make Michael’s
care possible that would improve his and his Family’s Quality Of life.
As soon as a 24/7 roster was in place and as soon as qualified staff with specialist skills started
working with Michael and his Family, Michael’s Quality of Life, as well as his Family’s Quality of Life
improved massively. The nursing service had a very different approach and a very different mindset
in terms of possibilities and opportunities for somebody being ventilator dependent with
Tracheostomy. The nursing service, bringing the right skills and the right mindset to the table, also
offloaded the burden and the responsibility of care from Michael’s family, who were finally able to
live their own lives, without constantly having to worry about Michael’s well being.
Michael was now not any longer at risk of readmission to hospital, as his ventilator care, as well as
his Tracheostomy care was in the hands of professionals who truly knew what they were doing.
Michael was also able to start working again, as he was still able to move his hands and he was
obviously fully conscious, as he had mostly recovered from his stroke.
The nursing service managed to get Michael back to work in his car dealership for around 20 hours a
week. This was only possible because he always had a nurse accompanying him to take care of and
manage the ventilator and the Tracheostomy. That sense of duty and purpose to go back to work got
Michael occupied and also got him exhausted pretty quickly, but over time his stamina improved
and Michael certainly had things to look forward to and he had things that kept his mind occupied.
Even though Michael’s Quality of Life was not back to where it was before he became ventilator
dependent with Tracheostomy, he still had a good Quality of Life and he had people around him with
the commitment, the skills and the determination to make his life better.
Patrik Hutzel, Critical Care Nurse, September 2012
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