Sepsis
- nmbrown6
- Jun 3
- 7 min read
The recent passing of the actress Patti Duke from sepsis triggered sad and almost tragic memories of Damien's experience with sepsis. In August of 2012, we traveled to La Jolla, California for an intense week of physical therapy. A doctor in Florida had put us in contact with a physical therapist in California. We had also spoken with a former patient of his who had published a book about her treatment. She had made remarkable recovery from her head injury and was a physical therapy student in Ft Lauderdale. She was a member of a group of students who worked with Damien during a pool therapy session in Plantation, Florida.
The physical therapist scheduled a week of one-on-one sessions covering an eight-hour period. The first day of therapy (6 Aug 2012) went well. However, by day's end, Damien had developed severe inflammation and discoloration in both feet. The therapist suggested that we take Damien to an emergency room for evaluation (Damien's bones are soft and the concern was that maybe some bones had fractured during the intense workout.).
We called for a taxi to take us to the hospital. When the taxi arrived, the driver was irate and refused to transport a wheelchair patient. (We would have put Damien in the back seat and put the collapsible wheelchair in the trunk. The driver would not hear of it.) The driver drove away in a huff - squealing tires and excess acceleration. Fortunately, a second taxi arrived and agreed to transport us to the hospital. Shortly, at around 6:15 PM, we arrived at the Scripts Green Hospital's emergency room. We removed Damien from the taxi and entered the emergency room. The room was full of people- I do not know if they were all potential patients or were family members waiting on their hospitalized loved one. We placed Damien near the back of the waiting room and I went to get the paper work to get him entered. While I was filling out the paper work, they came a took Damien into the examining area (rather quickly I thought). Wajih (Damien's nurse) and Paula went with him and I stayed behind to get things completed.
To be diagnosed with sepsis, you must exhibit at least two of the following symptoms, plus a probable or confirmed infection:
Body temperature above 101 F (38.3 C) or below 96.8 F (36 C)
Heart rate higher than 90 beats a minute
Respiratory rate higher than 20 breaths a minute
Significantly decreased urine output
Abrupt change in mental status
Decrease in platelet count
Difficulty breathing
Abnormal heart pumping function
Abdominal pain
Damien had not shown any symptoms during the day. He did not have a fever. However, we did not take his temperature so it may have been lower than usual. Since his crash, Damien had a very high pulse- 95 to 120 beats per minute. So, a rapid heart rate was not a warning. During the day, Damien was flat on his back for a long period. He did develop a labored respiratory rate but it was not rapid. His breathing returned to normal once he was upright and off his back. We had changed Damien's briefs during lunch. Damien is not regular with his urine output. Sometimes he will void three of four times during a 12-hour period. Other times, he can wait a full 8 to 12 hours before emptying the bladder. He is considered incontinent, but obviously he can control his bladder - just is not able to let us know prior to the event. So, we did not notice any differences in his urine output. Damien's mental status is very difficult to determine considering his injuries. He does answer yes or no by moving his head. He will also make choices when asked by indicating one finger for one choice and two fingers for another choice. His mental status did not seem to be different on that day nor on the preceding days. Hs breathing seemed normal once we had him sitting up. When Damien is uncomfortable, he will move his legs by bending at the knees then extending them. This is usually one leg at a time in a rotating pattern. He will do this when he develops a rash or raw area around the peg-tube. So, we did not notice discomfort that would indicate any abdominal discomfort or pain. The remaining symptoms require professional exams to determine- which were not available nor performed during the day.
When I went to the exam area, Paula and Wajih were standing in an unoccupied exam area. Damien was around the corner in an exam area that had 2 curtains pulled around and the foot of the bed area open. A curtain had been drawn across the entrance but the in and out traffic was so great that it did not remain closed. His area was full of hospital personnel-doctors, nurses, and technicians. You could tell that they were quite busy. I noticed that a set of cardiac paddles were on the bed next to Damien. Paula mentioned them and I (in full blithe spirit mode: totally naive and unaware ) said, "They just have them ready in case they need them." We stayed in our area until 10:15 PM. During our wait, one particular emergency room technician visited with us. He did not mention any specifics, just generalities as a way to keep us informed. At 10:15 PM, the staff took Damien up to the Critical Care Unit. The technician took us through a maze of hallways, on a couple of elevators, and finally up a staircase to the Critical Care Unit where Damien was being set up in one of the patient areas. When we finally spoke with a doctor, he was very concerned and wondered if Damien would make it through the night. He did say that Damien was severely septic. He did not mention which pathogen caused the severe infection but it was most likely a pneumonia causing agent. I thought the doctor was being ultra conservative and careful because I did not "feel" that Damien was not going to make it. I knew he was in for a hard few days, but that he would eventually leave the hospital. (Blithe Spirit at work again). Paula and I discussed the situation, and I agreed to stay at night and Paula and Wajih would return to the hotel to get some rest.
My night with Damien was basically uneventful. I sat next to his bed, held his hand and watched the monitors. I had brief visits with the nurse during her care of Damien. Once I dozed off and the nurse told me that I could not sleep in the room. That if I wanted to sleep, I could go to the waiting room just outside the Critical Care Unit. I did go to check it out but the waiting room was packed with family members of other patients-most were sleeping on chairs and couches, others on the floor. The waiting room population did fluctuate during our stay. Sometimes, I would be the only one to check out the area. I did find the vending machines. After that first night, I brought a book along so that I could read during my visit with Damien. Most of my time was spent reviewing the monitors and watching Damien.
Paula and Wajih returned the next morning and I went home to sleep and to be back by 7:00 PM that evening. Wajih remained with us until his scheduled flight back to San Antonio that Saturday. We maintained that routine for the remainder of our stay. At 8:00 AM, Paula would catch a taxi at the hotel and be taken to the Scripts Green Hospital. The same taxi would return me to the hotel. That evening we reversed the trip. I would be taken to the hospital at 7:00 PM and Paula would return to the hotel.
I was a bit shocked when I learned that Damien's emergency room experience was traumatic. Shortly after they had Damien in the exam room, he experienced cardiac arrest. They used the cardiac paddles to regain a heat beat- I have no idea how many times they had to resort to paddle stimulation. The remaining four hours were spent frantically stabilizing organ functioning and maintaining vital signs.
We were very fortunate that Damien was at the hospital and being cared for by an exceptional staff.
1. If we had walked Damien back toward the hotel, he would have perished. No way would EMS be there fast enough to get his heart beating again.
2. If we had put Damien in bed in the hotel room, he would have perished.
3. If we had taken a taxi to a restaurant for supper, he would have perished.
4. If we had done anything BUT go to the emergency room, he would have perished.
5. If we had been in Ava Marie, Florida: Buhler, Kansas: or Luckenback, Texas; he would have perished. (We have visited all of these areas).
Damien had very good medical staff overseeing his care. I am sorry but I do not remember all their names. I do know that Dr. Bao Luu was the physician in charge of Damien's case. For the first four days, they were very concerned for Damien's survival. By the 10th day, they were a bit more positive. By the 20th day, they were bringing in long term therapists- medical companies that provided personalized braces for both hands: another company developed braces for his feet to maintain ankle movement and prevent pressure sores.
On the 5th day, they had Damien's bed set so that Damien was in a sitting position. Then the bed would bounce and vibrate. This would mainly help breakup any fluids that were remaining in the lungs, help stimulate blood flow, and serve as sensory input. Damien was entubated for his 26 -day stay. (This proved to be a problem with his vocal cords a few years later.) During this time, he had a vast regimen of antibiotics, medicines, and saline solutions.
To be off that long from work, I had to use all of my annual vacation days. Then I had to sign up for medical days. One Friday, work called and said I was running out of time and needed to return to work. Paula remained at the La Jolla Hilton for the last ten days of August. She worked transportation out with one particular driver who transported her to and from the hospital each day. On the 25th of August, they transferred Damien to triage which was outside of but near the Critical Care Unit. They monitored Damien remotely but Paula made arrangements for him to be checked frequently during the night. Her concern was that something uncomfortable (an arm or leg moving off the bed) would occur and not show up on the monitor. On 1 Sept 2012 , I flew to La Jolla. Damien was discharged from the hospital on the 3rd of Sept 2012. We left the hospital for the airport and returned home.
One major change resulting from his hospital stay is that his pulse returned to a normal rate. Before the electroshock, his pulse ranged from 95 to 110 beats per minute-often going as high as 120 bpm. Now his pulse is in the 60s and 70s. The staff at the Scripts Green Hospital are excellent! We are very fortunate to have Damien with us. He is still making small improvements.
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