The Trauma of Sepsis
I can remember it like it was yesterday. Monday, October 8, 2012. 2:32 AM. My eyes opened right as the lights in my hallway turned on. I knew something was wrong. I heard my mother yelling at my sister to call 911. She bursts into my room, “Put some clothes on, your father can’t breathe.” I hurried and grabbed a sweatshirt and pulled sweatpants on over my shorts and ran downstairs. I looked into my parent’s bedroom. There my dad was, slumped over in his reclining chair, struggling to catch his breath. Moments later, paramedics showed up. My dad was a paraplegic, he was paralyzed during routine back surgery 8 years prior. There were wheelchairs in the dining room and the bedroom, my sister also informed the 911 operator of this. The paramedic, a young female, put the stretcher in the dining room and went in to look at my dad. She took his vitals and noticed that his skin was yellowing, put on oxygen mask on him then asked if my dad could walk out to the stretcher – THREE TIMES. And THREE TIMES we had to tell her NO – he can’t walk. My mom and I pulled my dad up and got him on to the stretcher, with no help from the paramedic. At this time, another paramedic showed up and helped her get my dad out to the ambulance. They drove away, no lights, no sirens. My mom and I left the house 10 minutes after they did. We wanted to give them time to get to the hospital before we got there. Even leaving 10 minutes after them, we still got there first and it’s nearly a 15-20-minute drive.
A little after 5 AM, a doctor finally came out and talked to us. He informed us that by the time the ambulance got to the hospital, my dad’s blood pressure dropped so low that he lost consciousness and he had started to aspirate. They said they had pumped liters of blood and waste from his stomach and lungs, which did not make any sense to anyone – why was he not throwing up at home? They had pinpointed the problem. A gallbladder infection had made its way into his blood and caused him to go septic. They wanted to remove his gallbladder, but he was still too unstable. So, we waited. Around 9 AM, he was transferred up to the MICU. I was not prepared for what I was going to see. I remember sitting in the waiting room of the MICU and waiting for them to bring him up. I heard the elevator doors open and looked out the doors of the waiting room and there he was, being pushed down the hall on a ventilator. We sat and waited while they got him situated in his room and then went back. When I walked into the room, my dad, who was 260 pounds, looked so small in his hospital bed. He was hooked up to a ventilator, an oxygen saturation machine, and the most I think I counted, somewhere around 10-15 IVs, maybe more. Basically, he was on life support.
That night, he was stable enough to have his gallbladder removed. After the surgery, it was about 10:30 PM, we went home. I had just stepped out of the shower when my mom got a phone call – he was in cardiac arrest. We rushed down to the hospital. They were able to get him stable. My brother, who was in Pittsburgh at the time for school, had his friends drive him up. When he got there, around 2 AM, we all just sat there at stared at each other. We didn’t know what was going to happen next. We stayed at the hospital that night, sleeping on the floor of the waiting room. I can still feel out cold and hard that floor was, using my jacket as a blanket and my purse as a pillow. Around 6:30 AM, we were woken up by code blue calls over the intercom. My mom looked at me and said go look, I got up and ran to the doors leading into his hall and saw a group of 10-15 doctors and nurses hovering outside his door. I ran back yelling it’s him and run back to his room. From Monday night, to Tuesday morning he had coded five times. The last two codes were the calls we heard. After this, they had placed him on constant dialysis in hopes to flush the infection out of his blood. The rest of Tuesday went smoothly, no codes, just sitting and praying.
Wednesday morning, we had a visit from our family doctor who told us we should start thinking about palliative care. The hospital staff was furious that came in and told us that. They said he had no right coming in and talking to us because he had no idea what was going on yet. Again, Wednesday went by smoothly, no codes. His sister had flown up from Florida to be with him and help take care of my grandma. By the time Thursday got around, our hopes were increasing. We were told the first 48 hours are crucial and we had made it through them. He had started to take breathes on his own, his oxygen levels were staying up, they put him on a feeding tube, and they took him off the paralytic and sedatives to allow him to wake up – if he could. Then, before we had to leave, they did a corneal reflex test where they took a cotton swab and pulled some off, so it was wispy and ran it across his eye – and he blinked! That was a good sign because it showed that oxygen was never cut off to his brain while he coded. We went home happy – finally, good news and progress!
Then, not even 12 hours later my mom gets a phone call. Something happened. We needed to get down there. By the time we had gotten to the hospital, they had been performing chest compressions for 45 minutes. It was like a scene from Grey’s Anatomy. There had to have been 30 people in his room. Doctors yelling and demanding answers for what happened because when they left the night before he was making progress. As soon as they got him stable, he would crash again. The doctor looked at my mom and told her that it could be minutes, hours, days, weeks, or even months, but he would crash again. Right after he said that, machines went off. My dad stopped breathing again. At that time, we as a family decided to let the doctors try one more time. They took us to a small room down the hall. Not even 10 minutes later, a nun walked in and informed us that my dad had passed away.
After his passing, I spent a lot of my time researching sepsis. I had never heard of it before and it turned out, not a lot of people had – roughly 55% of American adults have heard of sepsis. According to Sepsis Alliance (2018) sepsis is the body’s overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure, and death. Our immune systems work to fight off germs and prevent infections. In the cases where you do get an infection, your immune system tries to fight it off – either alone or with the assistance of medication. But, there are times where your body essentially turns on itself, for reasons unknown, and this is the start of sepsis. When your blood pressure drops to dangerously low levels, you go into septic shock – the most severe level of sepsis.
In 2014, sepsis was named the most expensive in-patient cost in American hospitals – costing nearly $27 billion each year (Sepsis Awareness, 2018). Any kind of infection, whether it be pneumonia, a UTI, strep throat, or influenza, can lead to sepsis and septic shock. Even a simple cut can lead to sepsis. Rory Staunton was 12 years old when dove for a ball during gym class and cut his arm. Instead of being sent to the school nurse, the gym teacher put band aids on the cut without washing it. The following day, Rory woke up with a pain in his leg and a fever of 104. He was taken to his pediatrician, where she examined the scrape on his elbow and took his vitals – noting mottled skin, the pain in his leg, and stomach tenderness. She, the pediatrician, advised Rory’s parents to take him to the hospital for re-hydration and fluids. Doctors at the hospital claimed his discomfort was the result of a sick stomach and dehydration, they gave him two bags of intravenous fluids, took three vials of blood and gave him a prescription for Zofran (anti-nausea). The pediatrician at the hospital said it was a stomach virus and that he would be better in a week. Rory continued to complain of pain, wasn’t eating and his temperature was uncontrollable. He was admitted to the ICU. Through the cut on his arm, bacteria had entered his blood. He was in septic shock. Rory was brought back to the hospital on Friday night, the day after being seen by ER doctors who said he just had a stomach bug and by Sunday evening, Rory had passed away.
Sepsis is the leading cause of death in U.S. hospitals. Reports show that roughly 40% of individuals diagnosed with severe sepsis do not survive. Around 50% of those who do survive suffer from post-sepsis syndrome (PSS) and 62% of people hospitalized with sepsis will be rehospitalized within 30 days. Along with PSS, survivors can suffer from PTSD, chronic pain and fatigue, organ dysfunction, and/or amputation(s). Survivors have a shortened life expectancy, are more likely to suffer from a diminished quality of life and are 42% more likely to commit suicide.
Post-sepsis syndrome is a condition where survivors are left with physical and/or psychological long-term effects, such as insomnia, nightmares, vivid hallucinations, panic attacks, disabling muscle and joint pain, extreme fatigue, poor concentration, decreased mental functioning, and loss of self-esteem and self-belief (Sepsis Alliance, 2018). Those who are older and survive severe sepsis are at a higher risk for long-term cognitive damage and physical problems. Problems they face range from not being able to walk, despite having that ability before their illness and loss of ability for everyday tasks (i.e., bathing, cooking). Doctors and other healthcare professionals, who care for these survivors, need to recognize PSS and help their patients get any necessary treatment by referring them to physical, emotional, and psychological support professionals (physical therapy, counseling, CBT, or neuropsychiatric assessment).
Along with reporting symptoms of PSS, many sepsis survivors report symptoms of PTSD. There are several long-term effects, both mental and physical, that make this group vulnerable to PTSD, such as nightmares, difficulty sleeping, organ failure and loss of limb(s). Once released from the hospital, it is not unusual for a sepsis survivor to want to be alone, avoid family and friends, experience flashbacks, feel anxious, depressed, frustrated, confusing reality, poor concentration, and not caring about one’s appearance. When treating sepsis, you are placed in ICU. Johns Hopkins Medicine released a report in 2013 that linked PTSD symptoms with ICU survivors. With these ICU survivors, researchers found that those who were suffering from depression before their hospitalization were twice as likely to develop PTSD and those who had sepsis during their ICU, and those who received high doses of opiates, were more likely to develop PTSD (Desmon, 2013).
In 2008, Boer, van Ruler, van Emmerik, Sprangers, Rooij, Vroom, de Borgie, Boermeester, Reistsma, & the Dutch Peritonitis Study Group conducted a study to determine to what extent patients who have survived abdominal sepsis suffer from the symptoms of PTSD and depression and tried to identify any potential risk factors for PTSD symptoms. There was a total of 135 patients who were eligible for the study, 107 completed the questionnaire. The combination of long ICU stays, and multiple surgical and non-surgical interventions make this group vulnerable for developing PTSD. To assess the level of PTSD symptoms, Boer et al. (2003), used the Post-Traumatic Stress Scale 10 (consists of 10 items, each ranges from 1 point, none, to 7 points, always – higher scores indicate more symptoms) and the Impact of Event Scale – Revised (consists of 22 items, ranging from 0, no problem, to 4, frequent problems – scores above 24 (possible 66 total) generally considered indicative of PTSD). Potential risk factors that were looked at were general patient characteristics, disease characteristics and postoperative course, and traumatic memories of ICU/hospital stay. Results showed that 28% of patients scored moderately for PTSD, while 10% were high scoring – making a total of 38% of patients reporting elevated levels of PTSD symptoms on at least one of the questionnaires (Boer et al., 2008).
Sepsis doesn’t just affect the patient, yet everyone around them as well. In a study conducted by Davydow, Hough, Langa, & Iwashyna (2012) it was discovered that the prevalence of substantial depressive symptoms in wives of patients with severe sepsis increased by 14% at the time of the diagnosis (3-4 times more than average) and husbands had an 8% increase. It was stated that older women may be at a greater risk for depression if their spouse is hospitalized for severe sepsis and that spouses of patients with severe sepsis may benefit from greater support and depression screening, both when their love ones passes or survives (Davydow et al., 2012). Due to seeing a loved one so ill, and possibly passing from sepsis, relatives may experience feelings of guilt, anger, develop anxiety or even symptoms of PTSD due to the fear and intensity of living through the experience.
Speaking personally, I can attest to those feelings of guilt, anger, and anxiety. We all thought my dad had the flu because I was sick the week before. We just assumed that he got what I had. It’s hard not to blame yourself. You think because you spend so much time with a person, you should have been able to notice that something was wrong. That’s where the feelings of guilt kick in. Then you get angry. Not just at yourself, but the individual. My dad didn’t want to go to the hospital, we tried to get him to go earlier that morning. If we would’ve just forced him to go, maybe it wouldn’t have ended the way it did. Then you think about the doctors and the nurses. You think about what went wrong in those 12 hours you weren’t there. What happened to the positive progress he was making? Then anxiety kicks in. What if we did make him go, and he knew what was going on and he was scared. Because he was unconscious, he didn’t know what was happening, how bad things really were. Maybe that was a good thing. Just thinking about the idea of him lying there knowing what was going on and not being able to say anything causes my chest to close up.
I chose this topic, sepsis and septic shock, because I think that it’s something not a lot of people know about and it is the root of my own personal trauma. There is no cure for sepsis. By the time it is detected, it may be too late — every hour treatment is delayed, the mortality rate increases 8%.
There is a helpful way to remember the symptoms (Sepsis Alliance, 2018):
S – Shivering, fever, or very cold
E – Extreme pain or general discomfort (worst ever)
P – Pale or discolored skin
S – Sleepy, difficult to rouse, confused
I – “I feel like I might die”
S – Shortness of breath
** Watch for a combination of these symptoms, if you suspect sepsis, call your doctor or 911 immediately or go to the hospital and say, “I am concerned about sepsis.”
References
Boer, K. R., van Ruler, O., van Emmerik, A. A. P., Sprangers, M. A., de Rooij, S. E., Vroom, M. B., & The Dutch Peritonitis Study Group. (2008). Factors associated with posttraumatic stress symptoms in a prospective cohort of patients after abdominal sepsis: a nomogram. Intensive Care Medicine, 34(4), 664–674. http://doi.org/10.1007/s00134-007-0941-3
Davydow, D. S., Hough, C. L., Langa, K. M., & Iwashyna, T. J. (2012). Depressive symptoms in spouses of older patients with severe sepsis. Critical care medicine, 40(8), 2335.
Desmon, S. (2013). PTSD symptoms common among icu survivors. Retrieved from https://www.hopkinsmedicine.org/news/media/releases/ptsd_symptoms_common_among_icu_survivors
Sepsis Alliance. (2018). Definition of sepsis. Retrieved from https://www.sepsis.org/sepsis/definition/#
Sepsis Alliance. (2018) Symptoms. Retrieved from https://www.sepsis.org/sepsis/symptoms/