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A close encounter of the worst kind: Sepsis

Author: Timothy G. Buchman, PhD, MD, FACS, FCCP, MCCM, Subject Matter Expert and IPA to BARDA DRIVe
Published Date: 9/18/2019 11:03:00 AM
Category: Medical Countermeasures; Innovations;

Day four of the annual professional meeting began like so many others: I had one more talk to give, and then a dash to the airport for the flight home. At lunchtime, I noticed a slight headache. By the time the session began mid-afternoon, the headache was worse. I bummed a couple of over-the-counter pain pills from a colleague (thank heavens for better prepared friends!), chugged a botTim Buchman recovering in the hospitalle of water, and listened to the three talks that preceded mine.

I felt a bit lightheaded starting my presentation. About ten minutes in, I had a shaking chill. Not a big one, not one that caused me to stumble, but a chill nonetheless. The audience did not notice—it was a talk I had given before, I knew the words that needed to accompany each frame. The session wrapped, I had another bottle of water, and started the journey.

Twelve hours, several more chills, and a few more bottles of water later, I made it home. I was exhausted. I told my wife that I thought I might be getting the flu (despite having received the seasonal immunization) and just needed to catch up on rest. She said “fine, but please let your doctor know”. Yes, we doctors have doctors.

My doctor also happens to be my neighbor down the street. He decided to stop by the house—"just to have a quick look” at me. He said that I didn’t look too bad, rest was a good idea, but maybe it was also a good idea to go over to the hospital and get some lab work done. No, I didn’t have a fever—but then I had continued my diet of over-the-counter pain medications that also happened to be antipyretic. Besides, I wanted nothing more than some sleep.

I took my doctor’s advice, and upon arriving at the hospital my white blood count was reported to be two and half times the upper limit of normal. My kidney function was only about 40% of the expected value. While I was not jaundiced, the lab data showed that my liver was not processing bilirubin well. Oh, and by this time my left leg had swollen to twice normal size and turned bright red. In “doctor-speak”, the diagnosis was erysipelas—likely caused by group A streptococcus—and I easily met the Sepsis-3 vital organ dysfunction criteria.

Did I mention that my blood pressure had started to fall?

I was admitted to the hospital, blood cultures were taken, IV fluids were started. Within minutes, I received broad spectrum antibiotics. I don’t remember much more about that first day in the hospital, except having the presence of mind to decline transfer to the VIP pavilion—better to be around medical and nursing staff who would treat me just as they treated everyone else.

By the next day, I was much better. The initial antibiotics had accomplished their “expected miracle”, the spectrum had been narrowed to address the likely pathogen, and my vital organ functions were improved. Only then did I begin to appreciate just how sick I had been.

That’s how sepsis is. Sepsis shows up uninvited, arrives unannounced, and triggers deep fatigue–all the while scrambling your brain just enough to hide the fact that “a little rest” might presage “the big sleep”. I treat sepsis, I study sepsis, I write articles on sepsis—and I was sure that sepsis was something that happened to other people.

That was six months ago this week. Unfortunately, it’s more than a bad memory. Becoming a “sepsis survivor” is not the same as being completely cured: sepsis confers excess risk of all-cause mortality for at least several years. My particular infection carries some likelihood of recurrence. On the advice of my healthcare team, I now carry specific countermeasures with me whenever I travel along with an instruction to begin taking the drugs should I experience similar symptoms. I have acquired some persistent leg swelling that requires me to wear compression stockings on a daily basis, a constant reminder that I remain vulnerable.

I was invited to join BARDA DRIVe and the Solving Sepsis team for my sepsis subject matter expertise in August 2018. Yet it took a personal encounter with sepsis for me to understand that no matter who we are, where we are, and what we do, we are all vulnerable. The BARDA DRIVe Solving Sepsis program is accelerating the development of transformative technologies to address sepsis as well as working with government partners. As September is Sepsis Awareness Month, this is a reminder to us all to be aware of the signs of Sepsis.

If you, a family member, a friend or a colleague, think, “Could this be sepsis?”

Ask the question.

Seek prompt medical attention.

You might save a life.

The life you save might be your own.


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