Two Memorial Days ago, psychotherapist Dean Rosen woke with a fever and figured he had the flu. But late that night, when he’d finally managed to keep a Tylenol down and it had done nothing, he let his wife drive him, weak and shivering, to the hospital.
“You are really, really sick,” he heard the emergency physician say. The voice was a blur: Rosen was in septic shock, blood pressure plummeting, and his kidneys had shut down.
Hospital staff pumped vasoconstrictors into his body through a port in his neck and fought the sepsis with antibiotics. He stabilized in the ICU.
But what the hell happened?
The root cause of sepsis is an infection—bacterial, fungal, or viral. Maybe it starts with pneumonia, or childbirth, or an infected wound. In Rosen’s case, scar tissue from Crohn’s disease created a blockage in his intestine, and that resulted in infection, and the medicine that he was taking for Crohn’s had weakened his immune system. Nobody had ever mentioned the risk.
With sepsis, the body senses the infection’s toxins and overreacts—like a bossy, hysterical mother who says, “Oh my God, just look at you!” and flies into action, wreaking havoc. If the sepsis is caught early—by a strong immune system or a smart physician—most people recover. But the first 24 hours are decisive, because sepsis spirals out of control fast. A recent study found that for every hour treatment is delayed, the risk of death increases by 4 percent.
Sepsis kills more people every year than breast cancer, prostate cancer, and AIDS combined. “Mortality’s usually 25 percent,” says Dr. Donald Kennedy, a SLUCare infectious disease expert at SSM Health Saint Louis University Hospital, “but when someone goes into septic shock, it can rise to 40 to 60 percent.”
Early symptoms include fever or chills, nausea and vomiting, fast heart rate, rapid breathing, fatigue, and weakness. As the condition worsens, it can cause rock-bottom blood pressure, confusion, shortness of breath, organ failure, and a scarily accurate feeling of doom or impending death.
If you’ve ever wondered why hospitals’ sterile procedures now read like Homeland Security protocols, it’s because the new enemy is antibiotic-resistant infection, which is often a root cause of sepsis. “And now we have antifungal resistance,” Kennedy says grimly. “A new pathogen reached the U.S. last year, Candida auris, and the drugs are few and far between that will be effective.”
One study pronounced sepsis the most expensive inpatient cost in American hospitals, with a price tag of nearly $24 billion a year—and the incidence of sepsis is rising by about 8 percent every year.
“We have a population in the U.S. that’s dramatically different than it was 20 years ago,” explains Kennedy, who’s a professor of internal medicine at SLU. People are living longer and therefore having more diseases and surgeries when they’re over age 65 and their immune systems are less robust. Also, people are living with HIV/AIDS (which compromise the immune system); there’s more organ transplantation (with antirejection meds that weaken the immune system); cancer’s more often survivable (with chemo that zaps the immune system); and more people are taking the new biologics (drugs that can work wonders for chronic autoimmune diseases such as rheumatoid arthritis, Crohn’s, and lupus but inhibit the immune system).
“The ads for Humira [a biologic] say, ‘If you experience flu-like symptoms, call your doctor,’” Rosen notes. “That’s not fast enough.”
The weekend Rosen got sick, Muhammad Ali died of septic shock.
“If I hadn’t gone to the ER that night,” says Rosen, “I would’ve died at home, thinking I’d feel better in the morning.”
