Shawna Forester Smith

I went home with a central venous catheter and a J-tube. I was (and still am) immunocompromised because I take corticoidsteriods (prednisolone and/or hydrocortisone) every day. (Sepsis and Impaired Immune System)

Once a week I was going for line care at a Winnipeg Health Region IV Clinic. On September 15, 2010, I woke up feeling kind of crappy. My dad picked me up about an hour later for my second appointment at the IV Clinic. After having a RN (Registered Nurse) flush my catheter with saline and then heparin (to prevent blood clots), I started feeling quite ill. By the time I left the clinic 20 minutes later, I was barfing in a paper bag, running a fever and feeling really crummy.

In the car on the way home I continued to vomit. By the time I got home and into my pajamas, I was alternating between vomiting and diarrhea. Then, I started feeling really sweaty and dizzy. I was so weak that I could not get off the floor of my bathroom. I crawled out into the family room. By this point I know that something was very wrong with me, but I was too sick to get to a telephone. I remember thinking that I needed to stay awake. So that’s what I did. When my sister-in-law came home about three hours later I used my last bit of energy to tell her to call an ambulance.

When the ambulance came my blood pressure was 50 over 20. They couldn’t find a pulse and I was hypothermic. I was in shock. The paramedics debated about whether we could make it to St. Boniface or if we should go to the closer community hospital, the Victoria General Hospital. They decided it was best to go to the Victoria General Hospital because they weren’t sure that we’d make it to St. Boniface.

I was taken to the resuscitation room. They started aggressive fluid resuscitation. They did blood cultures. At this point, they didn’t know what was wrong, but they definitely knew I was in shock. I started having a hard time breathing so they put a tube down my throat to help me breathe (intubation). I had been complaining about abdominal pain, so they called over to the Acute Care Surgical Service at St. Boniface Hospital, where I had all my previous surgeries. The surgeon on call was not my surgeon, but he was familiar with me. After speaking with the intensivist at the Victoria, they decided to transfer me to St. B. I needed a CT scan and I was far too sick for the community hospital’s ICU. So they loaded me in an ambulance with an emergency room (ER) doctor and four ER nurses.

When we arrived at St. Boniface, we went straight to the CT scanner. The scan showed a spot on my colon, but it was not anything that the radiologist or surgeon were terribly concerned about. I did not have an acute abdomen. I started to deteriorate in the CT scanner so they hustled me off to the Medical Surgical Intensive Care Unit (MSICU). My family waited anxiously for any news. In the middle of the night they determined that I had sepsis and that I was in septic shock. I was hooked up to several monitors and intravenous lines, as well as a machine that breathed for me.

The first three days were touch and go. All my family could do was pray that the antibiotics would work. They suspected that the sepsis was caused by an e-coli infection in my central line. The theory was that bacteria from gut was translocated to my catheter during one of my many episodes of vomiting. When the nurse flushed my line at the clinic, she essentially jetstreamed bacteria throughout my blood stream.

Lesson learned: don’t ever leave an IV clinic if you are feeling crappy without getting your vital signs checked. Had we checked my vital signs before I left, we would have realized that something was desperately wrong.

They removed my Hickman central venous catheter and put a new central line in my neck. Dr. Sharma, my intensivist, was still worried that I had something wrong with my digestive system. Dr. Andrew my surgeon suspected that I had an infarcted bowel, that is gangrene in my colon. He went in with the intent of performing a colostomy, a procedure where they remove the bowel and you then have to use a pouch to get rid of waste. Dr. Andrew wanted to wait a few more days, but Dr. Sharma wanted me to have surgery that day. So on September 18, 2010, I had my shortest abdominal surgery ever! I didn’t have an infarcted bowel, but I did have a piece of scar tissue that was blocking my large intestine. They removed the scar tissue and with it the bowel obstruction that we didn’t know I had.

I went back to MSICU after surgery. The next day I finally started to show some signs of improvement. The antiobiotics were working. At times I was conscious and somewhat aware of what was going on, although I could not speak because of the endotracheal tube for breathing. I would write childish scribbles on paper for my husband and my mom to interpret. At times I would get very agitated. I didn’t really understand what had happened to me or what was going on. While I was in ICU, I developed ICU psychosis. ICU psychosis happens to many patients in critical care from a combination of medications, the trauma of being in ICU and just being in the ICU environment where there usually is not natural light and a lot of noise from machines.

I developed Acute Respiratory Distress Syndrome (ARDS) and pulmonary and peripheral edema. (Sepsis and ARDS) ARDS is common in ICU patients and it causes severe lung disease and inflammation. Most people who develop ARDS die. The edema was from all the fluids they had to give me to treat the shock and resulting low blood pressure. I gained over 20 lbs of fluid during my stay in ICU. They did give me a diuretic called Lasix to help me pee out some of the extra fluid. I lost eight pounds in one day from the Lasix. They were very worried about blood clots, so I also had pressure dressings on my legs that were hooked up to a machine that constantly squeezed my poor little calves. They were running both Total Parenteral Nutrition (TPN) and tube feeding. I was in a catabolic state where my body was wasting my muscle to keep my body running.

They finally weaned me off the ventilator on September 21, 2010. After I came off the ventilator, I noticed a few things. I couldn’t hear as well as I used to. I also had tremors in my hands and legs. And the most distressing issue was I was having hallucinations, hearing things that weren’t there and I could not remember things I used to know. I couldn’t even recognize my parents or my sister. That was one of the scariest parts of being sick.

Late in the afternoon of September 22, I went back to 7A West. The ICU psychosis kept getting worse and worse. I developed diplopia (double vision) and severe vertigo (dizziness). I was so weak I could not even sit on the edge of my bed. A few days later we learned that the gentamicin was causing the diplopia, hearing loss and vertigo. I had developed a weird side effect from the gentimicin. I have many allergies to drugs, so it is sometimes difficult for doctors to find antibiotics for me. They called an allergist in to do skin testing.

I was placed on IV levofloxacin and meropenum.They called a psychiatrist to come see me. He started me on haldol and ceraquil for the psychosis. I didn’t sleep for four days. The high doses of hydrocortisone were making the psychosis worse, so we started tapering the dose. The psychosis raged on for about three weeks. My husband had to ponder the fact that this may be as good as I get. They were worried that I might have brain damage from the sepsis or latent mental illness like schizophrenia. I did turn the corner and get my marbles back, but was it ever scary when I was in the thick of it. I thought I was going to die.

I ended up spending seven weeks on 7A West. A lot of time and effort was spent on rehabilitating me physically. The sepsis and preceding months of hospitalization had taken its toll on my psychically. I went home in a wheelchair and had to go to physio two times a week at the outpatient department at the Victoria Hospital. I graduated from a wheelchair to crutches.

Now, I am walking on my own steam again. My latest hospital stay did set me back a bit physically, but I’m still much better physically then I was in the fall. The sepsis and treatment have left me with some permanent scars. The gentamicin has caused permanent hearing damage to low and mid tones in both ears. I will need a hearing aid. I have permanent lung damage from the ARDS and my asthma requires more medication now then I was on before. I get tired very easily and I have a hard time multitasking. Sometimes I get flashbacks to when I was in ICU. I had a lot of hallucinations when I was in ICU and in the weeks after. I remember talking to dead relatives and friends and seeing what I thought at the time was heaven. I even had visions of what life would be like for my husband without me. I remember talking with who I thought was god. It was wild. My time in ICU was one big trip. I’m a spiritual person but even I can’t wrap my head around some of the stuff that happened when I was in ICU. I have thought about writing a book about my near-death experience because I am scared I might forget it as time passes.

I have been told that recovery from sepsis can take anywhere from a year to five years. It is hard for me to know if I’m still feeling crappy from the sepsis or if it is from all the nutritional problems and the GP and CIPO. I have acquired a large cadre of medical specialists. I hope and pray that as time goes by some of these issues will get better. I don’t think I’ll ever forget my fight with sepsis and I hope that I never (ever) develop sepsis again.

Shawna has a blog that you can find at https://gpandme.org/