James T. Parsons
In May 2008, I found myself going to the ER with an intense pain in my left side, upper quadrant, and needing to have it checked immediately. It had been localized for several days, but I knew it wasn’t appendicitis (which is located in the lower right side).
I was then unaware that a similar danger can exist from diverticulitis, which can occur anywhere on the colon in those susceptible. As a doctor’s kid, I was also aware of the danger of peritonitis if whatever was causing my pain ruptured, but I was then unaware of the greater danger of sepsis.
If I had listened to my wife, I would have gone to my primary care physician more quickly, but I figure the pain would get better and I was monitoring my temperature carefully.
After several days, coming home from work late on evening, I was feeling particularly bad and I took my temperature. From no prior fever, I was now starting to have one. Something told me I needed to go immediately, so I looked at my wife, and said, “Babe, I think we need to go to the ER now!”
The triage could have been more effective once we arrived at the ER, since they simply said I likely had some sort of stomach flu and to sit down, and they would be with me. They did not take my vital signs on presenting. After 20 minutes of just sitting there, I found myself playing good cop to my wife’s bad cop – when we were trying to get my vitals taken. My wife was helpful in speaking up for me, but even with our hounding the triage person, they finally relented and took my vitals only 45 minutes after we arrived. My blood pressure was around 160/105. The nurse taking it said, “well that can’t be right, that is too high.” I looked at her dead-faced and barked, “take it again.” It was the same.
Only then did they understand that something was serious and quickly put me in a room, took my blood, and it came back with a white cell count of 13,100. My pulse was rapid, and they quickly put me on a gurney, put an IV in me, and started administering Cipro IV, morphine, and fluids.
They also determined likely, based upon the symptoms, I had diverticulitis and that they needed to make sure there had not been a rupture or necrotic tissue that would need to be immediately corrected by surgery, so they would need to do a CT scan on me. It would take about 1 hour for the contrast dye to absorb so they left me and my wife in the room out of the way, and the nurse would come and check on me every 15 minutes or so, it seemed. My blood pressure had come down some and was then generally 148/95.
This ER didn’t have the hustle and bustle you come to expect since it was late at night by that time, between 10 and 11:00 pm. They seemed to have limited blood pressure machines to use and so they would take one from room to room. I seemed to have been stabilized, and was doing better with the medicines and fluids, and was propped up on a gurney. I did not, however, have a cuff monitoring my blood pressure constantly, or emergency call button on me. No one was immediately around except my wife.
After 40 minutes, I had been doing decently well when quickly I started feeling first more tired, then nauseous, then really nauseous. I told my wife I wasn’t feeling good at all and to go get the nurse. The nurse took several minutes to get there, and by then it felt like my skin across my whole body was on fire and I was being burned alive. It was and still is the most painful experience I have ever had, even surpassing the fracture of my shoulder and the resulting physical therapy. When my wife came back and I was apparently sweating profusely.
When the nurse came in, her first concern was that I was going into anaphylactic shock because of the antibiotic, which was not unreasonable given my medical history. They flattened me out on the gurney and put the blood pressure cuff on me; I had dropped from the prior 148/95 to 71/50 in less than 10 minutes – which the nurse called a “vagal.”
I was still feeling really bad even after being flat, although it did help some. My wife quickly suggested to further raise my feet above my head, which I have since learned is called the Trendelenburg position. I quickly started feeling better and my vitals improved within seconds. It was then that the nurse indicated the danger of such dramatically falling blood pressure – kidney failure, followed by other organ failures.
The staff never used the term “sepsis” to us, and just described the situation as a vagal; almost certainly I had experienced shock, but it was septic shock. Although we didn’t know the full significance of these events, even though we knew a lot about medicine, my wife got on her cell and woke my parents out of sleep at almost midnight to tell them that I was in the ER. She believed they needed to know since it was possible I would have to have emergency surgery, and she later admitted that she thought it could be a road that lead to my death and they needed to see me before that.
Within 20 minutes of the shock, I was taken to the CT scan, and by the time I got back to the suite, my dad, a retired physician, was there. Once the staff understood that my dad was a physician, they quickly talked to him about what was occurring, but I don’t believe even then did they use the term sepsis to him. Despite going into septic shock, I count myself as fortunate.
The CT scan showed no necrotic tissue, and I didn’t require surgery. Because of the concern to my kidneys and other organ functions, they admitted me into the hospital and watched me for the next three days – monitoring my input and output. I was kept on Cipro with Flagyl as a secondary antibiotic, and the Friday of the week, I was released around noon.
The events created IBS-like symptoms for much of the next 6 months, and for some of those bouts I was put back on Cipro and Flagyl repeatedly to ensure that the diverticulitis did not return. I have some issues because of so many strong antibiotics were used, but those are relatively minor in comparison.
I had a lower GI done that confirmed I had diverticulosis pockets through out my colon and I learned that if the situation came back, I might have to undergo surgery sometime in my life to remove part of the colon, but at the current time it was doing decently well.
In January 2009, several months later, I first put the pieces together myself that I had experienced septic shock. No one ever used the term “sepsis” to me or my family. One friend, a physician, when he heard the story said, “I think you could have been a little septic,” but it didn’t really register then.
It was only in January that I heard the story of a Brazilian model who presented to an ER with a urinary tract infection and died of septic shock (Sepsis and UTI), after they had to amputate her hands and feet to try to save her from gangrene. I then began understanding how truly fortunate I had been.
In Summer 2009, a year later, I mentioned the situation to a friend who did medical malpractice defense and she indicated sepsis is the most common reason ERs are sued these days, when they miss it. I also learned that the danger is that once cascading organ failure begins, it is hard to stop that train from leaving the station.
I have read other stories on Sepsis Alliance’s website and it only underscores my relatively great outcome, given the dangers. What my story conveys, though, when compared to those that died or had serious complications like limb amputation is that with fluids, IV antibiotics and quick care, … and careful monitoring until the patient is certainly clear of danger … the outcome can be dramatically different.
What I would also convey to those that read this survivor story, is take lessons from it if you or your loved ones ever have similar issues arise. Obviously, we now know that an infection should be looked at quickly, watched carefully, and not let fester. One of my primary care doctors takes a small blood sample any time a patient presents with a possible infection to determine if it is bacterial or not, and the white cell count is known in minutes.
Look for a primary care doctor who does the same so if you have a bacterial infection, you get an antibiotic quickly. Watch all infections to see if they seem to be getting worse, and go to a doctor quickly if they do.
If you need to go to the ER out of concern, do so – and as Dr. O’Brien would tell you here – say you are concerned about the possibility of sepsis. Repeat the term “sepsis” a lot.
Also, take someone with you to the ER whenever possible, so you are not there alone, and make sure to have them advocate for your care and watch you in case something starts going badly.
For me, if my wife had not gone to get the nurse and had them respond to the shock immediately, I might have died from the resulting hypotension or, at a minimum, lost my kidneys and potentially suffered brain damage or other organ failure, by the time the nurse came back to check on me.
Maybe I was supposed to do something with this blessing, and part of that is telling my story to you, so others can survive and avoid sepsis in their lives.
I hope my story helps with that.
Addendum to my story, by James T. Parsons
After my first tour through the land of sepsis, I again came uncomfortably close to a return trip in Feb. 2011, a month after Sepsis Alliance had tracked me down off postings of my May 2008 adventure.
As a likely relic off my first septic tour, I had developed what appears to have been a fungal sinus infection. (Sepsis and Fungal Infections) After two surgeries to try to debride and correct the sinuses, in January 2011 I was still fighting a fungal infection in the beginning of Feb. 2011, although I had almost overcome it. Although true fungal infections are rare, normally only occurring in immuno-compromised patients with diabetes or HIV (both had been ruled out with me), I did ask my doctors whether I could have been immuno-compromised during the period I was at the verge of septic shock (May 2008) … after which I was hit with massive antibiotics for 3 months (antibiotics can select for fungal in susceptible individuals). The answer back was, “it is possible.” Thus I entered February.
In that first week of the month, a deep cold snap hit most of Texas on Feb. 2, 2011. Super Bowl Sunday occurred a few days later on Feb. 6, 2011, where people were huddled together watching the game – unknowingly sharing illnesses that had been bottled up for the prior week. I apparently caught some sort of flu, possibly H1N1. A week following the Super Bowl, I started to feel sick and could tell it was something – but often similar symptoms can occur with allergies. It didn’t seem that bad. (Sepsis and Influenza)
By Saturday, Feb. 12, I knew something was going on, but figured I would try to keep my sinuses clear as possible and go from there. By Sunday, I could feel some pain in my chest, not bad though, and figured there was a risk of a secondary bacterial infection. I stayed home sick on Monday, Feb. 14th – and went to see my doctor to see if he could better determine what was going on. A finger prick blood test showed nothing conclusive, but he believed that it was possible there was a secondary bacterial infection (I was thinking as a sinus infection) and agreed to prescribe an antibiotic. I went home, filled the prescription, took the first pill at 4:00 p.m., and waited for my wife to come home. By mid evening I was feeling better and the antibiotic seemed to be kicking in nicely. I went to bed, thinking that maybe I could be well soon, until I woke up at 4:00 a.m.
When I woke, I felt horrible. I had enough experience with shock that I knew there was a risk of anaphylactic shock off the antibiotic, and this felt like it could be going that way. I had taken augmentin, a penicillin derivative. I had previously taken the drug many years before and been ok, although I had always been cautious with penicillins because of a family history with it and my bad mold allergies. I knew that we needed to monitor my blood pressure to ensure that it was not going into shock, so I woke my wife up and told her what was going on.
She started taking my blood pressure, which was a little high – and I kept laying down with my feet raised. It normally is high when I am very sick, and it was definitely in that range. As we monitored it for the next hour or so, it came down a little more into the normal range, so we also wanted to keep open that I was just worried or upset. However, within the next hour it started creaping down, and my wife took it after that period and it was 100/60 (shock is 90/60). She thought that was good, but I knew that I was never that low, never, and I knew the danger was clear that I could be having an allergic reaction to the antibiotic. I had similarly reacted to cephalosporin in the past. The knowledge caused my natural adrenaline to spike, I am sure, and I told her to “take it again quickly.” It was high by then. Given that the method of treatment for anaphylaxis is epinephrine (adrenaline), I figured at least I had in fear spiked my own naturally. However, after that we couldn’t get my system stabilized or calmed, and I could not sleep.
For the next day, I was sicker than I had EVER been, ever, and nothing would help – including vicadin, benadryl, nothing. We had also contacted my doctor who had prescribed the antibiotic and he shifted me to Biaxin (clarithromycin) but that had not helped. I was drinking lots of fluids, LOTS, and it was passing through me as quickly. We figured I needed to be seen urgently so we first tried the ER. It was slammed with tons of flu patients and at that point I would triage low since I had few manifest symptoms outside the flu. We thought someone might need to assess the likely allergic response, and what could be done. We knew the general response to anaphlaxis is steroids, but I also knew that steroids could cause my immune system to lessen (allergies are generally believed to be an over-active immune system) so that would not automatically be an option for the response, since I needed my immune system engaged against the virus and the bacterial infection.
After arriving at the ER, we called to my primary physican’s urgent care clinic to see if they could get me in more quickly – then after hours since it was about 5pm. They could, so we let the ER know that is where we were going and we headed over. The urgent care family doctor who saw me felt it was “just the flu” and that she believed the antibiotic, Biaxin, was just making it worse, so she wanted me to discontinue it. She did some basic tests on me, my blood pressure was a little high, and she did a flu test. She wasn’t too set off when the flu test came back negative since it had been more than 3 days since I first showed signs. She thought I just needed to get lost of rest and fluids, and sent me home. It should be noted she did not do a chest xray.
The next day I was no better, and in fact much worse. My blood pressure was going higher, nothing would bring it down and I could barely sleep at all. I was taking in about a liter of fluids an hour and it was passing as quickly. I could not eat, and my wife left for the morning with the idea to come check on me at lunch. The time seemed to craw and if I thought I had been the sickest I ever had been the day before, I was wrong, – this day was worse. I had read the stories on the Faces of Sepsis in January and knew I was tracking a sepsis curve. I couldn’t understand why I would be going septic, but I felt that was occurring, even though all the health care professionals I had seen the day before simply said “its the flu.”
That day at noon, when she asked how I was doing, I felt she needed to understand the severity that I believed existed so I told her flatly, “Babe, you need to understand this is becoming life threatening, I have had the flu and this is not the flu, or not just the flu.” She looked at me, paused, and said, “Ok, let’s go back to the ER, then.” We loaded up the stuff we needed to take, and she drove me to the ER I knew did the best job in town on triage.
When we arrived, the ER that is normally quiet at mid-day was slammed again. The nurse did an initial triage, but again I had no manifest symptoms that would let them triage me higher, so we had to wait. I didn’t dispute their triage since they were so slammed, but we went into a corner and I laid down and we waited. One of the hospital administrative staff knew us and he waited with us, checking periodically where we were. After about 4 hours, they finally were able to get me back and started an IV on me immediately. Because of the complexity of my situation, there was not an obvious route for me.
Because their ER physicians were all tied up, they smartly put a third year medical student with me and he listened for 40 minutes to the complex issues I had going on. I had the chronic fungal infection, that might not be fully resolved. I likely had the flu (a viral infection – again possibly H1N1), and we had believed there was likely a bacterial infection since I had originally responded well to antibiotics, although the urgent care doctor the day before had taken me off the Biaxin. I told them that I knew that my system had been amped up after what I was pretty certain was close to anaphylactic shock, – and that was likely also going on – but I couldn’t seem to get my system to disengage, could not sleep, couldn’t keep liquids in despite drinking TONS of water, gatorade, etc. I also told him it felt like I was hyperventilating, which itself could be amping my system, but I couldn’t seem to slow my breathing down. The medical student went to talk to the ER physician and they decided that I needed a chest xray. With the IV fluids I was getting now, I was doing better, but I still wasn’t doing great. The chest xray showed pneumonia, though, so at least we had a basic answer. I joke now that I had the trifecta – a fungal, viral and bacterial infection at the same time – with likely an anaphylactic response. I was admitted into the hospital for pneumonia and for dehydration.
By the next day I was doing better and my blood pressure was coming down, my blood work looked good overall, and they started treating the fungal infection with oral Nystatin. Within a few days I was still progressing, and the decision was made to discontinue IV fluids, continue me on IV antibiotics for another day and discharge me. The next day I wasn’t great, but was ok and felt sick but the type of sick you can get rest, drink lots of fluids and get better. I went home, with a few more days of oral antibiotics and Nystatin.
Within a day or so, however, of being home, I started feeling bad again. By two days out of the hospital, I was starting to slide far down. We went back to the urgent care clinic to have them check on me, and a new doctor there listened to what was going on. We told him that when I was on IV fluids I seemed to do better, but once I was off them I started doing worse. He was open to giving me a liter of IV fluids there and seeing if that would help. It did and I started feeling better. My output matched the input of fluids, so I was not dehydrated, but the fluids seemed to just help. The doctor couldn’t explain why that was the case, but was willing to accept my reporting that it did help. We went home and I was able to sleep some that night.
The following day, though, I started doing worse again. We started becoming concerned that the fungal infections were getting worse, and that those were now causing issues. The antibiotic seemed to have taken out the pneumonia and all the doctors had listened to my chest and it sounded good. We decided we needed to go back to the same ER. When we got there, I reported that I was doing worse, but that I had done a little better the day before when I was on IV fluids at the urgent care clinic. We waited several more hours since the ER was still slammed with flu patients (the week was the worse for the year – and I suggested the Super Bowl parties might be a culprit). After we were finally readmitted into the ER, they started reevaluating me. They put me back on IV fluids, did several tests and did a new chest xray and it looked good, and all other tests were normal. The best guess they had was that the fungal infection was becoming problematic and I needed to get IV antifungals and IV fluids, so they put me on fluconazole IV and readmitted me.
I was hospitalized for another 3 days with IV fluids, fluconazole IV, and then they watched me for a day without IV fluids to ensure that I would do well enough without them to be discharged. I did, and went home. It took about another 2 weeks at home to finally get well enough to get out of bed and be able to not feel completely sick. I was kept on antifungals for a total of 30 days by the infectious disease (ID) specialist and it generally seemed to abate the problem. While I have since had a third sinus surgery to debreed a fungal infection there, I am hopeful that current efforts the fungal infection can be resolved.
After arriving at the ER, we called to my primary physican’s urgent care clinic to see if they could get me in more quickly – then after hours since it was about 5pm. They could, so we let the ER know that is where we were going and we headed over. The urgent care family doctor who saw me felt it was “just the flu” and that she believed the antibiotic, Biaxin, was just making it worse, so she wanted me to discontinue it. She did some basic tests on me, my blood pressure was a little high, and she did a flu test. She wasn’t too set off when the flu test came back negative since it had been more than 3 days since I first showed signs. She thought I just needed to get lost of rest and fluids, and sent me home. It should be noted she did not do a chest xray.
The next day I was no better, and in fact much worse. My blood pressure was going higher, nothing would bring it down and I could barely sleep at all. I was taking in about a liter of fluids an hour and it was passing as quickly. I could not eat, and my wife left for the morning with the idea to come check on me at lunch. The time seemed to craw and if I thought I had been the sickest I ever had been the day before, I was wrong, – this day was worse. I had read the stories on the Faces of Sepsis in January and knew I was tracking a sepsis curve. I couldn’t understand why I would be going septic, but I felt that was occurring, even though all the health care professionals I had seen the day before simply said “its the flu.”
That day at noon, when she asked how I was doing, I felt she needed to understand the severity that I believed existed so I told her flatly, “Babe, you need to understand this is becoming life threatening, I have had the flu and this is not the flu, or not just the flu.” She looked at me, paused, and said, “Ok, let’s go back to the ER, then.” We loaded up the stuff we needed to take, and she drove me to the ER I knew did the best job in town on triage.
When we arrived, the ER that is normally quiet at mid-day was slammed again. The nurse did an initial triage, but again I had no manifest symptoms that would let them triage me higher, so we had to wait. I didn’t dispute their triage since they were so slammed, but we went into a corner and I laid down and we waited. One of the hospital administrative staff knew us and he waited with us, checking periodically where we were. After about 4 hours, they finally were able to get me back and started an IV on me immediately. Because of the complexity of my situation, there was not an obvious route for me.
Because their ER physicians were all tied up, they smartly put a third year medical student with me and he listened for 40 minutes to the complex issues I had going on. I had the chronic fungal infection, that might not be fully resolved. I likely had the flu (a viral infection – again possibly H1N1), and we had believed there was likely a bacterial infection since I had originally responded well to antibiotics, although the urgent care doctor the day before had taken me off the Biaxin. I told them that I knew that my system had been amped up after what I was pretty certain was close to anaphylactic shock, – and that was likely also going on – but I couldn’t seem to get my system to disengage, could not sleep, couldn’t keep liquids in despite drinking TONS of water, gatorade, etc. I also told him it felt like I was hyperventilating, which itself could be amping my system, but I couldn’t seem to slow my breathing down. The medical student went to talk to the ER physician and they decided that I needed a chest xray. With the IV fluids I was getting now, I was doing better, but I still wasn’t doing great. The chest x-ray showed pneumonia, though, so at least we had a basic answer. I joke now that I had the trifecta – a fungal, viral and bacterial infection at the same time – with likely an anaphylactic response. I was admitted into the hospital for pneumonia and for dehydration. (Sepsis and Pneumonia)
By the next day I was doing better and my blood pressure was coming down, my blood work looked good overall, and they started treating the fungal infection with oral Nystatin. Within a few days I was still progressing, and the decision was made to discontinue IV fluids, continue me on IV antibiotics for another day and discharge me. The next day I wasn’t great, but was ok and felt sick but the type of sick you can get rest, drink lots of fluids and get better. I went home, with a few more days of oral antibiotics and Nystatin.
Within a day or so, however, of being home, I started feeling bad again. By two days out of the hospital, I was starting to slide far down. We went back to the urgent care clinic to have them check on me, and a new doctor there listened to what was going on. We told him that when I was on IV fluids I seemed to do better, but once I was off them I started doing worse. He was open to giving me a liter of IV fluids there and seeing if that would help. It did and I started feeling better. My output matched the input of fluids, so I was not dehydrated, but the fluids seemed to just help. The doctor couldn’t explain why that was the case, but was willing to accept my reporting that it did help. We went home and I was able to sleep some that night.
The following day, though, I started doing worse again. We started becoming concerned that the fungal infections were getting worse, and that those were now causing issues. The antibiotic seemed to have taken out the pneumonia and all the doctors had listened to my chest and it sounded good. We decided we needed to go back to the same ER. When we got there, I reported that I was doing worse, but that I had done a little better the day before when I was on IV fluids at the urgent care clinic. We waited several more hours since the ER was still slammed with flu patients (the week was the worse for the year – and I suggested the Super Bowl parties might be a culprit). After we were finally readmitted into the ER, they started reevaluating me. They put me back on IV fluids, did several tests and did a new chest xray and it looked good, and all other tests were normal. The best guess they had was that the fungal infection was becoming problematic and I needed to get IV antifungals and IV fluids, so they put me on fluconazole IV and readmitted me.
I was hospitalized for another 3 days with IV fluids, fluconazole IV, and then they watched me for a day without IV fluids to ensure that I would do well enough without them to be discharged. I did, and went home. It took about another 2 weeks at home to finally get well enough to get out of bed and be able to not feel completely sick. I was kept on antifungals for a total of 30 days by the infectious disease (ID) specialist and it generally seemed to abate the problem. While I have since had a third sinus surgery to debreed a fungal infection there, I am hopeful that current efforts the fungal infection can be resolved.
What did I learn and what would I pass along to others? First, for sepsis survivors, knew that you were immuno-compromised during the time period you were septic, particularly if you were close to or in septic shock, or had severe sepsis. Thus, conditions normally that only occur in HIV, diabetics or others might be possible in you. For me, I think it is a recurrent fungal infection, that has to be accounted for when I do take antibiotics now. Fungals are more quick to adapt, from my experience, so I would suggest being careful around conditions that could promote fungal infections. If you irrigate for sinus/allergies, be careful, clean your irrigation bottle with bleach regularly, and consider drying your sinuses out after you do so with a hair dryer or oven heat. In any aspect of your body, if you seem to have something “weird” going on that you can’t really explain, seek a good internal medicine or ID specialist to help sort out the issues. Make sure to tell them you are a sepsis survivor, and they might make sure to rule out issues that might occur in those who have been immuno-compromised.
Second, for all people, definitely read the stories on Faces of Sepsis, and learn what I would call the sepsis curve. Because sepsis does not present in one fashion, no one symptom can be dispositive. I think sepsis can also be identified if you step back from the situation, and look at how the situation is progressing as a whole. For me, with the pneumonia, I frankly just didn’t think I had pneumonia – or think it would make me that sick. It might not have so quickly – but for the reaction to the antibiotic – which is when I got much, much sicker. Even knowing what I did, I knew I was tracking a sepsis curve but didn’t know how. I sought attention and didn’t allow others to just label me with “it’s just the flu.” I knew it wasn’t. If I had not read the stories of the Faces of Sepsis the month before, I might not have listened to my inner voice.
Third, I don’t know why conclusively the IV fluids helped, but they did even independent of the IV antibiotics and antifungals. While oral hydration would seem to be the same, my best guess oral hydration ins severe cases is not fast enough to flush out the endotoxins that were likely making me sick off the trifecta infection. IV fluids are immediate, and yes I was outputting the fluids as fast, but it seemed to keep ahead of the sepsis curve and help me get through the worst periods.
Fourth, find good doctors and develop relationships with them over time. I don’t know if the first urgent care doctor made a mistake by not taking a chest xray on Feb. 15th or not. She listened to my chest, it sounded clear to her, and it was a complex issue. It is possible that if she had done an xray it would have been clear, since I was still on Biaxin, and then the next day they might not have thought to redo an xray. It is hard to say. Not all health issues are easily resolved, but I feel fortunate to have gotten through a serious health issue. However, I do encourage people to understand doctors don’t always know what is going on with complex issues, so make sure to be persistent … and find doctors that know you in good times so they will listen to you in bad ones. As sick as I was on Feb. 16th, I believe I was likely within a day of septic shock if I had not gone to the ER. Soon after I was better, I read Jean Law’s story, whose pneumonia did go into septic shock, and I think I did dodge a bullet for a second time.
