Larry S

This long note is intended to describe my experience with septic shock on Friday evening, July 14, 2017 when my wife transported me to the  hospital ED because I was feeling very ill. I was eventually admitted to the hospital CCU with a diagnosis of sepsis, hypotension, and bradycardia (R/O meningitis). I was treated in CCU until being moved to a “step down bed” on Wednesday afternoon, July 18. I was discharged home on Friday afternoon, July 20 with home fusion care. I am now recovering well, but I am not back to 100%.

Medical History:
I am a 68-year-old man who resides in Michigan with my wife. I work full-time as a lawyer. I have been in excellent health for my age. My only medical condition of note was hypothyroidism. I have also had a long history of “cluster headaches,” which were well-controlled by verapamil. I was a regular Red Cross platelet donor, which conveniently allowed me to review my 2-year history of resting BP (~100/70 – credit verapamil) and pulse (~60 BPM – credit my history as a former runner). I was not aware of any recent infection.

Treatment-Specific history:
I felt fine on Thursday, July 13, 2017 and had no problems sleeping that night. I awoke on Friday, July 14, 2017 at 7:00 AM and noted that I felt as if I had some muscle and joint aching. I went to work but cancelled my 11:00 AM Red Cross platelet donation, fearing I might be coming down with a virus. At about 1:00 PM that day, I went home to rest because I had a very busy day planned on Saturday. When I got home, my pulse was ~100 BPM, and my blood pressure was low (~90/60). But I did not have an abnormal temperature at this time. I suspected dehydration, and began drinking water over the next few hours (in excess of 200 fl oz). Then I developed the chills and could not get warm with blankets. My wife gave me a heating pad which helped me. She urged that I allow her to take me to the ER, but I declined repeatedly because “I am not that sick.” At approximately 7:30 PM, I glanced at my Fitbit and noticed that my pulse was 175 BPM, which my wife confirmed. I had not urinated since arriving home from work. I was alarmed and only then agreed to go to the ED.

Arrival at ED on Friday evening, July 14, 2017:
I walked into the ED between 8:00 PM and 8:30 PM on July 14, 2017 while my wife parked the car. I presented my symptoms to the person who first met with me. I was then asked to have a seat in the ED. The ED was busy, and there were few seats available. My wife and I took adjoining seats. My wife told me my complexion was becoming ashen. I think I was mentally intact at this time.

About an hour after arrival, I recall being taken to a room to meet with an assessment physician. I was told my temperature was approximately 101+. I do not recall my other vitals. Blood was drawn and urine was obtained (the only time I voided until the next day). An EKG was done in that room. I was then sent for a chest X-ray and perhaps other testing. I recall being placed in a wheel chair.

ED after Assessment:
My wife and I returned to ED. I moved from my wheel chair to a seat because of discomfort. I do not recall having my vitals being taken for the next several hours. I later experienced uncontrollable rigors. A blanket was provided at my wife’s request, but a warm blanket was declined by staff due to my fever. My wife approached staff again as my rigors continued (she was told to put the blanket over my neck), requesting to know “how much longer?” She was told that there were no vacant rooms at the time. She rubbed my limbs to warm them. I think others in the waiting room thought I was having a seizure and moved away from me.
I do not recall when I was moved back to be seen by a treating physician, but it seemed like several hours from when I first arrived at the ED. Sometime after midnight, I remember a wonderful nurse taking a detailed history from me. She took my rectal temperature (104.6) and other vitals. I had a spinal tap and additional testing. It seemed like things began to happen quickly after this point. I remember the nurse saying to my wife that I was “very sick.” I heard the words “sepsis” and “meningitis” used by medical persons in the room for the first time, about 3-4 hours after my arrival at the ED. The antibiotic IV that was started turned out to be the precise antibiotic that would be used to fight my infection after my blood culture results had been reviewed. That “lucky choice” is why I believe I survived and have had such a good recovery.

I believe that we were told that I would be admitted to the hospital about 4 AM. After those arrangements were made, my wife (who had been up nearly 24 hours straight) was advised that she could leave the hospital and return later.

Conclusion:
The ED was busy on the night I came in. My wife and I are very sensitive to the fact that the ED must treat patients in order of the severity of their condition, not “first come – first serve.” So the only times my wife went to the desk to make inquiries were the two times mentioned above. But I now realize that I probably went into septic shock while I was still in the ED waiting room when I experienced the rigors several hours after arriving.

My comments here are intended solely to assist my treating hospital and other hospitals in perfecting their protocols for promptly identifying sepsis patients. My best friend was diagnosed with sepsis approximately a year before me (with much worse long term results), so I have become very concerned about the recognition and prompt treatment of this common and deadly yet hard to identify condition. Sadly, sepsis is still not recognized as quickly as it needs to be in many fine hospital EDs.

My advice to readers:
Learn about sepsis and its symptoms. It can happen to anyone. Never ignore bacterial and fungal infections. Never be too shy to say to a doctor or nurse, “Do you think this condition could be sepsis?” If you are prescribed an antibiotic, take it exactly as prescribed. But don’t try to get an antibiotic from your doctor for a cold.