SEPSIS!

“What do we say to the Lord of Death?"
"Not today.”  ~George R.R. Martin, A Game of Thrones

   Before Les went into hospital I was surfing through the NHS website and found a big blurb about Sepsis. Apparently this relatively unknown illness is rampant in the UK--especially amongst the very young and those 65 and older, those with cancer and those who've undergone recent surgery. 
   I found another link to the Sepsis Trusts' Survive Sepsis website. The video I watched scared the hell out of me.
   Sepsis is blood poisoning--an infection which gains access for various reasons, to the body's blood supply, traveling throughout the body and attacking vital organs. Early stages feel like the flu: malaise, lack of appetite and extreme tiredness. This can go on for several days upon which it is accompanied by dehydration, slurred speech, fuzzy thinking, very high fevers with nights sweats that soak you, violent shivering, mottle skin, shortness of breath, blue lips, cold extremities, violent vomiting. Think Toxic Shock syndrome.
 I wrote down the symptoms and the "Sepsis Six"--the six timely treatments which save a person's life and tucked it away in my cancer notebook I kept for notes of all Les' appointments and transcripts of all conversations with health professionals regarding his treatment. And then I forgot all about it. 
   Les came home from cancer surgery and was doing well. His appetite picked up, his energy level grew slowly over the initial two weeks and the sunken cheeked, concentration camp look was beginning to recede from his features. He was sleeping well, going for brief walks outside and his sense of humor returned. 
   Les handled his stoma quite well. He changed the bag daily and emptied it frequently. Community nurses came in every day to change Les' bandages and assess his incision sites and general health. Slowly the incision were healing although they were attended by a pale yellow, creamy gunk and started to smell slightly. Now I have a VERY acute sense of smell and often small sour in milk before anyone else can even taste it. The incision in which the bladder catheter protruded from was swollen, red, and concerned me.
   I had a bottle of Hibiclens which I bought from the states. This is surgical scrub disinfectant solution. When I was scheduled for surgery the doctor asked me to stop by the pharmacy and pick up a bottle ($4) and wash all over with it in the morning before reporting for surgery. I also used it for wound after care at home on my incisions. I had three fourths of a bottle left and i brought it with me in my medicine chest when I moved here.  
   Les asked the nurses to call thirty minutes before visiting so he could shower each day. I removed his old bandages, and told him to wash his incision with Hibiclens. The nurses came shortly after assessed his wounds and applied fresh bandages. After he began using Hibiclens, his incisions looked much better and they began to scab over nicely; all except that bladder catheter site. 
   Wednesday afternoon Les seemed somnolent. He dozed and had no energy for a walk. His appetite, which had been building, suddenly disappeared. 
   Thursday I took my exam and Les was alone for four hours while I did some shopping for a grocery trolley and extra track pants for Les. When I returned in the early afternoon, he was awake and had a bite to eat but really wasn't hungry. A new set of community nurses visited and said all seemed well, but my spider sense said something was off. Les was quiet; a malaise fell over him. He slept all afternoon and early evening, and seemed confused and fuzzy in his thought process. I felt Les' forehead and he had a slight fever. He also developed shivers as bedtime approached. I warmed his bed and PJ's with a hot water bottle. He slept all night. 
   Friday morning Les looked terrible. That gaunt, starved look was back. He refused breakfast, had a small bowl of soup for lunch and ate no dinner. He drank water and juice steadily saying how thirsty he felt. It was almost as though Les had narcolepsy. He would nod off in the middle of a sentence and wake up shaking so violently Les appeared to be having a grand Mal seizure. He complained of exhaustion and weakly said he had to go lay down. It was 9:30 p.m. 
   Les called out to me in the middle of the night in a panic! I ran down the boat to our bedroom and I was shocked by the sight: it looked as though someone had drenched Les and our bed with a fire hose! His hair was sopping wet, his pajamas were dripping water. The down duvet was soaked through, Les' pillows were soaked and the sheets were sodden!
   I thought he had sprung a leak somewhere and I was peering closely at his incisions. He thought he had peed the bed but nothing smelled of urine.  I rang the water out of his pajamas in the bathtub, hung them to dry, got him dried off, dressed in clean, dry pj's, changed the bed and got Les settled down with a fresh hot water bottle, dry blankets and I went back to bed. Two hours later it happened again!
   After a repeat of drying. cleaning, re-bedding and a refilled hot water bottle we both slept through to 8 am this morning. I woke with a very bad feeling and decided I was going to observe Les closely and call the doctor if he seemed in any way worse.  My mind kept replaying the violent shaking spell and his mental disorientation.  
   Les didn't want to eat any breakfast. 
   "Baby you have to eat. You've lost thirty pounds since surgery and you have no fat left on your body. If you don't eat you begin the process of muscle wasting and you won't recover Les. Please baby, please eat."
He forced down half a piece of toast, part of a small bowl of organic oatmeal and a glass of orange juice. All morning he shivered. About lunch time I looked back through the cancer notebook and found the Sepsis notes. Immediately I knew Les had Sepsis and every moment we delayed brought him closer to death--and he was totally clueless. 
   Of course he wouldn't listen to me. I was overreacting, blah, blah, blah.  I wanted to call an ambulance. Les wanted to wait for the visiting Nurse, especially since today it was Jeremy who was scheduled and he is a favorite of ours. He is a good nurse who has gotten to know Les well. I reluctantly agreed. 
   Jeremy arrived about 1:30 p.m. and as soon as he came in the door I said, "Jeremy Les is extremely ill--I think he has Sepsis." The nurse quickly kicked off  his shoes, came inside, examined Les and agreed. He left for the office to talk with his supervisor about what we should do next. Fifteen minutes later Jeremy called me and told me to call the community nurses main number, explain Les' symptoms and I would be patched through to a doctor. 
   I called the number and it rang, and rang, and rang, and rang--endlessly until finally after over thirty rings someone picked up. I explained who I was.
   "Hello, yes my name is Mrs. Jaqueline Biggs. My husband Leslie is quite ill and needs immediate attention. He had surgery for rectal cancer on October 16th and has been home recuperating since October 31st. Since this past Wednesday he has slipped into a malaise. He is exhausted, has no appetite, suffers from violent shivering, extreme night sweats, he is confused, disorientated, dizzy, has mottled skin, cold extremities, cyanotic lips, and Oh my God he just threw up violently--twice! He has Sepsis and needs immediate treatment."
   "Okay Mrs. Biggs, I will pass on your concerns and an out of hours doctor will ring you. If you don't hear anything shortly then call 111 and they will tell you what to do next."
   I wanted to call and ambulance ASAP but again Les declined and we argued about it. He begged me to wait for the doctor to call. I waited for thirty five minutes and finally snapped.
   "I am an American Les. We don't stand around waiting while health care professionals endlessly discuss the merits of someone's symptoms until they die. WE DO something! I'm done and I am calling an ambulance NOW!"
   A paramedic arrived to the boat about twenty minutes later, took Les' vitals, took notes and called an ambulance. The out of hours doc called and spoke with the paramedic and then apologized for taking over an hour to return my call. She said the nurse who referred my call told her Mr. Biggs probably had a mild infection and was feeling unwell." UNBELIEVABLE!!
   We arrived to Watford General Hospital A and E about 4:45 p.m. The emergency room doc took his vitals, listened to my description and nodded affirmatively when I concluded, "He has Sepsis." Broad spectrum antibiotics were started intravenously right away. As I waited in the hallway for them to get Les settled in an ER bay bed, a paramedic came out to speak with me. He told me the ER physician thought Les had Neutropenic Sepsis--a side effect of the radiotherapy. Son of a bitch...something else the oncologist neglected to enlighten us regarding.
   Finally I stepped inside the blue curtained cubicle with my best beloved. Les was scared and broke out in tearful anxiety attacks, his lips thinning in a rictus grin of fear, hands shaking uncontrollably. I tell you now that death was in that room with us--a faint presence seeking a more permanent outline. My heart was in my throat but I hid my fear and swallowed my exhaustion, stroking Les' face, holding his shaking hands and reassuring him we were where we needed to be now. It was natural to be frightened, he has been through so much...
   We were in the A and E for just under two hours. a physician came and gave Les a very thorough exam. This medical doctor was a very young man who looked just like Harry Potter--I kid you not! He even wore the same eye glasses as Harry. He said Les' urinalysis showed infection bacteria were multiplying in his bladder. I said I was sure the bladder catheter was the main infection route. 
   Les is resting now in the Watford General Hospital Acute Assessment Unit where he will be given more antibiotics through his IV, and they will watch him closely for the next three days.
   80,000 people lose their lives annually to Sepsis; 30,000 of those in the UK. Please, please follow the links on this post and learn all you can about it. It may be the difference between life and death for someone you love.