SEPSIS: Diary of a Bad Few Months

Paul and Jane Jackson

Sep-sis /’sepsis/ n. A serious condition resulting from the presence of harmful microorganisms in the blood or other tissues and the body’s response to their presence, potentially leading to the malfunctioning of various organs, shock, and death.

Paul’s story

In September 2020 I was worried about two possible disasters: the first being the possibility of the re-election of Donald Trump as President, and second, catching COVID-19. Aside from those, I was feeling pretty good about my life at eighty-three years of age; my wife Jane and our kids and grandkids were healthy, and I seemed to be. I was walking two and a half miles every morning and a mile in the afternoon, up and down steep hills as I was quick to point out to anyone who would listen. I think I was pretty full of myself. Some little things started bothering me. I couldn’t write legibly in cursive anymore, so when I wrote checks, I printed everything except my signature. Also, my left hip was becoming chronically sore, especially when I took my walks. Worst of all was a recurrent weakness in my leg that caused me to take a couple of hard falls. All signs of my old age, I told myself, until the morning when I could not complete a sentence when I talked. I would try to say something, but the words weren’t there. When I tried to read, I had trouble understanding most of it. Jane sug- gested that I was having small strokes. We went to the emergency room where I was examined and where no evidence of strokes was found, but it was decided that I should be admitted for further examination.

Or something like that. Sepsis affects the brain and so I was disappearing down the rabbit hole, and what I remember from there were things that never happened. I can remember the hallucinations very clearly, but hardly anything else. I had developed sepsis of the lumbar spine, but it was months before I understood what had happened. I kept asking Jane what was wrong with me, but I could not remember what she told me. From mid-October of 2020 until mid-January 2021, I was a patient at Honor Healthcare-Thompson Peak, Honor Healthcare-Shea, and Scottsdale Advanced Healthcare, and semi-conscious most of the time.

Throughout, it was mostly hallucinations that I still remember clearly. For example, although I was out during the presidential election, I learned the results as I hallucinated that Jane and I were each sitting in broadcast control booths of the type that were used at KTVK, Channel 3 in the early 1960s when I worked there as a film editor. I asked her if Trump or the “other guy” won. I could not remember Biden’s name, and it mattered to me only that it was anyone but Trump.

Sometime in that period I awoke during the night thinking that I must be dying. I knew I was very sick, and it was reasonable to conclude that at eighty-three I was on my way out. I wasn’t afraid, but I regretted that I would have to leave Jane, my beloved companion for fifty-seven years, and my precious daughter and son, Carla and Dan.

I’m actually not sure if this happened after I was conscious or not, but whatever the case I had one more extended period of irrationality during which I was convinced that Jane was being held prisoner at Scottsdale Advanced Healthcare and I planned to slip out of the hospital that night to rescue her. But I woke up; the room was crowded with people (a hallucination according to Jane) and Jane was standing by my bed smiling at me (real) and I was so glad to see her I almost cried.

When I was stable enough, they sent me back to Advanced Healthcare where I stayed until four days before Christmas. I had discovered at the hospital that I was no longer able to walk and that upset me, but I was assured that the physical therapists at Advanced Healthcare would have me walking again in no time. SPOILER ALERT! They didn’t come close. Because of COVID all the patients at Advanced Health were confined to their rooms with no visitors allowed. To visit me, Jane would come to my window (which we couldn’t open) and we could shout to be heard through the glass or talk on our cellphones. It was a long drive through traffic for Jane to visit, so we communicated mostly by phone, as I did also with Carla and Dan who cheered me and in Dan’s case furnished me with shipments of organic protein drinks.

I tried to read but could not concentrate very well, so I watched football and MSNBC, and stared out the window. Even though the physical therapists showed up often to teach me leg exercises, I was stuck in a wheelchair even to get around the room and into the bathroom. But I was also dull. It was hard to think and to remember things. I often had to ask Jane what was wrong with me. I couldn’t remember or understand what the term “sepsis of the lumbar spine” meant. I just wanted to go home. I had learned by early December to use a walker and that was good enough for me. When I found out that I was to be released a few days before Christmas, I assumed I was cured.

At home Jane had put the tree up, and I shaved off my two-month growth of beard. Christmas arrived, but I didn’t feel right. I went to bed angry because I thought that Jane wasn’t following my “simple” instructions for watching movies on DVD. Sometime during the night, I tried to get up out of bed and fell down. Jane couldn’t lift me up, and I couldn’t even raise myself off the floor. She called 911 and when the medics arrived, I joked that the especially burly one would be able to get me up. And that was it; I went back down the rabbit hole and through the looking glass and stayed there for days.

Unlike the first time, I was terrified, hallucinating that I was in a hospital in a strange city and that Jane would not know where to find me, although through most of this time I was completely out. I was slipping away and wouldn’t be around to write this if it had not been for the efforts of my doctor, the hero of this story, who pulled me back so that I woke up in Honor Healthcare-Shea where a few years before I had been a volunteer in the emergency department. I was conscious and stayed that way.

That’s my story. I was sent back to Advanced Healthcare for two boring weeks under observation and frequent blood tests. I got home on January 17, still in a wheelchair. The next few months I practiced walking, first from the dining room to the living room, then up and down the driveway, the street, the park, and finally the hills, no cane needed. I had made it, thanks to all those who helped me along.

Jane’s account

For three months I was a full-time worker on behalf of Paul. I learned about sepsis, and about antibiotics for staph aureus. It takes much time to read articles on the web, and download research studies from PubMed, but I find it satisfying to understand – and share.

Paul was in the hospital four times since mid-October 2020: twenty-eight days. He had sepsis, the body’s immune system over-response to a blood infection (i.e., septicemia). Staphylococcus aureus bacteria invaded his lumbar spine facet joint between two vertebrae. Inflammation blocked the nerve to his left leg, and his leg suddenly gave out on him twice in early October, so he fell hard, injuring his right shoulder severely—rupturing a biceps tendon and the tendon on the top of the shoulder.

I kept a daily journal. Here’s the story.

Paul was increasingly unhappy by August, due to the pandemic isolation and politics, which scared and depressed him. I suppose that’s why he made the poor choice in September to walk down a steep dirtand-rock path that he had previously avoided; he fell and bloodied his knee, with no way to clean it. Staph lives in dirt. The immune system kills staph within 15 minutes, if it’s a small amount, but this was too much. The next day he jogged down a steep hill. That’s likely when staph entered his lumbar facet joint, due to pounding on the joint.

In early October, after Paul fell hard and injured his shoulder, he called our primary care physician, who put him on steroids for six days and ordered outpatient magnetic resonance imaging (MRI) of the lumbar spine (which couldn’t be done until Oct. 20 due to heavy workload caused by the pandemic). His hip pain increased and his ability to walk worsened.

On October 17, he suddenly became aphasic—couldn’t find words— so I drove him to the emergency room at Honor Health—Shea. They put him in the stroke ward for two nights. Their tests revealed nothing and he was discharged with a slight fever.

At home, he could hardly walk. I called our primary care physician, who arranged admittance to Honor Health - Thompson Peak, an orthopedic hospital (no COVID-19 units). As I was making final preparations to drive him there, he fell again in his study; he couldn’t get up but somehow dragged himself onto the bed, and he shook uncontrollably.

I called 911. He was taken to Honor Health - Thompson Peak with a temperature of 104 degrees

The next morning, Paul called me. He said, “Do you know how I could have gotten a blood infection? That drew four doctors into my room.” We were all surprised—a blood infection was the cause of his fever: specifically, staphylococcus aureus. He was given an intravenous (IV) antibiotic for six days. Few diagnostic tests were done; only the symptoms were addressed, not the locus of infection. The young orthopedic surgeon showed me the MRI and explained why he thought Paul’s problem was arthritis in his lumbar vertebrae, blocking the nerve to his left leg. The plan was for Paul to see an orthopedic surgeon after healing from the blood infection.

The staph culture on the sixth day was negative, so a central catheter was inserted into his arm and he was transported to Advanced Healthcare, a skilled nursing facility in north Scottsdale.

Ten days later, on November fifth, an ambulance took Paul to the ER at Honor Health – Shea; his IV antibiotic had failed and he was incoherent and incontinent. (Bacteria can influence the brain via the vagus nerve, which causes brain cells to produce inflammatory cytokines, resulting in “altered brain signaling”, which can manifest as confusion, memory impairment, depression, and loss of control of bodily functions.) While we waited in the ER for a room to be ready, he thrashed around. His most coherent statement was, “This is killing me!” I piled warmed blankets on him, for it was cold. The hospital was full. A COVID-19 unit was opened that week and each nurse had an extra patient to care for.

That hospitalization was Paul’s low point. The infectious disease doctor on his team put him on intravenous (IV) vancomycin, the antibiotic of last resort because of its bad side effects and toxicity to kidneys. (Whereas most other antibiotics only prevent growth of bacteria, vancomycin kills by preventing gram-positive bacteria from building cell walls). That specialist ordered many diagnostic tests. The only revealing one was the lumbar spine MRI with intravenous contrast. It showed septic arthritis (i.e., infected joint) of the facet joint between the lowest lumbar vertebra, and a small abscess in the muscle in his lumbar vertebra. Finding where the bacteria were hidden was empowering—It explained why he fell: inflammation blocking the nerve to his leg. Interestingly, no blood culture after the first two days at Thompson Peak ever showed any bacteria; it hid in his facet joint.

Paul was eleven days in the hospital. The first three days he was barely conscious but extremely restless; the fourth day aphasic but glad to be alive, the fifth day very verbal and upset, with vivid hallucinations and anger. “Why did you invite so many people here?” he said, irritated. “There’s no one here but me”, I replied. “One, two, three, four, five, six, seven, eight”, he said, pointing all around me, up high in the room. His heart rate, breathing rate, and blood pressure were much too high, each day. His serum potassium was so low that he was given it intravenously. On the seventh day, his systolic blood pressure plummeted from 170 to 100, and his kidney function decreased to one-fifth its nor- mal level, signs of impending septic shock -- so he was given albumin intravenously twice to prevent that. Each day, the kind nurses helped and cheered him. Physical and occupational therapists strapped him to their bodies and took him for short walks around the unit, and they taught him exercises in bed. They taught him to use a walker (which made his right shoulder hurt) and a wheelchair.

Septicemia in a spinal facet joint is called septic arthritis. It is uncommon. People of all ages get it, typically from impulsive forces, i.e., pounding on the joint. A fifteen-year-old boy got it playing football, as did a twenty-five-year-old man. Two research articles reported on obese women who got it from housework—lifting heavy objects. I think Paul got it from jogging down a steep hill in mid-September. In contrast, ordinary types of sepsis occur primarily in the elderly. As with former President Clinton, sepsis can result from a urinary tract infection. Lung infections are common causes, too. The web has much information.

After four weeks at Advanced Healthcare, on Saturday, December 12, Paul called me to say that he was dismayed that “someone tested positive for COVID-19, so everyone is confined to their room.” That day, Carla, Dan, and I noticed he had trouble speaking, was agitated, and said things that didn’t make sense. He looked gaunt and weak. He seemed unsettled, disoriented, irrational. He was unsteady and had a fever, his nurses reported; and they said that he wandered out of his room on Saturday night—not allowed. By Sunday evening his blood pressure and heart rate had skyrocketed; an ambulance was called to take him to the ER. Luckily, a kind nurse intervened and had a medic phone me. I pleaded to the medic to let Paul get a good night’s sleep where he was; I said that the ER was no place for healing, especially with the huge number of COVID-19 cases and thus overworked staff. The medic obliged. Paul remained in his room.

The next day, he was better physically, and calm and lucid enough to satisfy the staff, but not me. I called Paul and asked him why he walked into the hall on Saturday night. He replied, “I thought I was supposed to…. I don’t know, Jane—I was cold. I wasn’t unsteady—I was just walking into the hallway—I was confused because—I got confused.

I didn’t think I was confined to my room. What is sepsis?”

Paul was discharged from Advanced Healthcare nine days later, on Tuesday, December twenty-second, and given an oral antibiotic. He had vitality and was articulate. Most of his blood markers had improved to normal. He pushed himself around the house in a wheelchair. But I was uneasy; I thought it was too soon to stop the IV antibiotic.

Three days later, on Christmas night, he deteriorated fast. The oral antibiotic failed. I was up with him eight times that night. By the next morning, December twenty-sixth, his brain could no longer control/ communicate with his body. He slipped out of the bed onto the floor and could not turn over and lift himself up to a crawling position. I had to call 911 and have paramedics take him to the hospital. I cried. I thought he might die.

Visitors were not allowed; it was the worst few weeks of the pandemic locally. I got his medical record later. The critical care specialist wrote: “This patient is critically ill and has a high probability of sudden and clinically significant deterioration, which requires direct intervention and supervision …to avert/mitigate active and imminent decline.” Paul was in the intensive care unit for a day. He was semi-conscious for 2 days, and then had trouble finding words for 3 more days. They gave him three different types of antibiotics intravenously, including that which he had been given before. They repeated a nuclear medicine test for bacteria in the heart’s lining and they dripped potassium into his veins again. Nothing seemed to help his brain fog. Paul called on the fifth day, discouraged; he said, “I’m eighty-three; am I worth saving? This is expensive!” That evening, they gave him an extra- large dose of IV vancomycin and by the next morning he was articulate and focused. That day, they stopped IV antibiotics and started him on an oral broad-spectrum antibiotic. The next day Paul was told “We can’t find any evidence of infection in any test.”

On Monday, Jan. 4, he was discharged to Advanced Healthcare for physical therapy, occupational therapy, and oral antibiotic. He said, “I feel stronger than I have in months!”

Two weeks later, he was discharged to home, exactly three months since his first hospital admittance. He slept fourteen hours a day. He had physical therapy to improve his balance and mobility, but it didn’t take; he couldn’t remember the moves; he still had some brain fog. Three times he lost his balance and fell; the last time was in May, when he bloodied himself so badly that I drove him to the ER. They taped him up and gave him several tests. All were normal. After that, his progress was steady. By October 2021, a year after his first hospitalization, he declared himself “95% back to normal”, and 100% normal by January 2022. Thank goodness! His desire to live got him through—with skilled medical help and loving actions from family, neighbors, friends, and many medical personnel.

We are indebted to Christopher Crowe, D.O. and Maria Raquel Saldivar, M.D. for their skill, wisdom, and caring.

In these days of horror and terror in Ukraine, with the days ahead unknown and maybe unknowable, I share some of the story of my parents (and my own), mostly of my father — who lived under Nazi Germany and Soviet Communism and came to live as a patriot in the United States. Too familiar tales of horror and terror from some 75 years ago in the same Badlands of Europe that is now being resurrected. I write this now at the time of Purim, in my tradition, when we remember salvation against genocide, and we remember to forget the name of the murderer. I call these remembrances:

Fragments

from and by, David Kader

The only whole heart is a broken heart. *

My father was a dancer. Waltz, polka, foxtrot, even jitterEssay — Kader bug, but most happily the rumba. He loved a woman’s hand in his, to see her shoulder, hold her waist.

He ate everything “but nails and wood,” he reminded me often. Food was taken seriously, a meal cherished. I once asked him how he survived the Second World War in his Siberian imprisonment. “Garlic. Garlic saved my life.”

They called him “Monjak” in Warsaw. “Jake” at the Pinedale factory in the Great San Joaquin Valley when a refugee. “Jack” on the streets of Fresno, California. “Moshe” in his home. The century renamed him again and again in its image.

My father Moshe the dancer spoke Polish, Yiddish, German, Russian, English, some Czech and some Rumanian, and read and sang Hebrew, but mostly the language of silence in the years of the tyrants.

A postcard from the Warsaw ghetto to his Siberian prison camp, telling of the end. The message alone escaped.

My father Moshe the dancer once said: “Tyrants take away your future. They take away your past. Only now they leave you.”

Once so hungry he recalls imagining the taste of his own heart.

Shallow graves in the frozen mother earth of Poland to hold the murdered children the living chose to bury to save from the crow and rat.

I, David Jacob, am his third child; in his second family. A boy twin, I am, to a girl. My elder siblings, a girl and a boy stand and sit by a tree next to their mother before they were burned with wood under a blind sky.

The world may stand on mitzvot, prayer, and acts of kindness; but it trembles in the threat of human cruelty and the fact of human indifference to the tears and fears of others.

After six years …. six long and hollow years, he thinks: “Go home.” By Mongolia’s edge he treks, through Kazakhstan his legs carry him, finding a brother jumping trains, another in Tashkent, through Uzbekistan…to the “Welcome” mat at the door of his house on his street in his Polish town, now with strangers at the window. Fist to the temple, another to the heart, with a hearty: “Go home, Jew. Do not return if you wish to keep your life.”

Stuttgart DP Camp. Chocolates. Cigarettes. Meat. Nylons. Bananas. Deal in the black market. Love Lola. Twins - the story of Job! Palestine? Canada? New York City? The North Pole? Fresno! Full stop.

Nightmares. Curses. I want them all back! The thief, the whore, the awful and those full of awe. Take a pomegranate. Bite hard into its crust and flesh. Chew just once or twice and spit the pit out against some wall. Now put the pomegranate back.

I once asked: “Where was the frontline?” He answered:

“Wherever a tear.”

I once asked: “What did you read before they burned books?” He answered: “Kant, Marx, Tolstoy. In Yiddish, I met them.”

I once asked: “Where was God?”

He answered: “Where was man?”

I once asked: “Why didn’t you flee?”

He answered: “Why? Were they going to kill us all? And to where?”

I once asked: “Why do you pray?”

He answered: “When I pray I see the face of my mother and the face of my father. Like yesterday.”

I once asked: “Shall we travel to Poland sometime, us together?”

He answered: “Poland is for me a cemetery.”

I once asked: “What about memory?”

He answered: “Remember the future.”

I once asked: “To think the world’s beginnings have come to this debris?”

He answered: “Breathe the breath given to you.”

I once asked: “Is life good?”

He answered: “Life today is good.”

I once asked: “Would you want your life to live again, as it went?”

He answered: “One life is enough, Dovidel.”

I once asked: “Why is the way not straight?”

He answered: “If you want freedom, the way is not direct. Think of Sinai.”

I once asked: “Shall we rest?”

He answered: “Of walking of talking of singing, I am never tired. We will have sleep, forever, later.”

I once asked: “Such a life as yours and so long, now into your 80s. What is most remarkable to you - the inventions of the century, the discoveries? What?”

He answered: “Freedom.”

I once asked: “Tell me of Death?”

He answered: “Death is nothing. Life! Life is something. Ask me about Life.”

I once asked: “What is Life?”

He answered: “Life is with people.”

I once asked: “Why be happy?”

He answered: “To be happy is a mitzvah to the world. Anyone can despair. Ah, but to be happy!”

I once asked: “Is there Paradise?”

He answered: “The smell of your Patele’s challah is Paradise. When Shabbos becomes Shabbos that is Paradise. To see your Sarahala dancing, and boychick Aaron davening, that has Paradise.”

I once asked: “Do you answer all questions!?” He answered.

In the second half of his life, he took long daily walks, the dancer, did. “For the heart and the legs,” he said. Of course, for the heart — embedded with shards of glass and knitted together by the muscles and tendons of memories, that need exercise. Of course, for the legs that outraces the tyrants’ whirl wind and can’t stop, even with a USA passport.

1986. He wept before the Bill of Rights at the National Archives in Washington, D.C. “Why are you crying,” I ask. “I am here. With you. Free.”

My father Moshe the dancer was a patriot of no place, but the place called Freedom and sang all his life: Sim Shalom— Grant Peace to All the World.

The miracle of his life outlasts him in us; for him, the miracles are over. Adon Olom. “I shall not fear, body and spirit in His keep.”

*

Keep the fragments near and dear; for the only Whole Heart is a Broken Heart.