Blindsided by Sepsis

A Leesburg woman vows to raise awareness after her husband’s unexpected death.

Story: Chris Gerbasi Photos: Anthony Rao

Randy Adams went to a hospital for back pain and 10 days later, he was suffering what his wife Kathi believes was the beginning of sepsis, a potentially fatal condition triggered by infection.

Just that quick, the Leesburg couple’s world collapsed. For the next 14 months, they were staggered not only by Randy’s deteriorating health—including two apparent cases of septic shock—but also by endless questions about his care.

At the outset of the ordeal, Kathi knew nothing about sepsis. By the time Randy died from sepsis at age 60 in December 2017, she knew more than she ever wanted to know. Now Kathi wants the community, hospitals, and other caregiving facilities to be more aware about the dangers of sepsis—a medical emergency that requires quick detection and fast action to save the patient.

She doesn’t want anyone to experience what her “soul mate” of 23 years went through.

“He was my rock. I know life is life, and death comes, but I never thought I’d be a widow at this age and for him to go that young,” Kathi says. “He really was a good man. He loved me, and always just wanted me to be OK, along with his daughter (Katie) and his granddaughter (Chazzy).”

Kathi, who has worked as an administrator in the healthcare field, plans to become an advocate for sepsis patients and their families. She hopes to start a foundation for sepsis care in her husband’s name with the help of Dr. Jose Diaz, who runs the Pulmonary Group of Central Florida in Leesburg and was Randy’s pulmonary doctor for four years.

Sepsis is the No. 1 cause of death in the intensive care unit, Dr. Diaz says. The reason may be that sepsis offers a paradox to doctors.

“It’s easy to treat at the beginning but difficult to diagnose,” he says. “Later, when it’s full blown, it is easy to recognize but difficult to treat. So the problem is, how soon can we recognize sepsis? The sooner we recognize it, the better survival (chance) for the patient.”

Sepsis is the body’s extreme response to an infection, according to the Centers for Disease Control and Prevention. Sepsis develops when an infection you already have—in your skin, lungs, urinary tract, intestines, or elsewhere—triggers a chain reaction throughout your body. Sepsis attacks the organs, and without timely treatment, it can rapidly lead to tissue damage, organ failure, and death. Limiting exposure to infections may reduce the risk of developing sepsis.

Dr. Diaz and his colleague, Dr. Felipe Ortiz, are working with Leesburg Regional Medical Center to achieve 24hour oversight to identify sepsis and get the best outcomes. A specialist provider and a nurse practitioner are available overnight in the ICU, Dr. Diaz says.

LRMC sees about 60 sepsis cases a month, says Marjorie Westerkamp, ICU director for Central Florida Health Alliance. The goal for hospital staff is to recognize sepsis and implement interventions within six hours, she says. Otherwise, the risk of death climbs the longer sepsis is unrecognized, and the patient can go into septic shock, which occurs when blood pressure plummets and breathing slows to a dangerous rate.

The hospital uses a Cerner computer alert system to track patients for SIRS, or systemic inflammatory response syndrome, which is related to sepsis. The system tracks patients’ heart rate, blood pressure, white blood cell counts, and other factors over a 24-hour period, Marjorie says. If a patient screens positive for signs of sepsis, nurses proceed with a set of orders, including lab work for blood cultures, administering intravenous fluids, preparing antibiotics, and alerting a physician.

“So, hopefully, we can intervene before that patient goes into full-blown sepsis,” Marjorie says.

Antibiotics fight the infection, and fluids help the blood system provide oxygen and nutrients to tissue and organs—a treatment that can be lifesaving, according to the Sepsis Alliance, an advocacy organization based in San Diego. Vasopressors, a medicine used to raise blood pressure, and oxygen also may be administered.

At LRMC, a committee meets monthly to analyze staff response to sepsis cases, consider other interventions, and check mortality rates. The national benchmark is a 15 percent or less mortality rate, and LRMC fluctuates around that figure, Marjorie says.

Staff also walks through the intervention process with new nurse practitioners and looks at ways to better educate everyone involved to make sure the best practices are in place for patients. The community also needs to be educated, she says, because people with sepsis symptoms often wait too long before seeing a doctor. Similarly, Dr. Diaz says it’s important to educate staff at nursing homes, assisted-living facilities, and other care centers in Lake and Sumter counties, which have an aging population. People age 65 and older, as well as people with chronic conditions or weakened immune systems, are at higher risk for infections, which may lead to sepsis. By the time some patients are admitted to hospitals, they already have full-blown sepsis because it wasn’t recognized early enough, he says.

“We do believe there’s some room for improvement,” Dr. Diaz says. “I think, in the community, there’s more work to do…You have to continue education again and again and again.”

Kathi wants to be a part of that educational effort.

“I just want to help find the solution, as my husband and I decided to do when he was alive,” she says. “He was always trying to help other people.”

Randy was a tile setter and laborer who took care of himself, Kathi says. But he had health issues including mild chronic obstructive pulmonary disease, chronic sinusitis, and hypoxia, an oxygen deficiency. His bad back often caused excruciating pain.

In October 2016, he had a kyphoplasty outpatient procedure to fix a fractured vertebra. By the time he went to bed that night, the pain had returned. Two weeks later, he needed to go to an Orlando hospital to treat it.

Within 10 days, Randy’s condition went from bad to life-threatening.

Kathi watched him swell, cough, even seem delirious. Randy told her he felt “odd” but couldn’t explain it. Looking back now, Kathi believes her husband was showing sepsis symptoms: fever, pain, discolored skin, sleepiness, confusion, shortness of breath.

At some point early on at the hospital, a doctor discovered Randy had an infection. When and where he got this infection was uncertain.

Kathi says she felt unsure about the measures taken by staff to help her husband. Her concern was compounded by a lack of communication from doctors and nurses, none of whom ever mentioned the word “sepsis.”

Sepsis is a common complication among people hospitalized for other reasons. On any given day, about one in 25 hospital patients has at least one infection acquired while receiving treatment in a health-care facility, according to a 2016 CDC report. So if a patient is not getting better after surgery, for example, they may want to insist to doctors that sepsis be considered.

Kathi felt like no one was listening to her.

“You have to be an advocate when you know your family members better than the doctors know,” says Kathi, who did her own research on Randy’s condition. “You have to be a part of that arena with the doctors and the nurses.”

The worst was yet to come. Randy went into respiratory depression and a coma, and he was put on a ventilator.

“The ICU doctor did save his life. But it should’ve never happened,” Kathi says. “Ten days in a hospital. It should’ve never happened. I don’t understand.”

A doctor asked Kathi to sign a do not resuscitate order, and she refused. After several days, Randy regained consciousness.

“He got on the phone and said, ‘Hi, honey, this is your long-lost husband that fell in love with you 23 years ago,’” Kathi says.

Randy had survived septic shock, Kathi believes, though hospital staff called it respiratory depression and never discussed sepsis with the family. “I believe they knew,” she says.

The consequences for Randy were the amputations of half of his left foot and his right leg below the knee. Sepsis patients are prone to amputations because of blood clots and circulation problems.

Randy left the hospital but soon contracted pneumonia. He was admitted to a different local hospital, where he went into septic shock for the second time in two months, Kathi says.

Again, Randy survived, but every organ in his body had been affected. Over the next 12 months, he was in and out of hospitals and rehabilitation facilities. He was a fighter, but the damage from sepsis was irreparable. Though doctors initially didn’t say the word “sepsis,” it’s plainly typed on his death certificate.

“That man never complained through this,” Kathi says. “For somebody to go through what he went through and not complain is powerful. He just knew he couldn’t change it.”

Kathi is still haunted by questions, especially whether quicker intervention could have saved Randy. According to her, an attorney she consulted saw the MRI scan of Randy’s back that first night he entered a hospital.

Randy had a soft-tissue infection.