As my favorite basketball team was winning a game en route to the national title this is what I was doing. I have never seen overwhelming sepsis take a patient from me like this. This case would be a 'Grand Rounds' case at about any teaching hospital, but instead it happened in my little ER on a warm spring night.When you let yourself get to 428 pounds as a 21 year old you have made some choices that will impact you for the rest of your life. In this case the impact was a sudden death in spite of everything we could do. We worked on her for about thirty minutes longer than the MECCA would have because we could. Academically speaking the last thirty minutes was futile. But we had met the family and we had seen the tears and we did not want to let her go even though we all knew.
When you become very ill and you have chosen to forgo health insurance you are in big trouble (in spite of EMTALA). Not only are you less able to see a physician when you first get ill, but just by me telling your story to a receiving facility over the phone it becomes obvious that you do not have insurance and the availability of ICU beds is mysteriously effected. The only cure for this is for the government to pass SUPEREMTALAHIPAA which will prohibit description of the patient in any way when transferring from one facility to another. Any information given might lead one to a correct inference about insured status. It will go like this...
ME: "I have a patient for you".
RECEIVING FACILITY: "Okay."
In all fairness the die was cast long before I saw this patient. She ignored her symptoms for too long and got to us a few hours too late and even the MECCA could not have saved her at this point. Her girth made central lines impossible even with ultrasound guidance. We could not even Doppler a femoral arterial pulse. And within a few hours it was all over, the last minute of CPR pictured here with 10 ER personnel trading turns trying to get enough blood out of her heart to perfuse her brain.
All of us in the room bit our nails to the nub as we watched all our interventions fail; gorillacillin IV, fluids wide open, pressors that would make you or me bleed inside our brains... dopamine, levophed, neosyneprhine, epi... failure. Then asystole, then PEA, and a dead heart on the ultrasound. No movement... not even the flutter of a valve, and all our puncture sites pouring blood while the extremities clotted off and she bled into her gut.
Go Tarheels. They were clearly the best team this year.
* picture altered from original
