The intensive care unit is an oddly quiet place. It swarms with doctors, nurses, respiratory therapists, and medical students, but they confer in low voices, like librarians. The tinny buzz of daytime TV that forms the background noise of most hospital rooms is absent; ICU machinery is nearly noiseless. Lights blink, monitors chirp, respirators sigh.
The man in bed one came here from the emergency room, where he’d appeared one evening complaining of a bad flu. His joints ached, his skin was clammy, he had shaking chills. The doctor noted that one knee was swollen and tender; his patient explained that he’d been rock climbing the previous weekend and had had a fall. Nothing serious, but the fall had convinced him it was time to quit for the day. He’d had a long, soothing soak in the hot tub, then drove home. Two days later he started feeling sick.
Worried by his patient’s pounding heart and rapid breathing, the doctor drew some fluid from the knee and sent it to the lab for immediate analysis. The report confirmed his worst fears: the fluid was swarming with bacteria. This was no flu; it was the early stage of a generalized bloodstream infection, or sepsis. And it was a potential killer.
Sepsis is not one of those medical terms, like coronary, that have made it into the American household vocabulary. Few people outside the medical profession have ever heard of it. Yet all doctors--and particularly all critical care doctors--know and dread the sudden temperature change, the clammy skin, the drop in blood pressure that signal its onset. They are all too aware of sepsis’ deadly domino effect: the progressive shutdown of kidneys, liver, lungs, heart.
Their dread is well founded. Sepsis is the leading cause of death in noncoronary intensive care units; overall it ranks thirteenth among causes of death in the United States. Despite years of research and billions of dollars spent annually, there is still no effective drug treatment, and mortality rates hover around 50 percent. Worse yet, sepsis is on the rise: it now kills 175,000 intensive care patients annually, seven times the rate in 1980.
