Diana Kane, MD, knew something was very wrong. It had been a week since she had undergone an outpatient procedure at a local surgical center and for the past five days she had been experiencing symptoms of an infection, including fever and fatigue. As chair and medical director of Emergency Medicine at Chester County Hospital, Kane understands that early intervention leads to better outcomes - but she’s still human. Embodying the old adage that doctors make the worst patients, she urged herself to press on through her workweek. After all, she thought, “If I stop and give in, then I must be sick. I don’t want to be sick, so I’m not giving in.” But, soon enough, Kane was overwhelmed by the reality of her situation. On the morning of day six, as she watched her husband, a paramedic, get ready for a 16-hour shift, she told him that if he went to work, she would be dead by morning.
Within the hour, they were in the Emergency Department at Chester County Hospital. The nurses and physicians — all people she knew well — tended to her with incredible urgency. Kane had come around and admitted she was sick, but she was having trouble reconciling their austere demeanors and looks of concern with how she was feeling. Was she really dying? She couldn’t tell. She was living in a fog.
It turns out Kane contracted an infection in one of her legs from an instrument that was used during her outpatient procedure and subsequently developed sepsis.
Sepsis, as defined by the Centers for Disease Control and Prevention (CDC), is the body’s extreme response to an infection. In its mildest form, it causes inflammation throughout the body as well as fever, increased heart rate, confusion, pain or discomfort, shortness of breath, and clammy or sweaty skin. If the condition advances to severe sepsis or septic shock, organ failure occurs. The key is catching and treating sepsis early, before it progresses and becomes far more dangerous.
Any type of infection can result in sepsis, including pneumonia, urinary tract infections, and infections resulting from surgery, Kane says. Since it can originate in so many ways and present as other disorders, it’s not unusual for a source to never be pinpointed.
That doesn’t mean a diagnosis can’t be made. It does, however, make it trickier. Where one case is obvious, another could become apparent only after a battery of tests.
“Patients could be in the Emergency Department for three hours before we get one actual sign that they’re headed for septic shock,” Kane says.
To add yet another layer of complexity, the criteria for diagnosing sepsis is always evolving. “Everyone’s just trying to make sense of it all,” she says. “You’re talking about potentially being infected by something you can’t see.”
Kane emphasizes to healthcare providers and patients alike the importance of hand-washing both before and after changing a bandage and sterilizing the area of skin that’s about to be stuck with a needle. She has her staff dispose of bottles of saline that have been open for 24 hours because, at that point, it’s more likely to begin growing bacteria.
In the hospital, the protocols exist to keep patients and staff safe. Should a single link weaken, everyone’s all the more susceptible. No one knows that better than Kane.
During her own battle with sepsis, Kane was given blood, fluids, and antibiotics. She ended up spending seven days in the hospital, and received antibiotics and fluids via an intravenous (IV) line for her first month at home. All told, it was nine weeks before she began to feel normal and ready to return to work. “That first week home, I remember walking to the bottom of my driveway to get the mail and I couldn’t get back to the house. It was too draining,” she says.
Now, just a few years after her scare, Kane knows she was fortunate, and wants to use her own experience to help educate others about the dangers and warning signs of sepsis.
In spring 2017, Kane was instrumental in the formation of Penn Medicine’s Sepsis Alliance, an effort led by faculty and staff from each of Penn’s hospitals to enhance the organization’s response to the rise in sepsis. The team meets monthly to increase awareness of and support for sepsis-related efforts across Penn Medicine, and establish system-wide agreement on sepsis care delivery in alignment with the anticipated sepsis regulations being proposed by the Commonwealth and established regulations from the Centers for Medicare and Medicaid Services.
Additionally, the alliance has developed educational resources for use by its Penn Medicine providers that include sepsis pocket cards, micro-learnings covering various sepsis topics, information sheets, published literature and patient handouts.
Trusting your gut and intuition when you aren’t feeling well and being proactive about your own well-being and health is key, Kane says. Increasing awareness about sepsis among both medical staff and patients, can ultimately save lives.