I got a call from a young doctor about a patient who wasn’t doing well. Victoria was a nurse who had been healthy for most of her life. She was middle aged and slightly heavy, but prided herself on “never getting sick”.
Several days ago, she developed a painful sore throat and had diarrhea. She resisted going to the doctor. Now, she felt dizzy and was found to have low blood pressure. The young doctor was concerned and thought she needed to transfer to the ICU.
When I saw her she was already on a ventilator – a machine to help her breathing. She was sedated and couldn’t respond. I could see she was covered in a red rash over most of her body. She needed three different medicines by IV infusion to support her blood pressure. Things didn’t look good.
Her friend Nicole came up to me in tears, believing she had left things too late – neglecting to bring Victoria in sooner. She felt guilty and begged me to do something. I knew Victoria’s chances were exceedingly slim. A patient in septic shock on three ‘pressors’ had very little chance for survival. I tried to comfort Nicole – “just pray” I said “and let us do the work”.
I made sure she got the best antibiotics. I checked her immune function and saw she needed immunoglobulins. We optimized her therapy. Now we would just have to wait…
The next day a culture came back from Victoria’s throat. It was Group A Streptococcus – or the ‘Flesh Eating Bacteria’ as it is known in the popular press. This explained her condition – why she was so severely ill. This virulent germ was causing Toxic Shock Syndrome. Victoria had all the signs: low blood pressure, multiple organ dysfunction, a characteristic rash, and now isolation of the organism. The fact that she was still here was a good sign – she was fighting for her life.
Victoria continued to surprise us. On the second day in the ICU she actually opened her eyes and appeared to follow commands. Over the next couple days, the medicines for blood pressure support were tapered off. She was winning the war!
Soon the ventilator was no longer required – Victoria could breathe on her own. Her organ systems were functioning again. Her rash improved – with large sheets of dead skin sloughing off. To me it was another small miracle!
About a month later she came to my outpatient clinic. When I looked in the room, I did a double-take, as I couldn’t quite believe this patient in front of me had walked in, unaided and was completely fine now. Victoria had survived. We both agreed that ‘Someone’ wanted her to go on. She still had work to do.
That was a good day. RW
