Back to Christopher Reeve.
I was sure that there would be, somewhere among this morning's papers, after a day to digest the news, a story about exactly why Reeve died.
But there wasn't, not in the New York Times, the Washington Post, The Wall Street Journal, The Financial Times, USA Today, or the Charlottesville Daily Progress.
That's a lot of high-priced journalistic talent above: you'd thing someone would've gone beyond the "what happened" to "why."
But no.
The Washington Post had the clearest account of what happened:
1) As of a week ago - October 5 - Reeve was apparently fine, well enough to speak at the Chicago Rehabilitation Institute on behalf of the institute's research program.
2) Soon after, he developed a pressure ulcer, also known as a bed sore, a constant nemesis of paralyzed individuals. These usually occur over the sacrum (tailbone).
3) The sore became infected, and the infection spread from the localized site into Reeve's bloodstream. This is referred to as "sepsis" or "septicemia."
4) Reeve was undergoing treatment for his sepsis at home in Pound Ridge, New York. This consists of at least one and usually two powerful, broad-spectrum antibiotics given I.V.
I have no doubt Reeve was receiving the finest medical care money can buy.
Susan Howley, executive vice-president and director for research at the Christopher Reeve Paralysis Foundation in Springfield, New Jersey, said, "He had extraordinarily good state-of-the-art care, which is not necessarily something available to everyone who suffers a spinal cord injury."
Still, it would appear to me that Reeve was a victim of what I have referred to before as "V.I.P. Medicine."
The reason sepsis is life-threatening is the associated symptom complex that accompanies it.
Most important, sepsis can cause low blood pressure and septic shock.
That's why septic patients in the hospital who are unstable are always in the I.C.U.
5) Reeve was at home when his heart stopped beating. The Washington Post described it as a "heart attack," but trust me, it was a cardiac arrest, resulting from low blood pressure and subsequent poor perfusion of the heart muscle itself by the coronary arteries.
Home is not the best place to be if you're septic.
For one thing, the vast array of pressor drugs and real-time blood pressure monitoring by an indwelling arterial catheter are unavailable.
6) He lapsed into unconsciousness and coma at home
7) An ambulance transported him to Northern Westchester Hospital, where he remained comatose and died Sunday.
John Schwartz of the New York Times wrote the best overview of the enormous medical challenges facing paralyzed patients: his story follows at the very end of this post.
Article comments
1 - Claire Robinson
An interesting, informative and valued account of both Christopher Reeve, his death, and his injury. I too was greatly saddened at his death. He was doing some great work in an effort to aid people with similiar and/or related conditions.
Thank you for this piece.
Claire
2 - Mac Diva
I agree that the WaPo had the best explanation of Reeve's death. I cited their package about him on my thread about his death. I also made a point of saying that pressure wounds do not normally follow the causal path Reeve's did. I think it important to emphasize that before people latch onto to something inaccurate. In an online chat at the WaPo, a physician who treated Reeve during the early years of his paralysis did what he could to dispel some of the nonsense cropping up, such as there is some kind of "winding down" process for people with SCI. But, considering how people are, no telling what claptrap they will end up believing.
Considering your interest in SCI, I think you would enjoy reading Teddy Pendergrass autobiography, Truly Blessed, which I've reviewed. He does an excellent job of describing living as a quadriplegic. BTW, he had a bout of dysreflexia at the famous Live Aid concert. It was hot and there was no air conditioning. His temperature spiraled, sparking autonomic responses. Fortunately, his aides controlled it by packing bags of ice around him.
(For people not exposed to the subject matter, quadriplegics cannot control their body temperature. They are unable to sweat below the point of injury.)
Of course, with my background, I thought about issues of negligence while reading about Reeve. But, I'm going to withhold judgment until I know more. Reeve had a very powerful personality. He made have made the decision about whether to be hospitalized to care for his pressure wound. Reminds me of Pendergrass, again. He traveled to an awards show while requiring an operation on a pressure wound. So, let's wait and see.
3 - Eric Olsen
Exceptional post Joe, perhaps your best and most important ever - I really appreciate the information beign presented in such a clear and logical manner. Now I'm sadder still about it since it never should have happened
4 - E. John Love
Thank you for writing this detailed and informative description of the medical details and issues surrounding the death of this inspirational person. I have cited your article on my own blog.
Thanks again.
John.
5 - Mac Diva
Typo in previous comment: He may have made the decision about whether to be hospitalized to care for his pressure wound.
I've seen a few other pieces online alleging negligent care, but none of them substantiate the claim, either. Such a case turns on why Reeve was being treated when and where he was. It is possible his doctors approved the home treatment and/or that Reeve refused suggestions he be hospitalized. He spoke to scientists working on SCI research within a week of the day he died. Seems that he was very determined to adhere to his work schedule. Again, I think people should wait and see before assuming Reeve's caregivers were at fault for his death.