“Christine was a feisty woman!” said her husband Patrick, fondly. “She fought for special needs educational plans for families that needed help with their children with the school. She wouldn’t be afraid to go in front of a bunch of lawyers and fight it out, or the school principals or superintendents or the school board. I had no chance in an argument with her. We’d argue and she’d be all over me. And finally I would say, ‘Whatever you want, honey, it’s fine with me. I can’t argue with you -- you blow me away.’ She could argue with the best of them.”
He continued, “She did a lot of good in her day. She helped a lot of families out that needed it. She would help people get disability payments, people with a lot of medical problems. They would say, ‘You’re helping my son with the school. Would you help me too?’”
Patrick talked about their life 20 years earlier, when they were first married. “She raised horses and was able to walk in the mountains of Colorado, go on hiking trips and all that.” But Christine had an unusually severe case of scoliosis, and the curve in her back kept getting worse. “The scoliosis kept slowly crushing her lungs. She lived at home on oxygen and shortly after that she went into a wheelchair for a couple of years. Eventually she was unable to swallow and so they had to put a feeding tube in.” Christine was 43 years old.
She also had to have a tracheotomy, an opening cut in the neck to put in a tube to get air to the windpipe (trachea). “She fought back. She fought for two years after that. She put up a heck of a fight. She didn’t want to die. She was a real fighter. She kept plugging away.”
She was in and out of the hospital and she always had a variety of IV lines -- also known as catheters -- running into her body. Patrick is philosophical about the infections she got through these intravenous lines permanently breaching her skin: “It wasn’t so much ‘if’ they would get infected; it was ‘when.’ As with any patient in the hospital, they took her temperature a couple of times a day. As soon as she started getting a temperature, that meant that she had an infection. Then they had to pull out the old central line [a type of IV line], put in a new one, start an antibiotic, and take care of her that way.”
This got to be such a standard routine that Patrick didn’t think anything of it when it happened again. But this time the vascular surgeon who had to do the procedure to put in a new line said that replacing the line would have to wait.
“He was very busy, and said, ‘I can’t schedule you for another week or so.’ The infection got worse and worse. Eventually, they changed the line, but it was too late. The infection went throughout her body. She was unconscious for a week. She kept dying. Finally, they said to me, ‘We worked on her for six hours last night to keep her alive. She’s never going to wake up. What do you want to do?’ She was going to die anyway. I had to tell them, ‘You may as well let her go.’” Christine was 45 when she died.
Patrick understands intellectually that it’s not his fault that Christine died, but his words reveals that he still feels responsible: “I should have been way more active when I knew she that was infected and I knew they were putting it off. I just thought, ‘She’s made it through so many infections, she’ll make it through -- it’s no big deal.’ But she continued to get worse. Then she slipped into a coma. I never should have let that happen. I should have been more proactive. I should have said, ‘Get her to another hospital! Do something for her!” I should have been way more assertive than I was, and that’s definitely my fault.”
According to Dr. Peter Pronovost, writing in the Journal of the American Medical Association in July, 2011, central line infections -- also known as bloodstream infections -- kill about 31,000 people in the U.S. each year. And, despite what Patrick was led to believe, these infections are not inevitable. Dealing with them after the fact should not be business as usual.
Dr. Pronovost is quoted in the Wall Street Journal -- and in many other interviews -- as saying that by taking five simple steps, doctors can reduce such infections almost to zero. Are the five steps complicated, time-consuming, or expensive? You be the judge:
- Wash your hands.
- Wear sterile clothing and cover the patient with sterile drapes (disposable cloths).
- Avoid putting the catheter in the patient’s groin, a breeding ground for infection.
- Clean the patient’s skin where the line will go in, with antiseptic.
- Remove catheters as soon as they are not needed.
Was it inevitable that Christine would get a central line infection? No. Was it inevitable that, once she had gotten it, she would die? No. Would she have died eventually, of something? Yes, as we all will. But she didn’t need to die that day.
If you or someone you care about is hospitalized, what can you do to reduce the risk of a fatal infection from an intravenous line?
First, recognize the risk. If you have the opportunity to compare infection rates of different hospitals before choosing a hospital to go to, that would be ideal. This information is not always easy to come by. You might try asking your doctor or the hospital. If they don’t know or won’t tell you, that’s not a good sign. One site that does offer some information about hospital infections by hospital is Consumer Reports, at http://www.consumerreports.org/health/doctors-hospitals/doctors-and-hosp.... However, much of the information on this site requires a paid subscription, and the information is incomplete because in many states, hospitals are not required to report infection rates.
Second, ask the doctor what approach is used to prevent infections in IV lines. A good answer here is, “We use a checklist when we insert catheters/central lines/IVs.” A bad answer here is, “We do this all the time; we know what we’re doing.” It is often noted that pilots use checklists every single time they prepare to fly regardless of how experienced they are. The same approach in health care would save countless lives.
Third, help the patient watch out for the site where the line is inserted -- if something happens that could infect the site, ask that nursing staff clean it; it may even be necessary to replace the line with one inserted somewhere else.