Blood on Fire
A mother’s unexpected death in the hospital. A daughter determined to find answers.
Blood on Fire combines memoir with medical investigation. After her mother dies of sepsis in a respected teaching hospital, Ann MacDonald uses her skills as a medical writer to investigate what went wrong and why no one seemed to notice until it was too late. The book examines the cognitive biases, emotions, and hierarchical power dynamics that prevent swift diagnosis and interventions. It combines MacDonald’s personal experience with stories of family advocates, physicians, nurses, and researchers who are working to improve sepsis recognition and care.
Sepsis: An Immune System Firestorm
Sepsis is an ancient scourge that remains the leading cause of death in American hospitals. Technically described as the immune system’s overreaction to an infection, it is better understood as an immune system firestorm. It can kill someone within days.
It begins with an infection. At first immune system cells attack only the bacteria, viruses, or other infectious pathogens. But for reasons that remain unclear, sometimes this targeted warfare spins out of control. The immune system response becomes chaotic. Some immune cells increase their fire power while others retreat. Additional biological changes ensue, and not always in a predictable order. Blood vessels become leaky, so blood pressure falls. Tiny blood clots form and block the flow of blood to vital organs. Starved of oxygen, the kidneys, lungs, and brain become impaired. Without intervention, multiple organs begin to fail and the patient goes into septic shock.
Sepsis affects 1.7 million Americans each year – almost equal to the number diagnosed annually with cancer. It manages to kill more than a quarter of a million in a typical year, more than AIDS, breast cancer, and prostate cancer combined. And yet in spite of how common it is, this lethal disease frequently eludes detection. How is that possible? And what is being done to save lives?
A complex medical story told through the experiences of people who are working to save lives.
Carl Flatley, DDS
Flatley, a retired endodontist and NASCAR fan in Florida, never heard of sepsis until it killed his 23-year-old daughter Erin. In 2002, she underwent a routine outpatient surgical procedure. Five days later, she was dead of septic shock. Outraged and grieving, her soft-spoken father founded the Sepsis Alliance and transformed himself into a tireless advocate. (Image credit: https://blogs.cdc.gov/safehealthcare/concerned-about-sepsis/)
Kevin Tracey, MD
This neurosurgeon and inventor remains haunted by death of child with sepsis he cared for early in his medical career. Today Tracey is president and CEO of the Feinstein Institute for Medical Research and a professor of Medicine and Neuroscience at Hofstra University. His research has done much to clarify how sepsis develops from the interaction of two of the body’s most complex systems: the immune system and the nervous system. (Image credit: https://feinstein.northwell.edu/institutes-researchers/our-researchers/kevin-j-tracey-md)
Beth Wathen, MSN, RN, CCRN-K
Wathen has been a critical care nurse at Children’s Hospital Colorado for more than 20 years. In 2007, she was part of a team that had just implemented a rapid response team to respond when a patient unexpectedly deteriorates. One month later, a 7 year old patient died of sepsis in plain sight. Clearly the system failed. In the years since, Wathen and her team have worked to fix what went wrong. they have focused on building better systems and finding ways to overcome the cognitive biases that prevented the team from seeing what was happening right in front of them. (Image credit: https://www.aacn.org/about-aacn/board/beth-wathen)
Ciaran and Orlaith Staunton
How does a healthy 12-year-old boy die of sepsis days after he cuts his arm playing basketball? This is the question that has haunted Rory Staunton’s parents, Ciaran and Orlaith, ever since. When he was younger, Ciaran participated in the 1998 Good Friday Peace Agreement which ended the “troubles” in northern Ireland. Now he and his wife have founded End Sepsis, to honor their son’s legacy by implementing policy changes that have saved lives. (Image credit: https://www.endsepsis.org/about-rory-staunton/about-rory2/)
Helen Haskell
Haskell began her career as an archaeologist. She became a patient advocate after her 15-year-old son, Lewis Blackman, died in the hospital four days after undergoing routine surgery. As president of Mothers Against Medical Error, Haskell has emerged as a national leader in the patient safety movemetn. Her research has helped show how cognitive biases such as diagnostic anchoring prevent doctors and nurses from detecting sepsis fast enough to treat it. (Image credit: https://www.patientsafetyaction.org/staff/helen-haskell-ma/)
Ann MacDonald 