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Credit: Xiaolei Su, HHMI Whitman Center of the Marine Biological Laboratory. via

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?

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