Christopher Reeve--did decubiti kill him?

[NurseFirst]

intro:

several people have asked me about this since i changed my signature to say that decubiti killed him. so, i thought i would address the information...

first, as you will read below, we will never know for sure what killed christopher reeve. whether it did or didn't, even that it might have possibly been responsible for his death i think is worth emphasizing, so that it will increase folks' awareness and be more attentive. certainly, decubiti were a contributing factor, and not terribly indirectly, imo.

my editorializing:

what i found on the internet was this below, from http://www.paralysis.org, which is also on one of the reeve family sites. even in spite of what dana reeve says, i still feel the root cause was the decubiti. would he have needed the abx if he didn't have the decubiti? that is not addressed. it seems to me that she is going out of her way to make sure that people don't think it was due to poor health care (which is certainly understandable, and with which i have no argument.)

there's still something that doesn't quite make sense to me, like,

* wouldn't he have had some epi around if it was known he was "sensitive" to medication?

* how many ppl die of anaphylaxis if they are given immediate care? i don't know...anyone? anyone?

atthe time of reeve's death, i sent something to the reeve foundation asking them to help fund research on decubiti, far less glamorous, and far more needed, imo, than getting nerves to re-generate. and, i suspect, the money would go further (i.e., less money could make greater advances). and so it goes.

i guess it's my way of taking on "underdog" medical causes...

article from paralysis.org, also found on at least one reeve family/foundation site:

"skin care

the death of christopher reeve last october was attributed to heart failure due to sepsis (also known as septicemia), an infection that spreads from a specific location (such as a skin sore or bladder infection) to the blood and other organs. what exactly happened to christopher reeve isn't known and may never be; there was no autopsy. clearly, his death was related to pressure sores; at the time of his death reeve had been battling more than one skin sore. he had even experienced life-threatening sepsis just weeks before he died.

indeed, reeve died as a result of heart failure, which was included in the death certificate. there were complicating factors, however.

according to dana reeve, speaking on national television, neither a pressure sore nor infection directly precipitated reeve's coma and subsequent death. despite what was reported at the time, reeve's body almost certainly did not go into septic shock (a type of blood poisoning that can lead to organ failure and death). the most probable cause of death, dana reeve said, was a reaction to a drug reeve was given to help treat a suspected infection. he had been given the drug on previous occasions, successfully. reeve had a history of drug sensitivity. shortly after getting an injection of the drug, reeve's body went into shock (anaphylactic) resulting in coma and eventually, the shutting down of his organ systems. he never emerged from the coma and died less than 18 hours later.

dana reeve was very clear about the quality of care her husband received. she praised the medical staff and noted that their actions in the final hours were appropriate and unequivocal.

there may be lessons to be learned from the high profile life and death of christopher reeve. by all accounts reeve's final days were totally normal; he was on the road making a speech, he was busy being a moviemaker, an advocate and a dad, basically doing the things he wanted to do. he never paid heed to the actuarial life-limits placed on his type of paralysis by statisticians (11.4 years).

certainly, reeve's medical staff urged him to heed the fundamental protocol for dealing with any level of pressure sore, that is, to get out of the wheelchair and let the wounds heal up. but reeve chose to live his life fully and well and as much as possible on his own terms. he was not, as his wife explained, a man who was easily persuaded to slow down.

the primary lesson, of course, is to be especially aggressive with wounds. it may not be possible to prevent the occurrence of a pressure sore. with appropriate seating and sleeping equipment and attention to basic care, though, most people who are paralyzed can enjoy health and skin integrity for years to come.

while it may not have been a factor in reeve's death, septicemia is a real possibility if a pressure sore gets out of control. this degree of infection is generally controllable, however. "

[mattsmom81]

We all know quads, etc who refuse to do what's necessary to heal a pressure sore. all we can do is document document document that we tried, which is I'm sure what his primary nurse did. I'm sure she involved Dana in her persistance so Dana understood Chris' stubbornness was partly to blame in the lack of healing.

Lots of issues in his health could have contributed to his decline and eventual death so my nurse mind doubts it was 'one thing...decubiti'...but suspect it due to many contributing factors. VAP, aspiration, complications of immobility, etc.

[bobnurse]

Who Cares?

Not to sound mean or cold hearted, but Millions of People die every day. All this does is give the national attention back to bed sores, and fuels the desire to sue healthcare workers and facilities.

[Fraggle]

That's a terribly negative way to look at it. I think knowledge gives people the chance to take responsibility for their health. Certainly un-glamorous things like decubiti need attention. I know all about suing hcp's, I work for an insurance company. People sue b/c they feel powerless. There will always be greedy and opportunistic people out there, but some of that behavior can be prevented.

If we have to hide the truth about the issue from people b/c we're afraid of being sued, then more power to them to do so.

Who Cares?

Not to sound mean or cold hearted, but Millions of People die every day. All this does is give the national attention back to bed sores, and fuels the desire to sue healthcare workers and facilities.

[NurseFirst]

who cares?

bob, all those people who asked me about my signature, that's who.

i'm sorry you feel the way you do (seriously).

not to sound mean or cold hearted, but millions of people die every day. all this does is give the national attention back to bed sores, and fuels the desire to sue healthcare workers and facilities.

ah yes, and that great "statesman" :uhoh21: , joseph stalin was said to have said:

"one death is a tragedy; one million is a statistic."

ya know, the health care system is really broken in a lot of ways. however, i don't think that's an excuse to ignore this killer. especially since it occurs in many folks who are unable to fend for themselves, in institutions which are often sub-standard (ltc, snf)--not because of the nurses, but because of management. i find your attitude to be a bit surprising, and sad. are you okay? really...i'm worried about you.

nursefirst

and, mattsmom, if the quads and paras are failing to take care of themselves, what are we missing in terms of motivation, or making it easier to do? are we just automatically assuming that the reason they get the sores is because they aren't taking care of themselves. healthcare is a funny thing; some of those people we used to think were noncompliant with their meds, or drug seeking--guess what--they weren't; they had a different reaction to the medication which was genetically determined. yeah, i know it sounds like nothing can be done -- but i used to think, hey, kids get scraped up on asphalt playgrounds, that's just the way it is. i recently visited a playground (haven't been in many years, so if i'm way out of touch, just let me know) where the "ground" was soft and spongy.

[UM Review RN, ASN, RN]

All this does is give the national attention back to bed sores, and fuels the desire to sue healthcare workers and facilities.

Gee. I just happened to roll outta bed and come over to the computer, and this is what I see.

I happen to have a personal vendetta against decubitii.

There are wonderful treatment options that facilities could use to prevent skin breakdown rather than treat it, but they always choose to do something AFTER the beakdown has occurred.

That is why they SHOULD be sued. Is it the healthcare worker's fault? Yes, but only less so, IMHO, because it is literally impossible with staffing levels of today to turn and reposition the number of patients who are at risk to develop decubitii.

Though there are wonderful products available today that prevent decubs, if you look at the criteria for eligibility, the patient has to already have a Stage II or partial thickness wound in order to qualify to get one.

Yet I personally have never seen a nursing home patient develop a decub while using this overlay, even if they weren't turned on schedule. In other words, the time for the surface treatment prevention is not AFTER the patient sustains a decub. It is BEFORE. Why don't facilities decrease their liability by using these products before decubs develop? I can only gue$$.

http://www.kci1.com/products/surfaces/mrs/rikmrs/index.asp

[bobnurse]

Theres more to surfaces and products to treat or prevent a bedsore/pressure ulcer....Fluid intake, nutritional status, muscle tone, and etc......

I had a patient die of renal failure on friday, non-compliant diabetes....Because of HIPPA i cannot put her name here, but lets let her headline the papers and news stories.......

How about the guy before that, had a massive Myocardial Infarct.......Or the guy before him, Subdural Bleed from a fall on the ice.......

Neither one of these even made it to the local newspaper.....Well the obituary page, i forgot about that one........

[redshiloh]

I'm not sure why we are trying to assess blame here...There are paras and quads who DO take care of themselves i.e. pressure reliefs, turn q2h in bed, daily skin checks BID...and STILL get wounds. There are lots of reasons, our clinic RN refers to P*** poor protoplasm.

Mr Reeve very likely died from sepsis RT decubs, does that mean his caregivers or himself is to blame? WE don't know, we weren't there.

[UM Review RN, ASN, RN]

I had a patient die of renal failure on friday, non-compliant diabetes....Because of HIPPA i cannot put her name here, but lets let her headline the papers and news stories.......

How about the guy before that, had a massive Myocardial Infarct.......Or the guy before him, Subdural Bleed from a fall on the ice.......

Neither one of these even made it to the local newspaper.....Well the obituary page, i forgot about that one........

Bob, I understand what you're saying. Basically it's because if Joe Schmoe gets a decub, no one gives a fig, but if someone rich and famous gets one, suddenly there's a hue and cry.

Well, never miss an opportunity to educate as well as change something that needs changing. Of course diet and general robustness play a part in all of this, but believe me, on the front line are the preventative care products.

[bobnurse]

I'm not sure why we are trying to assess blame here...There are paras and quads who DO take care of themselves i.e. pressure reliefs, turn q2h in bed, daily skin checks BID...and STILL get wounds. There are lots of reasons, our clinic RN refers to P*** poor protoplasm.

Mr Reeve very likely died from sepsis RT decubs, does that mean his caregivers or himself is to blame? WE don't know, we weren't there.

Who was blaming his caregivers?

From what i read, they say its a drug reaction?

[UM Review RN, ASN, RN]

Who was blaming his caregivers?

From what i read, they say its a drug reaction?

That's the direct cause, but if you were to do a root analysis, it might very well be the decub that caused the necessity for the antibiotic that would be the cause.

[NurseFirst]

theres more to surfaces and products to treat or prevent a bedsore/pressure ulcer....fluid intake, nutritional status, muscle tone, and etc......

i had a patient die of renal failure on friday, non-compliant diabetes....because of hippa i cannot put her name here, but lets let her headline the papers and news stories.......

how about the guy before that, had a massive myocardial infarct.......or the guy before him, subdural bleed from a fall on the ice.......

neither one of these even made it to the local newspaper.....well the obituary page, i forgot about that one........

wow, it sounds like you've been having a rough time . maybe you need to take some time out, go some place beautiful. :balloons: :melody:

yes, there are a lot of ways that people die--and you know what? in the half-century and more that i've been walking on this planet i've seen real changes in health care, real changes in prevention of disease (i went to school with at least one person who had deformities due to polio.). and there are organizations, quite public and generally well-known, such as the american heart association, and the american diabetes association. people know about mis and dm.

the depth (no pun intended) of the problem of decubiti is unawares in the public consciousness. if more people know, yeah, maybe more people will sue.

and, you know what? changes will happen because of those lawsuits. (and trust me, i am no fan of lawyers, in general. in fact, i can hardly believe i'm defending lawsuits...! )

i remember when hospitals balked at the cost of protective needles; now you hardly see needles without some protective retraction or covering--and many things which were done by needle are now needleless. maybe it was jcaho, maybe it was lawsuits that changed things. but, left to their own devices, all the hospital administration saw was cost. so maybe it could be said that the legal system in this country is broken, too. my sister and brother and i lost tens of thousands of dollars due to incompetent lawyering; it would have cost us as much to pursue "justice". that's what has happened to this country: it's -- quite sadly -- run on "numbers". when the hospital administrators face loss of accreditation, or loss in terms of lawsuit--somehow, "doing the right thing" suddenly becomes quite affordable by comparison.

nursefirst