MRSA Update

More reasons to get immunized.

Apparently, in a recent CDC update in Annals of EM, there were more cases of necrotizing pneumonia associated with flu-like illnesses--10 in 2 months, with 6 deaths.

The deaths were notable for the speed of worsening and the age, worse in younger people rather than older.

Still rare, MRSA pneumonia may be more virulent as it is apparently able to kill the very cells (PMNs) that the body uses to neutralize it. Some of these cases were associated with a preceding MRSA skin infection.


0 for 3

I'm something of a black cloud.

3 times I've participated in resuscitations, 3 times the patients have shuffled off. It's been a watershed for me, the stepping forward, getting on the step ladder, and performing compressions. 90 percent of my thought is, 100 per minute, allow for full recoil, 100 per minute...10 percent is a sponge for death.

In the first resuscitation, we preserved dignity with our demeanor on his passing. Dignity in death, I now think, is not a function of tubes, or wires, or excreta, or the state of the body. It seems rather to be a state of the event. I've talked about the first loss before, a middle-aged man stabbed in the chest after bumming a ride. Twenty minutes out from the event, he arrived with a penetrating left chest wound; we opened the chest, plumbing for the heart, in the trauma bay. Heroic efforts would likely only have been successful if we had seen him get stabbed and immediately rushed him to help. Nevertheless, all that could be done, was.

I remember, after time had been called, the silence. The team set this. The team decided there was not space for idle chatter. I laid a hand on his knee before leaving, some attempt at communion. We didn't say a word following for what seemed like minutes. When we did talk, the chief's thought was to examine what we could've done better. He didn't speak of anything else for a good hour, and spent time just staring off even if others were talking.

There was a tacit understanding that the work we did was in the service of the patient and those to come which lent the event the dignity of respect. I hope it would've been seen that way by observers.

The third time, the dignity of passing was set by the observers. Death came sprinting down the long hallway of the ED in a wheelchair, nurses trailing behind, mouth open. She spewed up, yellow and frothy during CPR as we worked, knowing the futility. She had aspirated; her thin limbs spoke to her age, to long illness. Dry, papery skin and bones barely concealed underneath a patina of muscle. The success of CPR for non-responsive cancer patients is next to nil.

As I got down from the CPR step-ladder, her husband and son looked on. Both were seated, almost as if at a visitation; both were quietly crying. Not screaming. Not wailing. Not blaming. I can only guess what they were thinking, but their faces and attitudes bestowed upon their loved one all the dignity of her life until then. The resuscitation--messy, smelly, primal, and filled with the excreta of decay--was but a passing blemish. They were witnesses to her passing. The son and father accepted the gentle apologies and sympathies of the staff as they passed, and remained sitting as I left.

Dignity is in the spirit, in the mind, as well as in the body. Right thought and intention can overcome the bald shock of the body in death.