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One small cut

By 18 September 2023Feature Article


One small cut

Wracked with sepsis, a 41-year-old father endured a horrendous wait for treatment, then many days in ICU, heavily sedated. On finally waking, he wanted only to escape.

By Lily Richards

My husband ended up in intensive care from a scratch on his foot, barely 2mm wide. He’s not even sure how he got it, maybe from his own toenail? He was playing with our son on reclaimed land at the end of our street; a fatherly combination of grappling, Nerf guns and medicinal plant identification. We’re not a family big on organised sport, but we love nature — long walks, ocean swims, bike rides and moss gathering.

It was a normal winter day with nothing noteworthy to define it, except that the recent heavy rain had created a slush of mud, soil and ooze. Stagnant water crept up from under the overgrown fields. This local park used to be a rubbish dump — I remember scavenging there as a kid, hunting for discarded treasure, stepping over rotten mattresses and rusted fridges. Now the earth burps them up with the foul breath of human short-sightedness.

We are the worst at shitting where we eat. He cut his foot at 4pm; by 3am he had a pain in his knee that wouldn’t quit. By 6am he thought a doctor might be required — worrying words from a man who hadn’t volunteered to see a doctor for at least six years. By the time I got him to the urgent-care clinic, he was turning grey, the pain so bad he couldn’t find comfort in any position, seated or standing. They gave him liquid Nurofen and told us to go straight to hospital, where we waited in the Emergency Department reception for three hours, watching sprained wrists and migraines being triaged.

I spent much of this time on the phone to a doctor friend, asking for advice on how to better impress upon the understaffed nurses the seriousness of the situation. He memorably replied, “That hospital has more drugs than your husband has pain; make them give them to him.” Even with such clear encouragement I felt like a nag, and despite my gentle-voiced insistence he got nothing stronger than Panadol, causing him to slouch forever lower in the plastic hospital chair.

Eventually, after he started shuddering and sweating, and threw up Mountain Dew-coloured bile, they let him lie down. At which point my tone changed dramatically and my insistence produced morphine; he dozed as I watched a sinister sunburn appear around his knee and spread down his shin. Sometime later we were moved from the public waiting room into the ED ward, a kind of limbo for the seriously unwell, the sorting hat of the hospital.

Our neighbours were cancer patients and a man who had dropped a boat on his foot. None of these people declared pain above a six. My husband’s pain was a nine — I could tell he was holding back on saying 10 because no one wants to peak too early.

He wasn’t given antibiotics despite the infection markers in his blood creeping towards the hundreds (a normal infection marker is under five). Nor was he given IV fluids, despite the almost constant throwing up. Instead we waited. We waited for someone to make a plan. In the absence of a plan, my husband deteriorated.

In the dead of night, 13 hours after we arrived, a tall orderly wordlessly wheeled my husband’s bed up to the elective surgical ward, because someone somewhere thought he might need his knee operated on. This was when his blood pressure started to drop. They pumped him full of four litres of IV fluid, but it wouldn’t stabilise.

A little after midnight he went into toxic shock. All his major organs began shutting down and the doctors went from doing nothing to trying everything. A triple seven was called and whatever a collective noun for doctors is materialised in front of me. They gave him antibiotics and aspirated the knee to see if the infection was in the joint.

I watched as my husband asked the assembled doctors why his face felt weird, why his kidneys hurt. His blood pressure continued to drop and he was rushed to the High Dependency Unit, then taken into surgery, after which he was ventilated and in a coma for nine days while the ICU staff tried to get the infection under control.

During this time I realised that ICU was basically God. An overlay of two apparently contrary ideas kept forming in my mind as I sat vigil by his bed, watching them apply Vaseline to his eyes to keep them from drying out and suctioning spit from his mouth because he couldn’t swallow. God had designed such a complex creature that when something goes wrong, it takes all the science we have to keep it going. They took over all his functions, from his nutrition to his breathing, topping up his vitamins and organising his eliminations. He became part of the bed; it moved for him, an automated air-filled mattress forming valleys and hills to stop bed sores forming. Day and night were simulated; no windows, no weather, no sense of time, no fresh air. He was confined inside a room he couldn’t leave and a body he wasn’t in control of.

While my husband fought for his life, school lunches had to be made, dinners cooked, the house cleaned and birthday parties attended. Nights were spent with my phone on my pillow, in case the ICU called with news of his deterioration.

One frigid weekend, I rugged up and took our daughter to her friend’s birthday party.

We arrived early; a sandwich board indicated the entrance to an underwhelming office building; shared premises with financial advisers and a dental practice. We walked down a hallway lined with thin grey carpet, fluorescent lighting flickered across a low ceiling. My daughter whispered, “I feel scared already,” and I started to think about the similarities between “escape rooms” and ICU. Escape rooms being where a team of players discover clues, solve puzzles and accomplish tasks in order to win (read: escape). The ICU being where surgeons, nurses and infectious-disease doctors came together to solve the puzzle of my husband’s critical illness to try to win his life back.

Ordinarily it would have been him at the party doing drop-off, in regressive gender-normative terms, he is the mother and I am the father. I work full-time and he is the heart of the home: dying hair, pulling teeth, painting faces, making costumes, facilitating outlandish art projects and feeding pets. This made his absence all the more galling. I expanded into the role. I could do all those things, but we missed him the way you miss a load-bearing wall.

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While my daughter was watching her friends shake an old alarm clock and wonder if it was somehow a clue, I slipped out to go and hold her dad’s mottled hand.

His body was alight with infection, his immune system turning on itself. He was trapped in a halfway consciousness; not death, not life. Pain was so severe he was on all the popular street drugs; oxy, fentanyl, sevredol. The doctor friend of ours described the effect of sepsis in the body as “running when you should be sleeping”.

We don’t know how anaesthesia works, it just kind of does. Maybe something to do with the consciousness of the cell itself being blocked. One ICU nurse described my husband’s experience, while being pumped full of propofol to keep his consciousness dulled, as like locked-in syndrome.

“Have you heard of that?” she wondered. In fact, The Diving Bell and the Butterfly — a 2007 film depicting just that condition — were some of the first words my husband said when they brought him back around a second time. The first hadn’t worked so well. When he started to speak, they found a secondary infection in his lungs. Every breath he took was tiring, his oxygen saturation dropping, like a wind-up toy that couldn’t be wound any further. The doctor called me at 8pm to say they were going to put him under again. Lowered back to the bottom in the diving bell, with his consciousness fluttering on the edges like a butterfly.

He could hear, they told me. In the ICU they’d recently discovered that people were more traumatised when they were kept totally sedated. The new practice is to bring the patients around a few times a day; back up to the surface where they can hear you, but can’t speak or see. These were the worst times for me. A whisper near him and he would turn sharply towards me; there, but not there. Mostly the awareness expressed itself in increased pain and confusion and they would increase the propofol again, dropping him back into the ocean of wherever it is we go when we’re not here.

When he was brought around that final time, he wanted to leave. Immediately and aggressively. His behaviour caused a small pool of shame to form inside me.

Here were the people who looked after his immobile body day and night, in 12-hour shifts, never leaving him alone for a second. These people took over doing what he couldn’t; they ran his body for him in his absence, noting every single moment in case a hiccup or a moan or a fresh rash could be a clue as to what was keeping him sick.

And while keeping him alive, they imagined a man. A man loved by his sister and his wife so much they barely left his side. A fit 41-year-old man with everything to live for and a critical case of sepsis he got from playing with his son in a field.

When he awoke all he wanted was water and to get the fuck out. Wild-eyed, he stared down every doctor and nurse as though they were wardens, locking him in a cell. He wanted to escape.

As an adult I have never been as scared as I was waiting. Waiting for the doctors to take me seriously when I told them something was very, very wrong. Waiting to see if he made it out of surgery. Waiting to see if they could discover why he wasn’t getting better. Waiting for the call to tell me he hadn’t made it.

I became that old film cliché; reaching for God despite never thinking he was there before. The equivalent of grabbing for a bannister you’ve never used just as you begin to fall. God is something we scoff at until we stumble and all of a sudden him being real is all that matters.

“God, if you are real, please save this person that means the most to me.”

Despite the slow start and the hours of medical inaction, once he was admitted to the ICU, the best resourced part of the hospital, care for my husband was given in abundance.

Moments that loop in my brain include a nurse showing me her paint-by-numbers leopard (surprisingly good), an orthopaedic surgeon who always wore jandals (in the middle of winter) and a general surgeon who kept making jokes about shaving patients. All of these people, with their own complicated lives, were dedicated to saving my husband’s. His escape was narrow, like a 2mm cut from nowhere. Recovered now, we’re taking this like a cosmic slap to the face, all the more awake because of it.

This story appeared in the October 2023 issue of North & South.