In December, 2009 my sister Liza died of influenza.
She was previously healthy and only 49 years old. She sought medical care early. She was cared for at a good hospital in a major city. She had no other infections. And she was unvaccinated.
To say I was surprised is an understatement. And yet, I’m a pediatric intensive care physician.
As a clinician, it’s easy for me to trace out the clinical course of Liza’s illness. The physiology of organ failure, mechanical ventilation and critical illness are familiar to me in the same way that your daily work is to you. It’s the human side that I still haven’t come to terms with. The part where you watch your sister die over the course of three long weeks while you stand helpless. The part where you listen to a physician tell your family that they are out of options. The part where you know that they are right and you realize that influenza is sometimes too much to handle, even with all our modern medicine.
That part is much harder to process.
Her symptoms started with fever, but progressed to vomiting after a few days. She went to the urgent care clinic twice over the course of a few days before ending up in the emergency department of the local hospital. She had begun to experience difficulty breathing, and the emergency physician noted that the oxygen saturation in her blood was very low. They put her on oxygen, and an x-ray revealed that both her lungs were filled with fluid. A condition that led to her being diagnosed with pneumonia.
You see, your lungs are supposed to have air in them. They should look like sponges. Pneumonia is just the term we physicians use to describe the situation when fluid, infection, and inflammation fill those little air spaces in the sponge.
Pneumonia can come from viruses or bacteria. If your pneumonia is caused by a bacteria, you can get antibiotics to kill the bacteria. However, if your pneumonia is caused by a virus, like influenza, there is not much we can do but ride it out and wait for your own immune system to clear it. The simple fact is that we just don’t have very good medications for viruses. Tamiflu can be prescribed and it might slow down the virus, but it doesn’t kill it or stop it.
So, they did the only thing they really could do, and started her on IV Tamiflu. She was moved to the intensive care unit downtown, and within the next few hours she struggled to breathe and her oxygen saturations continued to fall. She had to be placed on a ventilator, and the hope was that her lungs would recover after a few days. After all, it was ‘just the flu’.