The Comeback Kid
At first, the IV seemed to do the trick, and the hospital discharged Rayna that night. But by the next morning, she’d gone downhill again. It was team picture day, but Rayna was too weak to dress herself. She sweated through her uniform. By Tuesday night, she was back in Montgomery Regional Hospital.
At 2:00 that morning, a doctor called Rayna’s parents, Willie and Andrea DuBose. Your daughter’s white blood cell count is off the charts, he told them. It looks like she has bacterial meningitis.
Meningitis is an infection of the fluid of the spinal cord and the fluid surrounding the brain. With symptoms that include drowsiness, headache and fever, it appears for all the world like the flu. Even if left untreated, most people will recover from the viral form of meningitis in a week or so. But a second, rarer strain of the illness can kill its victims in hours. That type is caused by a bacteria rather than a virus. And that’s the form of meningitis Rayna had contracted.
The doctor told the DuBoses that their daughter was being flown to Virginia for emergency treatment. And that she might not make it through the night.
The next three weeks of her life are nothing but empty pages to Rayna. Dr. Adam Katz, though, will remember that time for the rest of his days.
Katz had become an attending physician in the University of Virginia Hospital’s department of plastic surgery only a week before. When he was called in to consult on Rayna’s case, he found a situation that makes a young doctor wish he’d chosen to go to law school.
Rayna had slipped into a coma. She was on a breathing tube, and sepsis had taken hold. Bacterial toxins had flooded her circulatory system. Her blood pressure was dangerously low, and the blood vessels in the peripheral areas of her body—the arms and legs, the bones, muscles and tendons—were shutting down to maintain blood flow to vital organs like the brain, heart and lungs. Her brain had swelled, her kidneys had failed and she’d suffered a heart attack. Plus, gangrene had set in, turning her extremities completely black.
“As a surgeon, I was torn,” says Katz. “Of course, I wanted her to survive. But I knew that if she did live, I was going to have remove all of her fingers and toes.” Katz had never before performed an amputation, and it was not a prospect he relished. He worried about the quality of life that Rayna would enjoy following the surgery, especially with a heart, brain and kidneys that may already have suffered irreparable damage. For the time being, though, the young surgeon decided, there was nothing much he could do. “If she survived, she’d be facing a lot of surgery.” But, he says, “I didn’t think she was going to survive.”
If you ask Rayna what saved her life, she’ll tell you she doesn’t know. She was in a coma, after all. But when traditional sepsis treatments—antibiotics, fluids, a ventilator—failed to stem the illness, her physicians turned to a new medication: Xigris. It was the last, best chance to save her young life.
During the previous two decades, more than 20 experimental drugs in more than 30 studies failed to show any benefit against sepsis. But in the fall of 2001, the Food and Drug Administration approved Xigris, a synthetic version of a human protein. The drug, biologically engineered and manufactured by Eli Lilly and Company, has it roots in the work of a pair of OMRF scientists, Drs. Charles Esmon and Fletcher Taylor.
Through more than a decade’s worth of research at OMRF, Esmon and Taylor discovered a method of controlling the body’s clotting cascade through the use of an activated protein. Eli Lilly built on this research to create Xigris, which works by helping to normalize the body’s clotting system and calming inflammation.
Eight years of clinical trials culminated in a large, multi-center study that found the drug reduced mortality among the most severe sepsis patients by 24 percent.