In July 2017, the lives of the Moeding family were changed forever.
“The worst thing about losing someone you love is the ‘what ifs’,” reflected Megan Moeding. “When David died there were many questions, all very good ones. One of them was, of course, why? No one could or can answer that question even today. The other one was what if he would have come in sooner.”
Moeding is a registered nurse with a critical care background. She recently acquired her Doctor of Nursing Practice and has boards to pass in September 2018 before she is fully certified. Her husband, David Lee Moeding, was a stage IV Non-Hodgkin’s T- cell Lymphoma and Non-Hodgkin’s T-cell rich B-cell lymphoma survivor and bone marrow transplant recipient who underwent a splenectomy and radiation as part of his cancer treatment. He had been cancer free since 2013.
“David died at age 39. It was roughly 6-7 hours from the onset of the fever to when David presented to the ER. The doctor said it was a reasonable amount of time to wait to come in,” recalled Moeding. “The doctor told us he did not think things would have been different even if he came in right away. But with David’s history of a bone marrow transplant and not having a spleen and recent infections, I felt like he should have come in sooner.”
Below is David’s story in Megan’s words.
My father had passed away unexpectedly while visiting my sister in Tanzania, Africa. We were heart-broken and in shock. After a two week delay, due to transporting my father home, we were able to say goodbye and lay him to rest on July 5. Little did I know, I would be doing the same for my husband just 6 days later.
David had to work the weekend following my father’s funeral so he spent the day after with our children, myself and family before traveling home Thursday evening to work on Friday. Because we knew he would be working all weekend, we decided the kids and I would stay with family for the weekend. When I woke up Friday morning, I had a text on my phone that asked me to call him when I got it. I called him around 9 a.m., and he told me he was home. He had spiked a fever and threw up around 4 a.m. He reassured me he took Ibuprofen and was feeling better. I told him he needed to go to the hospital or, at minimum, go see his primary care doctor. He said he would call and get an appointment and call me back.
About an hour later he called and said he couldn’t get into the clinic until the afternoon. I told him that was too long to wait and asked if someone could take him to the ER. He said he had talked to his family and his niece was in town and could take him. He reassured me again he was “fine”. I could tell by the sound of his voice he wasn’t okay. He sounded almost drunk to me. I told him to call his niece and go to the ER. I would pack and be on the road as soon as I could. I arrived at the hospital around 1 p.m. He was in the ER on a stretcher, hooked up to the monitor with IVs pumping in antibiotics and fluids as fast they could. I saw his heart rate was tachycardic and his blood pressure (BP) was low. He told me he had already had one liter of fluids and one dose of antibiotic and was feeling better.
His niece was in the room with him as she had brought him to the hospital. I began to ask him questions about his medications, including his daily antibiotic he took to prevent infection due to not having a spleen. He couldn’t remember exactly if he had taken them every day that week, and told me he didn’t need a lecture from me. I told him he was very sick. I don’t think he realized how sick he was, as he had been through this song and dance before. In fact, just over a month prior, he had sepsis of undetermined origin and had been hospitalized and on home IV antibiotics for two weeks. Just as I was asking if he had any imaging done he developed severe abdominal pain. The nurse came in to take him to CT scan. David told her about the pain and she updated the doctor and took him to CT.
Fifteen minutes later David returned from CT doubled over in pain on the gurney. The nurse told me they were going to move him to their procedure room because they needed to put a central line in to run vasopressors. I knew that was a bad sign.
I began to call David’s parents. Luckily, his mom was just arriving at the hospital. She called his dad to tell him to come to Sioux Falls. I also called my family, as they had our daughter, who was 5 at the time, back in Huron. I told them to bring her as soon as they could. I had our 7-month-old son Wilson with me at the hospital. Just as things started to take a turn, a dear friend came and took him to the lobby for me.
They moved David into the procedure room and began to try to place a central line in his internal jugular vein. He was breathing rapidly and the doctor began to tell us about David’s labs. He said his liver enzymes were elevated and his kidney function was down. His white blood cell count was elevated as well and his first set of blood culture had come back positive. The CT scan didn’t show a lot, only that his colon was inflamed so they were going to have a surgeon take a second look at it, but that was the most probable cause of the infection at this point. David continued to have severe abdominal pain. They were able to give him some IV pain medications but due to his low BP they weren’t able to use a lot. The doctor was having difficulties getting the line in due to scarring from a previous tunnel catheter in that side from chemo in the past.
We were discussing his breathing status. The doctor reassured me his rapid breathing was his body compensating from his CO2 being high; and as long as he was doing okay on his own, they would not have to assist his breathing with the ventilator. David did begin to struggle and said he couldn’t breathe. I could hear him gasping for air, and he was clearly in distress. His mom and I were at his side reassuring him he would be okay and to calm down, but he began to sit up and gasp. I knew the situation was getting worse. Respiratory therapy and anesthesia were called to the room, the flight team was already there to assist and the eEmergency was also on camera to help with charting. The room was chaotic to say the least.
I had requested the chaplain, and she was there with us too. It was a very surreal experience. I knew what was coming, but I could do nothing to help so I began to pray. I prayed out loud over David for Jesus to be there and heal him, for Him to assist the doctors to do what they needed to make David better. In the midst of this, the surgeon entered the room. In a very urgent way, he explained to David he believed the infection was in his colon and the best chance he had to survive the infection was to remove his colon and give him a colostomy.
David was in so much distress. I spoke for him and told the doctor yes, do whatever you have to do to help him. So the decision was made to take him to surgery. I could see David was struggling more now with breathing and the monitor showed his oxygen levels were dropping. I began to cry, “Help him. Just intubate him!!” To me, it seemed like no one was doing anything. David sat up and looked me in the eye and said, “I don’t want to die.” I said, “I know you don’t, honey” and began to pray again. I kept telling him how much I love him and hugging him.
It’s hard to recall exactly what was happening, but I remember signing the consent for him to go to surgery and the doctors and nurses getting things ready. Respiratory therapy was there, and I remember I kept telling them to intubate him. They didn’t seem like they knew what was going on. I decided I couldn’t watch anymore. I kissed and hugged David goodbye and said I would see him after surgery. His mom and I went to a meditation room and a new chaplain was sent to be with us. Sitting in that room, was the worst and most uncomfortable minutes of my life. I knew how sick David was, he had been sick many times since his cancer diagnosis, but never like this.
Knowing what I knew about medicine was a curse in those minutes that felt like years. I remember feeling like I wanted to crawl out of my body. The chaplain went to check on how things were going and came back to report, “he was struggling.” I remember thinking I did not like him and he was not helping. A few minutes later the ER doctor came in and told us that David’s heart had stopped and they were doing CPR. He told us the medications they had given him and everything they were doing, but there had been no return of a heart rhythm.
He asked if I wanted to come to watch and I said no. I knew what they were doing, and I did not want to see David like that. He asked if I wanted them to stop and I said, “No, keep going.” He agreed. David’s mom and I hugged each other yet again and sobbed. About 20 minutes later, the doctor returned with a grim look on his face. I knew before he said a word, David was dead. His first words were, “I’m sorry.” I began to shake my head and yell out, “No! No! No!” He said, “I’m sorry, yes, he is dead.” I began to sob, and told him I couldn’t go home without David. But I had to and did.
Sepsis is a life-threatening complication of an infectious process that without rapid diagnosis and treatment can quickly progress to tissue damage, organ failure and death. Great Plains Quality Innovation Network is working to improve early recognition and raise awareness of sepsis as a medical emergency. Awareness of the signs and symptoms of sepsis is critical knowledge that can save lives.