My sister once said to me, “I know mom and dad had MS, but that’s not a terminal disease. So why did they die so young?” 

I had wondered the same thing, so many times, but always managed to explain it away as stuff I couldn’t understand about the disease process because I was young, because I had no medical background, etc. Memories of hospitals, nursing homes, hospice nurses, doctors, chaplains, and therapeutic harpists (good god, how ridiculous!) swirl together in my head when I think back to the two year period in which both my parents died.

Now that I’ve spent a year working in hospitals and recently completed a micro class focusing on infectious disease process, it occurs to me that both my parents probably died of infections, not “complications of MS,” as their death certificates state. And that makes me really sad and kind of angry. Could their deaths have been prevented? Postponed? And at what price? I mean, their quality of life pretty much sucked anyway. But could we have had a few more years with them? Could they have hung around long enough to meet their grandson? These are the questions that keep me awake at night.

Infections are a really, really scary thing. Like, I’d never realized how scary. I mean, they’re not terrifying to normally healthy people, but this weekend at work, I got to wondering how many patients in hospitals actually die by infections gone wild. I surmised it’s most of them. Then I felt really stupid, like, “You’re a nursing student halfway through school! You should know this stuff!” But should I, really? Instructors teach, “Infection. Bad.” But I can honestly say that I don’t ever recall a single instructor, or even a preceptor nurse, saying, “Most of the people in hospitals don’t die of their disease, it’s the infections that do them in.”

Case in point: This past week, we had only four patients in our ICU. Three of them were eerily similar: all females with end-stage cancer. One was 50 with lung cancer, another, 73 with lymphoma, and the third, a mere 45 years old with cervical/ovarian/uterine cancer. All three are on vents. All three families are in a pretty good amount of denial about the status of their family member. And all three patients have out of control infections that are killing them. But I never hear the doctors or nurses say that this is the problem (except in rounds or out of earshot of the families): they blame the disease. I don’t get that. I mean, the families know that this one’s got MRSA and this one’s septic, but whenever I hear the doctors and nurses mention that to the families, it gets really downplayed.

When is it the disease itself, and when is it the infection? I’m really confused and perplexed about this. I have an older friend whose even older sister passed away last week.  Again, she had a ton of other medical conditions (diabetes, heart problems, etc.), but she was also septic. And THAT’s what killed her. But that’s not what the family was told.

This bothers me. I feel like I don’t “get” something I’m supposed to get.  Do most really ill patients in hospitals ultimately die because of infection? Or because of their disease? Or some combination of the two? And if it’s infection, what can we in the hospitals possibly do that we don’t already do? Infection is a tricky thing. Even when they teach us aseptic technique in lab, I find myself wondering things like, “As soon as you open that sterile package, the stuff in it is exposed to air, so isn’t it now ‘dirty’?”

I don’t know the answers (obviously). I only know that this has me very confused and questioning. And a little sad.