Fatal Sequence: The Killer Within

by Kevin J. Tracey

The human body is capable of killing itself for little apparent reason, and it happens often enough to rank as the third most common cause of death in the United States today. Kevin Tracey, a neurosurgeon, immunologist, and highly regarded scientist, offers in Fatal Sequence an easily understandable account of the medical and scientific "perfect storm" that is severe sepsis, the medical crisis that can descend on patients fighting off even seemingly nonfatal illness or injury. Severe sepsis killed "Muppets" creator Jim Henson, who had been hospitalized for pneumonia, and took the life of Christopher Reeve, who was being treated for pressure sores of the skin.

Fatal Sequence tells the story of Janice, a one-year-old who arrives in the emergency room, burned by boiling water after she crawled behind her unsuspecting grandmother as she turned from the stove. She survives the night, but the following morning is only the beginning of her long and intense battle against severe sepsis, as her body attacks itself. Tracey, who cared for the girl during her four weeks in intensive care, draws on her case to vividly illustrate why sepsis happens, in a sensitive, suspenseful story that renders cutting-edge science human, accessible, and unforgettable.

Genres: Nonfiction, Medical

238 pages, Hardcover

First published March 15, 2005

Reviews

[Richard C. · Rating 3 out of 5]

This is a book that on the face would seem to appeal mostly to physicians--and maybe that was the author's intent. But--in reality--it was a shocking look at the dangers of infection--don't we hear about that all the time? And specifically those that we catch in the very place we go for a cure: the hospital! Scary but a good read.

[Stephanie · Rating 4 out of 5]

In my other life I was a critical nurse so the subject matter interested me. The last 50 pages were a bit too technical for me. Overall, a good read.

[Rita · Rating 4 out of 5]

A book on severe sepsis sounds like it would be a fairly dry read. And so what a surprise to find that this book is actually a touching account of this illness, illustrated by the battle fought by an 11-month old who develops it after having been burned on over 75% of her body. The first two-thirds of the story are a beautifully written ode to the struggles of this little girl - I cried, sobs and all - detailing the effects of a burn on the human body, as well as the development of and treatment options available for septic shock and sepsis, while the last third discusses the possible causes of this still largely poorly understood illness.

No knowledge of science or medicine is necessary to read this book, though the discussion in the last third does get fairly dense. The author writes in a clear and concise manner aimed at the general public, and successfully infuses a sense of humanity throughout, reminding the reader that finding a cure for sepsis is not about treating an illness, but healing people.

[Misha · Rating 4 out of 5]

The subject of the book by Kevin Tracey is fascinating: severe sepsis
and septic shock are seldom mentioned yet the death rates of these
conditions are staggering: 30-70% and 20-35% respectively. Sepsis is
the second leading cause of death in non-coronary intensive care unit
patients.

Tracey starts the book's story with a case of an infant burn victim
who suffers first from septic shock then from severe sepsis. The
struggles of this patient became the motivation for author's later
research and the refrain of this book.

It is interesting to read how modern-day doctors with all the
sophisticated life-support machinery feel impotent in the face of this
deadly condition.

Tracey then advances the theory, that he participated in developing,
of TNF and HMGB1 cytockines (molecules used for cell signaling) and
activation of white blood cells (macrophages). The uncontrolled
release of TNF leads to body-wide activation of macrophages which
change the viscosity of the blood, clog the capillaries and lead to
organ failure and death. Tracey posits that one of the functions of
the vagus nerve is to control the immune system response and to
contain it in a particular area through neutralizing HMGB1 in places
where it is not needed. Severe sepsis is the failure of this limiting
function. The latter is apparently still a theory, at least it did not
make to the wikipeida pages. This failure is similar to causes for
autoimmune diseases such as arthritis, lupus. The implication is that
operation of the vagus nerve is influenced by the person's mood,
health, rest, etc. This would explain the mood-related flareups of
auto-immune diseases. Having to rest to fight infection and so on.

It feels like the medical science is on the verge of a major
breakthrough in understanding of the operation of the immune system
and, hopefully, in effectively treating deadly conditions that the
doctors for ages were powerless to stop.


Tracey keeps the medical jargon to the minimum, talks with ease about
complex phenomena. The book is easy to read. He does occasionally
slip into research-grant proposal writing style. Oh, well.

[Candace · Rating 5 out of 5]

This is a fascinating book. It begins with the case history of a little girl who was accidentally burned, and then details the author's work to try to understand exactly what had happened to the little girl and why. As someone with autoinflammatory conditions, I found it absolutely fascinating. Very well-written and very accessible.

If you're interested in this subject, you might find a related blog post of interest: Do allergies really explain anaphylaxis?

[Selena · Rating 4 out of 5]

This book really held my interest since I lost a child to sepsis. It gave me a better understanding of what sepsis is. The author does a great job of explaining things at a lay person's level throughout most of the book, but towards the end when he was discussing research, I had to read things a couple of times to understand- and I have a beginning understanding of medical terminology. I do recommend this book to anyone that wants more information on sepsis.

[Susan Ozment]

How sepsis and shock kill people. A young burn victim is the example given.

[Tyra · Rating 5 out of 5]

Love this story and what it has taught me. I constantly refer to it if I need to compare / contrast severe sepsis and acute septic shock.

Thank you Dr. Tracey for sharing this story- Because of your experience with Janice, I have taught my children when they grow up to never carry boiling water in the kitchen without ensuring a child is not near (in case the water spills).