“You’ll know when you see them,” he said. His eyes were starting to close again, exhaustion pulling him back down. “Soon. Not yet, but soon.”
Before I could ask anything else, he was asleep.
I sat there for a long time, holding his hand, wondering what he’d meant, who was coming, and why it sounded like he’d been planning for this.
The infection hit on day four, November 19, at 3:07 in the morning.
I was in that half-asleep state you fall into in hospital chairs. Not really asleep, but not fully awake either. Aware of every sound. The monitor beeping. The ventilator in the next room. Footsteps in the hallway. The elevator dinging.
Then a different sound.
A sharper alarm.
The cardiac monitor changing pitch.
I jerked fully awake and stood up so fast the visitor chair scraped loudly against the floor. Through the glass window, I could see my grandfather’s monitor. His heart rate had jumped to one-oh-eight. His oxygen saturation was dropping. Ninety-one. Ninety. Eighty-nine.
Isabelle Grant, the night-shift nurse, was already rushing into the room. I followed right behind her.
My grandfather’s skin was flushed. Not the healthy pink of good circulation, the red mottled flush of fever. His forehead was covered in sweat. The sheets were damp.
“Temp’s one-oh-one point eight,” Isabelle said, pulling the digital thermometer from his ear and checking the reading. She frowned. “That’s a big jump from the midnight check. He was ninety-eight point four.”
Then I moved to the other side of the bed, my professional training overriding the personal worry. My hands went automatically to check his radial pulse, rapid and thready, while my eyes scanned the monitors.
“Check the wound,” I said.
Isabelle moved to carefully lift the gauze dressing covering the sternotomy incision, the long surgical cut down the center of his chest where they’d cracked his sternum open to access his heart.
What I saw made my stomach drop.
The incision was red, not the normal pink of healing tissue. Angry red. Erythema, inflammation extending at least two centimeters out from the incision edges on both sides. The skin around the wound was warm to the touch, hot even, and there was drainage, not the clear or slightly pink serous fluid you’d expect. This was serosanguineous, blood-tinged, yes, but also thick and cloudy. And it had a faint smell. Not strong yet, but there. That slightly sweet, foul odor that every nurse learns to recognize.
Infection.
“We need labs,” I said, my voice coming out sharper than I intended. “Lactate, CBC, blood cultures times two from different sites, and a wound culture. And call Dr. Cole. This is sepsis.”
Isabelle looked at me. We both knew I wasn’t on duty. I was just family. I had no authority here.
“Anna,” she said gently, “you’re not—”
“I know.” I cut her off. “I know I’m not on duty, but I’m still a nurse practitioner. I’ve worked in cardiac care for seven years, and he’s my grandfather.”
She held my gaze for a moment, then nodded. “I’ll put the orders in and call Dr. Cole.”
By 4:30 in the morning, the lab results started coming back. I’d convinced Isabelle to let me stay in the room while they worked. I stood in the corner out of the way while they drew blood cultures from two different sites, one from his IV line, one from a fresh stick in his other arm. While they used sterile swabs to collect samples from the wound drainage. While they pushed IV fluids to support his dropping blood pressure.
The labs printed out at the nurse’s station. Isabelle brought them back and showed them to me.
Lactate: two point eight millimoles per liter. Normal is under two point zero.
Lactate is a marker of how well your tissues are being perfused with oxygen. When it’s elevated, it means your body is under stress. Organs aren’t getting enough oxygen. It’s one of the key indicators of sepsis.
White blood cell count: fifteen thousand cells per microliter. Normal is forty-five hundred to eleven thousand.
His immune system was in overdrive trying to fight an infection.
Dr. Cole arrived at 5:30 in the morning, looking tired but alert. He’d obviously gotten woken up for this. He reviewed the labs on his tablet, examined my grandfather, looked at the wound.
“This is sepsis,” he said, confirming what I already knew. “Probably a surgical-site infection. We need to move him back to ICU and start broad-spectrum IV antibiotics immediately. Vancomycin and piperacillin-tazobactam, to cover both gram-positive and gram-negative bacteria until we get culture sensitivities back.”
Relief washed over me.
Someone was taking this seriously. Someone was acting.
“I’ll put the orders in now,” Dr. Cole said. “Transfer within the hour.”
At 6:03 in the morning, 3:03 a.m. Hawaii time, I called my parents.
It rang four times, then voicemail. My mother’s cheerful recorded voice.
“Hi, you’ve reached Linda. Can’t get to the phone right now, but leave a message and I’ll call you back. Aloha.”
I hung up without leaving a message.
Called again at 6:18. Voicemail again.
This time I texted: Grandpa has sepsis. Surgical-site infection. Call me ASAP.
The message showed as read at 6:45 a.m. I watched the three little dots appear.
Someone was typing.
Then they disappeared.
No response came.
At 7:15, I tried again. Called my father’s cell phone. Voicemail.
Finally, at 8:47 a.m., 5:47 a.m. Hawaii time, my phone rang.
Tyler.
I answered immediately.
“Anna, what the hell?” His voice was irritated, groggy. “It’s five in the morning here. What?”
“Grandpa has sepsis,” I said, keeping my voice level. Professional. “Surgical-site infection. His lactate is elevated. He’s febrile. They’re moving him back to ICU. He needs aggressive treatment.”
There was a pause on the other end. I could hear ocean waves in the background. He must have stepped outside onto the hotel balcony to take the call.
“Sepsis from what?” Tyler asked.
“The surgical incision. It’s infected. He’s on IV vanc and pip-tazo. They’re monitoring him closely.”