'100% preventable': Reeve didn't have to die

For several days after Christopher Reeve died on Sunday, October 10, the cause of his death– a blood infection resulting from a bedsore– was all over the news. "A common complication in paralysis patients," was a typical sympathetic media refrain.

But a Charlottesville doctor says the Superman actor, who was treated at UVA hospital in 1995 for a spinal cord injury following a riding accident, could– and should– have lived for many more years.

Reeve's death, says Joe Stirt, "was 100 percent preventable."

"I've cared for [quadriplegic] patients as a physician in the ICU, as an intern and as a resident," says Stirt, who is a local resident but works as an anesthesiologist at Richmond Community Hospital. "Bedsores," he says, "should never happen."

Moreover, they're simple to cure, Stirt says.

So what really happened to Reeve? First the basics.

Bedsores, also known as pressure sores, develop from extended periods spent sitting or lying in the same position. In extreme cases, the sores, which often form over the tailbone, can go bone-deep and be many inches in diameter. For wheelchair-bound patients, bed rest to remove pressure and allow maximum blood flow to the problem area is required to help stave off infection. If infection occurs, it can spread into the blood, creating a life-threatening condition known as sepsis. Stirt wonders why Reeve's medical team allowed him to remain in his home when sepsis developed.

He has a theory.

"It would appear to me that Reeve was a victim of what I've referred to before as 'V.I.P. Medicine,'" says Stirt. A patient who can afford state-of-the-art homecare, Stirt explains, is often not hospitalized as quickly as someone without such resources.

Sepsis can cause a relaxation of blood vessels, Stirt says, which can lead to perilously low blood pressure. That's why hospitalization is "imperative" to administer intravenous drugs such as antibiotics (to beat infections) and vasopressors (to constrict blood vessels), as well as to perform blood pressure monitoring through a catheter inserted into a blood vessel. These are things, Stirt says, "you shouldn't try at home."

Though early reports attributed Reeve's death to a heart attack– in which part of the heart is deprived of oxygen due to constricting of the arteries, or a blood clot– later stories were more specific: Reeve died of cardiac arrest after slipping into a coma at his home. Cardiac arrest, Stirt explains, means the heart simply stops beating.

"There are many ways to get to that point," he says.

Stirt questions why no major news outlets offered a detailed medical explanation of exactly why Reeve died. He also wonders why no doctors stepped forward to publicly express outrage. (He does both on his blog, bookofjoe.com.)

Adam Katz, a plastic surgeon and director of the Chronic Wound Care Clinic at UVA, agrees with Stirt that a bedsore should not be fatal.

"It's unusual in our experience for people to become septic from a bedsore even when they're neglected," says Katz. "For someone who's getting great care, it's even more of a disconnect. The bedsore doesn't just sneak up on you and make you sick. It's likely he'd had it for some time."

Cheryl McMillan Overturf, a family law attorney based in Ninety-six, North Carolina, says she was shocked when she heard of Reeve's death. Like Stirt, she's bothered reading comments online from people who believe "We shouldn't get into the details of why he died." Overturf disagrees.

"It's just reprehensible," she says.

Overturf, now in her mid-30s, knows first-hand the difficulties Reeve experienced. At age 16, a car accident left her a quadriplegic. Although her injury was not as high on the spine as Reeve's– she has limited movement in her upper arms and can breathe without a respirator– she has lived with the constant awareness of pressure sores and their deadly danger.

Every hour, she says, Overturf reclines her seat to take pressure off her tailbone, and she lies down for an hour at lunchtime each day. For the most part, it works, she says. But nothing is perfect.

"I had my first pressure problem in 1992, eight years after my accident," she recalls. The sore developed after Overturf had spent "a full three months" bedridden. In other words, these sores don't develop overnight– and once they do, she says it would be impossible not to notice.

"They're deep," she explains. "It gets to the point of gangrene. You cannot even imagine how bad they smell when they get infected like that."

In addition, she says, quadriplegics have other signs when something is physically wrong.

"Your body will let you know what's going on," Overturf explains. "If my leg is caught on something, I get a headache, I start jumping around."

The possibility that Reeve's medical team didn't notice is hard for Overturf to fathom.

"The thought of criminal negligence comes in with this," she says.

But both she and Stirt acknowledge another more likely possibility: Reeve, well known for his determination to walk again, rejected medical advice in order to keep up with his hectic schedule.

"I don't know if he just refused to stop to take care of these things," she says.

Stirt points out that Reeve flew to Chicago for a speaking engagement at the Rehabilitation Institute of Chicago the week before his death.

"Basically, he had to fly several hours," says Stirt. "It didn't help him a whole lot."

Through Maggie Goldberg, spokesperson for the Christopher Reeve Foundation, Reeve's doctors declined comment. And while Goldberg could not comment on his medical condition, she could confirm the recommendation that paralysis patients with bedsores stay in bed. Goldberg recalls that Reeve was far from his bed, having attended his son's hockey game the day before he died.

"He wasn't going to let a bedsore slow him down," she says.

Even if Reeve disobeyed medical orders, neither Stirt nor Overturf judges him. In fact, they say, it's possible the very thing that killed him is what kept him alive.

"What we're talking about is a strong-willed person who chooses how he's going to live his life," says Stirt. "If he didn't have the attitude he had last week, he wouldn't have lived as long as he did."

He may have been tempting fate, however.

In an interview published in Reader's Digest this month, Reeve reported three serious infections in the past year, including one caused by "an abrasion on my left hip that I probably picked up one day when I was on the exercise bike."

That seemingly "benign" problem developed into a strep infection, Reeve reported. "Then a lot of major organs shut down."

In those incidents, Reeve was lucky– he pulled through and was able to continue fundraising for the two causes closest to his heart: stem cell and spinal cord research.

Now, while it seems likely that his work will continue, he will not be here to see it happen.

"It's just so sad," says Overturf. "He would be heartbroken. All his publicity, everything, lost because of a stupid bedsore."

Overturf says Reeve's loss is especially hard because of the "bond" individuals with spinal cord injuries share. Reeve, she says, was particularly inspiring.

"The smile on his face, his amazing ability to hold his family together and to show love" impressed her, she says. "He showed the world that we're cool, we're okay, we can still have wonderful lives."

And while Overturf believes that Reeve's work was important and should continue, she wouldn't trade the life she has now– with marriage, friends, and a career– for the ability to move.

She wishes Reeve had felt the same.

"I more wish there was something that could have been done about his bedsore," she says, "than about his walking again."

Why did a bedsore kill Superman?
COURTESY CHRISTOPHER REEVE FOUNDATION/DAN FLOOD

Anesthesiologist Joe Stirt says Reeve could still be alive.
COURTESY JOE STIRT

#