Fatal Sequence: The Killer Within »

Kevin J. Tracey, M.D., is chief executive officer of the Feinstein Institute at North Shore-LIJ Health System in Manhasset, New York. He is a leader in inflammation research and the study of the way the immune system responds to infection and injury.

Severe sepsis, a critical illness that most often afflicts victims of initially nonfatal illnesses or injuries, is the third-most-common killer in the United States. In Fatal Sequence, neurosurgeon, immunologist, and clinical investigator Kevin J. Tracey offers a chronicle both scientific and human, using cases he personally experienced to illustrate the clinical nightmare of organ failure that typifies the disease. 

In clear, accessible language, Tracey explains how the brain, which normally restrains the immune system and protects the patient, can fail during severe sepsis—allowing the immune system to indiscriminately kill normal cells along with foreign microbes. Fatal Sequence is a compelling documentation of an all-too-common situation: doctors fighting to prevent patients’ deaths at the hands of complications from injuries and illnesses that should never be fatal in the first place. 

“This book is a must for anyone interested in protecting the body from foreign organisms and, in many instances, itself.” —Jamie Talan, Newsday

Doody Review Services

Reviewer:David J. Dries, MD(University of Minnesota Medical School)
Description:This is a case presentation intended to review advances and research issues in the care of patients with infection and organ failure.
Purpose:Readers are provided a series of telling anecdotes and insights into the ups and downs of shock and sepsis research as applied to the care of a severely injured patient.
Audience:Trainees, practitioners and, most important, the non-medical reader with interest in infection is an appropriate audience. The author is a noted sepsis researcher with involvement in much of the seminal work related to infection and its management.
Features:The reader begins with a hectic ambulance ride to a burn center. The course of a severely burned child is traced through resuscitation, operating room management, and postoperative care. During the course of the patient?s month-long hospital stay, Dr. Tracey describes shock and infection manifest by the most severe complications including multiple organ failure. From this experience, Dr. Tracey places treatments available in the mid-1980s in the context of later work describing the patient response to infection, which sometimes complicates care of this problem. He ends with his own more recent work on nervous system control over immune response. While specific references to original work are not provided, detail is sufficient to allow the concerned reader to do database searches for additional information. A concluding subject index gives access to medical terms.
Assessment:This is a good read for the clinician and layperson with an interest in infection and shock. Dr. Tracey has been a central figure in this work for two decades. While his concluding statements regarding neurologic modulation of immune response await confirmation over time, Dr. Tracey provides insight into some of the work that frames the way clinicians think about and treat an important clinical problem.