'The Pitt': What Is a Pulmonary Hemorrhage, and How Does Liver Failure Cause It? Louie's Death, Explained

If there are two things The Pitt has proven it excels at, it’s tugging on our heartstrings and introducing us to horrifying new medical maladies.

This week’s episode managed to do both when the writers killed off a beloved frequent flyer in the emergency room at Pittsburgh Trauma Medical Center in a very traumatic way. Louie Cloverfield, a recurring character since the very first episode of the hit new series from HBO, returned for Season 2 with complaints of a toothache and ascites, or a retention of fluids in his abdomen.

While the ER staff were successfully able to drain his excess fluid, which was a symptom of liver failure that was caused by his history of alcohol abuse, Louie suddenly stopped breathing, and his heart had stopped beating. As this week’s episode commenced, Dr. Langdon called a code for Louie and initiated CPR. But, after intubating him, the breathing tube suddenly filled with blood, which Dr. Robby blamed on a pulmonary hemorrhage before pronouncing him deceased.

What Is a Pulmonary Hemorrhage?

A pulmonary hemorrhage is the medical term for severe bleeding in the lungs or airway, and is caused by injury or inflammation in the respiratory tissue. Pulmonary hemorrhage can be fatal, especially if it is of a large size, as it can prevent both adequate ventilation—aka breathing—and gas exchange, which means enough oxygen is not being transported throughout the body.

In Louie’s case, the blood was “filling up his lungs” enough to start backing up in his breathing tube after he was intubated. It came pouring out of the end when they tried to suction it and left the front of his body covered in blood.

How Does a Pulmonary Hemorrhage Relate to Liver Failure?

While Dana and her nursing student, Emma, stood in the doorway and watched the code team try to resuscitate Louie, the charge nurse leaned over to her young shadow and explained he was suffering a “pulmonary hemorrhage from liver failure.”

But, how do problems with your liver cause bleeding in your lungs?

Well, one complication of liver disease is called portal hypertension, which is high blood pressure originating in the liver’s vascular system. According to the Mayo Clinic, this increased pressure happens because cirrhosis, or scarring of the liver, slows the speed of the flow of blood through the organ.

In rare cases, according to the Cleveland Clinic Journal of Medicine, portal hypertension can cause pulmonary hypertension in a “grim” condition known as portopulmonary hypertension. Though the cause is not well understood, the journal reports a “poor prognosis” for patients suffering from the condition.

High blood pressure can damage blood vessels over time, according to the Mayo Clinic, leaving them weaker and more prone to rupture. If the blood vessels in the lungs rupture, it can lead to a life-threatening pulmonary hemorrhage, as was the case for Louie.

Fans Weren’t Prepared for Louie’s Unexpected Loss

Louie’s sudden death left fans a sobbing “mess” just minutes into this week’s episode, with one even having to take a moment and “pause the Pitt stream to reflect” after the frequent flyer patient passed.

Meanwhile, we’re still waiting on any concrete updates regarding the condition of Debbie Cohen, the septic waitress with a diagnosis “worse than MRSA.” We can only handle so much loss, so here’s hoping she pulls through.

Related: ‘The Pitt:’ What on Earth Is a Death Doula?