Logan Roy was not behaving like his usual, virile self. Succession’s leading octogenarian and media-empire patriarch was shivering. He was moaning and grimacing and babbling. He was yelling—and not in the way that would actually be normal for him. He needed to pee, like bad. It got weird: He mistook his daughter for his estranged wife, and his son-in-law for an appropriate bathroom companion. He believed there was a dead cat under his chair.
Turns out, Logan had stopped taking the medication (antibiotics, almost certainly) prescribed for his urinary tract infection. By the time a long-awaited shareholder meeting rolled around, Logan was fully incapacitated. “Oh, fuck!” cried his daughter, Shiv. “He’s piss-mad.”
It seems like just another wild twist in the popular television drama. But Logan’s total thrashing by a UTI—leading to a state of incoherence so profound it creates a power vacuum—is totally plausible, urologists say.
“It may not be the most common thing, but it certainly could happen,” David Ginsberg, a urologist at University of Southern California’s Keck School of Medicine told me, after I caught him up on the relevant plot details .
UTIs occur when bacteria enter the urinary tract, and then begin to flourish out of control. The symptoms are deeply unpleasant: a persistent and frequent urge to pee, painful or burning sensations during peeing, and urine that appears cloudy, pink, red, or cola-colored. These are often enough to land someone in their doctor’s office or the emergency room, where they are given an antibiotic treatment. This usually works. Most people who get UTIs—which more than half of women experience during their lifetime—don’t have to contend with further symptoms. And those worse outcomes don’t come on suddenly. “Most folks usually don’t go from nothing to an acute psychotic event,” Ginsberg says.
But if—as with Logan—a person’s UTI isn’t properly treated, the infection can spread to the kidneys and, eventually, the bloodstream, becoming septic. If the infection becomes serious enough, a host of symptoms now familiar to viewers of Succession set in: delusion, lethargy, agitation, confusion, paranoia and hallucination. “The body basically loses control,” said Matthew Wosnitzer, a urologist with Yale New Haven Health. Or as Shiv put it, in Logan’s case: “His urethra had wrested control from his brain.” Any number of other infections—including pneumonia— can, if left untreated, lead to the same constellation of cognitive impairments. “It’s not the actual UTI itself, it’s your body’s reaction” to it, says University of Maryland urologist Rena Malik. “It’s the insult of the infection.”
It’s not just poetic that the most powerful Roy would succumb so completely to a measly UTI; it’s also pretty in line with reality (if, again, a rare event). The media kingpin’s fragile health has been a central issue in Succession— from the show’s pilot, in which Logan almost died of a hemorrhagic stroke on his 80th birthday, to last week’s episode, when he almost collapsed during a walk. Logan Roy matches some of the key risk factors for UTIs, which include being older or immunocompromised, and having dementia or diabetes. Logan’s history of strokes is also potentially at play, says Ashley Winter, a urologist in Portland, Oregon who watches the show. “A stroke can affect bladder function,” she says. “It can also affect the nerves that go to the bladder, and your brain’s ability to regulate your bladder.” If Logan wasn’t emptying his bladder every time he peed, Winter says, it would be a recipe for a UTI.
Luckily for him, by the end of the episode Logan had largely regained his mental faculties, thanks to fluids and hydration. Even without the help of Roman’s suggested Tabasco suppository, he was returning to his old rhino self. I asked Wosnitzer, is that really possible? Can a human really recover from a delirium-inducing UTI that fast? Definitely, he confirmed, with something like an intravenous infusion of a broad-range antibiotic cocktail. “They can have a rapid turnaround,” he says. “They snap out of it.”
However fleeting, Logan’s dance with sepsis is a reminder of how much power can dangle on one person’s physical fragility—both in the real world and in Succession’s fictional one. No matter how much money and control you have, Winter says, “your body might retire for you at some point.” And when you come face-to-face with one of the most common outpatient infections, you might want someone loyal by your side to help you recover. “Potentially he’s starting to realize fucking with your kids when you’re frail is not a great thing to do,” she says.
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