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What killed Rob Sweitzer? Could his life have been saved if he had been seen earlier in St. Mary's emergency room?

These are the questions torturing his widow, Rachel, and no doubt the entire emergency team the night he died.

Rob — a healthy 39-year-old who worked out regularly — felt like he was getting a cold on a Friday night in early February.

Even so, he and Rachel — both dedicated animal-rescue volunteers — got up Saturday morning and went to work at a local cat shelter. But by afternoon, he felt worse, coughing and losing energy and suffering intense pain in his lower back.

When he started breathing hard, they finally went to St. Mary's ER, at 6:30 p.m. It was packed. It was the start of Tucson's severe flu outbreak.

At 7 p.m., he was called for triage — a preliminary assessment of the severity of his symptoms. His vital signs were stable. He was assessed as needing a low level of care, hospital officials have confirmed.

At no point during the next eight hours was his condition re-assessed, despite Rachel twice pleading for help as she said his pain became unbearable and his breathing more strained.

That day, some 170 patients flooded St. Mary's ER, creating a huge bottleneck, resulting in waits well beyond eight hours for many patients. Hospital officials called in more staff and opened additional inpatient beds to try to handle the onslaught.

After 2:30 a.m., when Rob was finally called to see an emergency physician, X-rays showed severe pneumonia, his lungs filled with fluid, by his wife's account. Barely able to breathe, he was placed on full oxygen. Morphine did not control his pain. When his heart stopped a second time, they tried unsuccessfully to intubate him. He was pronounced dead near 7 a.m.

An autopsy found his lungs severely inflamed and filled with blood, but the cause remains unclear. County Medical Examiner Dr. Bruce Parks said he suspects "a catastrophic infection" of some kind but has not been able to identify the organism that caused it.

Sweitzer's case has been sent to the Centers for Disease Control in Atlanta for further tests.

Though reluctant to analyze a case she did not handle, Dr. Linda Lawrence, president of the American College of Emergency Physicians, said Sweitzer may have developed sepsis, the body's response to overwhelming infection, a condition that can destabilize the patient.

"If that is what happened, there are drugs for sepsis. The patient can be put on a ventilator and monitoring lines to balance the body's fluids," Lawrence said.

"Earlier intervention would have allowed better management of a patient in this condition."