Eight weeks ago, we rushed one of my dear friends, “Lucy”, to the closest hospital in Burlington County, New Jersey. In January, 2007, she had slipped and fallen on the ice. As Lucy is in her late 50’s, any fall can be a painful or even serious one. For weeks as winter passed, she complained increasingly about the pain in her leg. Weeks turned into months; by late May of this year, the leg was so painful that she could barely walk, let alone stand.
When I arrived at her house, I was met with, frankly, a pretty ghastly sight: Lucy, at the top of the stairs, dressed and ready to go, her skin so yellow that it was shocking. Her face was drawn and gaunt, even though she is a plus-sized lady. What struck me the most was the look of pure, unadulterated pain in her eyes. She could barely move, let alone walk. All this because of a months’ old fall on the ice?
When we arrived at the emergency room, she couldn’t even get out of the car and couldn’t walk into the hospital. EMT members nearby carried her in, and she was examined immediately. After nearly an hour, we were able to get a glimmer of a prognosis. Her kidneys were shutting down, her heart so weakened that she had to be ‘shocked’ back after what the doctors called ‘an episode’. Her blood pressure was dangerously low; Lucy was one very, very sick woman. The ER doctor told me that if we had waited a few more hours to bring her in – a few hours, not a day – chances were that she would have been dead.
Lucy was immediately admitted to the hospital. She was put on oxygen, her vital signs constantly monitored, and placed in the intensive care unit. While the paddles had literally saved her rapidly-failing heart and thus her life, she was still one very, very dangerously sick woman.
MRI’,s CAT scans, blood work and a battery of other tests rapidly followed. Her youngest daughter and her former husband both showed up at the hospital in a panic. Both were able to provide much-needed background on her medical history, including that pesky right leg that had never been the same after that January slip on the ice.
In a little over 24 hours, a preliminary diagnosis was reached: Lucy’s body was housing the MRS bug, and the staph infection had formed a clot the size of a golf ball near her spinal cord. It was the clot that had caused her so much anguish when she was on her feet, not the after-effect of a slip and fall. On one hand, it was great news that her medical team had been able to conclude a diagnosis; on the other, the problem now was how to treat this infection.
MSR is a germ whose medical Latin name is Methicillin-Resistant Staphylococcus aureus. No one is quite sure how it is transmitted or how it finds its host. Recent studies have shown that this staph infection is more than ten times more likely to occur in hospitals and nursing homes than anywhere else. On any given day, according to a new study by epidemiologists, slightly more than 30,000 American hospital patients are home to this germ at any given time. One of the problems with diagnosing MRS is that its symptoms don’t necessarily suggest its presence upon first inspection; symptoms include pneumonia, skin outbreaks and blood infections. Each of these most-prevalent symptoms could indicate any of hundreds of other conditions or diseases.
MRS has been in the national media spotlight of late because so little is known about its origins, so little can seemingly be done to prevent it, but its impact, when undetected, can often result in permanent damage to the heart and other organs, and death. Health care workers are urged to take every precaution available to prevent this ‘silent but deadly’ germ by thoroughly washing their hands, by decontaminnating equipment on a constant basis, and by separating patients known to carry the germ from the balance of the hospital or nursing home population.
MRS isn’t confined to the sick or the elderly; it is an equal-opportunity germ. It hosts in individuals who are in varying stages of physical weakness due to any number of existing conditions. It can also be passed on to a healthy individual by intermingling of blood or bodily fluids. It can take weeks – or months – before symptoms appear, and its presence confirmed through blood tests.
While it took months for Lucy’s infection to surface and be diagnosed, what is most puzzling to her right now is how she got it in the first place. Lucy lives alone with three dogs of varying size and temperment, as well as two cats who are indoor and outdoor cats. She had been under considerable stress for the past year with unresolved issues with her former husband, her youngest daughter who ran into financial difficulties, her own quite serious financial problems, and staring down the decision to possibly have to sell the family home, which she dearly loves. Lucy, who has so many wonderful charming qualities, has her doctorate in Education; she is not an unintelligent woman. But the stresses she encountered on a daily basis most likely left her so physically drained and weakened that the MRS germ just latched on for a ride. To this day, no one can pinpoint any particular circumstance in which she would have been in the position to contract MRS.
The cure for her problem is still ongoing. Lucy spent nearly three weeks in the hospital, hooked up to a rather daunting looking machine that pumped a very particular type of antibiotic into her blood stream and into her heart. During that time, she was kept in bed and monitored 24/7 by a number of machines. She had setbacks: one in particular, where she developed uncontrollable chills, a high fever, and body spasms, sent her back into intensive care until her vital signs were stablized through another set of antibiotics. She was terribly weak, terribly depressed, and a source of a tremendous amount of worry on the part of us all. While the strain of antibiotic that was being pumped into her appeared to be shrinking the clot, she was far from well. It had taken her a while to get her body familiar with the antibiotic in the first place; since it was one of only a very, very few that could contain and combat MRS, she didn’t have much of a choice.
For the first ten days in the hospital, Lucy hallucinated on a daily basis. She didn’t recognize her family, children, former husband or friends. It was nearly two weeks before she could remember what year it was, and then each day. (She drew strongly upon memories of the year 1977 during that time; the doctors said it must have been a good time in her life to have left such a lasting impression.) Her temper, which had always been somewhat on the short side, was now totally out of control. She screamed at her doctors, nurses and hospital staff; she tried on several occasions to rip her IV tubes out of her arms. Twice, she was tied to her bed because she threatened to not only remove the tubes but to leave the hospital. She swore freely and often. Lucy’s children, who are spread out along the East Coast, took turns staying by her bedside, despite the fact that she didn’t recognize them.
After slightly over three weeks in the hospital, Lucy was moved to a nursing home, where her medication treatment could be administered and monitored. Again finding herself confined to bed, Lucy was now certainly lucid and physically looked 100% better than that horrible day we took her to the emergency room. But as she began to feel better more with each passing day, she became very, very angry with the situation in which she now found herself. It wasn’t so much self-pity as anger that fueled her emotions. This was a woman on a mission to get out of that nursing home and back into her own bed.
Lucy stayed in a double room at the nursing home for a little less than three weeks. She welcomed visitors and phone calls, she felt well enough to turn her nose up at the ‘hospital food. But she was still so weak; the antibiotics were stilled hooked up into her arm, dressings needed changing every day, and sometimes her temperature spiked for no apparent reason. Although her doctor had told her upon entrance into the nursing home that she would most likely be there for at least eight weeks, her insurance company felt otherwise. They decided that she was now well enough to regulate and administer her own medication by herself (which she was), and didn’t need the round the clock care of nursing personnel to monitor her. Lucy was just well enough that she was sent home.
It’s been a little over a week now since Lucy came home. Her big, old Victorian house has no central air conditioning. The three dogs are still underfoot every day. When I come to visit, I let the dogs out each day and feed the cats. I bring cans of ginger ale and a filled ice bucket to her now, propped up on a chaise in her family room. A large fan has been tremendously helpful in keeping the room, where she spends nearly all of her day, pretty comfortable – so far. She had talked about buying a room air conditioner, but so far, nothing has happened. Her youngest daughter has moved in with her temporarily, and carries pretty much the full burden of responsibility for her mother’s health. She does the laundry, the cooking, and the (miniscule!) cleaning. It drives Lucy temporarily insane to be so dependent on her daughter and the kindness of her friends and neighbors. Right now, the clot by her spine has been shrunken significantly, the antibiotics are doing what they’re supposed to do. But Lucy is still so very weak and still so very anxious to get back to her old self at the same time. We both know that that isn’t going to happen for quite some time. The last prognosis by her doctor is that she should expect to feel sick until at least Thanksgiving.
The only time she’s been outside for over two months was to enter and leave hospitals.
We both continue to be absolutely amazed at how this one incident, this nasty, evil germ that no one can even properly pronounce let alone detect early on, has taken away so much of her life and maybe so much of her future. She could have died from the MRS infection. Lucy is one very lucky woman in many respects; I just wish that I could help her see it that way.
MRS has received much-needed media attention of late, mostly because of the really high numbers of hospital personnel – and patients – who are exposed to it, and who contract it. It’s somewhat like Lyme disease in that it took a number of years to be not only accepted as a legitimate disease, but was also difficult to diagnose and treat properly. Lucy had already been diagnosed when the media outlets started running articles about MRS. We were shocked when we realized that this was the very same, exact condition that she had. Pay attention to your physical well-being. If you develop persistent and unusual symptoms, even if they don’t cause you physical discomfort, get yourself checked out as soon as possible. Take care of yourself; if you don’t, who will?
