Today’s recall of Nestle cookie dough got me thinking about other E. coli O157:H7 cases that we’ve recently handled. John McDonald was a 5-year-old boy who we represented in a ground beef outbreak that occurred in 2007. Unfortunately, John’s illness was about as bad as an illness can get without causing a death. (it is unbelievable how many times I find myself saying that about our clients)
John was hospitalized at East Tennessee Children’s Hospital from October 4 through 12, then was transferred to the University of Tennessee Medical Center where he remained until October 29. During his hospitalization, John’s kidneys failed requiring extensive dialysis to cleanse his blood, and he became badly anemic requiring many blood transfusions.
But these conditions, though in and of themselves potentially lethal, were just the beginning. What truly separates John’s illness from most of the hemolytic uremic syndrome illnesses that we see was the extent of injury to his gastrointestinal tract.
Jim McDonald, John’s father, was present at the moment it became apparent just how severe John’s illness was. It occurred in the early morning hours of Thursday, October 11, 2007. He recalls:
As usual, I got up to help as much as possible when the nurses came in and woke us up. When we opened his diaper, I got excited since it looked like he had had dark brown diarrhea, which told me that his digestive system was finally starting to kick in again. Realizing how liquidy the diaper was, we turned on an extra light to help us while changing him.
I will never forget what I saw. To my dismay, the diaper was not full of a bowel movement like I had desperately hoped. It was full of blood. An entire bowel movement of blood. Maybe an entire cup of blood. I got light-headed and almost passed out. I immediately sat down and grasped my head, apologizing to the nurses and telling them that I could no longer help them treat my son. This was the first of five grossly bloody stools that day.
Now bloody diarrhea is typical in the setting of an E. coli O157:H7 illness. But this was another animal altogether. John was losing blood from his gastrointestinal tract like he was bleeding from an opened artery. In fact, over the course of the day on October 11, John was given two transfusions of packed red blood cells to address the significant blood loss he had suffered. John was transferred to The University of Tennessee Medical Center the next day, where he endured, hopefully, the fight of his life.
After transfer to UT, it became apparent that John was suffering from an infection somewhere in his body. Coupled with the fact that he was bleeding heavily from his rectum and was constantly complaining of severe abdominal pain, doctors began to suspect that the infection was in his abdomen. Heavy duty antibiotics were administered, but with no effect. John continued for several days to exhibit signs of severe infection.
The afternoon of October 16, 2007, doctors began to suspect that John had suffered a perforation (e.g. a puncture) somewhere in his gastrointestinal tract. Besides the immense pain, the concern was that the contents of John’s gastrointestinal tract, including the shiga-toxin producing E. coli O157:H7 bacteria, would escape and cause severe, potentially lethal infection elsewhere in his body.
At around 8:00 PM on October 16, John was rushed to the Operating Room for an emergency exploratory laparotomy—i.e., an incision through the abdominal wall to gain access to the abdominal cavity. What the pediatric surgeon found inside was a mess of fecal material and grossly swollen bowel loops. The surgeon also found a portion of John’s rectum to be necrotic (i.e. diseased and dead) and there he located the perforation through the rectal wall that had allowed the contents of John’s bowel to spill into his abdomen, thus causing the severe infection in his peritoneal cavity.
Ultimately, the surgeon decided that the necrotic and damaged portions of John’s colon and rectum stood no chance of recovery or survival, and so he removed about five inches of John’s colon and rectum. After cutting and removing the damaged tissues, the surgeon washed John’s peritoneum copiously with normal saline. He then took a portion of John’s colon outside of the peritoneal cavity and formed a pouch out of John’s own tissue. This pouch was then connected a colostomy bag to drain feces from John’s abdominal cavity.
It goes without saying that John’s illness was severe. After his surgery to remove part of his colon, John had to be sedated and kept on mechanical ventilation for many days. He was hardly able to walk at discharge on October 29, 2007. About John’s discharge, his father recalls:
October 29, 2007: John got to come home today. He came home to a new house. He still couldn’t walk, but was trying to very hard. It was difficult for him (like Michaela) to rebuild his strength in his atrophied and skinny legs. We carried him when he couldn’t crawl. Nonetheless, everybody, including John, was thrilled that he was home. There were many tears of joy shed by all.
John’s recovery is still ongoing. He has done well since discharge, and has proved to be an extremely tough little customer. We were honored to represent him and his family (by the way, his younger sister Michaela had HUS too), and have truly been inspired by his story.