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Medical Mystery: How One Family Fought Back

MRSA — drug-resistant staph — may be the most frightening epidemic since AIDS. Here’s how one family was forced to confront it, from Superbug by award-winning science and medical writer Maryn McKenna

It was New Year’s Eve 2005, but Scott and Katie Smith had little interest in celebrating.

Fourteen-month-old Bryce, their only child, had been struggling with a cold since two days before Christmas. Since then, they’d gone back and forth by phone with his pediatrician, trying to catch each other during the busy holiday season. The doctor advised Tylenol, Advil, Nyquil, and patience; he seemed to think they were just anxious new parents. They were anxious — Bryce’s breathing was harsh and his fever would not break. They thought he was sicker than his symptoms showed.

Just after midnight on New Year’s Eve, Katie’s anxiety spiked. Normally, Bryce, who had her dark-blond hair and Scott’s brown eyes, had a permanent faint tan thanks to Scott’s Colombian heritage, but tonight he was yellow, dull and dark like a fading bruise. His belly puffed out and he grunted with effort when he breathed. Frightened, Katie and Scott rolled the limp toddler in a light blanket and tore off through the wide, empty streets northeast of San Diego toward Rady Children’s Hospital.

When they ran into the emergency room, before they could even speak, the triage nurse’s head jerked up.

“Is that your son?” she asked. “Is that your son breathing like that?”

Panting, Katie nodded. The nurse scooped Bryce into her arms. She banged the button that opened the doors to the ER, and pulled her walkie-talkie one-handed out of her pocket. “Come with me,” she said.

In the back of the ER, what seemed like a dozen people pounced on Bryce at once, pulling off his clothing, checking his blood pressure, lifting his eyelids, and flicking a flashlight across his eyes. A nurse slid a small clip with a bright red light inside it onto Bryce’s big toe to measure his pulse rate and the oxygen in his blood. Beyond the doctors’ shoulders, Katie saw the read-out. From watching TV programs she remembered that pulse-ox, a measure of how much oxygen was getting into Bryce’s blood, was supposed to go to 100. Anything less than 95 was dangerous. She watched the numbers tick upward. They stopped at 82.

Words bounced up from the health care workers huddled around Bryce: Pneumonia. Consolidation. They took X-rays using a portable machine that was shoved quickly through the door and back out again. Finally a doctor detached herself from the scrum. Bryce was very sick, she said. He would need to go to the intensive care unit, but first he needed surgery. Cell debris and fluids had filled up the air spaces of his lungs, and the slurry was as solid as gelatin, too thick to suck out through a tube. For Bryce to breathe, they would have to cut open his lungs and scrape out whatever they could.

The doctors advised sedating him and taking him to the OR immediately, and told Scott and Katie they could hold his hand, if they wanted. A lot of parents wanted to leave at that point because it was too hard to watch their child slip into unconsciousness. Scott and Katie locked hands and shook their heads — they would stay. Leaning over the gurney, they watched as the sedative slid into Bryce’s IV line. His eyelids fluttered shut, his body relaxed, and the grunting faded to a whistle.

The gurney holding their son slid between swinging doors and vanished. Scott burst into tears.

The next time Scott and Katie saw Bryce, it was early morning on New Year’s Day, and he was lying flat in a curtained bay in the hospital’s pediatric ICU. Twelve IV bags of drugs and fluids dangled above his head; they were plugged into infusion pumps, beeping, blinking boxes with small screens and keypads. Five drainage tubes pierced his chest. The respirator mouthpiece was taped to his face so it wouldn’t slip, and his face was as pale as the tape. Though he was deeply sedated to keep him still, he was also secured between bolsters to ensure he couldn’t thrash about and pull the lines loose.

The slender, energetic chief of pediatric infectious disease, Dr. John Bradley, was waiting for them with questions. Had Bryce ever been in the hospital? Had he had any skin infections or the flu? Had anyone else in the family been in the hospital? Had anyone recently gotten out of jail? Exhausted and frightened, they answered no to everything, though the questions didn’t make sense to them. They could not make sense either of Bryce’s chest X-ray, a black and gray image of his ribs and lungs mottled with bright patches of white.

Black meant healthy lung tissue, Bradley told them, and white was the infection that kept Bryce from breathing properly. The right lung was almost entirely white. When Katie squinted at the monitor, it looked to her as though the white continued beyond Bryce’s lungs. Bradley told her that was right. The infection, whatever it was, had eaten a hole through Bryce’s lung and into the space between his lungs and his chest. It would take another day for test results to confirm it, but Bradley thought he knew what was making Bryce so sick. The lung inflammation was a clear sign of pneumonia, and Bradley thought the infection that was causing it was MRSA. Scott and Katie looked at him blankly — neither of them had ever heard of the bug. Bradley didn’t tell them that the Rady team knew it very well. Not long before, they had treated a two-week-old who had lost all the tissue on his back to flesh-eating disease caused by MRSA, and a three-month-old who died of MRSA pneumonia and septic shock.

From those cases and others, the Rady physicians knew how to respond when they suspected an overwhelming MRSA infection: hit the organism with the strongest drugs possible, and give the hard work of breathing to machines so the body could heal. The emergency room doctors had given Bryce vancomycin immediately, and the respirator was dialed up as high as possible. But the glowing green numbers on the monitor over his head showed that his oxygen level was still perilously low. The gas was not penetrating the ravaged tissue. It was like pumping air into a brick.

Identifying MRSA and quelling it was the job of Bradley and his colleagues in the children’s hospital’s infectious-diseases department. Keeping Bryce alive and stable while the antibiotics did their work was the critical care team’s challenge. The team head was a physician named Bradley Peterson, brilliant and highly credentialed, and also direct and so brusque that nurses were reserved around him and physicians like John Bradley contrived to be present at family chats to soften the force of his personality. When the Smiths arrived in the ICU, Peterson was already in Bryce’s enclosure, giving orders to a nurse: change this, change that, order a transfusion. Something about the distraught young parents touched him. He stopped. Without introducing himself, he said, “I’m going to save your son.”

ABOUT THE AUTHOR

Maryn McKenna, author of Superbug: The Fatal Menace of MRSA (Copyright © 2010 by Maryn McKenna), is an award-winning science and medical writer and author of Beating Back the Devil: On the Front Lines with the Disease Detectives of the Epidemic Intelligence Service (named one of the top 10 science books of 2004 by Amazon). She is a journalist for national magazines and a contributing writer at the Center for Infectious Disease Research and Policy at the University of Minnesota, and has been a fellow with the Henry J. Kaiser Family Foundation and at the University of Michigan–Ann Arbor. She lives in Minneapolis.

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