Life-Threatening Infection

The Fight of His Life

John Meyer intensive care patient52-year-old John Meyer started his workday as a business developer at a local aerospace company on May 18, 2011 like any other. However, increasing abdominal pain convinced him to go home for some much needed rest. Just the previous week, this Franklin resident had traveled to England, Germany and France for a six-day whirlwind business trip that he had taken many times before.

By the time his wife, Loreen, got home from work that day, his pain had worsened. It was when he developed bloody diarrhea a few hours later that John and Loreen knew they needed to get him to Milford Regional for emergency care. Initially, doctors stabilized John and told him to come back in the morning to meet with a gastroenterologist. However, the continuation of bloody diarrhea throughout the night brought them back to Milford Regional where he was subsequently admitted.

What ensued was a month-long hospital stay during which John literally fought for his life while doctors used a combination of clinical expertise and teamwork to save him. Within 48 hours of his admission on May 19, his kidneys began to fail, and he started to show signs of sepsis, indicating a potentially deadly infection. A colonoscopy and CT scan of his abdomen both showed severe inflammation, but doctors were uncertain as to the cause. They initially suspected an E. coli infection based on his symptoms—and even tested for the traditional strain found in the United States—but tests came back negative.

As John’s health became progressively worse, he was transferred to the intensive care unit where he required dialysis. For two weeks, John remembers very little as he floated in and out of consciousness. Meanwhile, a team of specialists at Milford Regional, including an infectious disease physician, a gastroenterologist, a hematologist, a nephrologist, and countless other nurses and critical care specialists were racing against the clock to determine why John’s health was deteriorating so rapidly. Michael C. Newstein, MD, PhD, infectious disease specialist at Milford Regional, states John was one of the sickest adult patients with this type of infection he’d ever seen in his decade-long career.

Doctors interviewed both John and Loreen extensively about John’s travels, including where he’d gone and what he’d eaten while on his business trip. Little did John know, that one of his healthy breakfast choices would contain fenugreek, an Egyptian seed, that the Center for Disease Control (CDC) would later confirm had been tainted with a not-yet-identified form of E. coli. Ultimately, more than 4,000 people in Germany and other countries would suffer from this outbreak; at least 53 people would die.

When John’s blood platelet count started to drop considerably, Dr. Michael Constantine, an oncologist/hematologist and medical director of Dana-Farber Cancer Institute with Dana-Farber/Brigham and Women’s Cancer Center at Milford Regional, examined John and performed a blood test that revealed fragmented cells consistent with a rare condition called hemolytic-uremic syndrome (HUS). This disorder usually occurs when an infection in the digestive system produces toxic substances that destroy red blood cells, causing kidney injury. If John had HUS, Dr. Constantine knew that treatment needed to be initiated right away.

Dr. Constantine immediately consulted with several other physicians on John’s care team. “[HUS] is pretty tough to diagnose because there’s not one test that really points to it,” he says. “I think it was a good team effort. You need to have all of the experts involved to figure out what’s going on.”

Within an hour, Dr. Constantine and the rest of the team decided that John likely had HUS and that he should begin receiving intensive plasmapheresis treatments to remove toxins from his bloodstream. Fast work between Milford Regional’s blood bank and the Red Cross had John quickly receiving the first of many daily plasmapheresis treatments that would ultimately save his life. “If it had taken another day to figure it out, it might have been a day too late,” says John, reflecting back on the importance of that singular diagnosis.

It was during the second week of John’s hospitalization—and after the plasmapheresis had been initiated—that news about the E. coli outbreak in Germany had begun to spread. The following week, the CDC confirmed that based on John’s stool sample, he had, indeed, contracted the German strain of E. coli; John was the first case to be identified in the United States.

“In retrospect, we know that this was a new pathogen, so the labs weren’t testing for it,” says Dr. Newstein, noting the challenge in treating John without having any protocols. “No hospital laboratories had the diagnostic tools to identify it.”

Loreen says even despite all of the unknowns, she never once doubted the care John received or the decisions that physicians were making to treat him. Although she could have transferred John to a larger hospital in Boston, she deliberately chose to keep him at Milford Regional. “At Milford Regional, he had the undivided attention of the team,” she explains. “If I had moved him to Boston, he wouldn’t have been the only person in a crisis situation who would have required that attention. The attention would have been divided.”

Dr. Newstein touts continuity of care and expedited treatment as two of the many benefits patients receive at a community hospital like Milford Regional. Teamwork plays an important role, too. “I think it works well at Milford because we, as physicians, work so well together,” notes Dr. Constantine. “We do what’s right for patients no matter what. That’s what we do, and that’s what we’re here for.”

Nearly a month after he was admitted, John was discharged home. He spent the remainder of the summer undergoing physical therapy to gain back much of the strength he’d lost. By the end of August, John was able to ride his bike again, though not nearly for as long or as far. Full recovery was still months away, but it didn’t stop him from returning to work in the fall. Looking back, John is thankful to have received care at Milford Regional. “I’m glad that’s where I was,” he says with gratitude. “I don’t think there are better doctors anywhere else. I think the amount of attention they gave me was probably more than I would have gotten at any other hospital.”

Read more about Michael Constantine, MD

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