A nine month collection of family emails chronicles Mary’s health from the first sign of a “boil-like” skin infection to end-stage heart failure. The email subject lines were alerts, meant to be opened immediately, and at times a call to action. Conversations between Mary’s remaining eleven children also occurred during hospital visits, dinner gatherings, and through texts and phone calls.
I am Mary’s daughter-in-law and a retired nurse. I too, cared deeply about Mary. With my nursing background, I was naturally drawn into many medical discussions, but I think my most helpful contribution came from my own experience with my aging mother. From that experience, I learned that infections play significant havoc on the previously healthy elderly—their tipping point more precarious, their fragility a factor. I knew that deadly infections can result from being a patient in the hospital; that cognitive changes can be misinterpreted as an aging phenomenon, and that family vigilance is vital.
Mary was one of the most determined women I’ve ever known, and at 90 years young, was strong physically, spiritually and emotionally. By all defining parameters, she was healthy; she lived independently, her mind was sharp, and she didn’t have any chronic medical conditions.
All of that changed, subtly at first, and then drastically in the final months of her life. She overcame many healthcare acquired challenges, but in the end, they overcame her.
Email Subject Line: What’s going on?
Following a hip fracture repair, Mary complained of an uncomfortable lump during the recovery period. During a routine post-operative check-up, her incision site was not examined. Mary put up with it.
Two years later, redness and stiffness developed at the knee followed by a “boil” near the original operative site. She made three visits to her family physician and two courses of antibiotics were prescribed with no improvement.
Mary suspected a relationship between the hardware in her hip and the skin infection. As the weeks went on, the abscess did not get better, and it eventually erupted and drained.
Mary was immediately hospitalized and the hardware in her femur was surgically removed and the bone cleaned, as doctors determined the abscess was related to bacteria at the site of the previous hip repair. The culture taken during surgery showed E. coli, resulting in a six week course of antibiotics.
Email Subject Line: Our Amazing Mom!
Mary pulled through the surgery with flying colours. She was walking on her first post-operative day. She was determined to get home as soon as possible.
Email Subject Line: Mom’s Progress
She had three good days and then bloody diarrhea developed. I knew this could be the beginning of a downward spiral, recognizing the likelihood of a C. difficile infection taking advantage of the wrong antibiotic prescriptions over the past weeks. An infectious disease specialist was consulted, but it was difficult for the family to get answers to their many questions from the specialist or staff. The first set of antibiotics for the C. difficile infection didn’t make a difference. A second round of the same antibiotic was required.
Email Subject Line: Mom’s Progress
In addition to her bacterial infections, on the fifth day after surgery Mary experienced excruciating pain in her leg. An opioid was prescribed and an X-ray ordered, only to discover a re-fracture of her femur. She developed delirium. It was very difficult for the family to see her this way and upon their insistence the opioid was removed.
Mary had been through a lot. She suffered physically and mentally as a result of the infections, side effects of the strong antibiotics, fracture of her femur, her pain and pain medications. And she wasn’t out of the woods yet. Two weeks after her surgery she was transferred to a special care unit because her heart was beating irregularly. Blood clots developed in her lungs and then heart failure. We were shocked because her strong heart and her mind had been her greatest assets to recovery.
As time went on Mary often felt like her mind was in a cloud. She complained of feeling lostand was troubled by her deteriorating mental state.
Email Subject Line: Our Mom and the Doctor
There was talk of a second surgery, but could she tolerate it? Our goal was to help her get home, that’s what she wanted most of all. After rehabilitation Mary never really walked again. She did not return to her home, but rather went to a care home. I sensed her sadness.
Email Subject Line: Our Mom
Nine months after the abscess first appeared we said good-bye to our beloved Mary. She suffered at the end; her body racked with pain. We are left to wonder why the infection developed in the first place and how much the bacterial resistance to the antibiotics used for extended periods of time contributed to her decline. We cling to the sweet memories of her singing at the campfire playing her guitar, yodeling, the family gatherings, her cookies, her handcrafts, her wisdom, her laughter and her tremendous capacity to love each of us in her large family.
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