Fungus Among Us
Caught in a medical twilight zone
by Nancy Nelson
From the March, 2013 issue
My eighty-year-old dad was hospitalized on November 30, one of the unlucky souls whose back and hip were injected with potentially fungus-contaminated steroids. We'd been watching the news, thinking, "Phew, at least he didn't have those terrible epidural injections that sent contaminants straight to spinal fluid and caused meningitis," and it seemed like he was safe. But then he developed even more pain in his hip, slow and insidious, months after the August treatments. Finally his doctor sent him to the hospital for testing, and, just like the pain progression, his evaluation proceeded languorously over the course of several weeks. (There seems to be an opportunity here to tsk, tsk about the high cost of health care and this incident's contribution to it.)
As the meningitis epidemic mounted, the federal Centers for Disease Control and Prevention stepped in and developed a protocol for potential infection cases. It was conservative, meant to quash infection whether the offending organism could be detected or not. Even as the staff at St. Joe's soldiered on trying to diagnose the source of my father's pain, they followed the protocol, hooking him up to intravenous anti-fungal medication.
The drug was known to be toxic to kidneys, which was bad enough, but in his case it appeared to produce hallucinations. Once, when I was sitting with him, Dad's eyes fixed on a pair of his slippers resting on a shelf across the room. "Are those moving towards me?" he asked repeatedly. I thought it was some sort of optical illusion resulting from his frame of reference. "No, I don't think so," I answered every time, bobbing up and down to see for myself, "maybe it just looks that way." After many repetitions, I moved the slippers far back on the shelf, to where I hoped they would less resemble a disembodied spook inching towards him. My stepmother, Pat, said he reported that the crucifix on his wall was changing colors.
When I'd read about people having
hallucinations, it sounded weird and terrifying. But in real life, sitting with a senior citizen, it wasn't so bad. I only wish he could have seen something more entertaining or inspiring, maybe a sports figure, a celebrity, or a lost loved one.
During a Friday morning visit, I happened to be there when Dr. Shalhoub, the pain specialist who gave the injections, came to visit. That poor fellow was in exquisite agony himself from having unknowingly caused so much suffering. He came to apologize and told us about his days visiting patient after patient that he'd treated. What a tragedy to befall someone like him--a man who chose a low-prestige specialty because he truly wanted to help people. His practice was in tatters as he scrambled to see infection cases, while prospective new patients headed for the hills. It made all the difference to us that he had the courage to come to visit. I managed a few inadequate words that hadn't occurred to me previously: "It's not your fault they supplied you with contaminated material."
"Thank you," he sighed. He looked relieved to have come into a room where he wasn't blamed--the contaminants' unwitting messenger.
Was there any fungal infection at all? Despite the fact that Dad was in the hospital for three weeks and there was plenty of time for poking and prodding his artificial hip joint and attempts to culture the fungus, no one committed to a clear answer. The doctors concluded that if there was an infection, it must have been a small one, since there were no overtly terrible laboratory results or clinical evidence. That's good, I guess. But what about the pain? What caused it? Possibly related to remaining sutures and scar tissue from Dad's second hip replacement surgery? That's their best guess, so far.
I have at least a couple of takes on the experience. Pessimistic: wow, was this time-consuming, expensive, and painful. That's without going into the breathtaking negligence demonstrated by the compounding pharmacy in New England that prepared the steroid. My dad is back home, but still taking kidney-damaging medication that costs thousands of dollars and will have no effect if he hasn't got any fungus-related problems.
The bright side: well, he's not dead from meningitis, is he? While it's hard to feel my dad benefited from the CDC protocol, maybe he did. The medical staff at St. Joe's did such a full-dress job that we have peace of mind that a sneaky infection isn't moldering in his bones, only to take us by surprise when it's too late.
Score, by my reckoning: negatives, 75 percent; positives, 25 percent (only because it has to add up to 100 percent).
Maybe that's a more than fair balance, considering.
[Originally published in March, 2013.]