“Your test results came back. You have c. diff.”
The nurse was standing at the foot of my bed, holding an information pamphlet. She tossed it on the bed.
That was it. That was how I was informed that I had been diagnosed with a debilitating infection that will be with me the rest of my life.
I knew about Clostridium difficile, the impossible-to-eradicate, difficult-to-control bacteria that is endemic to hospitals. I knew it originates in feces and can be transferred from patient to patient via the unwashed hands of health care personnel. I knew because The Atlanta Journal-Constitution, where I work, has reported in depth on the growing problem of hospital-borne infections. C. diff infections alone kill 14,000 Americans a year, according to the Centers for Disease Control and Prevention.
Still, for a moment I doubted that I had heard the nurse correctly. She said it so nonchalantly, her answers to my questions were so perfunctory, I wondered if I had confused this diagnosis with something else.
Sadly, I hadn’t. Sadder still, I would soon learn that unless I pleaded, cajoled, complained and all-but-browbeat them, many hospital staffers would not follow basic precautions necessary to keep me from being re-infected.
So now, as politicians wage war over health coverage, I am among the thousands of metro Atlantans grappling with a stark reality. It is this: In all too many cases, access to care comes with the risk of a terrifying and costly — but preventable — disease.
The irony is that, up to the moment of the nurse’s announcement, Northside Hospital had been my hero.
I had arrived at the emergency room before dawn one day in May, writhing in pain and desperate for answers. The dull, nagging pain that roused me from my sleep the day before had progressed to unbearable. Two trips to a different hospital had resulted in nothing more than prescriptions for pain medication and instructions to follow up with my doctor.
Northside’s emergency staff treated me with compassion and respect, patiently listening as I struggled to explain my symptoms. After a series of tests I was diagnosed with acute small-bowel volvulus, a potentially fatal kink in the intestines. Emergency surgery was required.
Tears flowed. Even my husband, whose high-pressure job has primed him to be an expert at remaining calm in stressful situations, couldn’t hide his anxiety.
The previous day, I had shopped for my upcoming beach vacation. Now I was in the midst of a medical crisis. I made calls to my family. I signed the consent forms, and was prepped for surgery.
The operation was successful, leaving me with only a three-inch incision. My doctor said I could expect a full recovery and reassured me that the pain would subside in the coming days.
It didn’t. As the days dragged on, the pain and nausea continued. My fever soared and I was so weak that I couldn’t get out of bed. After nine days in the hospital and a slight improvement, they let me go home.
Just one day later I was rushed to the ER again.
Credit: Mea Watkins
Credit: Mea Watkins
My abdomen had swelled to several times its normal size. Pain and nausea assailed me at the slightest touch. Severe diarrhea set in. My heart pounded in my chest. I gasped for air. As the medication burned through my veins, I wondered how much more miserable this would get.
Once the hospital isolated c. diff as the culprit, a large metal box was attached to the door of my isolation room. It held disposable gowns and rubber gloves, which medical personnel and visitors were required to put on before they entered.
The contact precautions posted with the box included a warning: Alcohol foam does not effectively eliminate c. diff spores; hands must be cleaned with soap and water before and after every contact with the patient to avoid spreading the infection.
Housekeeping used bleach to clean my room — the only disinfectant deemed effective in killing c. diff spores. But I noticed that some health care workers either partially or completely disregarded the contact precautions. Some of them didn’t bother to wear the gowns, and if they cleaned their hands when they entered the room, they used alcohol foam instead of soap and water.
One staff member took my vital signs, walked into my bathroom and emptied a container of my urine, then handed me my food tray — all without changing gloves. It’s a good thing I wasn’t in the mood to eat.
I began insisting that people wash their hands. One nurse assured me that alcohol was sufficient. I argued, finally forcing her to read the posted precautions. When she did, she looked startled.
But it was nearly impossible to monitor everyone who entered my room — I would often wake up to someone hovering over me, and I had no idea if they had washed their hands.
I reported my concerns to Patient Relations, but the representative who came to my room didn’t seem particularly concerned. The representative never followed up with me as promised, nor did I see an improvement in the staff’s behavior.
After seven days, the infectious disease specialist said I was doing much better and that I would likely go home the next morning. That afternoon I received a new diagnosis: peritoneal abscesses, two of them.
My immune system had trapped the c. diff bacteria in a cavity to keep it from spreading to other areas. Another surgical procedure was required to drain the abscesses.
I was angry.
I hung a sign on my door imploring everyone to wash their hands with soap and water: “I want to go home! PLEASE wash your hands thoroughly with soap & water before and after entering my room. Please. Thank you.”
Credit: Mea Watkins
Credit: Mea Watkins
The sign got a lot of attention. I noticed that most hospital workers started washing their hands with soap and water.
Nearly four months later, I still struggle with exhaustion, occasional bouts of nausea and painful, recurring abscesses. Now that I have been treated for c. diff, I am at a greater risk for a recurrence.
Credit: KENT D. JOHNSON / AJC
Credit: KENT D. JOHNSON / AJC
The c. diff infection tripled the length of my hospital stay and the bills ran into the tens of thousands of dollars. My husband and I have paid our portion of the bills, and insurance is handling the rest.
In response to my request for comment on this column, Northside Hospital spokesman Russ Davis said: “Clostridium Difficile (c. diff) is a bacteria that can live on anyone’s body normally without causing any illness. When antibiotics are given however, many normal bacterium are killed allowing the (c. diff) bacteria to grow, causing infection. … Our goal is always to prevent and control infection no matter what the source.”
That’s my story. I hope others can learn from it.
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