Granddaughter Down

A week ago Monday I got an email I never wanted to receive: Annie informed me that our granddaughter, Taivyn, was in intensive care battling a raging bacterial infection. The bottom fell out of my stomach. She's only three and a half.

Her small body was invaded by Clostridium difficile (colloquially known as C diff), which attacked her opportunistically following a pediatrician-prescribed course of antibiotics to knock out a respiratory problem. It is now nine days and counting since she was admitted to the hospital's intensive care unit, with no clear end in sight. Now she taking even stronger antibiotics to battle the C diff. This appears to be a clear instance of the cure being far worse than the disease.

As often happens with colitis (inflammation of the colon) she suffers additionally from diarrhea (hourly), stomach cramps, and rectal prolapse. There's nothing fun about it. While there's no immediate threat to life (thank God), it's totally exhausting for Taivyn and nerve wracking for both parents—my son and daughter-in-law, Ceilee and Tosca.

In order to starve out the bad guys, Taivyn is not taking any food orally. Instead, she's receiving both medication and nutrition through a PICC line (peripherally inserted central catheter). Ceilee & Tosca are at the hospital almost continuously, sleeping there every night, and leaving only long enough to shower, eat, change clothes, and visit their four-month-old son, Connor, who's safely at home isolated from his older sister's infection. Their #1 job is to be there for their suffering daughter as she rides the waves of nausea on her frustratingly slow boat to recovery.

For all of this misery though, it occurs to me that Ceilee & Tosca are actually lucky. While I know that's not what anyone is feeling right now, let me count the ways:

a) Foremost, Taivyn's life does not appear to be at risk and there are excellent long-term prospects for a complete recovery with no lasting effects. While the infection is debilitating and requires serious attention (how could 9+ days in ICU be anything else?) the prognosis is not dire.

b) Right away, Tosca's immediate family (mother, sister, and grandparents) traveled out from Missouri to rally around her in time of need. It's a terrific boon that they're able to suspend their regularly scheduled lives to take primary responsibility for care of Connor. Plus, it means that the dog (Zeus) will get walked & fed, food won't spoil in the fridge, the mail will get opened, etc. That's a considerable relief.

c) Ceilee & Tosca run their own business (they operate seven Cricket cell phone stores in Las Vegas). With managers in place to handle day-to-day affairs they have the freedom to take all the time off they need on short notice. Few have such flexibility. What's more, they have robust health insurance and the staggering hospital bills will be taken care of. Whew.

Antibiotic Merry-Go-Round
Apparently most of us have C diff bacteria in our gut. Ordinarily, this is something we can ignore, as the normal complement of intestinal flora are robust enough to keep C diff in check. Those natural defenses were breached however when Taivyn took antibiotics for her respiratory infection. That left the gate unguarded and the C diff marauders walked right through, producing the bacterial bloom that's been causing so much mischief.

While Taivyn's intestinal skirmish is highly likely to have an innocuous ending (my fingers and toes are both crossed as I type this), it's hard to not reflect on how this intersects with a disturbing trend among bacteria of all stripes to develop strains that are resistant to antibiotic treatment. The more bacteria see antibiotics, the more chances they have to develop evolutionary strategies to circumvent their effectiveness.

While I don't know any details about how bad the original respiratory illness was, I wonder about Taivyn's risks down the line, now that her body has been flooded with large doses of multiple antibiotics. How much are the bacteria in her young body being given the data they need to develop resistant strains for future battles—perhaps battles where her mortality is more in question? It's scary.

Seeing the Diff—the Roads Not Taken
When a loved one gets sick it immediately grabs your attention, and offers a reality check about what matters. It provided me some perspective on how much of my day-to-day focus is devoted to emotional minutia (For example, I spent a couple hours over the weekend agonizing about how best to approach a person who's feelings I may have hurt with an abrupt piece of feedback delivered Saturday afternoon).

On the one hand, it's unlucky that Taivyn was stricken with diarrhea and a bacterial infection. On the other, it's lucky that it was diagnosed promptly and treated seriously. It's enormously beneficial that Taivyn has loving and attentive parents who can afford high quality health care. On the other hand, perhaps the original application of antibiotics was precipitous (we may never know) and there may be a price to pay later in terms of decreased effectiveness of antibiotics. These things can be hard to weigh, and point out how often we must make decisions—sometimes decisions with large consequences—with only partial information. Sobering.

Grandmother Up
I spoke with Annie by phone last night. She was home in Virginia and I was in Missouri. Ceilee had just asked her to join the troops in Las Vegas, and she was calling to let me know that she was accepting the draft and moving up her planned Dec visit to deploy for Nevada in the next 24 hours, to further bolster the number of family boots available at Ground Zero to battle the infection.

While I won't get out there until the second week of Dec, Annie will still be there then and I'm fervently hoping that it will be a heartfelt, joyous time, with everyone able to celebrate the good health we too often take for granted.