The causal link between Hazel “Abby” Jacobs’ Listeria infection and cantaloupe grown at the Jensen Farms facility is clear. In the summer of 2011, Abby’s good friend, Sharon Goodall, regularly did her grocery shopping, shopping at City Market located at 508 East Main Street Cortez, Colorado. During August and September, 2011, Sharon purchased one or more cantaloupes from this City Market location, which Abby then consumed.
Abby was born on April 7, 1938 in Yellow Jacket, Colorado to Edward and Edith (Chamblee) Watson. Hazel was raised on their Yellow Jacket farm with her three brothers: Cecil, Bill and Tom Watson. After losing her mother at a young age, her father Ed married Sadie Chandler, which made her “sis” to eight more brothers. Later, Hazel married Chuck Englehart of Lewis, Colorado. She had often said that some of her fondest memories were of their first years when they traveled from state to state. She loved the adventure of living in a small RV hooked to the back of the old truck as Chuck worked in different mines.
After a few years of mining, Chuck, Hazel, and their first child, Rob, returned to Lewis, Colorado and purchased farmland. After their second child, Rhonda, was born they were still living in a single room home, which was later, referred to as “the little red house.” It was evident they were going to need more space so they built their first new home. After they moved in, Neal and Lisa were born.
There was never a dull or lazy moment as Hazel guided her four children through all the adventures a farm could offer. Working on the farm and raising their family was Hazel’s first priority but she was also known for her involvement in the community. She attended the Arriola church, helped lead projects in 4-H, Girl Scouts, and White Elephant fundraisers. Her kitchen was the most used room in the house. There was always cooking, baking, canning and then cleaning up to get it ready for the beauty shop, which included cut, color, perm and style at no charge. When she was not busy in the kitchen she was the local “Avon” lady and worked the winters at the County Clerk’s office. On many occasions the family hosted ice cream and croquet gatherings in the summer, then followed that up with poker and chili parties in the winter. Hazel was a dedicated sister to her brothers and their wives. She dearly loved each and every one of her nieces and nephews. Hazel’s friends were like the sisters she never had. Her daughter, Rhonda, recalls her mom:
Hazel was a wife, an amazing mom to four children and our rock. Whether the situation was good or bad, she remained the solid foundation of our family. Along with her children, mom also took care of the dogs, chickens, cows, and horses. Mom was also extremely close with our neighbors. Although she had such a busy life, I never recall mom missing any of our sports games, our showings at 4H, or every time we participated in rodeos. Every Sunday, mom partook in church; something that she looked forward to all week.
The years flew by as their family grew and the farm was sold. They moved to Cortez which is where Hazel became deeply involved with the church and her growing Faith. Over time, Hazel and Chuck grew apart and eventually separated. In the years that followed, Hazel had many new pathways, the first being two years of school to become an Ordained Minister.
Through her church and ministry she met and married Elvin Jacobs. During their marriage, and due to their shared love of the Word, Hazel became known as Abigail, or Abby. Sadly, after only one blessed year of marriage, Elvin passed away. After the loss of Elvin, Abby began work with the ministry she is most known and loved for. Through her favorite ministry, she counseled and supported numerous people in their time of need. She spent countless hours and resources with this program and the people she helped will never forget her for the work she did.
Abby Jacobs was a 73-year-old single woman living in Cortez, Colorado when she was stricken with listeriosis. Although she had struggled with serious rheumatoid arthritis since her 40’s, her health was otherwise good. She did have to take steroids and Methotrexate for her arthritis, which made her vulnerable to the bacteria, which would claim her life.
To her three children, Rhonda Crosby, Lisa Gasper and Robert Englehart, and her eleven grandchildren, she was known as a vivacious and joyful mother and grandmother. That changed quickly in September of 2011. Abby’s oldest son, Rob, recalls his mother’s inherent strength and determination to cope with anything:
Mom was a strong woman raised in a pioneer family of Southwest Colorado. She grew up with three brothers on a dirt poor farm so she knew how to survive. As children she raised all of us to stand up and be counted. The strength and pride she instilled in us has carried each of us through life very well.
Mom battled rheumatoid arthritis the last 35 years of her life. Trust me, if you don’t know what that does to a body both physically and spiritually, then you have no idea of how strong she was. If anyone could handle pain she could. Mom carried herself through these years with dignity and grace never once allowing herself any pity from those around her. I absolutely admired her for that.
While recovering from some minor foot surgery in early September, Abby developed headaches unlike any that she had ever had before. Abby went to Durango Orthopedic Associates to see Gwendolyn Grant, MD on September 1st. Dr. Grant recorded Abby’s complaints:
She was overall feeling fairly well on Sunday and doing all of her usual activities by in the afternoon as she was sitting and watching TV, she suddenly had the onset of pain and stiffness in her shoulders to the point where she really could hardly move them. She was also stiff in the neck and developed a headache at the same time that was bilateral in the temporal area. She had sensitivity around the eye and sensitivity of the scalp and the right side of her head. She said she was in so much discomfort she could hardly move.
Dr. Grant suspected Abby was suffering from temporal arteritis, an inflammation of the artery that supplies blood to the head. She ordered a temporal artery biopsy, which was performed on September 1st, but showed no abnormalities.
Daughter Rhonda remembers how Abby’s Listeria related symptoms began to take their toll during the late summer, well before Abby was hospitalized for the final time:
As the headaches, neck pain, and leg cramps continued mother was now facing something else; bloody stools. She took her stool specimen to the hospital, however, somehow it got lost in their lab and we got no results. The days continue, with mother’s health declining, the joy expressed through her eyes started to disappear. Mother started losing weight increasingly. Fatigue and confusion were also taking control of her life. Seeing my mom in pain was not as bad as seeing her lose her happiness, faith and strength that she had once held so close.
Abby was seen on September 9th by her primary care physician, Andrew McAlpin, MD who prescribed oxycodone and ordered a CT scan of the brain which was described as normal on September 15th. Over the next weeks, Abby felt progressively worse and was seen by Dr. McAlpin on October 4th for complaints of bloody stool and increasing fatigue. On October 6th Abby called in to let Dr. McAlpin know that the blood in the stool had lessened.
Abby’s headaches persisted as her malaise increased. On October 9th, her head pain increased and she was barely able to get out of bed. Her appetite was gone, replaced by nausea and an overwhelming lethargy. Rhonda recalls:
One awful night on October 10th she fell and hit her head. She eventually picked herself up off of the floor and went back to bed. Her health provider found her in the morning and called for an ambulance immediately, and she was taken to the Cortez Hospital. I received the information from my sister in law, and left work to be at the hospital with her. I’ll never forget that 45-minute drive to Cortez; I was so angry and confused. My tears poured down while I asked myself, why didn’t she call me?
By the time I got to the hospital she had fallen asleep, trying to avoid her intense pain. Her heart rate was continually decreasing, low 40’s and at many times 35 beats per minute. A pace maker was contemplated to be installed in Mother’s chest, and we were all very focused and worrying about her heart.
The decision was then made to transport her to Durango, Colorado hospital because they have a cardiac cath. lab. I left the ICU that night thinking, her heart? Why her heart when this all started with headaches? Mother was transferred safely to Durango. The ICU physicians and nurses were doing all they could. She received another CAT scan and the report came back stating that mother had a stroke. She suffered right-sided weakness and paralysis of the right leg. Although she was in so much pain, my spirits were lifted in thoughts that many people survive from strokes.
She was seen by Dr. Robin Page who noted that she was in atrial fibrillation and lumbar films showed an L2 compression fracture. Atenolol was given to control the atrial fibrillation and morphine for the fracture. Abby’s atrial fibrillation converted to bradycardia, which quickly resolved. Abby was admitted for observation for cardiac concerns and was transferred the following day to Mercy Medical Center for further evaluation and possible placement of a defibrillator.
Abby was promptly admitted to the ICU at Mercy on October 11th. By the time of her arrival atrial fibrillation had ceased and the primary concern was her abnormal labs. Ginny Schoenfeldt, MD, noted that “the patient does have a severe headache. She has been diagnosed with temporal arteritis despite having a negative biopsy.” In particular, Abby had developed “rapidly developing pancytopenia,” a condition in which all types of blood cells are reduced in number.
At Mercy, Abby reported that her headaches and heart palpitations were worse. She also reported chest pain of four weeks duration. She also reported passing bright red blood during the prior week, which her internist attributed to hemorrhoids. Her physical exam did not reveal any obvious acute cardiac issues. The doctors concluded, however, that Abby had “paroxysmal atrial fibrillation” (recurrent arrhythmia which can last minutes or days) which was newly diagnosed but might have existed for some unknown period of time.
While a pacemaker was deemed appropriate for Abby, the doctors did not want to proceed until her platelets recovered due to the risk of bleeding. Meanwhile, Abby’s abrupt pancytopenia raised concerns for some type of blood cancer and an oncology consultation was requested. On October 12th, Cynthia Cathcart, MD evaluated Abby’s blood disorder. Sepsis was in the differential diagnosis, but not strongly suspected due to the lack of fever or hypotension. Dr. Cathcart initially thought Abby’s blood count abnormalities might be the result of medications but considered the need for a bone marrow biopsy.
But on the 13th, Abby developed a fever and was started on antimicrobial therapy. The next day, her cultures were reported positive, and Dr. Schoenfeldt felt that Abby had suffered an “embolic cerebrovascular accident” based upon the atrial fibrillation diagnosis and Abby’s inability to give a detailed history. Although there was no reason to suspect sepsis when Abby was admitted, the evidence for an overwhelming infection soon developed. An MRI of the brain showed what appeared to be “multifocal signal abnormalities” that was felt to be consistent with an embolic event although eventually the MRI would be read as caused by an “infectious etiology.” A brain CT showed what appeared to be a “small cortical infarct.”
Abby’s son, Rob, recalls the extent of her suffering:
The poor woman was absolutely miserable. The pain and agony she was going through was unbearable. The day we checked her in to the hospital was the first time in my life that she begged me to make the pain stop. Can you believe that? After all those years of battling arthritis, she begged me to make the pain stop. We now know that the listeria was slowly destroying her.
Abby’s temperature remained elevated until October 15th. Also on the 15th it was decided that a PICC line placement would be best for antibiotic therapy, so Abby underwent yet another procedure for the insertion of the line. She was started on Vancomycin.
Abby underwent echocardiography, which showed only minor heart abnormalities. A CT of her lungs showed some congestion, a pleural effusion, and small areas of collapse as the base of the lungs. While the doctors considered if Abby had infectious endocarditis, her listeriosis gained force. On October 19th, she had to endure a lumbar puncture, which yielded both white cells and elevated protein levels consistent with an infection. Rhonda recalls the bittersweet quality of her mother’s final days:
The biggest gift we received was the fact that mother was alert enough to see and talk to each grandchild. She allowed them their tears but tried to give them each a word of wisdom. Her sense of humor was shown when she claimed we were all gathered at the hospital for a family reunion that was all about her. We were mostly convinced our mother was going to be okay.
Sadly, her good days didn’t last long. Her heart went into arterial flutter and atrial fib. Her lab studies of WBC, RBC, and platelets came back abnormal. The doctor wanted family consent to do a bone marrow aspiration. As a family, we decided that this test would be too painful for mom, and denied the test. Blood cultures then started to arrive as mother started to decline.
Sepsis occurred from listeria. Mother also received a spinal tap, shown positive for meningitis. She was now back in a confused state, only responding at times. Reading scriptures from her bible was the most calming thing we could do for her. When we weren’t reading, we were researching what listeria is and praying to God that it wouldn’t take mother’s life.
According to Dr. Schoenfeldt, Abby seemed to be improving until the morning of October 20th when “she had [an] acute change in heart rate, started coughing up some blood and soon expired.” Abby had previously expressed her desire not to be left in a persistent vegetative state and thus there was no intervention. With her family by her side, she quietly passed away at 8:10 AM.
We lost our mom October 20th, 2011. Eleven grandchildren, one great-grandchild, and one unborn lost their grandmother. There isn’t a single day that I don’t miss my mom. I know how much it has affected my dad, my sister and brother, my uncles, my nieces and nephews and of course my own children. This loss took a toll on our whole family and we will never forget the strength and spirit my mom obtained. She was an inspiration to all and she will never be forgotten.
For Abby, listeriosis was a miserable end to a remarkable life. Abby’s son Rob remains upset over his mother’s needless death:
Anger is a good word to describe how I feel today. Angry that she was cheated out of several more good years of her life, angry that she had to suffer so miserably to die and angry that I don’t have my best friend to talk to anymore….Proud that she was mine.