The causal link between Sharon Jones’ Listeria infection and contaminated cantaloupe grown at the Jensen Farms facility is clear.  In August and September 2011, while living at the Victorian House, Ms. Jones consumed Jensen Farms/Frontera cantaloupe purchased at King Soopers in the Castle Rock area of Colorado.

On the morning of September 15, Sharon was found unresponsive in her room and was transported to the Emergency Department at Parker Adventist Hospital.  A blood specimen collected on September 15 was culture positive for Listeria monocytogenes (LM).  The Colorado Department of Public Health and Environment (CDPHE) Public Health Laboratory confirmed this result (CDPHE Laboratory ID Number HUM-2011025518) and conducted Pulsed Field Gel Electrophoresis (PFGE) of the isolate cultured from her blood.  Test results showed that Sharon was infected with LM strain identified as CDPHE “11-D/11-E.”  CDPHE foodborne epidemiologist Alicia Cronquist has confirmed that CDPHE Strain “11-D/11-E” is equivalent to CDC PulseNet Pattern GX6A16.029/GX6A12.0069, which is one of the five outbreak associated strains.

Sharon Jones from Marlerclark on Vimeo.

Sharon Jones—Her pre-Listeria cancer struggle

Sharon Jones was a 62 year-old native of Colorado who was raised in Denver, along with her five siblings.  She graduated from Aurora Central High School in 1967 and married David A. Jones in 1969.  Sharon and David met in 1965 in study hall on the first day of school.  Early on they became friends.  David became close to Sharon’s family, even joining them on vacations.  In 1966 Sharon and David began dating and David asked Sharon to marry him that summer.  They were finally married November 8, 1969.  They were together for 46 years and married for 42.

They had one son (Dub).  Dub was named after David’s grandfather, Wesley Bacon Justice.  They moved their growing family to Castle Rock, Colorado in 1976, where Sharon worked at the Douglas County Treasurer’s Office for 35 years.  For 28 of those years she was the Chief Deputy Treasurer.  In 2002, Sharon was elected Douglas County Treasurer.  David acted as campaign manager.

Sharon was known by all for her friendly, gracious, and warm personality, earning her the unofficial title of County Hugger.  She was so good in this role that she enticed hugs from the most irascible personalities, a quality earning her hundreds of friends by the time she retired.  Her generous nature and conscientious leadership made her a favorite elected official among her employees, peers, fellow elected officials, state government, and treasurers’ offices across Colorado.  She retired after her second term, in 2011, and continued working part-time for the Sheriff’s Office.

An adventurous soul, Sharon, David and Dub took numerous camping trips and road trips across the United States.  She developed a love for hot air balloons and determined that her second career would be as a hot air balloon chaser.  Sharon also became a “motorcycle mama,” graduating at the top of her ABATE riding class and then taking cross-country trips on a bigger bike than many men ride.  It was a source of great amusement for her son, Dub and daughter-in-law, Melody, to watch people’s reaction to seeing this short, round, matronly woman putting on her leather gear, hopping aboard a large motorcycle and roaring off.  Sharon’s zest for life and joy was near limitless.

In 2007, Sharon’s life took a marked turn when she was diagnosed with ductal cell carcinoma of the right breast.  Although she was devastated by the news, she refused to let the cancer take over her life.  She hit back hard, undergoing a lumpectomy, lymph node resection, radiation and chemotherapy.

Following her cancer diagnosis and treatment, Sharon continued to be followed by various doctors for several years.  Her internist and primary care provider, Stephanie Kraft, MD, noted that she was fairly stable overall.  She was also regularly treating with oncologist, Douglas Resnick, MD, and was on the drug, Arimidex, to suppress Estrogen-associated breast cancer recurrence.  She was working with Dr. Slamowich on her obstructive sleep apnea, using a CPAP machine to assist with her breathing at night.  Other than that, there were no medical events or significant changes in her medical history for several years.

Then, starting on July 6, 2010, routine lab tests showed a new finding—elevated liver function tests (LFT’s). Eventually Sharon was referred to Parker Imaging Center for studies of the spine, which indicated scoliosis with multilevel disc space narrowing and arthritis.

In June, 2011, an MRI of the lumbar spine was performed, the results of which were terrible news.  Sharon had diffuse metastatic cancer from the T10 to S3 and the iliac bones, with ventral epidural tumor extension at L5, causing severe central stenosis at L5.

The radiologist reported these findings to Dr. Kraft, who contacted Sharon and scheduled an appointment for the following day.  In the meantime, Dr. Kraft spoke with oncologist, Dr. Resnick, who advised treatment with the chemotherapy drug, Decadron.  She called the office of neurosurgeon, Chad Prusmack, MD, and discussed the findings with PA, David Whatmore.  Additional imaging studies were scheduled to definitively identify the stage of the recurrent metastatic breast cancer.

Dr. Kraft discussed the extent and seriousness of the current findings with Sharon and her husband, David.  To say the news was heartbreaking would be a profound understatement.  Dr. Kraft discussed the plan, and instructed Sharon to go to the Emergency Department if she developed increasing weakness, numbness, pain, bowel or bladder problems; signs and symptoms that signal advancing metastatic disease.

Sharon returned to the Parker Imaging Center on June 6 for an MRI of the cervical, thoracic and lumbosacral spine.  Widespread, multilevel metastatic cancer of the spine and pathologic fracture of ribs 6 and 9 were evident secondary to spread of the breast cancer.  A CT scan of the brain on June 11 demonstrated metastatic cancer of her skull but no involvement of the brain itself.  Neurosurgeon, Dr. Prusmack, reviewed the spine imaging studies and advised radiation for treatment, given the absence of neurological signs and symptoms at this time.

Based on the results of several studies, and the finding of metastatic cancer of the spine, Sharon’s cancer was determined to be a stage IV and she was referred to an oncologist, Dr. Resnick, for treatment recommendations in addition to radiation therapy.

Sharon began treatment with radiation in July 2011 and underwent insertion of a right subclavian vein PowerPort for administration of the chemotherapy.  Over the next month, Sharon had several hospitalizations for medical problems related to her cancer treatments and medications, including an alarming episode of medicine-induced psychosis.  These series of events weakened Sharon greatly, and she began having great difficulty tolerating the many side-effects of the intense radiation and chemotherapy regimen prescribed by Dr. Resnick.  After consultation with Sharon and Dub, Dr. Kenney decided to halt the intense radiation and chemo, instead switching to Faslodex (Fulvestrant).

Eventually, on August 15, Sharon was transferred to an assisted living facility, The Victorian House, to help with her mobility.  A home health nurse came to the residence to work with Sharon twice weekly with “great results,” as Dub recalls.  “Dr. Kenney was optimistic that she would experience a full and long-term remission.”

At Victorian House, Sharon was independent for most all her care, including brushing her teeth, general grooming, dressing, and skin care, although she did need some assistance with bathing.  Dub remembers, “through rehabilitation and hard work, she had just gotten to the point of being able to get in and out of bed on her own, in and out of a wheelchair, and had just started using a walker.”

She remained independent for most activities, but did need some assistance for dressing beginning the second week of her stay until September 15, 2011. Nonetheless, she was doing much better by early September.  As Dub’s wife, Melody, recalls of that time:

As her strength improved and she regained her independence, we enjoyed a fun-filled three day September weekend with out-of-town family.  She went shopping and enjoyed being back out in the “real world.”  She had met with her oncologist and was planning on resuming treatments, something she had been too weak to do up until that point.

Most importantly for Sharon and her family, she was strong enough to continue with the chemotherapy treatments she desperately needed.  According to Dub, “my mom’s oncologist felt that she could still have a good chance at extending her life, if not achieving full remission, if she began taking the chemotherapy treatments soon.  My mom and all of her family were hopeful and overjoyed at this news.”

Even more important than the treatments themselves, was the effect the renewed strength had on Sharon’s optimism:

I noticed a change in my mom’s outlook because she began to act and talk like she could and would survive; she started planning trips and vacations; she spoke of future events; she was overall happier and had a positive outlook.  This was an important change because the oncologist had told us both that a positive attitude is as effective as all of the other treatments.

Dub, Melody, and Sharon began working on the itinerary and logistics for their long-planned trip to Italy together.  Dub, after months of anxiousness surrounding his mom’s health, began to relax a bit.  Only a few short days later, however, all their plans were forever changed.

Her Acute Listeriosis Infection

On September 14, 2011, however, Sharon’s health took a sudden turn for the worse.  She was noted to be suffering from some nausea that evening.  She also vomited at least once.  At 6:40 AM the next morning, Jasmine, a care giver at The Victorian House, went into Sharon’s room and found her lifeless, only minimally responsive in bed.  It was clear she had vomited in her sleep, as her face, mouth and neck were covered with vomit.  911 was called immediately.  Dub received a call from the facility letting him know about this mom’s sudden change.

South Metro Ambulance and paramedic team were dispatched to the assisted living facility.  When checked, Sharon’s blood pressure was elevated at 140/100, her heart rate was 100/minute, and her temperature was 101.0° F.  She was immediately transported to the Emergency Department at Parker Adventist Hospital, arriving a little before 8:00 AM.

Parker Adventist Hospital:

September 15, 2011

At the ER, Sharon was barely moving her extremities and could not respond to questions when asked.  Dub did his best to provide his mom’s medical history.  She was connected to oxygen and IV fluids, and a catheter was inserted, producing 150 cc of strong-smelling urine.  Shortly after, ER physician, Carl Bennett, MD, arrived at the bedside.  He noted she was “awake, following only basic commands, not interactive, protecting her airway and moving air well but with occasional coarse breath sounds – definitely altered.”  Blood tests and imaging studies were ordered in the hopes of quickly pinpointing the source of her fevered state.  The imaging studies showed no new or acute findings, providing no evidence of the source of her infection.

Dr. Bennett’s diagnostic impression was early sepsis with fever, lactic acidosis and altered mental status.  He started her on antibiotics with Vancomycin and Levaquin until the results of the blood cultures were available.  Dr. Bennett also discussed Sharon’s case with Sound Inpatient Physician, Margie Kubowicz, MD, who was aware of the recent Listeria infections in the community following exposure to contaminated cantaloupe.  Sharon’s immune system was compromised due to the cancer treatment, thereby placing her at greater risk for Listeriosis if exposed to the bacteria.  Accordingly, Dr. Kubowicz broadened the antibiotics treatment to include ampicillin via IV.  The IV steroid, Solu Medrolm was also administered given the possibility of adrenal insufficiency.

Dr. Bennett and Dr. Kubowicz met with Dub to discuss Sharon’s overall clinical picture and prognosis given her metastatic cancer and present health.  The doctors mentioned a lumbar puncture to further investigate a source of the infection, but Dub wanted to hold off unless it became absolutely necessary since her spine was so extensively involved with the metastatic disease.  They discussed and Dub approved of a DNR (do not resuscitate) status, but wanted to reserve the right to use pressor agents in the event she became hypotensive.  With her DNR status in place, she was admitted to the ICU at approximately 4:00 PM.

Shortly after her transfer to ICU, Dr. Kubowicz arrived to insert a central line using the left internal jugular site for insertion of the catheter.  Sharon was evaluated by infectious disease specialist, Sandhya Ayyar, MD.  At that time, her fever was high at 102.9° F and she remained drowsy and difficult to arouse, with incoherent speech.  Dr. Ayyar agreed she was severely septic.  Dr. Ayyar recommended continuation of vancomycin and levaquin, and broadened testing for various bacteria.

Sharon was transported to the radiology department for a brain MRI.  The results showed no apparent abscess.  There did appear, however, to be diffuse thinning of the membranes surrounding the brain, raising the possibility of meningitis.

September 16, 2011

Sharon remained unresponsive in speech, but she was opening her eyes.  She could only follow simple commands when reevaluated by Dr. Kubowicz in the morning.  Her general, feverish health remained the same.

At this point, the source of her infection and resulting sepsis was still elusive.  The treating doctors spoke to Dub, stressing the importance of a definitive diagnosis to guide them in treating her condition.  With knots in his stomach, Dub relented to their renewed request for the lumbar puncture.

Later in the day, Dr. Kubowicz reevaluated Sharon and decided she could be transferred to a regular medical floor with pulse oximetry monitoring.  She spoke with Dub and asked him to bring Sharon’s CPAP machine to the hospital for use at night, which he did.

Oncologist, Nadine Mikhaeel, MD, from Cypress Oncology came by to evaluate and consult.  Sharon had received only two doses of Faslodex since August 25, with her last dose occurring only several days earlier, on September 12.  Breast cancer markers were ordered and the results were not positive.  CEA was high at 47.8 (NR: 0.0-4.1), and CA 27.29 was high at 86 (NR: 0-38).  Given the aggressiveness of her cancer, Dr. Mikhaeel wanted to treat Sharon with chemotherapy, but understood that Sharon had previously been unable to tolerate it.  She concurred with the current course of treatment, but also spoke with Dub, who said he would agree to further treatment if the lumbar puncture confirmed an infection.  If, however, it revealed carcinoma, she was to have no further treatment.  Everyone agreed to the plan.

Dub’s wife, Melody, reflects on this time:

My husband, an only child, was suddenly faced with decisions involving his mother’s potential death. Doctors needed to know what kind of life-saving measures we wanted them to take because it would be touch and go for at least the first 48 hours. As we struggled with these decisions, the kind we didn’t think we would be faced with so soon, we were struck with the utter unfairness of it all. Our grief filled the room, and while I am not her biological child, I am her child by marriage and I felt sorrow as profoundly as if she were my own mother.

September 17, 2011

Sharon remained stable with the persistent fever.  She was lethargic but responded to voices.  The skin on her right arm, left leg and left buttock had begun to break down with sores, requiring the nurses to turn her every two hours.  The nurses noted that Sharon “became increasingly anxious and agitated; moaning and crying out” when positioned on the right side.  IV and oral Tylenol were given for the pain.

Also that morning, the gram stain of the blood culture bottle obtained on September 15 revealed the presence of gram positive rods, identified as Listeria species.  This critical information was called in to the treating nurses on duty at 6:13 AM.

Shortly thereafter, infectious disease specialist, Robert Bogin, MD, came by to review the lab results and examine Sharon.  Given the results of the blood cultures, he opined she was suffering from Listeria sepsis with probable central nervous system involvement.  Dr. Bogin discontinued all of the antibiotics except ampicillin, which was ordered at two grams every four hours.  He also ordered potassium replacement for treatment of hypokalemia.

Richard Feret, MD, arrived midday to reevaluate Sharon.  She was sleepy but responsive to voice.  Dr. Feret agreed with the antibiotic coverage for Listeriosis, but did not see any benefit to obtaining a lumbar puncture.

September 18, 2011

The final report for Sharon’s blood cultures was completed on this day, with the report indicating “2 bottles drawn – 2 bottles positive for gram positive rods and Listeria species.”  The specimens were sent to the Colorado Department of Health for further confirmation and investigation.

Meanwhile, Sharon had become much more responsive overnight.  She was following all verbal commands and had good memory recall when reevaluated by Dr. Feret.  Her chief complaint was back pain and pain in the tail bone.  She was mildly hypertensive and still had a fever, with a temperature of 100.4° F.  Swallowing was improving and a full liquid diet was ordered with advances as tolerated.

Oncologist, Dr. Thomas Kenney, came by that afternoon to reevaluate Sharon and review the lab results.  With obvious dismay, he wrote that Sharon’s health status was already very tenuous because of breast cancer recurrence and metastasis, and that the “Listeria infection and sepsis was yet another setback.”  The plan was to continue anti-estrogen treatment with Faslodex since Sharon was unable to tolerate chemotherapy.

Dub recalls sitting with his mom at one point, their hands locked together, when she looked straight into his eyes and delivered a devastating blow:

My mom held my hand and looked deeply into my eyes as she asked me to kill her.  She said that her quality of life was stolen from her, that any possibility of treating the cancer was gone, and that she didn’t want to live any longer.  I don’t believe any of us have dealt with anything more emotionally devastating before.

September 19-21, 2011

Over the next several days, Sharon’s anemia stabilized and her thrombocytopenia and hyperglycemia improved.  A second set of blood cultures were thankfully negative for Listeria.  The PICC line was established.

Sharon remained “ill-appearing, weak and quiet, with tenderness in the left abdominal quadrant, pain in the left hip, and 2+ lower extremity edema.”  Mentally she was much improved, answering questions and following all commands.  Her diet was further advanced to soft, then solid, foods.  The IV of Dilaudid was working well to control her pain.  It was changed to oral Vicodin in preparation for her pending discharge, which both Sharon and her family were anxiously awaiting.

On September 20, physical therapist Denise Foster and occupational therapist Emily Pak stopped by Sharon’s room to evaluate her state and devise a treatment plan to get her mobility back.  Unlike her state when she was living in the assisted living facility, where she could ambulate with a front-wheeled walker, Sharon’s struggle with Listeriosis had left her significantly weaker with very little endurance.

During the interview by the therapists, Sharon complained of generalized pain as well as intense bilateral hip pain.  Gross upper extremity range of motion was within functional limits.  Gross lower extremity strength was 2/5 in the hips and 3/5 in the knees.  Static/Dynamic sitting balance was fair/poor.  She required the most assistance for bed mobility, between lying down and sitting up.  Sharon was unable to lift herself off of the bed, nor was she able to stand, bear weight or walk.

The PT felt it was unsafe to transfer Sharon to a chair by pivoting her from the bed.  Therefore, a slide and Hoyer lift were advised.  The treatment recommendations included training in bed mobility, balance, coordination, gait and transfers, as well as therapeutic exercises.

The OT thought Sharon would benefit from functional strengthening and mobility training as well as ADL training three to five days per week.  This would hopefully increase the likelihood of Sharon attaining her goal of independence.  Both therapists agreed that discharge to a skilled nursing facility was necessary given her current level of functioning.  Sharon’s Case Manager was advised and began making the necessary arrangements.

Sharon’s oncologist, Dr. Mikhaeel, ordered continuation of Faslodex to be administered once monthly, starting one week from discharge if Sharon was able.

September 22, 2011

Finally, after a week in the hospital, the day Sharon and Dub had longed for finally arrived.  Dr. Feret did the final discharge check and summary, noting that Sharon was generally improved but with severe weakness and deconditioning following her battle with Listeria.  Overall he was concerned about her prognosis.

Arrangements had been made to transfer Sharon to the skilled nursing facility, Life Care Center of Aurora (LCCA).  While there, she was to receive IV ampicillin until October 2, as well as rehabilitative therapies to facilitate her independence.

Life Care Center of Aurora (LCCA):

September 22 to October 13, 2011

On September 22, Sharon arrived at LCCA via ambulance, where she was admitted under the care of Joel Peacock, MD.  At the time of admission, she was hypertensive and tachycardic, but with no fever.  That first day was mostly focused on getting Sharon in her room and settled.  Dub set out to make his mom’s living space as comfortable and inviting as possible.  See Life

The following day, Dr. Peacock performed a thorough exam, reviewing her past and recent medical history, diagnostic data, allergies, current medications and treatment plan. Additional orders were added to the treatment plan and included Physical, Occupational, and Speech/Language Therapy.

Starting on September 24, Sharon’s aggressive rehab began.  OT and PT therapists, Kyle Larson and Lisa Werner, arrived at Sharon’s bedside early that morning.  She was able to actively participate in 10 minutes of graded therapeutic activities while lying down.  She was also able to safely roll side-to-side with maximum 2-person assist.  Dressing tasks were completed with maximum 2-person-assist while lying in bed.  Sharon could not maintain sitting balance without moderate to maximal support, and she demonstrated poor bilateral lower extremity strength of 2/5.

After OT and PT, speech therapist, Emily Smith, arrived to assess her cognition.  Sharon had cognitive-linguistic deficits, primarily in the areas of short-term memory, problem-solving, and initiation.  Short-term recall of functional information with no instruction/cues was moderately impaired.  Dub also recalls Sharon’s short-term memory becoming noticeably affected, as “she was unable to remember the names and relationships of some of her friends.”  Functional problem solving and safety awareness for daily living tasks required visual and verbal instruction/cues and was mildly impaired.

During her time at LCCA, Sharon was followed weekly by Dr. Peacock, who noted generalized edema—“puffy face, arms and legs.”  On the positive side, her blood pressures were stable and she tolerated the IV ampicillin well.

On September 29, Sharon was noted to still be struggling with confusion at times, especially struggling with finding the right words.  Dr. Peacock wrote that she was “declining; not making much progress with her various therapies.”

He had a long and difficult discussion with Sharon and Dub about her quality of life.  Dr. Peacock wanted to discern what she wanted with respect to further treatment, CODE status, and hospice care.  A second discussion regarding the various options was pursued by oncologist, Dr. Mikhaeel, on September 30.  Sharon, despite the huge setback in her cancer treatment brought about by Listeriosis, could not give up.  She was a fighter, and would continue to fight.  In the end, they all decided that Sharon would continue the Faslodex monthly.

On October 2, Sharon completed the last of her antibiotic treatments for listeriosis.  The results of various lab studies demonstrated slightly worsening anemia and thrombocytopenia.  Further, her cancer markers were elevated—CEA was 20.3 and CA 27.29 was 89.8.

By October 4, Sharon was feeling weak and unwell.  She told Dub that she didn’t think her body could tolerate any further treatment and requested to change her code status to DNR.  She wanted to know more about her options, including hospice care.  Dub made arrangements for a discussion with Hospice services.

A repeat round of blood and urine sample tests indicated her serum ammonia level was elevated at 46, consistent with metastatic liver disease.  The results of the labs were sent to the oncologist, Dr. Mikhaeel, and lactulose was ordered to lower the ammonia level.

To add insult to her already extensive suffering, Sharon developed bilateral conjunctivitis, causing intense irritation and pain to her eyes.  She was treated with eye ointment. She also began to feel increasingly sick to her stomach, prompting a prescription of Zofran to help with those symptoms.  On October 11, with her body slowly failing, Sharon stated that she did not want to continue with the occupational, physical, or speech therapy—it was simply wearing her out.

At this point, the oncologist delivered the expected and disappointing news—they had run out of options in the way of treatment.  Sharon was not a candidate for chemotherapy or radiation—her cancer was too far along, and it was both aggressive and progressing.  Dub wanted to have an MRI of the brain performed to determine whether the cancer had metastasized there as well, but Dr. Mikhaeel felt it was ultimately unnecessary.  Even if the cancer had metastasized in her brain, there really were no additional treatments to offer.  Dr. Mikhaeel and Dr. Peacock requested a Hospice consultation.  The decision was eventually made to transition her to Brookside Inn.

The rehabilitation hospital told us that her insurance would no longer pay for her to stay there if she didn’t participate in physical therapy.  It wasn’t only that she was too weak, but her hope was gone.  She was released from the rehab hospital and moved to a $250/day self-pay nursing home because insurance would not pay unless she participates in physical therapy.

Brookside Inn:

October 13, 2011 to January 29, 2012

Sharon was transferred to Brookside Inn on October 13, where she could continue to receive skilled nursing care with concurrent palliative care provided by VistaCare Hospice.  She was accompanied by Dub and Melody for the transition, making the move a bit easier.

Upon her admission, she was totally dependent for bed mobility, transfers and toileting.  Sharon’s care was overseen by a physician from Senior Care of Colorado, Mike Todd, MD.  Due to severe deconditioning and profound weakness, Sharon preferred to remain in bed most of the time, but was occasionally able to get up in a reclining wheelchair for meals and family visits.  Routine weights were discontinued because the procedure involved getting her off the bed and was simply too painful for her to endure.

The immobility and decreased activity resulted in pressure points and decreased circulation to her skin, which in turn led to tissue breakdown and sores.  These problems were addressed by the wound care team who provided gentle cleansing and rinsing, as well as protective powder, gels and frequent position changes.  Nonetheless, Sharon was in intense pain.  Subcutaneous heparin injections were also too uncomfortable for her and were discontinued by Dr. Todd.  Reflexology was ordered to provide some comfort.

At one point, in mid-November, Sharon stated that she was reconsidering cancer treatment.  When questioned further, she said that she was aware it would not cure the cancer, but thought it might help with the pain.  She was clearly desperate for any relief and for more time with her beloved son, Dub, adding that she “would do anything for that boy.”  Ultimately she was too unwell to restart the treatment.

For Dub, watching the bright, loving woman he has known his whole life slowly waste away before his very eyes, was nearly impossible to bear:

The tumor on the lumbar portion of her spine had grown so large and was so painful that my mom could not raise her head more than 15 degrees.  She could not feed herself.  She could not drink on her own.  It hurt her to move even the slightest amount and because she could not get out of bed, she was in diapers all of the time.  There were other consequences as well:  her liver continued to fail due to untreated tumors on it; the cancer spread to her lungs and brain; her bones continued to get weaker as the cancer grew.

On January 6, 2012, the staff was attending to pressure sores on Sharon’s buttocks and noticed that her legs and feet were splotchy and cool to the touch, with noticeable swelling.  She denied any pain or discomfort.  Dr. Todd was notified.  His impression was poor circulation likely due to her overall state of health versus end of life mottling.

Sharon’s nausea and vomiting resumed for several days in January, which was treated with medication and improved.  The Hospice nurse came in on January 23 to reevaluate her health status, which was not good.  Her vital signs were a subnormal 95.4° F.  Oxygen saturation was 67% on room air.  Her speech was garbled.

The next day, Sharon was medicated with Ativan and oxycodone for anxiety.  She rested quietly in bed with even, non-labored respirations. Sharon was noted to be “drowsy but responding to stimuli – no nausea or vomiting for 4 days; no complaints of pain or discomfort.” She was eating less than 5% of her meals and was not taking in fluids by mouth.  Terminal secretions were noted as well as skin discoloration from the thighs to the toes.  All of her extremities became cool to the touch.

Dub, Melody, and the rest of her family visited frequently over the next several days.  Her level of consciousness varied from sound sleeping to drowsiness to fully awake.  She remained comfortable and without complaints, except for some mild nausea on the 28th.

On January 29, at 11:00 PM, Sharon’s heart rate slowed to 42 beats per minute.  Her blood pressure dropped to 86/46.  Ativan and oxycodone were administered.  Sharon’s sisters were there at her bedside, touching her hands and whispering loving words her ears.

At 11:15 PM, Sharon Jones, only 62 years old, took her last breath.

Ultimately, there are few words to accurately convey the unfairness of what happened to Sharon Jones, all from eating a cantaloupe.  Her daughter-in-law, Melody, describes the situation well:

Listeria paved the way for cancer to spread with a vengeance. It weakened Sharon so severely that she was unable to pursue cancer treatment that would have allowed her to enjoy retirement from 35 years of public service, the last 8 as a popular elected official. Plans to visit her ancestral home in Italy in 2012 – gone. All that she worked for and planned to enjoy in retirement – gone. Time with her beloved son and family – gone.

Listeria took away her life.