In 2009 Vernon Knudsen was 74 years old and lived with his loving wife, Marjorie, in the small town of Onalaska, Texas, just north of Houston. Vernon was happily retired and normally enjoys a quiet, peaceful life.
Vernon’s medical history has included high blood pressure, high cholesterol, an irregular heartbeat, and essential tremor—a common movement disorder that typically affects elderly persons, characterized by trembling arms or hands. Additionally, Vernon has undergone minor surgeries to repair a hernia and to treat sleep apnea. Regardless of these health setbacks, prior to August 2008, he was in good shape for his age and worked quite hard to stay that way. To ensure his continuing good health, he saw his doctor regularly and took various medications, which kept his minor ailments at bay. During the fall of 2008, Vernon routinely ate Keebler peanut butter and cheese crackers.
On August 6, 2008, Vernon’s health took an unexpected turn for the worse. That morning, he began to feel short of breath; any small exertion seemed to aggravate the condition, causing chest pains and labored breathing. Frightened at the rapid onset of symptoms, he immediately made an appointment with his doctor, Isnardo Tremor, MD, at the Huntsville Family Medicine Clinic. Upon observing Vernon’s condition, Dr. Tremor diagnosed him with cardiomegaly—an enlarged heart. To confirm the initial diagnosis, Dr. Tremor scheduled Vernon for further testing at Huntsville Memorial Hospital.
Vernon arrived at Huntsville Memorial on August 7, where he received an echocardiogram and Doppler tests. The tests revealed moderate pericardial effusion—an accumulation of fluid around the heart. For further analysis, Vernon’s treating cardiologist recommended that he undergo a stress test. A complex procedure, Vernon was told that the stress test would consist of a diagnostic nuclear imaging study in which a radioactive tracer—Cardiolite—is injected into the patient through an IV to see if the heart muscle is receiving the blood supply it needs.
Over the next three weeks, Vernon’s shortness of breath became progressively worse. To make matters worse, he began to suffer from profuse diarrhea and nausea. He was also rapidly losing weight, a dangerous sign for an elderly person with health complications. By the end of August, in addition to all of the other symptoms, he began to experience chills and a fever, and also began sporadically coughing up blood.
By August 27, Vernon was vomiting blood every fifteen minutes. Terrified and believing he was perhaps on death’s door, he called Dr. Tremor’s office to report the symptoms. Without hesitation, the doctor implored him to go to the emergency room immediately.
By the time he arrived at the Huntsville Memorial Hospital emergency room, Vernon’s symptoms were spiraling out of control. A chest x-ray revealed that he had fluid accumulating around his right lower lung, indicative of an infection. His fever had reached 102.4° F and his heart was racing at 117 beats per minute. Compounded by the litany of complications, his blood pressure shot up to 190/63, necessitating intravenous treatment with Lasix. At this point, his shortness of breath was so severe that he was in a state of respiratory distress. Too weak to breathe on his own, he was placed on a Bi-Pap breathing machine, which forced air into his lungs.
Vernon’s wife, Marjorie, could hardly believe the rapid deterioration of her husband that was taking place right before her eyes. She recalls:
Everything was happening so fast, I really couldn’t believe it was real. They were doing all they could to help my husband, but he just seemed to be slipping away. I can’t tell you how scared I was.
Initial diagnostic test results indicated even more trouble: Vernon’s blood and sputum cultures had tested positive for Salmonella. This came as a shock to Vernon and Marjorie; they had no idea where he could have become infected with Salmonella. The Knudsens were even more shocked when they later found out, through contact with the health department, that Vernon’s infection had been caused by the simple act of snacking on Keebler peanut butter and cheese crackers.
The tests additionally showed traces of blood and protein in Vernon’s urine, as well as elevated BUN and creatinine levels—all indications that his kidneys were not functioning properly. Sensing the severity of Vernon’s condition, the treating physicians administered Levaquin and Cefepime, two powerful antibiotics, trying desperately to combat the symptoms.
Within a few hours, Vernon’s condition had finally stabilized. He was soon transferred from the emergency room to the intensive care unit. His diagnosis read like a medical textbook: Salmonella, sepsis, pneumonia, hypertensive emergency, anemia, respiratory distress, and pericardial effusion. With such dire diagnoses, both Vernon and his treating physicians knew that he would not be able to leave the hospital for the foreseeable future.
In the days that followed, the results of Vernon’s laboratory tests yielded increasingly bad news. His BUN and creatinine levels continued to rise, while his carbon dioxide levels decreased, due to the pneumonia. All the while, his white blood cell count continued to climb as a result of his infection and his red blood cell count dropped, signaling worsening anemia.
During the early days of his hospitalization, Vernon’s doctors tried desperately to manage his myriad symptoms. Initially, Vernon remained on the Bi-Pap machine for breathing assistance, but, fortunately, the doctors were able to wean him off the machine as his breathing improved. Still, he needed oxygen treatment administered through nasal tubes. He also received Solu-Medrol and nebulizer treatments to help resolve his continued shortness of breath.
As the hospitalization wore on, Vernon experienced several frightening emergency events. At one point, his hemoglobin and hematocrit levels plummeted, requiring an emergency transfusion with two packs of red blood cells. In another instance, after Vernon had been moved to a regular hospital unit, his heart began to beat irregularly and at an abnormally fast rate.
Due to the instability of Vernon’s condition, he had to be transferred back to the intensive care unit. To control his heart rate and blood pressure, his doctors tried multiple drugs, including Cardizem and Lovenox, but to no avail. They then started him on Coumadin and later Digoxin and Metoprolol before he was finally stable enough to return to the non-intensive care floor.
Vernon’s suffering in the hospital continued for nine days, although, as he recalls, it felt like an eternity. Throughout the ordeal, he suffered from back and neck pain. His nurses often found him uncomfortably perspiring and restless, yet too weak to move.
On Friday September 5, despite continued problems, Vernon was finally stable enough to be sent home. His discharge diagnoses included Salmonella septicemia, pneumonia, pericardial dysfunction, atrial fibrillation, severe sepsis, hypertensive chronic kidney dysfunction, and anemia. His doctor instructed him to see his general practitioner in a week and told him to return for another appointment with the cardiologist.
The next week, Vernon returned to the Huntsville Family Medicine clinic for his follow-up visit with Dr. Tremor. Test results from the visit revealed that his hemoglobin and hematocrit levels were abnormally low, his prothrombin (clotting) time was too high, and his neutrophil level was also too high, a hallmark of acute inflammation. At this point it had been over a month since Vernon initially fell ill. He began to wonder if his condition was ever going to improve.
Unfortunately, Vernon’s fears about the lack of improvement in his condition proved to be well-founded. By mid-September, he was once again plagued by diarrhea. As the days continued, he developed a fever, a cough, and abdominal pain.
On the morning of September 23, just after 8:00 AM, he returned to the Emergency Department at Huntsville Memorial Hospital. He explained to the doctors that he was sick again, but this time, he said, he felt different. The attending physician noted that while Vernon did not appear to be “severely ill at this time,” he eventually “got that way during the last episode.”
The doctor’s words were prophetic. A stool specimen collected that morning tested positive for Clostridium difficile. Vernon was admitted to the hospital for observation, placed on contact isolation, and started on the antibiotic Flagyl.
The following day, Vernon was moved to the intensive care unit. His diagnosis list was even lengthier than it had been during his prior hospitalization. He was now suffering from acute exacerbation of chronic obstructive pulmonary disease (COPD), pneumonia, diarrhea, hypertension, anemia, renal insufficiency, coronary and aortic atherosclerotic disease, and was becoming increasingly confused and disoriented. He was soon subjected to a bronchoscopy and a chest x-ray. The x-ray showed a large pericardial effusion—fluid around the heart. He was next referred to nephrology to address the progressive deterioration of his renal function. The nephrologist delivered the fearful news that he might have to undergo dialysis if his renal function continued to deteriorate.
On September 26, after briefly returning to a normal room, Vernon was once again taken to the intensive care unit due to his increasingly dangerous fluid retention. A central line and chest tube were surgically placed; the chest tube drained the fluid accumulating around his heart and lungs. He was then intubated and began breathing with the help of a mechanical ventilator. Due to the fact that he was so restless, the doctors had to sedate him and secure his arms to the bedrails. Feeling helpless in every sense of the word, Vernon moved his lips but could not speak, all the while writhing and tossing his head from side to side while pulling at the restraints.
On September 27, after 24 hours of suffering, Vernon was taken off the ventilator. Fluid retention, however, remained a problem. His chest continued to be drained and the catheter site began to become severely irritated. Meanwhile, the doctors were carefully monitoring his urine output, which was poor, knowing they soon might have to resort to dialysis.
Vernon remained in a dazed state. On September 28, a nurse reported that he was confused and was having difficulty speaking. He was also unsteady on his feet and, at this point, both hands were shaking so badly that he could barely manage to eat. To make matters worse, he was still suffering from severe anemia, thus necessitating more blood transfusions.
On September 30, Vernon suffered another crisis. The on-duty nurse arrived in his room to find him lifeless and not responding to stimuli. It took multiple nurses several attempts to rouse him. When he finally opened his eyes, he did not seem to focus. He was unable to speak clearly and had difficulty swallowing. Weak and unsteady, he attempted to get up but nearly fell to the floor. Luckily catching him and preventing further injury, the nurses were able to ease him back into bed safely.
By the following day, the doctors decided that Vernon’s condition was beyond the treatment capacities of Huntsville Memorial. Accordingly, the doctors arranged from him to be transferred to Memorial Hermann Hospital in Houston, where he could receive dialysis treatments, if necessary. An ominous sign, there had been no improvement in Vernon’s urine output, while his BUN and creatinine levels continued to rise—it seemed that dialysis was inevitable.
In hindsight, Vernon realized just how dire his situation was by the time he was transferred to Memorial Hermann. “By the time I got there I was nearly dead,” Vernon recalls. “They saved my life there.” On arrival to the new hospital, Vernon’s condition was said to be “guarded.”
Vernon remained in Memorial Hermann Hospital for nearly two more weeks. During his stay, his weight ballooned from 160 pounds to 188 pounds as a result of water retained due to his progressively deteriorating kidney function. On discharge, his diagnoses included hepatic encephalopathy, cirrhosis of the liver, pleural and pericardial effusion, diarrhea, and C. difficile. Even after leaving the hospital, he continued to receive Flagyl to treat the persistent bacterial infections.
A week after Vernon’s discharge from Memorial Hermann Hospital, he returned to the Huntsville Family Medicine clinic for a follow-up examination. He was still experiencing four or five bouts of diarrhea per day and had almost no appetite. Because of the lack of adequate food intake, his body was wasting away, essentially eating itself from the inside out. Making mobility especially difficult, his legs remained swollen and he continued to suffer from shortness of breath. The doctor’s visit at least yielded one bit of good news: a stool culture test, fortunately, yielded negative results for Salmonella and C. difficile toxins.
Vernon’s good luck did not last. He continued to feel extremely weak and eventually required surgery to treat the recurrent pleural effusion. Subsequent diagnostic tests also revealed that he now has cancer of the throat and neck. To treat his litany of conditions, he has been in and out of the hospital more than six times since October 2008. Today, Vernon says he simply spends his time hoping and praying that treatments, including chemotherapy, will rid him of his continuing illness. “Right now,” he states, “I am too weak to fight it.”