At 6:41 AM, on January 20, 2009, Minnie Borden was pronounced dead.  It was a stunning end to an illness that came about all because of an invisible collection of bacteria contained in a package of peanut butter crackers.

Minnie Borden was born in 1926, in the town of Lanett, Alabama.  Although she stopped attending school after the fifth grade, her education certainly did not cease to carry on.  In the words of her only daughter, Earlene Carter, “She was educated through her life experiences.”

Starting around age 16, she began perfecting her notorious work ethic, one that carried her through life until her retirement at the age of 70.  For many of those years she worked tirelessly as a housekeeper for local families, eventually segueing into the food service industry.  She continued in this field, ultimately working at the Sinclair Community College as a cook until she decided the time had arrived to retire.  The year was 1996.

Refuting the notion that retirees ease into an idle existence, Minnie continued to be a spitfire of independence.  She suffered from rheumatoid arthritis, a condition she was diagnosed with in the 1960s.  But despite the sometimes debilitating pain pulsating in her fingers, knees, and hips, she continued to be mobile, doing her own shopping and upkeep around the house without assistance.  By 2002, she was still as active as ever, but with a trusty cane planted firmly at her side.  Living by herself in Dayton, Ohio, Minnie stuck faithfully to her daily morning routine, rising from her bed, then making her way to the bathroom to clean up before heading to the kitchen for some breakfast.  Her days were peppered with a few favorite TV shows, some light chores, and chats with family and neighbors.

In late 2007, Earlene noticed that her mom’s joint pain had became very severe, making it more difficult for her to remain mobile.  Earlene purchased a wheelchair for her to use in the house.  She took to her new wheeled companion well, and continued living independently and generally caring for herself along with some assistance from Earlene, who lived a quick five miles down the road.

By fall of 2008, other than arthritis and poor hearing, her health was excellent.  It was quite unusual then, when in November, Minnie mentioned to Earlene that her appetite was lacking and her stomach hurt.  There was nothing unusual about her diet at that time.  In fact, she continued to enjoy one of her favorite snacks on a regular basis, Little Debbie’s Peanut Butter Cheese sandwich crackers.  Speaking daily and seeing each other nearly as often, Earlene took note of her mother’s new discomfort, but other than mentioning the abdominal pains, Minnie did her best to keep the escalating situation to herself.

On November 24, Earlene picked up Minnie for an appointment with an arthritis specialist, Dr. Mujeeb A. Ranginwala.  Again, she mentioned the stomach pain, but was not overly vocal about her discomfort.  He had a blood sample collected and sent to the lab for testing, but nothing unusual was uncovered.  They left the appointment and Earlene took Minnie back to the comfort of her home.

As the days continued, and November turned into December, Minnie’s gastrointestinal issues worsened and she became undeniably weaker.  Earlene started going over to her mother’s house early each morning, motivating her out of bed and providing some assistance for her to make it to the bathroom.  Earlene washed her up and even helped her dress, though Minnie increasingly stated that she would rather remain in her robe.

By December 10, Minnie was no longer able to keep quiet about her intensifying stomach cramps and distress.  That morning started off typical—Earlene came over and helped Minnie up, then took care of some cleaning chores around the house.  After she was done, Earlene returned home.  About an hour after she arrived home, the phone rang.  It was Minnie, with notable distress in her voice, stating that the stomach pain was worsening and was now in her chest too—she needed to go to the hospital.

Earlene hustled over to Minnie’s house, helped her to the car using the wheelchair, and together they headed off to the Miami Valley Hospital Emergency Room (ER).  As soon as the nurses and doctors were told that Minnie was having pain in her chest, their immediate concern was a potential heart attack.  An EKG machine was connected to Minnie’s frail body to monitor her heart functions, and a blood sample was obtained and sent to the lab for testing.  After preliminary results indicated she was not suffering from a heart attack, the treating physicians decided it was prudent to admit her for further observation and testing.  It took a number of hours before a room was ready and she was transferred from the ER.  Over the next two days, she was carefully observed and her blood test results were monitored.  A heart attack was ultimately ruled out and the causes of her abdominal and chest pains were left unanswered.

Earlene was at the hospital with her mother at the time of discharge.  The treating physician discussed the recommendations for physical/occupational therapy—preferably in a skilled nursing facility—to help with Minnie’s weakened state.  Moving Minnie to a nursing home was out of the question for Earlene.  The strengthening therapy she needed could be provided with in-home treatment visits, and if needed, Earlene agreed to have Minnie move in with her.  “I have been by her side and she has been by mine.  We walked that walk together for many years.  Whatever she needed, I could do and did, and whatever I needed that she could do, she did.  We cared for each other deeply.”

After being discharged, Minnie was driven home.  Earlene again used the wheelchair to move her from the car to the house, making it to the bedroom where she could rest.  Once home, however, Minnie’s gastrointestinal complaints only worsened.  By now, Minnie’s failing strength made it necessary for Earlene to help her mother out of bed to use the bedside toilet during the night, several times a night.  Earlene also had to help Minnie dress and groom herself every day, something she had not previously had to do.

Earlene also noticed that Minnie’s stools had turned loose and black.  When pressed, Minnie stated that she passed similar black stools recently.  Earlene continued to provide her with as much water as she could consume, aware of the importance of staying hydrated.  The downhill decline only continued.  As Earlene recalls, “I treated her like she was a little baby that I took care of, cleaning her up, powdering her down, and sanitizing her bottom.”

When her black, loose stools failed to resolve, Earlene became worried and decided a visit to the doctor was necessary—an appointment was set for December 18.  Earlene drove Minnie to the appointment and went into the examination room with her, bringing a sample of the stool along in an adult diaper that she had begun putting on Minnie.  Dr. Chitanya Kadakia, her primary care physician, took one look at the sample and said “there’s blood in that stool.”  The tone and words of Dr. Kadakia sent chills up Earlene’s spine as he explained that she must go immediately to the ER.  He agreed to call the hospital in advance to notify them that Minnie was on her way.  A short time later, they arrived at the Good Samaritan Hospital ER.

She was examined and noted to be very weak and pale, with bright red blood discharging from her rectum and black tarry stools.  Her abdomen was tender to the touch, with pain described as achy.

Minnie’s stay at Good Samaritan Hospital lasted from December 18 until her discharge on December 29.  While in the hospital, Minnie endured repeated procedures while the doctors attempted to diagnose her illness.

On Friday, December 19, Minnie was given a transfusion with packed red blood cells (PRBCs).  She continued to have frequent watery diarrhea and was in constant pain.  The next day, an esophagogastroduodenoscopy was performed, which revealed a benign gastric ulcer without any active bleeding.  The doctors remained stumped.

By Monday, December 22, her stools were described alternately as “greenish liquid” and “reddish brown,” indicating continued infection and bleeding.  A peripherally inserted central catheter (PICC) line was placed in her right arm, with Minnie wincing and struggling to maintain her composure throughout the procedure.  Later that evening, she passed another large green liquid stool.

Finally, on Wednesday, December 24, Christmas Eve, a sample of Minnie’s bloody liquid stool was obtained and sent to the lab to be cultured for pathogens.  Why this was not done sooner remains a mystery.  The results were alarming, and provided an explanation for her continued suffering—she was infected with Salmonella Group B.  The Ohio Department of Health was notified, and conducted further testing on the sample, revealing that she was infected with Salmonella Typhimurium, the same strain later identified as part of the nationwide PCA Salmonella outbreak.

Throughout her stay, Minnie also suffered from light-headedness and chest pressure.  Indeed, tests demonstrated that her bleeding had resulted in low hemoglobin levels and that she had suffered a heart attack.  Testing of her heart showed that the left ventricle was weakened, reducing its output and leaving Minnie with developing congestive heart failure.

She was treated with antibiotic therapy and provided numerous additional PRBC transfusions to combat her low red blood cell levels.  The diarrhea began to subside, as did the rectal bleeding.  Although her appetite was still weak, Minnie could tolerate a regular diet by the time of her discharge on December 29.  Once again the recommendation for a skilled nursing facility was mentioned to Earlene, and once again her deep love and desire to provide for her mother prevailed.  She would do whatever it took to care for Minnie, whether in her mother’s home or in her own.

Earlene, a nurse, and a nurse’s aide, walked with Minnie as she was wheeled down to Earlene’s car.  The kind women smiled and wished Minnie well, waiving as she headed back to the comforts of her own home.  At that time, none of them knew she would be returning to the hospital in only a few short weeks, never to return home again.

It was evident that Minnie could not be alone for the foreseeable future, and thus Earlene moved into Minnie’s house.  Over the next two weeks, she practically lived by her mother’s side 24/7.  Minnie had not recovered any semblance of her normal bowel habits after being infected with Salmonella, and needed constant supervision.  Earlene ran trips to the store for food and prescription refills, but did so quickly for fear of leaving Minnie alone for too long.  “I was never gone from the home more than an hour, because I was her only caregiver.  It was just she and I, and I am an only child.”  In between caring for Minnie, Earlene did her best to care for herself.  She would run home daily to get her mail and make sure everything was alright at her own home, then rush back to be by Minnie’s side.

Finding foods that Minnie would eat became difficult.  She would drink Ensure, enjoying the strawberry, vanilla, and chocolate flavors.  Earlene also fixed oatmeal, cream of wheat, and applesauce.  Although she could only eat very small amounts, the fact that she would eat provided hope.

But the situation took a sharp turn for the worse on January 15, 2009.  Minnie’s nurse was scheduled to come by the house and check up on her status that day around noon.  The morning started off difficult, with Minnie protesting getting out of bed and Earlene struggling to motivate her.  She also continued to have loose stools.  When the nurse arrived, she examined Minnie and noticed that her nails were turning blue, indicating a decrease in her blood oxygen levels.  Earlene promptly called an ambulance.

The first emergency vehicle to arrive was a fire truck.  Three firemen made their way into the house and began tending to Minnie.  Earlene explained that her mother had been in the hospital recently and was still weak following her discharge.  The ambulance arrived a short time later.  Minnie was placed on a cot, moved to the ambulance, and transported back to Good Samaritan Hospital.

A long-time neighbor of Minnie’s, Shante, came over to Earlene, asking about the situation and whether she could help.  Shante’s presence and support was exactly what Earlene needed at that time, so when she offered to accompany her to the hospital, she quickly accepted.  After closing up the house and turning off the lights, they hopped in the car and headed to the hospital.

When Minnie arrived at the hospital, she was quickly moved into the emergency department.  Because of her extremely debilitated state, it was decided that a PICC line for nutritional support was needed, along with IV fluids.  Earlene arrived a short time later.  The nurses placed a bladder catheter and collected blood samples for testing.  All the while, Earlene tried to keep Minnie calm by chatting with her, combing her hair, and giving her sips of water.  Later that night, after the decision to admit her was made, Earlene—exhausted and barely able to keep eyes open—kissed her mom and told her that she would be back first thing in the morning.  She drove Shante back home, thanking her for the comforting companionship, and went home.

She called her son, Ernest (or Mack to his family and friends), explaining the details of the day culminating in Minnie’s admittance to Good Samaritan.  She could tell Mack was upset, but she had no idea just how truly worried he was.  They said “good night” and hung up the phone.

After being away from the house for most of the day, the freezing cold December air had frozen the water pipes.  Exhausted, but fearful of a broken pipe, Earlene began working to thaw them out and get a flow of water going.  A short while later, as she continued working on the pipes, the doorbell rang.  Earlene had heard a truck outside, but did not recognize the sound of the engine, so she apprehensively approached the door.  “Who is it?” she called, and from the other side heard Mack’s familiar voice, “It’s your son!”

That night they chatted about Minnie and their hope for a quick recovery while they worked on the frozen pipes.  Eventually the pipes thawed enough to produce a small flow of water out of the faucet, and Earlene and Mack rested until morning.

First thing on January 16, Earlene and Mack were at the hospital to check on Minnie.  Her smile, a mile wide, let everyone know how happy she was to see her grandson.  That day Mack managed to get Minnie to drink a full cup of broth, giving them both hope that a turn-around was imminent.  Mack spent the day at Minnie’s side, and she seemed to be feeling stronger.  That night they said their goodbyes, and he headed back down to his home in Chicago.  It was to be the last time he would ever see his grandmother alive again.

By the next day, Minnie was eating poorly and the decision to insert a feeding tube was made.  Staff arrived to move her to the operating room to perform the procedure, and Earlene made her way to the waiting room to sit and pray for her mother’s recovery.  Earlene vividly recalls a moment after the procedure was complete and the tube was connected for the first time: “When I got back to the room the nurse was giving her food and medication through the tube and she was moaning and crying ‘Oh lord Jesus have mercy that hurts that hurts, oh lord Jesus have mercy that hurts that hurts.’”  Those words echoed through Earlene’s head, and she fought back the tears.

The doctors continued to treat Minnie’s profound metabolic disturbances.  Blood and urine tests indicated she now had acute pancreatitis thought to be related to gallstones.  Minnie’s downward spiral continued.  Earlene kept vigil at the hospital convinced that her tough as nails mother would rally.

On the evening of Monday, January 19, Earlene was sitting with her mother, trying to keep her eyes open and failing.  She looked at the clock and noted it was 6:40 PM, only a short time until Wheel of Fortune and Jeopardy came on, two of Minnie’s favorites.  “I told her I was going to go home and get some rest, and I would see her in the morning.  She shook her head so I kissed her on the forehead.”

As she drove home, she “prayed for [her] mother to be okay.”  She changed into her night clothes and climbed into bed, only to be interrupted a short time later with a phone call.  It was a girlfriend from California, calling to check in.  Over the hour and a half conversation, Earlene told her all about Minnie’s rapid downturn and the hospitalizations.  Eventually their conversation came to an end, and they said good night.  Once again Earlene settled into her bed to rest.  As her muscles relaxed and she eased into the sheets, the phone rang again.  Earlene grabbed the receiver and listened intently as the voice on the other end explained that it was Good Samaritan Hospital, and that Minnie had taken a turn for the worse.

I got real nervous, got up and I couldn’t even find socks to put on.  I finally got myself together and put a hat over my head, got my coat, went to the car and took off.  I didn’t call anybody.  I was just scared about my mother.  So I drove on, trying to stay strong and praying all the way.

Earlene rushed to the floor where Minnie’s room was located.  She found the treating physician who explained that Minnie’s heart had stopped, but that she was revived and was stabilized for the time being.  She was still being tended to, so Earlene paced patiently until she was told it was okay to enter the room.  Minnie did not move, and her eyes remained closed.

[The doctor] said I could go in and talk to my mother, but she was not even conscious.  So I stood there and I looked at her, and I touched her.  I kissed her on the forehead and said ‘mom, I love you.’  My momma didn’t even know I was there, she didn’t even know that I said I loved her.  All she knew is the last time I pointed to the clock and told her it’s 6:40 and she can watch her programs at 7.

A hospital clergy arrived and found Earlene sitting in a chair looking overwhelmed with despair.  Together they chatted and prayed until the nurse said Minnie was being moved to Intensive Care Unit (ICU.)  Earlene stayed behind for a few minutes to gather her mother’s belongings before being escorted to the ICU.  She sat in the lounge and waited as Minnie was set up in the ICU room.  Eventually she needed to use the restroom.  On her way back to the waiting room, a doctor stopped her and explained that Minnie’s heart again stopped beating, but that doctors were working on stabilizing her.  A fighter to the very end, her heart began to beat once more, but Earlene was mentally weary.  She was asked about placing Do Not Resuscitate orders in the likely event Minnie’s heart failed once more.

Earlene called Mack in Chicago, and Minnie’s sister in Georgia, explaining the situation.  Finally the decision was made to let her go peacefully.  Earlene sat by Minnie’s side for the last time, touching her forehead, her arms and legs, noting the warm and cool spots on her skin.  Nurses and doctors continued to stop by and check on Minnie’s vitals.  Her pulse was very weak and only getting slower.

The moment she had dreaded for so long finally came.  Earlene said a final prayer, kissed Minnie’s forehead for the last time, and told her that she loved her.

At 6:41 AM, on January 20, 2009, Minnie Borden was pronounced dead.  It was a stunning end to an illness that came about all because of an invisible collection of bacteria contained in a package of peanut butter crackers.

For Earlene, her mother’s death is still hard to grasp:

This was a very heartbreaking, troubling experience, not understanding really what happened, how did it happen so fast, what caused it to happen and still really don’t understand what happened.  It has been very hard for me, it continues to be very hard for me because it seems so unreal that she was so vibrant and strong until November and something made her weak and took her before her time.  I often tell my son that his grandmother was the rock and glue that held our family together.