Robert Moss was a true representative of The Greatest Generation. A child of modest means, Robert gave up a college scholarship to fight in the Navy in World War II, where he suffered a severe gunshot wound in combat. After the war, Robert returned to Louisiana, where he married a woman named Mary Jane, produced two children (Rebecca and Robert), and began a business called Moss Carpet and Flooring that still exists today.
Robert was eighty-three years old at the time of his death. He had developed certain chronic medical conditions over the years, but he was strong and capable up until October 2009. In fact, his daughter frequently called on her 82-year-old father for help with virtually any task that required a materialman’s physical skill or knowledge. Robert knew almost everything, in the humble opinion of his daughter, and he ably lent his assistance to any task that needed doing up until his illness in October 2008.
Robert was married to Mary Jane for many years, and the couple lived in West Monroe, Louisiana. Robert regularly ate Austin-brand peanut butter crackers, which he purchased often at the Sam’s Club located on Frontage Road in Monroe. He had eaten the crackers daily as a snack for about two years prior to his illness.
Robert’s symptoms related to the Salmonella infection that he contracted from the Austin-brand peanut butter crackers began about the second week of October 2008. Robert, who has suffered from problems with constipation for most of his adult life, began to suffer from loose stools that soon turned to frequent bouts of outright diarrhea. Other symptoms included a fever, muscle aches, fatigue, headaches, and abdominal cramps.
Symptoms worsened dramatically around Tuesday, October 14. The diarrhea was occurring with painful regularity, and was frequently preceded by a round of abdominal cramps as painful as anything that this hardened World War II veteran had ever experienced. Robert began to look as ill as he felt, and ultimately lost an estimated 10 pounds before receiving any medical treatment for his illness.
Instead of visiting doctors, Robert treated himself as best he could with home remedies and over-the-counter medications, but nothing really helped. The diarrhea would not slow; the cramps would not relent; and Robert continued to lose weight.
By mid-October, however, the illness that Robert had until now passed off as just a stomach virus became too much to bear. He finally sought medical help on Thursday, October 16, at Glenwood Regional Medical Center in West Monroe. He was admitted to the emergency department with nausea, vomiting, diarrhea, and significant fatigue. His white blood cell count was elevated, and blood tests showed that his kidneys were not clearing wastes from his bloodstream. In fact, Robert was in acute renal failure (ARF). After giving blood and stool samples for testing, Robert was admitted to the regular hospital for treatment of his gastrointestinal symptoms, severe volume depletion, leukocytosis, and kidney failure. He was immediately started on the antibiotics Vancomycin and Zosyn.
Robert continued to suffer from severe gastrointestinal symptoms over the course of the next several days, causing persistent, severe volume depletion. Blood and urine tests continued to show that Robert was in acute renal failure as well, and that his kidneys were, as a result, unable to produce the urine that cleansed his body of dangerous toxins. A nephrology consult on October 17 advised that Robert’s treatment plan should include the avoidance of any drugs that had a potentially nephrotoxic effect.
The stool sample that Robert submitted in the emergency department on October 16 tested positive for Salmonella bacteria on October 18. This certainly shed some light on the cause of his violent symptoms and profound decline, but his family was left wondering where he could possibly have become infected by such a notoriously dangerous little bug?
On October 19, Robert continued to be desperately ill. In fact, the consulting nephrologist noted that the renal failure continued to worsen, and that the diarrhea that was the source of Robert’s volume depletion continued as well. And to further complicate Robert’s already complex medical picture, blood tests showed that the Salmonella bacteria had escaped his gastrointestinal tract and entered his bloodstream.
Robert would remain hospitalized at Glenwood Regional Medical Center through Thursday, October 23. Antibiotic therapy ran almost constantly while he was hospitalized, with the regular administration of Zosyn, Vancomycin, and Ciprofloxacin by central line. Ultimately, Robert began to produce more significant amounts of urine in the days prior to discharge, and experienced a gradual resolution of his acute renal failure back to his baseline. His discharge diagnoses included gastroenteritis, bacteremia, and acute renal failure.
But the Salmonella bacteria that had so thoroughly permeated Robert’s natural defenses were not done wreaking havoc—not by a long shot. At discharge, he continued to suffer from regular bouts of diarrhea, which had never been a problem before. In fact, Robert would continue to suffer from regular bouts of severe diarrhea for most of the rest of his life, ultimately resulting in dramatic and heart-rending weight loss, further breakdown of his body’s natural defenses, and severe de-conditioning.
Robert’s persistent diarrhea was a primary cause of his initial admission to Cornerstone Hospital on February 24, 2009. It was postulated that the Salmonella infection in his gastrointestinal tract was still active (as it had been as recently as December 23, 2008). Stool tests, however, were negative for Salmonella; but they did ultimately show a positive result for Clostridium difficile, which is commonly associated with the administration of exactly the antibiotics that Robert had received while hospitalized in October 2008.
Ultimately, Robert was discharged and transferred to rehabilitation on March 23, 2009, only to be re-admitted at Glenwood Regional Medical Center on April 6. Robert reported to the attending physician that, ever since he had become infected by Salmonella, he had suffered from fairly regular diarrhea, sometimes producing four watery stools per day, frequently causing bowel incontinence, and sometimes associated with abdominal cramps. The physician’s impression was recurring diarrhea, dehydration and associated anorexia. Robert continued to be positive for Clostridium difficile.
Robert was ultimately discharged from Glenwood Regional Medical Center to a skilled nursing facility on April 13, 2009. For the next several months, he remained under constant medical supervision (at Glenwood Regional Medical Center or with Agape Hospice Group), for a variety of medical problems, not least of which was the chronic diarrhea and related weakness, fever, and general de-conditioning.
Thereafter, and throughout the rest of the year until his death, Robert was almost always ill and in a medical facility. He suffered from a variety of medical problems, including kidney and heart disease; but more significant to his ultimate demise, Robert continued to suffer from Clostridium difficile-associated diarrhea. The persistent diarrhea continued to cause its gradual breakdown of Robert’s body.
Robert’s medical records over the course of his last months of life are littered with reference to his severe diarrhea. On June 1, he was again admitted to Glenwood Regional Medical Center, with a chief complaint of fever and persistent diarrhea. He was discharged to Glenwood’s skilled nursing center on June 8, and the discharging doctor, Donald Hammet, MD, listed fever, diarrhea, and history of C. difficile colitis as the top three discharge diagnoses. Robert remained in the skilled nursing center through June 14, on which date he was discharged with the primary diagnosis “Clostridium difficile colitis.”
Robert was again hospitalized at Glenwood Regional in July 2009. His chief complaint was bloody diarrhea. C. Collins Coon, MD, Robert’s treating gastroenterologist pre-dating even his Salmonella infection, consulted on the day of Robert’s admission. He noted, “[R]obert was hospitalized last month. He had a hospitalization back in 10/2008 for Salmonella bacteremia. He has been in and out of the hospital with diarrhea and recurrent Clostridium difficile.”
Unfortunately, though he survived his July hospitalization, Robert continued to decline over the next several months, gradually becoming weaker, frailer, and generally more broken. He passed away in 2009, having endured, ever since his Salmonella infection in October 2008, a chronic state of illness caused significantly by his persistent diarrhea.