Before Charles died he wanted to resolve the claim against Frontera, Freshpack, Walmart and Primus.  He wanted to make sure the $250,000 in medical bills were repaid and that Tammie and the boys were fairly cared for.  He never got to see that happen.

We tried in countless meetings (including the last one that ended a few hours ago) to see if the shippers and brokers who procured the Listeria-tainted cantaloupe, the retailer that sold the deadly fruit, and the auditor that gave the grower a glowing food safety audit, would do the right thing before Charles died – they would not.

I promised Charles before he died that I would not let up – I will not.

Charles Palmer was 70 years old at the time that he was infected by Listeria monocytogenes.  He was married to Tammie Palmer, and they lived in Colorado Springs, Colorado.  Charles and Tammie have two children, David (18) and Charlie (20).  Charles was everything to Tammie and their two sons.

Charles was a retired Master Marine Corps Sergeant.  After 22 and ½ years in the Marine Corp, Charles worked as a security guard and maintenance person.   He has lived life cleanly, as one might expect of a man with his military pedigree, and before becoming ill with listeriosis, he had had no major medical problems.  In fact, despite being 70 years old, his medical history over the previous several years was essentially non-existent.

Even before Charles’ Listeriosis illness, the Palmers had busy lives.  Tammie’s brother, who is 56 years old, suffers from multiple sclerosis.  He lives with the Palmers, and Tammie provides regular care and assistance.  Tammie’s mother, who is 76 years old and has her own complex medical history, also lives with the Palmers, and again, Tammie is the primary day-to-day caregiver.  Clearly, the Listeriosis illness that unfolded for Charles at the end of August 2011 could not have come at a worse time for this busy, happy couple.

On August 19, 2011, Tammie and her son, David, and his good friend Cody Gracy, went to Walmart store 1896 in Colorado Springs to pick up a few grocery items.  Actually, Cody needed a little cash, having not been able to get to the bank or an ATM, and indicated that he would use his credit card to purchase the several grocery items in exchange for cash from David or Tammie.  These several items included one cantaloupe manufactured and distributed by Jensen Farms and Frontera.  Afterward, Tammie, David, and Cody went back to the Palmer household, where Charles ate the cantaloupe over the next several days.

The illness that would threaten Charles’ life began with a simple, though severe, headache and stiff neck on August 30.  After eating breakfast that morning, he took the unusual step of taking a short nap, trying to deal with his developing symptoms with Aleve and rest.  The next day, as Tammie recalls, “Chuck was much worse.”

He was really out of it and not responding to me.  He was still in bed from the day before and I sat him up trying to find out exactly what was wrong, his eyes just rolled back in his head.  This scared me half to death, I called 911 next.   I had never seen Chuck in any condition like this.

At 3 PM on September 1, the ambulance rushed Charles to Memorial Health System in Colorado Springs, where he saw William Kimble, MD.  Dr. Kimble took a medical and social history, but at this point, Charles was unable to respond verbally.  He withdrew from noxious stimuli, but otherwise did not respond; therefore Tammie, who had ridden with him in the ambulance, provided all history.

Dr. Kimble’s examination revealed a blood pressure of 181/104 and a low-grade fever.  He noted that Charles’ behavior was similar to someone suffering from receptive aphasia, which is impairment in language ability.  Blood tests were consistent with infection, with an elevated white cell count, and a spinal tap also showed white cells with many polymorphonuclear leucocytes, mononuclear cells, and 200 red cells.  But no organisms were seen.

Given Charles’ history of severe headache with altered mental status, fever, and leukocytosis, Dr. Kimble suspected that he was suffering from meningitis.  Therefore, he initiated a septic workup, which included the lumbar puncture, as well as blood, cerebro spinal fluid, stool, and urine cultures.  Dr. Kimble started Charles on Rocephin, Vancomycin, and ampicillin intravenously, which provided broad-spectrum coverage for the possible causes of his meningitis.  Charles remained hemodynamically stable while in the ER, but his mental status was generally altered and inconsistent.

With a working diagnosis of meningitis, Dr. Kimble consulted with infectious disease.  Together they decided that Charles should be admitted to the hospital for antibiotic treatment.

Charles underwent imaging studies that included a head CT and chest x-ray, which showed no acute intracranial abnormality and ruled out pneumonia as a cause for his acute illness.  To his wife of 31 years, this hospital admission for Charles’ developing illness was, understandably, a traumatic event:

He was admitted and transferred to a private room 7514 where we were told to wear robes and masks because of the type of infection he had.  This is awful and I felt like we were treated like a piece of disease that nobody wanted to be around.   This was probably the most horrific experience of my life.   Chuck was really out of it and did not even know what was going on.  He was the one who was always strong when we had an emergency and then I realized this was all on me in his grave condition.

Tests done on the blood sample that Charles submitted in the ER began to grow gram-positive rods on September 2, prompting another consultation with infectious disease specialist Donald Strandberg, MD.  Tammie, who continued to be the historian given Charles’ mental status, reported that her husband had had some diarrhea for a couple of weeks, but was not aware of any bleeding.  She suspected that Charles may have suffered from irritable bowel syndrome, but indicated that he had never been diagnosed with the condition.  Tammie indicated that it was really only shortly before his emergency trip to the hospital that Charles had become lethargic, confused, and clearly ill.  Dr. Strandberg noted that there had been a recent Listeria outbreak in the community, and given the growth of gram-positive rods in Charles’ blood, that the illness “will no doubt be Listeria.”

As a result, Dr. Strandberg’s diagnosis was presumed Listeria meningitis.  He agreed with the existing antibiotic therapy, and in his differential diagnoses he included an intra-abdominal process, such as diverticulitis or liver abscess, for which a CT scan had been ordered.  He added Zyvox to the antibiotic regimen for better coverage of the infection in Charles’ cerebrospinal fluid, and requested that additional stool studies be done.  Dr. Strandberg’s examination had also noted spider angiomata on Charles’s skin, which caused him to suspect liver involvement, increasing his risk for bacteremic Listeria infection.

A CT of the abdomen and pelvis was done the afternoon of September 2.  Dr. Carlos Cardenas reported that the scan showed a suspicious 2.9 cm left renal cortical mass, raising a suspicion for renal cell carcinoma.  There were also bilateral common iliac artery small aneurysms and an abdominal aortic aneurysm (AAA).  Dr. Cardenas recommended a gastroenterology and renal consultation.

Over the next several days, Charles actually began to feel slightly better, with an improvement in his mental status to the degree that he was beginning to speak again.  He continued to have severe neck stiffness, however, because of the meningitis, and an elevated serum creatinine level meant that he had possibly suffered an acute kidney injury, thought to be related to dehydration from the diarrhea.  By September 4, the local health department had been notified that Charles had tested positive for Listeria, and had instituted their epidemiological protocol by calling Tammie to discuss her husband’s recent food history.

On September 6, Samuel Iwata, MD, a gastroenterologist, consulted with Charles as a result of his abnormal CT scan and repeatedly guaiac positive stools.  Charles was tired during the exam and, though verbal to some extent, was unable to answer questions directly.  His platelets were low as well. Dr. Iwata wanted to do a colonoscopy, but at the time thought it would be too difficult for Charles to tolerate the prep due to his gastrointestinal illness.

Two days later, Charles saw an urologist and vascular surgeon.  The surgeon, Dr. Laura Kissell, discussed the AAA with Charles and Tammie, as well as the risks for rupture, but thought that it would be safe to follow nonoperatively and recommended a formal CTA in another three months.  For the moment, she ordered a carotid duplex to evaluate for carotid stenosis and a lower extremity arterial duplex to evaluate for popliteal aneurysm, since patients with infrarenal aortic aneurysms are at higher risk for popliteal aneurysm.

Infectious disease kept Charles on the ampicillin drip for treatment of his Listeria infection.  His mental status continued to improve, but he also continued to have diarrhea and abdominal pain, as well as continued guaiac positive stools.  His medical team decided to establish a peripherally inserted central catheter (PICC line) to accommodate the continuous antibiotic therapy that he would need.

On September 10, Charles was finally stable enough to be transferred to the Physical Medicine and Rehab part of the hospital, Marc Kelly, MD, would assume primary care.  At his admission exam, Charles needed assistance to stand from a sitting position, and to walk about 30 feet.  He also remained quite confused, and so goals were set to get him back to a modified independent or supervised level, based on cognition, so that he could be discharged home.

Cognitively, Charles had never been like this before.  It was frightening to Tammie, who helplessly watched as her husband did strange things like try to use a cell phone as a remote control for the television in his room.

I was excited thinking I have my husband back and there is some hope he will recover.  But watching his actions was scaring me again.  When I questioned the doctor about this, all he could say was it will take time and we don’t know how much brain damage has been done.

Physically, he was still at great risk for falling because he had lost so much weight and was so weak.  Somebody had to be with him in order for him to get out of bed.  It was a big chore for him to just get up and sit in a chair for 20 minutes; it just wore him out completely.

The admitting nurse at the rehab unit echoed some of Tammie’s concerns.  She noted that Charles was alert and oriented, for the most part, except to the time of day.  But she acknowledged that he remained confused at times and was not totally compliant with orders to remain in bed.  Fortunately, Tammie remained with Charles just about all the time, which was a significant measure of safety, because she was the only person whose word was law with this elderly Marine Top Sargent.

By September 14, Charles’ medical team thought that he was well enough to be able to tolerate the preparation for a colonoscopy, and so the procedure occurred that day.  Richard Folan, MD, found and removed three pedunculated polyps in the sigmoid colon, in the descending colon, and in the transverse colon.  He also located a partially obstructing mass in the recto-sigmoid colon, which he sampled for biopsy.  After consulting with Tiffany Willard, MD, Dr. Folan recommended surgical removal of the mass.

And so Charles was again transferred back to the regular hospital on September 14.  He was taken to the operating room, where his preoperative presumptive diagnosis was rectal cancer.  Dr. Willard performed an “ultra-low anterior resection with an end colostomy,” indicating that she had performed the “end colostomy” in order to protect him from potential anastomosis breakdown.  Dr. Willard noted no intraoperative complications, and Charles was stable after surgery when he was taken to recovery.  The biopsies taken during the surgery ultimately confirmed the diagnosis of rectal cancer with 11/14 lymph node involvements, but the surgical margins were fortunately negative.

Two days after the surgery, on September 16, Charles’ urinary output diminished, his serum creatinine increased, and he began to report a significant increase in pain.  He remained confused and had to be reoriented to time and place.  A retroperitoneal ultrasound was done due to his renal failure, and a small amount of complex fluid was seen over the liver.

Over the next two weeks, Charles was treated for ongoing kidney injury, shortness of breath due to atelectasis or pneumonia, and for problems with the ostomy that Dr. Willard had performed on September 14, including exploratory laparotomy for intra-abdominal hemorrhage, and revision of the colostomy.  With regard to the cancer diagnosis, Dax Kurbegov, MD, an oncologist, thought that Charles would be a good candidate, post-discharge, for adjuvant chemotherapy and possibly, chemo-radiation therapy.

Toward the end of September, Charles was beginning to feel somewhat better.  Though he remained very weak, he could get out of bed and walk short distances.  On September 29, Tammie was able to take him outside in a wheelchair for much needed fresh air.  He was also tolerating physical therapy relatively well.

On October 3, Dr. Willard evaluated Charles for discharge.  She found him to be in decent condition given all that he had been through.  His discharge diagnoses were Listeria monocytogenes infection, rectosigmoid mass with resection ileostomy, renal mass, and atherosclerotic cardiovascular disease with infrarenal aortic aneurysm.  He was discharged from the hospital that day.

The days and weeks that followed were trying for both Charles and Tammie, who continued to be his primary caregiver, in addition to the same role that Tammie filled for her brother and mother.  She states:

After 35 days Chuck was finally released from the hospital, with Home Health Care having to be in place before he could leave.   It was suggested that Chuck go to a nursing home until he was stronger rather than coming home. Oxygen was delivered and we started our new journey as a family.  It felt like we were starting out a new life with Chuck.  He was so weak and I did not feel real comfortable bringing him home in this condition, but he begged me to just come home so he could sleep in his own bed.   He lost 45 lbs while in the hospital and could barely walk. We had a RN, CNA, Physical and Occupational Therapist here to help me with him for the first month.  This was the most stressful time as we live in a tri-level place and I had to constantly be going up and down the stairs to check on him.  I worried especially at night because he looked so pale and was constantly checking to make sure he was still breathing.  This was terrible to have to worry and not be able to sleep for hours.

For his own part, Charles has had more than a little difficulty coming to terms with the fact that his own medical condition has increased substantially the demands on his wife.  He states:

When I was released from the hospital I weighed about 100 lbs.  My normal weight is 140-145 lbs.  When I looked in the mirror after taking a bath, which is another ordeal in itself, I was scared because the vision I saw looked like a P.O.W. in Hanoi, nothing but bones with my skin sagging.  I bought some small weights and try to work out everyday for 30-45 minutes to try and put some kind of muscle on my body.  I also wear ankle weights for a while everyday to try and strengthen my legs.

I worry everyday that my physical and mental life will also be a burden on my wife and family trying to take care of me.  If I could get back just half the strength I used to be I would probably be a lot less stressed.  This always trying to take care of me is not something I want or the pressure put on my family to wait after me.

Charles was seen for post-hospitalization follow-up, and for treatment of his rectal cancer, on several occasions in October.  He has since remained under the care of oncologist Dr. Kurbegov.  Though he remained weak, frail, and undernourished for months, he has developed better cognition and awareness, and has simply enjoyed being finally out of the hospital.  He has continued to participate in physical and occupational therapy.

Charles continued follow-up at the Rocky Mountain Cancer Centers over the last years as he also struggled with his recovery from the Listeria infection.  Eventually, the cancer was too much.  He died with dignity surrounded by the people – his family and friends – who loved him.