Mrs. Juanita Orozco Gomez is 66 years-old, and lives with her husband, Cesar, and grandson, Jesse, in Angleton, Texas. Juanita and Cesar have raised a tight-knit family of nine children, and 31 grandchildren.
In August 2011 Juanita Gomez consumed Jensen Farms/Frontera cantaloupe purchased at the Kroger grocery store located at 1804 N. Velasco Street in Angleton, Texas. The blood specimen collected from Juanita Gomez in August 2011 cultured positive for Listeria Monocytogenes. Test results were confirmed by Laboratory Services at the Texas Department of State Health Services, which also conducted Pulsed Field Gel Electrophoresis (PFGE) on Mrs. Gomez’ isolate. Results of genetic testing showed that Juanita was infected by strain GX6A16.0029/GX6A12.0069, one of the strains associated with contaminated cantaloupe.
During the summer of 2011, Juanita (or as her husband Cesar like to call her, Juany) was eagerly anticipating the end of August. Juanita and Cesar’s 50th wedding anniversary was August 27, Juanita’s 66th birthday on August 25th and exactly two weeks later on September 8, Cesar would be celebrating his 71st birthday.
The summer of 2011 was one of the hottest and driest summers that I can recall. Juany and I would sit out in the shade on the front porch every day and weekends were especially important for us to sit outside because our kids and grandchildren would often visit us and we enjoyed seeing their smiling faces as they came up the driveway. On some of these hot summer days we decided to enjoy some cantaloupe while we waited for our family’s arrival. I never imagined that the deliciously sweet cantaloupe would almost send my wife to her deathbed.
On August 19, 2011, Cesar performed his morning ritual by rising around 8 AM and having breakfast ready around 9 AM. Cesar gave Juanita her usual eggs and corn tortillas, but instead of her usual healthy appetite she just picked at the food. A short while later she complained of nausea and lack of appetite. Cesar didn’t worry at the time, thinking she was just tired of his breakfast eggs. Juanita decided to rest a bit more and Cesar left to run an errand at the post office.
When he returned, Juanita was still sleeping so he kept himself busy by gardening in the yard, tidying up the house, and starting the laundry. By noon she was still sleeping, therefore Cesar gently woke her up. She made her way to the living room and watched a little TV while Cesar cooked rice and chicken for lunch. With his encouragement she ate most of her meal, but again complained of nausea afterwards. Cesar made a mental note to bring up the nausea at Juanita’s next check-up at the doctor’s office, thinking her regular medication might need to be adjusted.
After lunch they sat in the living room and watched some TV shows. Juanita got up a few times and headed to the restroom mentioning that she had an upset stomach. Cesar tried to get her to drink some water when she returned but she refused it. At dinnertime Cesar fixed tamales, which Juanita ate, but she again mentioned the nausea. She also mentioned feeling dizzy. Later that evening, as the dizziness worsened, she started having trouble walking. Cesar was now very worried. He helped her to bed around 11 PM. She fell asleep quickly and he read his bible until around midnight.
Sometime during the middle of the night, Cesar became aware of Juanita repeatedly getting up and going into the bathroom. She was suffering from increasingly worsening diarrhea and vomiting.
She was doubling over in pain constantly and I knew at this point Juany was very sick. I felt anxiety and I wanted the clock to hurry up and turn hands so one of our daughters might show up because I was afraid and confused as to what I should do for her. I was too distraught to think clearly.
At around 3 AM neither had slept a wink. Juanita was distraught with tears having soiled and wet her clothes, the bed sheets and having to be carried to sit on the toilet. In a rush Cesar removed all the sheets and piled them in a corner and ran back to the bathroom to help her. Juanita sat using the toilet with her clothes still on, while simultaneously leaning over to vomit in the bathtub. Cesar—himself scared and helpless—could only console her and rub her back. They were both exhausted and she kept collapsing into his arms. Finally he could wait no longer. Around 4 AM he called his daughter, Rosa. As she recalls, “My father sounded very nervous as he told me my mother was really sick and he didn’t know what to do. I asked him what was the matter with her and he said she had been vomiting and had very bad diarrhea and that she was burning up with fever.”
For Cesar, he did his best to keep calm while talking to his daughter:
I tried to hide the crying and fear from my voice when I spoke with my daughter. Rosa said she would be right over and after hanging up I tried to bring Juany some water but she was not drinking. When I tried asking her questions her answers were unrelated to the subject. I got her up onto her feet and held her from under her arms to help her walk but she was shaking too hard as if she were having a seizure.
When Rosa walked in and saw her dad struggling, she hurried to help him drag Juanita, who was completely unresponsive at that point, into the bedroom. “I stopped in front of the restroom in the hallway where I found my father dragging my mother out of the restroom. I immediately grabbed her legs and assisted him in getting her in the bed.” After about a minute of their pleading, she opened her eyes again.
Fear struck me as I took in my mother’s appearance. She was shining with sweat and her skin from head to toe was burning to the touch. Her entire body was violently shaking as if she was either at an advanced stage of Parkinson’s disease or having a seizure. I asked her several questions as I held her face in my hands so she could look at me. Her responses were simply “Uh huhh” to every question and her eyes were glassy. She looked at me as if she was looking through a window. Then she became limp and her eyes closed she was not responding at all for a while. I turned to my dad and yelled at him “We have to get her to a hospital now!”
Once they arrived at Angleton Danbury Medical Center, Cesar and Rosa placed Juanita in the chair and pushed her into the lobby. It was slow going as she shook so much that she slid out of the chair several times. She continued to be ill in the lobby and they waited for what seemed hours until finally a room became available. After what seemed an eternity they called her in and took her temperature, which recorded 105.6 °F.
They provided Juanita’s history to the ER physician, Roger Collins, MD. Her blood pressure was 167/74 and her oxygen saturation was 96%. An IV was started to push fluids (normal saline), and she was given oral Tylenol to bring down her significant fever. Dr. Collins examined her, not finding any obvious acute pathology. She was put on oxygen by nasal cannula, and both urine and blood samples were sent to the lab for culture and blood studies. She had good oxygen saturation and continued to be stable in the ER.
Throughout this ordeal, Rosa calls: “I have never seen my father so afraid in my entire life. The man was on the brink of tears which I know he was fighting because I was there and I was doing the same for him as well.”
By 7:12 AM, her fever had come down to 103.6º F, her oxygen saturations remained in the 90’s, and her vital signs remained stable. An emergency CT scan was done at 7:40 AM, which showed no acute intracranial findings, and a chest x-ray showed no signs of pneumonia or cardiopulmonary disease. An EKG was normal if tachycardic. After another half hour of observation, she was discharged from the hospital at 8:10 AM with a prescription for Zofran to treat her nausea.
On August 21, 2011, the cultured blood sample taken in the ER was showing growth, and a gram stain showed gram positive cocci in the aerobic culture bottle. A lab report indicates the anaerobic culture bottle contained beta hemolytic strep. Given the blood culture results, the hospital attempted to reach Juanita that same day in order to bring her back to the ER. Late in the evening, her daughter returned the hospital’s message and the triage nurse, Patricia Milligan, asked her to bring her mother into the ER. As instructed, Juanita was taken back to the emergency room, arriving just after midnight.
As we entered the emergency department I told them the situation and how I was asked to bring her back. We were asked to wait in the lobby and it took 5 hours for them to call her in. I had been taking her to the restroom every 10 to 20 minutes with my father’s help. I also notified my siblings of the situation at that point.
At this time she was complaining of increasingly painful stomach cramps and severe diarrhea. Her temperature was 100.9º F. She was again started on IV fluids and given Zofran and Demerol by intramuscular injection for nausea and pain. A CT scan was taken of her abdomen and pelvis, which showed diffuse generalized mucosal thickening of the entire colon. The radiologist felt it was likely infectious colitis, but that the possibility of Clostridium difficile colitis should be considered.
Dr. Kalyani Koduri admitted Juanita to the hospital for continued IV hydration and treatment of acute kidney failure. She reported having abdominal cramping and watery diarrhea for three days, with occasional vomiting. The cramping was worse before a bowel movement, and improved somewhat afterward, but the cramping would not go away.
Dr. Koduri ordered Ciprofloxacin and Flagyl, and had stool samples sent to the lab to be cultured and tested. He continued her insulin, but held her oral diabetic medication and anti-hypertensive because of the acute renal failure, which he thought was likely due to dehydration from the diarrhea. He also placed her on Lovenox for DVT prophylaxis. While his wife was being tended to, Cesar could only sit by and pray:
We had nine children and never did we experience such a traumatic event before. The hospital could not, at that point, tell me what was wrong with my wife. Doctors out ruled the stomach virus and I asked constantly what was wrong with her and the only reply was that they were running tests. It was very frustrating not to have an answer.
On the afternoon of August 23, 2011, Dr. Koduri came in to see Juanita. She was still having some abdominal pain and diarrhea, but these were improving. Her fever had stayed down. He continued to diagnose acute colitis, and continued her current regimen of antibiotic therapy.
Dr. Nizar Charafeddine came in to do a gastroenterology consultation in the early afternoon, requested by Dr. Koduri. He reviewed the history of this illness and examined Juanita. He found her abdomen to be soft but mildly distended, and tender in both lower quadrants. The stool samples had come back negative for C. Difficile, and the blood cultures were so far negative. Her white count was 9.9 and her platelets were 261,000.
Dr. Charafeddine concurred with a diagnosis of acute colitis, ongoing for two or three days without any blood, agreeing that it was likely infectious in etiology, despite negative stool cultures so far. He agreed with the plan to give IV fluids, IV antibiotics, and a full liquid diet. He also wanted to do a colonoscopy soon.
Cesar stayed by his wife’s side throughout, only going home when the doctors and hospital staff told him he should go and rest. This only brought him more distress:
Sometimes I would go home because they insisted I go. I felt so much shame and sadness that I didn’t want them to know I was running out of gas in my car and had no money. The little money I had I spent on food and personal hygiene items for Juany. We are not able to put money into savings. We do okay every month but live on a fixed income and this illness not only devastated us physically and emotionally but financially as well.
On the morning of August 24, 2011, the nurse making rounds noted that Juanita was still having loose, green stools. Dr. Koduri came in to see her. He thought she was stable enough to go home, but wanted Dr. Charafeddine’s recommendations first.
Dr. Charafeddine came in to see Ms. Gomez later in the afternoon, and he agreed that she was doing better and was stable enough to go home. Dr. Koduri wrote a discharge summary, and she was discharged home that afternoon around 5:30 PM. She was advised to avoid greasy and spicy food, follow her diabetic diet, and to follow-up at St. Thomas Clinic in one to two weeks.
After her discharge from Angleton Danbury Medical Center, Juanita went home with her family by her side. She was incredibly weak and barely able to care for herself. The planned celebration of their 50th wedding anniversary was effectively ruined, as was Juanita’s own birthday.
When they learned the reason Juanita had become so ill, it was a complete shock. “We were migrant farm workers ourselves for many years and adhered to strict rules of hygiene and never once had we, or any of our nine children, or 30 grandchildren become ill with Listeria. I pray that we never experience this again.”