Wife, officials seek answers to source of infection
By Sherry Jacobson
The Dallas Morning News
Copyright 2007 The Dallas Morning News
DALLAS — It started with a nagging pain in Mike Chandler’s lower back.
After 10 days of doctor visits and a fistful of prescriptions for painkillers, the 33-year-old Garland firefighter was rushed to Medical Center of McKinney, unable to breathe and showing signs of kidney failure.
It took two more days for a test to confirm that he was fighting a severe infection.
By then, Mr. Chandler was dead.
His death certificate stated simply that he died of multiple organ failure, pneumonia and sepsis, which is the body’s response to an overwhelming infection. But the underlying cause of death was what his loved ones could not believe.
An antibiotic-resistant staph infection — methicillin-resistant Staphylococcus aureus, or MRSA — killed a strong, healthy firefighter in less than two weeks.
MRSA – often pronounced MER-sa – strikes adults and children, and it sometimes returns after treatment to cause havoc in a carrier’s life. But its ability to kill quickly, even before it’s diagnosed, is the most frightening part.
Mr. Chandler’s survivors knew little or nothing about MRSA, beyond the sudden realization that Americans, who take such pride in their health care system, can be stricken and killed by an infection when they are otherwise healthy.
“He’s a guy who climbed a hundred flights of stairs with an 80-pound weight on his back just to keep in shape,” said his wife, Karen Chandler. “He was giving his life to help people, to help society.”
Major health problem
When Mr. Chandler died so unexpectedly six months ago, MRSA had not yet reached the public spotlight, beyond the occasional death report.
It wasn’t until last month that the Centers for Disease Control and Prevention surprised the nation by announcing that 19,000 Americans were dying from MRSA infections every year, about 2,000 more than die of AIDS.
“Invasive MRSA disease is a major public health problem,” concluded a government study in the Oct. 17 Journal of the American Medical Association, which estimated there were 95,000 severe MRSA infections in 2005.
Since May, Mrs. Chandler has channeled her grief into trying to understand how a simple infection could kill someone as strong as her husband, and, more importantly, why the doctors who treated him failed to diagnose it.
“When I was getting his medical records together, I decided that I needed to figure out what happened and why it was missed,” Mrs. Chandler said.
“I knew nothing about staph or MRSA,” said the 36-year-old sales representative, who switched to selling real estate to be closer to home after her husband died. The couple has a 6-year-old daughter, Faith.
Her mission to understand what killed her husband plunged her into a world of medical Web sites and scientific journals. She learned that MRSA bacteria live harmlessly in the nasal passages of roughly 30 percent of the U.S. population and that the bacteria can also infect the skin, causing a pimple or boil that clears up with or without treatment.
Severe MRSA cases were first detected among hospital patients in the 1960s and, two decades later, began spreading among drug abusers. Four children died of MRSA infection in Minnesota and North Dakota in 1997, signaling the growing threat posed by community-acquired strains.
Most people think they have a spider bite when the infection first appears. If the infection becomes invasive, it would be more difficult to stop because mainline antibiotics cannot kill MRSA.
Race with time
A timely test can determine the effectiveness of the other antibiotics, among them a powerful intravenous treatment for the most serious infections. But if the infection is spreading, it can become a race with time.
Mrs. Chandler spent the summer absorbing as much as she could about MRSA, sometimes asking a friend with a scientific background to interpret medical jargon.
The journey was heartbreaking at times.
“I really feel bad for any wife who has to sit on the phone and go through her husband’s autopsy report line by line with the coroner to find out what it says,” she said.
Mrs. Chandler has puzzled over how her husband might have become infected. The answer is uncertain, although his job put him at greater risk of contact with such infections.
They usually spread through contact with other people or with contaminated surfaces. The best way to prevent infection is regular hand-washing and disinfecting surfaces touched by peoples’ hands and bare feet.
MRSA infections have tended to spread within hospitals and other health care settings, which Mr. Chandler visited as part of his job.
Mrs. Chandler was told that her husband and other firefighters transported several nursing home residents to local hospitals in the weeks before he got sick. It was Mr. Chandler’s job to take their vital signs.
Chad Purcell, president of the Garland Firefighters Association, said the Fire Department followed standard disease-prevention practices, including using latex gloves, masks and protective clothing when necessary.
“But sometimes, patients have to be picked up and put on a cot, and they’re touching you on the face, neck or arm,” said Mr. Purcell, who drives a fire truck. “You would have to wash your uniform, take a shower and clean all the equipment to make it safe after every transport. It’s impossible.”
MRSA infections also are spreading in high school athletic departments, child care facilities, dormitories, gyms and spas, according to a warning issued by Texas health officials last month.
Precautions taken?
Mrs. Chandler turned her attention to the confines of her husband’s fire station. Were enough precautions taken, she wondered, to stop bacteria from growing and spreading during the five months he was in the Garland department?
“People who live in close quarters can spread it easily,” she said, repeating facts she’d absorbed during her educational efforts.
Mr. Purcell said the showers and bathrooms in Garland’s firehouses were disinfected regularly, although not daily. And a few firefighters developed skin infections recently.
“Three or four guys possibly had a simple staph infection this year,” he said. “They went to the city clinic and got antibiotics, but they were never tested for MRSA. We have nothing confirmed.”
Mrs. Chandler’s efforts to collect death benefits through the state’s workers’ compensation system were denied by Garland’s insurance carrier on the grounds that her husband’s work-related back injury did not cause his death.
“His death was due to an ordinary disease of life [to] which the general public is exposed,” stated the decision by Texas Political Subdivisions, the insurance carrier. Mrs. Chandler said she is fighting the decision.
Garland officials declined to comment.
It is possible that Mr. Chandler became infected during the 10 days he was seeking medical treatment for his back pain. He visited one emergency room in McKinney and four private doctors’ offices.
The doctors focused on his aching back, Mrs. Chandler recalled. In hindsight, she wondered if they all missed something.
There were three small boils on the back of his neck, she said, which the Chandlers believed were just ingrown hairs. The spots became red after a few days, she said.
“No one paid any attention to his neck,” Mrs. Chandler said. “It was all about the pain in his back.”
‘Sicker and sicker’
Mr. Chandler believed he had wrenched his back May 4 while moving equipment during a training exercise during his 24-hour shift, his wife said. By the time he got home the next morning, he could barely walk. Doctors thought it might be a herniated disc or pulled muscles.
But Mr. Chandler did not respond to the painkillers or muscle relaxants they prescribed.
“He just kept getting sicker and sicker,” Mrs. Chandler recalled.
By May 14, Mr. Chandler woke up covered with a rash and no longer able to urinate. His wife was on a business trip, so friends drove him to the emergency room at Medical Center of McKinney.
Although Mr. Chandler was alert and talking, doctors could detect no blood pressure, and they feared his kidneys were failing. During a subsequent lung scan, he stopped breathing, was revived and moved to intensive care.
By the time Mrs. Chandler got to the hospital, the doctors were saying that her husband “was scaring them,” she said, because they couldn’t identify the source of his downward spiral.
“You know it’s serious when you walk into the emergency room and four doctors come to greet you,” she said. “And three of them are specialists who were called in the middle of the night.”
A diagnosis was still evading them, but, for the first time, an infectious-disease specialist guessed that it might be MRSA. Even before tests confirmed the infection, the doctor started him on antibiotics.
In the struggle to save his life, Mr. Chandler was taking a dozen different medications and being prepared for dialysis when things took a turn for the worse, his wife recalled.
“At 2:30 a.m., they woke me up,” she said. “They still didn’t know what was wrong with him.”
Mr. Chandler’s family had arrived from Houston, knowing that the situation was serious but still convinced that it was going to turn out fine.
“Mike’s the baby of the family, the youngest of four brothers and the healthiest of all of us,” reasoned Gene Chandler, an older brother. “I knew he’d be OK with dialysis. Even the morning he died, I thought he’d pull out of it.”
Mike Chandler’s death at 5:37 a.m. May 16 came as nurses were turning him to change the sheets on the bed. He stopped breathing, and the fight was over.
It was a stunning moment for the people who loved him and didn’t expect to lose him so soon.
“Thirty-three-year-old men just don’t die,” said his wife.