Still Lisa: Strep infection turned childbirth into battle to survive

Photos by Laura Seitz
Deseret Morning News

Published: Sunday, March 12 2006 12:00 a.m. MST

"Each day," wrote Steve in an e-mail to his friends, "is a new emotion based on one or two central themes — fear and sorrow, mostly for each day Hannah is without her mommy. I am trying to stay positive and trying to envision our family as four people in the future. I continue to pray. I continue to talk to Lisa, even when I'm not in the room with her. I wear her wedding ring around my neck on a chain she normally wears — I won't take it off until I can put it back on her finger, or at least around her neck."

Lisa and Steve met at a party in Chicago in 1996. That first night they talked for five hours straight, about his Peace Corps stint in Micronesia and her medical missions to Peru, and the bumpy terrain of relationships. Already, they discovered, they could discuss anything without flinching. "Blunt" and "Blunter," their friends affectionately nicknamed them. They got married two days after Christmas in 1997, put their belongings in storage and immediately set off on a three-month whim-driven, low-budget honeymoon through the South Pacific. In 1998 they settled in Utah, lured by the promise of mountain trails.

Lisa was a hiker, a skier, a biker, a hugger, a nurse, a traveler, a woman who never sat still. If there was one moment that summed Lisa up, it was that time on a camping trip to Idaho when Steve was struggling to land a large fish and Lisa took off her clothes to jump in the river and toss it up on the bank. Then she ran in her underwear down the road looking for the sign that would tell them if they could keep the fish.

On Day 12, Lisa was transferred to the burn intensive care at University Hospital. More like chemotherapy than fire, the strep-induced toxins had burned her from the inside out. It seared more than half of her body, including her tongue, and her hair fell out in clumps.

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Before it can destroy, invasive Strep A has to find a way in. Its doorway could be a wound, even one as innocuous as a bug bite. Half the time, it simply finds a vulnerable area — a sprain or a bruise — with no skin break. Boise microbiologist Amy Bryant tells of a child who bumped his knee while trick or treating. Within 48 hours, doctors had to amputate his leg because of strep.

Invasive Strep A is sneaky, its virulence due in part to antigens on its cell surface that are so similar to human heart, bone and muscle tissues that they serve as a disguise; the bacteria appear familiar and safe, catching the immune system off guard.

Some scientists theorize, too, that certain people have immunological markers that predispose them to bad outcomes. In addition, strep specialists think it's likely that the immune system itself may cause harm by overreacting. One infectious disease specialist says it's like turning on a sprinkler system in an art museum to counteract cigar smoke: a major, destructive offensive against a nonthreat.

The Utah Health Department started tracking invasive Group A Strep only a year ago — too soon to figure out whether public health or private citizens can do anything to avoid it, says Susan Mottice, a state epidemiologist. They have not yet found predictability in what feels too much like brutal random chance. There were 70 reported cases of invasive Strep A last year; officials are certain that's an undercount. It's an unsettling fact, experts say, that the number of invasive cases is increasing.

It's unclear how Lisa's strep began, but impossible not to wonder. Had she tripped on something and discounted the ensuing bruise as nothing? Did she pick it up at work? Did it sneak in through the C-section site? Many local physicians familiar with her case declined to discuss it because of potential litigation. Hospital risk management teams counseled even those doctors not involved with Lisa's care not to discuss strep for this article.

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In the burn unit, surgeons sliced out dead tissue on her mottled limbs, hoping to save as much leg as they could and at least part of her right hand. A day after that they removed her legs below the knees. When the tissue continued to die, they went in again, and then again, each time taking off more, until the legs ended just inches below her hips. Two days after they amputated her legs, they cut off her right arm, leaving a stump midway from elbow to shoulder.

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