"SUPERBUG" BACTERIA

The epidemic raged through the hospital nursery, endangering or infecting newborn babies. It was 1960, when penicillin was still effective against most pathogenic bacteria, but a new strain of Staphylococcus aureus had emerged—a strain that was resistant to penicillin.

I was a research assistant at a large teaching hospital in the Chicago area, and found myself assigned to finding the source of the infection. Was there a Typhoid Mary on the staff? Some cleaning woman or nurse's aide, perhaps? There was only one way to find out. For several weeks I moved from one room on the nursery floor to another, taking nasal swabs from every person who entered the room, then culturing the bacteria from them in the laboratory. It made me less than popular with the nursing staff, but the hospital administrators had given strict orders about the need for cooperating with my study. My results did indeed show the source of the infection—the pediatricians who moved from one baby to another without thoroughly washing their hands.

At that time hospital-acquired infections were much rarer than they are today. The “magic bullet” penicillin was given routinely to control infections as soon as they appeared. But the appearance of penicillin-resistant bacteria was a red flag for biologists, if not for much of the medical profession. Pharmaceutical companies responded by modifying the structure of penicillin to create methicillin, and for a time methicillin controlled all the bacteria that were resistant to penicillin. Eventually, some strains of bacteria emerged that were resistant to methicillin; now we call them methicillin-resistant Staphylococcus aureus, or MRSA. Some bacteria failed to be controlled by other antibiotics, also. Today many infections still respond to various antibiotics, but occasionally they do not.

How did this come about? As Charles Darwin realized in the nineteenth century, evolution occurs when something in the environment kills part of a species before it can reproduce. (This is what is meant by natural selection.) In a population of Staphylococcus (staph), some of the bacteria contain mutations that make them vulnerable to a given antibiotic, but other bacteria may be resistant to it. If an infection is treated with the antibiotic, only the resistant bacteria survive and reproduce. Bacteria multiply rapidly; soon, many resistant bacteria are in the environment.

Though antibiotics can be lifesaving when necessary, their misuse has led to selection for resistant bacterial strains. Most physicians are aware of the problem. However, even now many people continue to insist on being given antibiotics at the first sign of an infection, or even as a preventive measure.

In 2011 an infection spread through a National Institutes of Health (NIH) hospital near Washington, D.C. Caused by a drug-resistant strain of Klebsiella pneumoniae, it infected 18 patients and killed six of them. Carbapenem-resistant Enterobacteriaceae (CRE) is another danger: it is a particularly nasty class of bacteria that causes serious intestinal illness and is fatal in about 50% of cases. It is resistant to the powerful class of antibiotics called carbapenems. So far CRE has been found mainly in hospitals, but it has spread to most states now, and it seems inevitable that it will spread to the general community.

How can we aging people avoid getting these infections, which are especially dangerous to the elderly? One strategy is a no-brainer—stay out of hospitals! Many procedures can be done in outpatient settings today, which costs less and is less likely to lead to infections. If we do have to be in a hospital, we should forget politeness and insist that anyone who touches or even breathes on us wash their hands or use alcohol-based sanitizers. Beyond that, there is little we can do now except to stay as healthy as possible. Our bodies contain many “good” bacteria that help protect us against dangerous pathogens; if we are generally in good health and have not destroyed those helpful bacteria, we have a good chance of staying free of “superbug” infections.

BEING A CAREGIVER

How did this happen to me? I never planned to take care of anyone else. After years of working in editorial offices, I earned a PhD from Stanford and set up my own business. The Stone Cottage was a writing and editing service for educational publishers; I specialized in biology, but worked on nearly any program for science education. My chemical engineer husband was self-sufficient, and we had no children. We seemed to be doing everything right.

In the mid-eighties my husband, who already had type 2 diabetes, had a heart attack. I stopped working for a few weeks to help him recover. Around the same time, my widowed mother decided to move from Florida to California to be near us. Again, I stopped working for a while to drive her and some of her belongings across the country and get her settled in a house she bought. Eventually, our lives settled down and I returned to my writing and editing.

As it turned out, my husband’s health worsened greatly over the years. Though he was well for long periods, every year or so he would have a medical crisis and enter the hospital for a while. By the time he died in 2003, he had had a sextuple bypass and several other cardiac surgeries, a cervical laminectomy, and amputations of a leg and some toes; and was on dialysis. His medical bills came to more than a million dollars, so even though he was well insured, we had to use our retirement savings to pay our portion. I cut down greatly on working to care for him, adding to our financial difficulties.

During the same period, my mother became unable to live alone, so we bought a larger home with an in-law apartment where she could live. I was the only caregiver for both her and my husband, doing the cooking, laundry, and other household chores.

After my husband died, my attention focused on my mother, who was in her nineties. More and more, she needed my help with bathing and other routine daily activities. In 2005 she entered an assisted living facility, and though I visited her almost daily, my life became much easier. When she died at the age of 101, my role as a caregiver ended.

My slide into caregiving was gradual, as it is for many caregivers. At first it was a matter of taking my mother shopping, occasionally rushing my husband to the hospital, and generally being available when they needed my help. Over the years, though, caregiving took over my life. I had little time for building a network of women friends or pursuing my individual interests.

Of course, in a sense I was lucky. Having a home office, I could combine working and caregiving when the projects were small enough and the deadlines were reasonable. (Any freelance editor will find that amusing.) If I could do it again, perhaps I would hire more help, so I could stay active professionally. As it was, I lost touch with what was happening both in science and in publishing, and failed to learn the new techniques that are needed for editors today. Though I have continued to write, I have done so only sporadically. Geriatrics  will probably be my last full-length book.

Would I do it again, given the cost to my own life? Yes! Though professional caregivers can be excellent, only a family member can provide the ill or aging with all the loving help and shared memories they need. Caring for my husband and mother gave me a sense of fulfillment I have never felt otherwise; during those years I became much closer to them, and found myself becoming less self-centered. We all benefited from our situation.

However, I would reach out more for help. Like many caregivers, I was naïve about the financial aid that is available. I might have been paid at least a small amount for my time, as my staying home made it possible for my husband to remain out of a nursing home. We probably could have received Medi-Cal benefits, but assumed that because we had a nice home and car, we would be turned down. Instead, we struggled to stay afloat. A social worker asked me once whether we needed financial help; why was I too proud to say yes? Caregivers’ support groups were available, and I should have made time to join one. The Unitarian women’s circle I found after my husband’s death was a wonderful source of friendship and support, but I could have found it years earlier. If it takes a village to raise a child, it also takes one to care for those near the end of life and for their caregivers.