By Lyndsey Layton
Washington Post Staff Writer
Tuesday, September 1, 2009
LAS VEGAS -- In Room 519 of Kindred Hospital, Linda Rivera can no longer speak.
Her mute state, punctuated only by groans, is the latest downturn in the swift collapse of her health that began in May when she curled up on her living room couch and nonchalantly ate several spoonfuls of the Nestlé cookie dough her family had been consuming for years. Federal health officials believe she is among 80 people in 31 states sickened by cookie dough contaminated with a deadly bacteria, E. coli O157:H7.
The impact of the infection has been especially severe for Rivera and nine other victims who developed a life-threatening complication known as hemolytic uremic syndrome. One, a 4-year-old girl from South Carolina, had a stroke and is partially paralyzed.
The E. coli victims are among millions -- one in four Americans -- sickened by food-borne illnesses each year. As waves of recalls have caused the public to lose confidence in the safety of food, lawmakers are scrambling to respond. In July, the House approved legislation that would give the Food and Drug Administration broad new powers and place new responsibilities on food producers. The bill would speed up the ability of health officials to track down the source of an outbreak and give the government the power to mandate a recall, rather than rely on food producers to voluntarily pull tainted products from the shelves.
The Senate is expected to take up its version in the fall, and the issue has become a high priority for the White House.
It is impossible to say whether new laws and tougher enforcement would have prevented the contamination of the Nestlé cookie dough, which the company voluntarily pulled from stores hours after the government linked it to the outbreak.
Last week, chilled packages of the chocolate-chip cookie dough returned to supermarkets after a two-month absence as company executives tried in vain to find the cause of the contamination. They scrubbed their production plant, bought new ingredients and started making dough again.
Linda Rivera has just been trying to stay alive. Her cascading problems started about seven days after she ate the dough when her kidneys shut down and she went into septic shock. Then doctors had to remove part of her colon, which had become contaminated. Soon, her gallbladder was inflamed and had to be excised. Shortly after, her liver stopped functioning. It is unclear exactly what is causing her loss of speech, although the toxin produced by the E. coli O157:H7 bacteria can attack the brain.
Of all the victims, Rivera has spent the most time in hospitals -- about 120 days since May. She was recovering well enough at one point to go home for nine days but, during that reprieve, she had to be rushed to the emergency room three times.
Her case is unusual because E. coli O157:H7 tends to most seriously affect the very young and old. At 57, Linda Rivera is not part of either vulnerable group. Her situation is also unique for the number of major organs that have been injured. Her family and one of her physicians said she had no underlying health problems that would have exacerbated the infection.
"Once these patients get into a downward spiral, it's hard to pinpoint why things go wrong," said Michael Gross, a kidney specialist who has treated Rivera. "The chances of her coming out of the hospital and getting into a normal life cycle are low."
The Rivera family never gave much thought to food-borne illness. "You watch a commercial, you go into a store and you just assume it's okay to eat," said Linda's husband, Richard, a sales manager for a Web site. "I assume if it's on a shelf, it's safe. But this whole thing has changed the way I look at food."
Among the pathogens that can harm human health, E. coli O157:H7 is one of the most lethal, and there is no known cure. The Centers for Disease Control and Prevention estimates about 70,000 people are infected annually with E. coli O157:H7, but the actual number is unknown because many illnesses go unreported.
"People just don't really understand how horrible food-borne illness is," said William Marler, a prominent Seattle-based food-safety lawyer who is representing the Rivera family and 23 other victims in the cookie dough outbreak. "They think food-borne illness is a tummy ache and diarrhea."
E. coli O157:H7 is typically associated with beef because the bacteria lives in the intestines of cows, goats and other ruminants. But in recent years, the bacteria has turned up in unexpected places, such as spinach and other leafy greens, and, now, cookie dough.
Linda Rivera was a high school teacher's aide who was always in motion, cheering her sons at their soccer games and wrestling and track meets, ferrying her twin teenage boys across town to playing fields and skate parks. Now she struggles to hold up her head. Her communication is reduced to shaky hand signals; she turns her right thumb up or down slightly in answer to her husband's questions.
Richard Rivera's eyes well up when he contrasts the exhausted, gaunt woman lying askew in the hospital bed with the bubbly blonde he married 12 years ago. It was a second marriage for both, and they each brought three children to the union. "We called ourselves the Brady Bunch," he said.
A bearish man in sneakers, shorts and a baseball cap, he spends his days and nights in Room 519, rubbing Linda's feet, dabbing her eyes with a cool washcloth and trying to spoon-feed her medication. He sleeps fitfully in a chair by her bed.
He holds up both sides of the conversation.
"Are you hot?" he asked Friday. "Give me a thumbs up if you're hot." He watched as Linda shakily turned her right thumb upward. "Okay, baby, do you want the blanket off your leg? Linda, you're turning red. Are you breathing? Okay, I just wanted to make sure."
Linda Rivera is so weak, she can't suck on a straw long enough to draw liquid out of a cup. She is being fed nutrients intravenously.
Once the CDC made the link between the outbreak of E. coli illness and Nestlé cookie dough in June, Nestlé immediately recalled about 3.6 million packages at a cost of $30 million to $50 million, according to Laurie McDonald, a company spokeswoman.
The company and FDA investigators focused on Nestlé's Danville, Va., plant, which produces all its refrigerated cookie dough. E. coli O157:H7 was not found in the plant or on equipment but was detected among the samples of dough that Nestlé routinely sets aside for analysis. However, the contaminated dough had a different genetic fingerprint than the strain that caused the national outbreak, puzzling company officials.
In consultation with the FDA, Nestlé bought new supplies of flour, eggs and margarine and restarted production July 7, McDonald said. The revived product, which is packaged with a "New Batch" label and a prominent warning against eating raw cookie dough, went on sale last week. It is too early to track sales, McDonald said.
Nestlé "is aware of Mrs. Rivera's illness and our thoughts and prayers are with her and her family," McDonald said. She said the company has been in contact with the Rivera family through Marler and "we have offered support to the family." She declined to elaborate.
Neither Richard Rivera nor Marler would say whether Nestlé has made any payments. Linda Rivera has not filed a lawsuit against Nestlé, although three of Marler's clients have.
In the three months since she fell ill, Linda Rivera missed her 18-year-old son J.J.'s high school graduation. She missed Mother's Day. Her stepsister unexpectedly died last week, but Richard hasn't told Linda, not wanting to add to her stress.
When friends or family relieve him from his post inside Room 519, Richard stands in the 107-degree heat outside the hospital and takes deep drags on Marlboro Lights. At twilight Friday, one of those friends, Greg Van Houten, joined him on the sidewalk.
"What do you think, Greg?" Richard asked.
"I think she's dying," Van Houten said.
Richard nodded. His eyes filled with tears.
Moments passed. The two men went back inside the air-conditioned hospital. In Linda's room, her husband, her sons, neighbors and friends formed a small circle around her bed. In yellow hospital gowns and face masks, they clasped hands and prayed for her return to health.
"You made it this far -- don't give up on us, Mom," said Tony, one of her 17-year-old twin boys, who sniffled beneath his face mask. "You've done everything for me in my life."
Since May, there have been several moments when Richard thought he might lose his wife. Each time, she rebounded, and then relapsed. "That's how it's been through this whole thing," he said. "You feel like you're taking five steps forward and then three steps backward."
He is hoping for another, final rebound.