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Four-year-old Madras girl on the mend

by: Photo By Holly Gill - The McCool family, from left, Adam McCary, 16, Dennis, Madison and Juanita McCool.

By the time that Juanita and Dennis McCool first heard about the nationwide E-coli outbreak, their 4-year-old daughter was in a Portland hospital recovering from the ravaging effects of the deadly bacteria.
   Although their daughter's illness is not officially listed among the state's E-coli cases, the McCools have no doubt -- and their doctors at St. Charles Medical Center in Bend and Doernbecher Children's Hospital in Portland confirmed -- that it was almost certainly E-coli that caused her sickness.
   The Madras couple's ordeal began on Aug. 25. Their tiny blonde daughter, Madison, who weighs just 36 pounds, did not seem her usual energetic self when her mother stopped to get her on the way home from work.
   "I picked her up from day care and she looked really tired," said Juanita, who works as the attendance secretary at Madras High School. Madison had no appetite and went to bed early, but was up a few hours later with a fever of 102 degrees and diarrhea, which continued over the weekend.
   By Monday, the McCools' daughter was still sick, and had begun vomiting. "That's when I started getting scared," said Juanita.
   A visit to the doctor Monday morning (Aug. 28) helped allay her fears, when she was assured that it was probably just a stomach flu that would run its course. "They said to bring her back if she gets worse," she recalled.
   Much to their dismay, the "stomach flu" didn't get better. Juanita stayed home to help her daughter through the first serious illness of her young life.
   On Tuesday, Juanita was alarmed to notice that her daughter's stool was bloody -- a sign of E-coli infection. She took Madison to a doctor in Redmond. "We knew it was something more than stomach flu," she said, noting that Madison seemed exhausted.
   On the doctor's advice, she immediately took Madison to St. Charles in Bend. The doctor who admitted their 4-year-old daughter suspected that she had an E-coli infection.
   "The night we were admitted to the hospital, the doctor said the best case scenario would be three or four days in the hospital; the worst case scenario would be flying to Portland and being put on kidney dialysis," Juanita said.
   Over the next few days, Madison's condition gradually worsened. Exploratory surgery found colitis -- an infection of the colon -- caused by the infection.
   "All they could do was let it heal on its own," Juanita said.
   The McCools were informed that their daughter had a complication called hemolytic uremic syndrome (HUS), which occurs most often in children under age 5 and the elderly. With HUS -- the main cause of acute kidney failure in children in the United States -- red blood cells are destroyed, and the kidneys may fail.
   As Madison's kidneys slowly shut down, doctors monitored the process with blood tests several times a day to check the kidneys' function. When blood tests showed it was almost time for dialysis, she was given a blood transfusion and prepared for transfer to Doernbecher.
   While Juanita "was a wreck," Dennis, who works at Bright Wood, took his cues from the medical staff. "I just kept watching the doctors, and they were relaxed," he said.
   During the "slow and agonizing" week, Dennis confronted a doctor with the question that was weighing on him. "All I want to know is if I'm going to be taking my daughter home?" he asked. The doctor assured him that Madison's illness was not as severe as it could have been, and there was a 97 percent survival rate for HUS.
   "She could have had eye damage, brain damage," he said. "There's a host of things that can go wrong. I would have hated to see what a severe case would be."
   When Madison's illness reached the point where she needed dialysis on Sept. 3, Doernbecher Children's Hospital sent a small plane with a medical staff to pick up Madison and Juanita. Dennis drove to the hospital.
   At Doernbecher, Madison was bombarded by doctors in the pediatric intensive care unit, including a pediatric surgeon, renal doctor and gastrointestinal doctor. At least one of her parents stayed with her at all times.
   Two days after Madison's arrival, doctors inserted a catheter for kidney dialysis. "That was when I fell apart," said Juanita. "Watching your daughter slowly get sicker, day by day, was one of the worst nightmares of my life."
   Adam McCary, Madison's 16-year-old brother, had been away working at Camp Davidson over the summer, and got back around the time that Madison was transferred to Portland.
   "When I heard E-coli, I realized it was a lot more serious than I thought it was," he said.
   When Adam finally got a chance to see his little sister at Doernbecher, he was overwhelmed. "It was hard to see her with needles in her arm. She was really swollen; she didn't look like Madison."
   In spite of the fears and stress felt by the family, the effects of the dialysis were remarkable. "She started getting better really quick," said Juanita.
   After two days of kidney dialysis, she was transferred out of intensive care into a regular room for the last two days of dialysis.
   "She was a trooper," said Juanita. "She knew what they were doing was good for her. She stuck out that lip and let them do it."
   Sept. 15 -- more than three weeks after she became ill -- Madison was discharged from the hospital.
Other sick children
   

   During Madison's stay at the hospital, Juanita noticed at least five other children undergoing treatment for the effects of E-coli, but staff insisted there was no outbreak.
   When Juanita learned that a nationwide outbreak of E-coli had been linked to contaminated spinach, she tried to recreate the week prior to Madison's illness, since it can take two to nine days after exposure to the bacteria for infection to develop.
   Six days before Madison became ill, Juanita remembered sharing a salad containing spinach with her daughter at a buffet in Tigard. Juanita never became ill, but doctors told her that it affects the young and the old most severely.
   On her own, Juanita decided to investigate, and learned that one of the produce suppliers for the restaurant had sold some of the contaminated spinach.
   Because doctors never tested Madison's stool for the presence of E-coli, there was never a conclusive diagnosis of the cause of her illness, but the McCools remain certain that it was E-coli.
   Madison continues to improve, but has lingering problems. "She still complains abut her tummy hurting," said Juanita.
   Recent tests have shown that Madison has some resulting kidney damage, according to Juanita. Doctors have put Madison on high blood pressure medication to control the protein in her urine.
   The family is grateful for all the support they received when Madison was at Doernbecher. "There are countless people to thank," said Dennis, who took vacation time from work to spend time with his daughter. "We had a tremendous support crew while we were there."
   Juanita received supportive e-mails from family and friends, who couldn't call the hospital for fear of disturbing Madison. Instead, she said, "There were lots of people praying."
   The whole episode was a lesson in patience for the family, as Madison slowly returned to the lively, happy child she was before the illness. "It's really scary," said Juanita. "You'll either beat it or it'll beat you."