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Chapter 7 E. coli

February 13, 2008. The bacterial infection in Ray’s right lung has been identified: E. coli.

“E. coli! But isn’t that associated with . . .”

“Gastro-intestinal infections? Not always.”

So we learn from Dr. I_ . Again we’re astonished, naively—there is something naive about astonishment in such circumstances—for like most people we’d thought that the dread E. coli bacteria is associated exclusively with gastro-intestinal infections: sewage leaking into water supplies—fecal matter in food—insufficiently cooked food—hamburger raw at the core—contaminated lettuce, spinach—the stern admonition above sinks in restaurant restrooms Restaurant employees must wash their hands before returning to work.

But no, we were mistaken. Even as, invisibly, a colony of rapacious E. coli bacteria is struggling to prevail in Ray’s right lung with the intention of swarming into his left lung and from there into his bloodstream to claim him, their warm-breathing host, totally—as totally as a predator-beast like a lion, an alligator, would wish to devour him—so we are learning, we are being forced to learn, that many—most?—of our assumptions about medical issues are inadequate, like the notions of children.

It’s liquidy-voiced Dr. I_—or another of Dr. I_’s white-coated colleagues—(for in his scant six days in the Telemetry Unit of the Princeton Medical Center Ray will be examined or at least looked at by a considerable number of specialists as itemized by the hospital bill his widow will receive weeks later)—who explain to us that E. coli infections, far from being limited to the stomach, can also occur in the urinary tract and in the lungs. Escherichia coli are found everywhere, the doctor tells us—in the environment, in water—“In the interior of your mouth.”

Most of the time—we’re assured—our immune systems fight these invasions. But sometimes . . .

Patients with E. coli pneumonia usually present with fever, shortness of breath, increased respiratory rate, increased respiratory secretions, and “crackles” upon auscultation.

(Why do medical people say “present” in this context? Do you find it as annoying as I do? As if one “presents” symptoms in some sort of garish exhibition—Patient Ray Smith presents fever, shortness of breath, increased respiratory rate . . .)

Now the exact strain of bacteria has been identified, a more precise antibiotic is being used, mixed with IV fluids dripping into Ray’s arm. This is a relief! This is good news. Impossible not to think of the antibiotic treatment as a kind of war—warfare—as in a medieval allegory of Good and Evil: our side is “good” and the other side is “evil.” Impossible not to think of the current war—wars—our country is waging in Iraq and Afghanistan in these crude theological terms.

As Spinoza observed All creatures yearn to persist in their being.

In nature there is no “good”—no “evil.” Only just life warring against life. Life consuming life. But human life, we want to believe, is more valuable than other forms of life—certainly, such primitive life-forms as bacteria.

Exhausted from my vigil—this vigil that has hardly begun!—I slip into a kind of waking sleep at Ray’s bedside as he dozes fitfully inside the oxygen mask and in my dream there are no recognizable figures only just primitive bacterial forms, a feverish swilling and rushing, a sensation of menace, unease—those hallucinatory patterns of wriggling light obscuring vision that are said to be symptomatic of migraine, though I’ve never had migraine headaches. My mouth has gone dry, sour. My mouth feels like the interior of a stranger’s mouth and is loathsome to me. The jeering thought comes to me You must have been infected too. But you have been spared this time.

Waking I’m not sure at first where I am. The sensation of unease has followed me. And there in the hospital bed—my husband?—some sort of disfiguring helmet, or mask, obscuring his face that has always seemed to me so handsome, so youthful, so good . . .

Something of the derangement of Widowhood is beginning here. For in dreams our future selves are being prepared. In denial that her husband is seriously ill the Widow-to-Be will not, when she returns home that evening, research E. coli on the Internet. Not for nearly eighteen months after her husband’s death will she look up this common bacterial strain to discover the blunt statement she’d instinctively feared at the time and could not have risked discovering: pneumonia due to Escherichia coli has a reported mortality rate of up to 70 percent.