It has been almost a year since my last blog entry. Due to some magic that I don’t fully understand, this blog now has three times more traffic than it did when I posted regularly. Most of this readership comes from search engines, so I know I don’t owe anyone an explanation for my absence, but I thought I’d offer one anyway. Think of it as a little public service announcement for those who might run into similar problems. You know what I’m talking about, those NBC commercials where d-list actors try to teach you something in thirty seconds? Bullies are bad. The environment is good. A rainbow spreads out across the screen while dulcet tones signal that the network has reached a satori of self-satisfaction. “The More you Know . . .” The more you know . . . what? In all honesty, I don’t know how this information will be useful to you, but it makes me feel better in posting it. If nothing else, maybe I can quell a few rumors. Since my return to life, to work, and to the internet, I’ve heard people say they thought I had an aneurism, or I went into a diabetic coma, or I ate tainted rabbit. Granted, I started the last rumor myself, but that’s just all the more reason why I should set the record straight. It wasn’t the rabbit. It wasn’t our lop-eared friends, who make excellent pets and pair well with Chianti. It was the bacteria Pasteurella Multocida, which somehow made it into my blood stream and into my brain.
You see, when I went offline in April, I almost went off-line for good. One morning I checked into the hospital with nothing but a mild ear infection; I was given antibiotics and sent home. That evening, I knew something was wrong. My wife, Ann was out of town, so I called a friend to take me to the ER, where I went into an unresponsive seizure in the waiting room. My right eardrum burst. A spinal tap came back positive for bacterial meningitis. I was put on a respirator and given a PICC line. Over the course of the next thirty-six hours, bacteria spread to my circulatory system, and I went into septic shock. My whole body swelled to twice its normal size. A nurse had to administer eyedrops regularly because my eyes were swollen open. My blood pressure crashed. I was on the brink of organ failure. Just as my family was wending their way here—from Bermuda, from San Francisco, from Seattle—at the news that I might not make it through the day, the ICU finally started to turn things around. “That’s the closest I ever want to be to seeing a dead thirty-nine year old,” said one of the nurses. Even as they identified the bacteria, put me on the right intravenous antibiotics, and pushed the infection back, I still didn’t wake up. My family plied with music, read to me, and tried to stir me back to consciousness. Jamie and Ann played RockBand tracks for me on their iPods. They read Greg Rucka to me. They read Philip Larkin. Ann whispered in my ear. “It’s Jose Garces! He’s come to sign your copy of Latin Evolution!” I say nothing.
I woke up about the time they were going to have to put me on a feeding tube. They don’t know why, but I’d like to think I came back because I was finally hungry enough to do so. While people were still trying to figure out if I was of sound mind, I was visited by a speech therapist, tasked with administering the “swallow test”. I tried water, graham cracker, and a little bread.
“What do you think?” she asked, as I chewed deliberately, exaggerating every motion.
“It’s awful!” I said, surprised at how small and thin my own voice was.
“You’re having trouble swallowing?”
“No. The bread is awful. . . It tastes like paste.”
I hadn’t had shelf-bought white bread in almost a decade. I felt bad about being snobbish, but even the man who delivered my next meal, did a double-take after unveiled it. “Pureed country bread and sausage?” he said. “What? Did you fail the taste test too?”
Meningitis is a bit like pneumonia in that any bacteria, and even many viruses can cause it. Not all meningitis is caused by meningococcus, anymore than all pneumonia is caused by pneumonococcus. (In fact, pneumonoccocus is one of the more common bacteria that cause meningitis). Any bacteria or virus that gets past the blood brain barrier and infects the meninges, the insulative membrane which protects your brain and central nervous system, becomes meningitis. Meningococcus is particularly nasty, because it’s contagious, but none, not even the relatively mild viral infections are a walk in the park. My infection, not contagious, was caused by Pasteurella Multocida. This is commonly found in the mouths of dogs, cats, and rabbits, but has no business being in the spinal fluid of human beings. The doctors were suspicious that my two perfectly healthy, orange cats, Leon and Diego had somehow punctured me. Like all good television doctors they did a thorough search of my body, checking above my hairline and between my toes. The found no signs of an infected bite or scratch. My family and I, like all good educated people, weren’t happy with this kind of ambiguity, so we turned to the internet.
What’s the first thing you find when you google Pasteurella? Rabbits.
The word ‘Pasteurella’ strikes fear into the hearts of many bunny lovers. It conjures up images of nasty abscesses, of sticky noses, of sick sad bunnies.
So I quickly hatched my own theory about how I contracted meningitis.
It was the rabbit stew.
Specifically, it was Paula Wolfert’s “Rabbit Stew with Preserved Pear and Ginger“. Paula Wolfert’s The Cooking of Southwest France is one of the best French cookbooks I know, for people who want to spend more time on a dish than Julia Child, and yet, not put truffles in everything like Thomas Keller. She may even have been first recommendation for a French cookbook, if it hadn’t been for the little fact that she had tried to kill me.
Or maybe the H-mart tried to kill me. See, I don’t usually go around cooking rabbits. Like most Americans, I think they’re cute and more importantly, expensive. When they’re in the produce section at a Korean supermarket, however, they are neither cute nor expensive. They look like alien embryos and they cost only slightly more than “Old Black Chicken”.
Or maybe it was my fault. My kitchen is never quite as clean as Alton Brown’s.
I try to be clean. I know all about cross-contamination. But when you’re making stew, you have to get a bit messy. You have to cut pieces across the bone with a cleaver, rather than at the joint. That way the marrow can simmer into the dish.
I explained all this to my ID doctor at the time. He listened patiently to my rabbit theory along with my detailed instructions on how to make a proper stew. I explained not only about the marrow but about the collagen and how it breaks down to help thicken the sauce. The doctor showed genuine interest in my theory, but acted like he had never met someone who cooked rabbit before, or for that matter stew. “So . . . this rabbit . . . How did I put this . . . You didn’t serve it raw, right?”
No, goddamn it. It’s stew. You cook it forever, and it’s glorious.
People humored me after that. Several people asked me about the rabbit and where it came from, and they recommended against my eating rabbit in the future. But I’m pretty sure they were only humoring me. ICU doctors and nurses probably know that patients who have been under Propofal for six days are going to say all sorts of nonsense. I imagine this usually works quite well, but in this case I had my family and the internet at my disposal, so even before I had learned to type again, I was on-line and spreading Facebook rumors about Paula Wolfert and her rabbits.
Three days later I would be equally convinced that a vicious cult was kidnapping all the patients from the ICU in order to “re-educate” them in the ways of the Lord before sending them to the great beyond. My clinical acumen, then, was understandably a bit off. My neurologist called it, “a little ICU disorientation,” not wanting to upset me. The nurse used the more clinical term, “ICU psychosis,” when talking to Ann, though was surprisingly cavalier about the whole thing. In retrospect, I realize this is because approximately one third of all ICU patients may suffer from some level of ICU psychosis; it’s a result of trauma, medication, and the unfamiliar environment. It usually only lasts a few hours or a few days, and almost always clears up when the patient is moved from the ICU back to a regular hospital room. Ann however, didn’t learn this, and so spent the next two days believing that I was out of my gourd for good. To her credit, she adapted quickly to this new information. In spite of my continual queries about how she got past the security checkpoint at the elevator, she decided she wasn’t going to lock me up somewhere like a Charlotte Bronte character. As long as I could still cook and play piano, it wouldn’t matter if I occasionally thought men in robes were hunting me. We would endure, even find a way to enjoy our lives.
The hallucinations worsened because I was on morphine. Remember when I mentioned organ failure? Well, the good news is all I lost was my gallbladder. It took three or four days for my body to telegraph this news to the world, because I was eating so little and was on so many antibiotics.
“How bad is your pain on a scale of one to ten?”
“According to yesterday’s scale or today’s?”
“Is it a dull pain or a sharp pain”
“The pain is dense, like clay”
” You’ve been reading too much Emily Dickenson. Is it a dull pain or a sharp pain?”
It was hard to concentrate during the questions. The hospital was sponsoring a competition in the ICU where doctors and nurses were supposed to work collaboratively to make parade floats representing common diseases. The one right outside my door was making a parade float of a drowned girl who had a clock for a face, and I was really having a hard time figuring out what disease she represented.
“Does it hurt when I put pressure on it or when I let it go?”
It was two days later before they actually removed the gall bladder, but my sanity was restored before then. As advertised, when I was moved from the ICU, my “little ICU disorientation” subsided. It was like water draining from a drowned village. Everything was sodden, but ordinary, even tedious. I thought the pain in my gut had subsided, except that every so often another doctor would come by and insist on poking at it, like a schoolyard bully flicking some bookish kid behind the ear. Sure, I curled up in a little ball, but otherwise I felt fine. Even when I went in for the HIDA scan, and they had to perform it twice, only to tell me that they couldn’t find my gallbladder, I thought that was good news. I mean, if my gallbladder was all swollen up, it should be easy to find, right? Apparently that just means there’s no blood supply getting to it. The surgeon who removed it said it was almost gangrenous.
In the end, I recovered much more quickly than expected. For a long time, people kept telling me how lucky I was, and for a long time I hated those people. According to most of the medical research I have done, there have only been thirty or so recorded cases of Pasteurella meningitis in English medical records in the last century. How could I be lucky? But illness and recovery is about contradictions. The worse the illness, the luckier you are to live through it. I was lucky because if I had arrived at the hospital any later, I would’ve died. According to the admitting doctor in the ER, I also would’ve died if I was a half hour earlier; he said he would have just drained my ear and sent me home. I was lucky because they were able to diagnose the problem and respond to it in spite of its rapid escalation. I’m lucky because I hear fine out of my right ear in spite of the ruptured eardrum. I’m lucky because I didn’t have to go to rehab, as expected; after nineteen days in hospital I was released directly to home care. I was lucky to have my family there and adequate health insurance and people at work who covered for my classes. I was lucky I had adequate insurance. Did I say that already? Very well. I was lucky I had adequate insurance. One day in the ICU costs $3,000 and that’s not including the tests and consultations. That’s pretty much just the rent.
I have also come to peace with rabbits. I haven’t eaten rabbit since the illness, but now that I am lucid, I know Paula Wolfert wasn’t trying to kill me, and I encourage you to try the recipe which can be found here. Since my time in hospital, I did a fair amount of research, and I have found no evidence that anyone has ever gotten Pasteurella meningitis from eating a rabbit.
This may be of some comfort to people who like rabbit, but is probably of little comfort to people who own cats. The vast majority of people who had Pasteurella meningitis handled animals. Only ten percent of cases were people actually bitten, but the vast majority of meningitis victims had handled pets. It seems likely that the contagion is passed through saliva, a “lick is as bad as a bite,” as one source says. But don’t get all freaked out because your cat or dog licks your kid’s face in the morning. It’s still far, far, more likely that they’ll die tripping over their pet than from contracting meningitis. Thirty cases, right? Think about that. According to Atul Gawande, there are roughly a thousand cases of flesh eating bacteria in U.S. hospitals every year. So if you want to be a full-blown bacteriophobe, you have bigger things to worry about, like dirt.
I guess that makes this a pretty useless PSA. Well, you might still contract all the other varieties of meningitis, particularly viral meningitis. Since my illness at least six people I know have come forward as having had meningitis or knowing people who have had it. One can recover from viral meningitis without medical care, but I wouldn’t recommend it. You can’t tell what kind it is unless you’re admitted to a hospital, and all reports suggest that even viral meningitis hurts like a motherf*****. If your case is bacterial, immediate hospital care is necessary or death is inevitable. Basically, if you have the telltale signs of a spiking fever, headache, and most importantly a stiff neck, get yourself straight to the hospital. True, I didn’t have any of those symptoms, but I’ve been told that’s what I should say if I want to make myself useful.
And oh yeah, wash your hands frequently if you own cats. Chances are your cat won’t give you meningitis, but you never know what you might give your cat.
So there you go. The More You Know. . .