E. coli strikes like lightning
October 4 2003
Her back arched off the hospital bed. Her jaw slammed shut. Her face, covered with light freckles around the nose, turned deathly blue.
A seizure gripped Patty Timko.
This seizure was unlike the others in recent days, when she went rigid, as if holding herself back from flying out of bed. This one was worse, her family said later. And it wasn’t letting go.
Her father struggled to hold on to Timko’s right leg. Her mother grabbed her daughter’s left hand. She wanted to sing to her, to calm her. Phyllis Timko is a music teacher, and the earlier seizures were made somehow easier by songs like “All Night, All Day, Angels Watching Over Me” and “Somewhere Over the Rainbow.” But all she could do now was urge her daughter to breathe.
The sound of medical alarms filled the small room at Barnes-Jewish Hospital in St. Louis. Doctors rushed in. Nurses shouted at the family: “Give us the room!”
As they left, Rich Timko looked at his writhing little girl - the baby of the family at 20 years old - and thought: This is it. We’ve lost her.
Striking at random
Patty Timko’s body was fighting a mutant microbe called E. coli 0157:H7. Toxins produced by the bacteria flooded her bloodstream, damaging delicate vessels. Blood clots formed; one in her right shoulder swelled her arm grotesquely. Her kidneys shut down. Sickness-induced hallucinations filled her mind. And now seizures.
All from something she ate. It hardly seemed possible.
The popular image of food poisoning is an upset stomach and perhaps a few too many trips to the bathroom. You ate something bad. It tasted funny. You got a little sick and it was over.
But E. coli 0157:H7 is food poisoning in one of its rawest and most feared forms, as the recent outbreak at a restaurant in the St. Clair Square mall illustrated.
That outbreak also showcased the pathogen’s uncanny ability to strike seemingly at random. Only a half-dozen people got sick, despite the potential to reach hundreds. The victims ate different items. They ate on two different days. It occurred at one of the most popular places in the food court.
And it’s unlikely that health officials, who already have spent a month on the case, will ever pin down its source.
The victims were linked at some unknown point in a moment that passed without notice. As a result, they are left with unsettled questions.
“Why does this happen to my child?” asked Cindy Pawlow, mother of a 7-year-old boy who was seriously ill.
There is no comforting or easy answer.
Sickness with no cure
Each year, about one person in every four in the United States contracts a food-borne illness, according to the U.S. Centers for Disease Control and Prevention. The vast majority of cases are mild.
But at least 325,000 people are made so sick they go to the hospital. Five thousand people die. That’s more deaths each year than the combined total from all 15,000 products regulated by the U.S. Consumer Product Safety Commission. And contaminated food is blamed for more accidental deaths than firearms, industrial machinery and explosives.
The most common food-borne pathogens have names like salmonella, shigella and campylobacter. E. coli 0157:H7 is on a different level.
“I’d rather roll the dice with salmonella or campylobacter than E. coli 0157:H7,” said Bill Marler, a Seattle lawyer who specializes in litigation tied to food-borne illness.
Each year, the E. coli strain leads to 73,000 cases, 2,100 hospitalizations and about 60 deaths. It causes severe bloody diarrhea and intense abdominal cramping; some female victims compare the pain to childbirth. In the worst cases, the toxins spill from the intestines into the bloodstream, causing hemolytic uremic syndrome. That was what hit Patty Timko so hard.
It is a sickness with no cure. Antibiotics are useless. Doctors are left only to wait for the pathogen to run its course.
It has no taste and no smell. Even if it did, only a microscopic amount is needed to make you sick.
“That’s the insidious thing about E. coli,” Phyllis Timko said. “It doesn’t tell you it’s there.”
And its victims say it is not a bug to be taken lightly.
“I would not wish this on anyone,” said one of the victims, Jamie Eastwood.
A meal at the mall
They each had their own reasons for being at the mall at the end of August.
Eastwood, 25, and her fiance, Brett Hellinga, came specifically to eat at Habaneros, a new restaurant in the food court at the mall in Fairview Heights.
“It was one of our favorite places to eat while in town,” Eastwood recalled.
The couple had moved to Springfield, Ill., to start new jobs after Eastwood’s graduation from law school at Southern Illinois University Carbondale. The months after law school were filled with friends’ weddings - including one in St. Louis on Saturday, Aug. 23.
That day, the couple drove to O’Fallon, Ill., to stay with Eastwood’s parents. Another friend from law school, Kate Reed, who lives in Rantoul, Ill., joined them.
Eastwood raved to Reed about Habaneros. And before the wedding, they went there. Just after noon on Saturday, Eastwood ordered a beef taco salad. Reed got the chicken taco salad. Hellinga ordered a steak chimichanga.
“We ate like pigs,” Eastwood recalled.
The next day, the Pawlows headed to the mall after church.
It was time for a new family portrait at Sears, the first one to include 2-year-old Nathan. Cindy Pawlow was relieved: She’d been feeling a bit guilty about waiting so long to get a portrait made with her youngest son.
In the pictures, everyone was smiling. Everyone had their eyes open. Everyone was looking at the camera. It was perfect.
A bit later, the family headed over to Habaneros. Cindy Pawlow shared a beef taco platter with her two youngest sons, Steven and Nathan. Her husband, Jeff, got a chicken chimichanga. Stan - their 7-year-old, missing two front baby teeth - went with the barbecue chicken quesadilla. He loved barbecue.
Cindy Pawlow, a nurse, is a cautious mother. So before they ate, the food court table was wiped down and the family cleaned their hands with antibacterial gel.
Less than two hours after the Pawlows ate, Patty Timko took a half-hour lunch break from her job at Build-A-Bear Workshop, where she works with her oldest sister, Stephanie Griesemer.
Timko got her food at Habaneros to go and ate in the backroom at Build-A-Bear. Griesemer, who was pregnant and suffering from morning sickness, remembers smelling, but not seeing, her sister’s food and being made nauseated all over again. The spicy smell upset her stomach.
For nearly a month, Timko would be the only person to know where she ate that day.
Opening a restaurant
Tom Budinick of Chesterfield had big plans for Habaneros.
It was his entry into the popular Mexican restaurant category. He ran one in the Chesterfield Mall for two years until he felt his idea was refined enough for expansion. On May 28, he opened in St. Clair Square.
The food is prepared in an open-air kitchen in view of customers. He uses only all-white chicken breasts. The peppers, onions and cilantro in the salsa are all baked right there in a open-faced gas oven. He was especially proud of the tortillas, which lack the gummy texture found in some Mexican places.
Budinick, who at 42 has spent 25 years in the restaurant business, planned to open a third Habaneros in St. Louis County this year.
Things were really taking off.
“No good explanation”
And then it began.
A day or two after eating, Patty Timko felt like she had a head cold or the flu.
Hellinga felt his stomach cramping. At home on Tuesday, Aug. 26, three days after eating at Habaneros, he turned to his fiancee and asked if she felt OK. She did, and he put the pain out of his mind.
But the next day at work, Hellinga felt his stomach pain intensify. He was in the bathroom every half-hour. He noticed increasing traces of red in his stool. At 29, he felt he was too young to be having something like this.
“You absolutely, positively know there’s no good explanation for it,” Hellinga recalled. “You’re thinking, ‘Is it cancer?’”
Late Wednesday, Hellinga decided to go to the emergency room. The doctors were baffled. He was told it could be salmonella, shigella, Crohn’s disease or an intestinal issue like colitis. They pumped him full of IV fluids and antibiotics. They took a blood and stool sample. They wrote him prescriptions for medicines to control the cramping and pain. And then they allowed him to go home.
At the hospital with Hellinga, Eastwood felt a twinge in her stomach. She wrote it off as sympathy pains.
But less than 24 hours later, Eastwood was in the hospital with the same symptoms.
“It was like an alien was trying to eat out from the inside of you,” she said.
On Thursday, shortly before Eastwood made her trip to the hospital, she called her law school friend Reed at home in Rantoul, Ill. Reed was sick, too. They compared symptoms. The cramping. The diarrhea. It was identical.
“Oh, my god,” Eastwood recalled saying.
Reed had thought she was the only one. She’d been consumed by the worst pain she’d ever felt - much worse than the cramps back in May when she had a gallstone and surgery to remove it. And that night Reed went to a hospital in Champaign.
It was suddenly clear to Eastwood. She and her fiance shared only three meals with Reed that weekend in O’Fallon: Habaneros, chicken at the wedding reception and a pancake breakfast at her mother’s house.
Eastwood suspected the chicken at the wedding dinner. She was curious if others at the reception were sick. She called two friends who sat at their table. They felt fine.
The possibilities narrowed.
“A horrible ... scary night”
Stan Pawlow’s stomach had hurt all week.
But Cindy Pawlow wasn’t too concerned. Her second-grader made it to school each day. He was eating normally. But that Friday morning, five days after eating at Habaneros, Cindy Pawlow spotted blood after Stan went to the bathroom. Soon Stan was on his way to the hospital. Doctors - unsure of what was going on with their young patient - collected some samples and sent him home. But the next day, with his pain worsening, he was back. And for the first time, Cindy Pawlow thought there was something really wrong.
Cindy Pawlow saw something familiar in Stan’s symptoms. Last July, she got shigella, a food-borne illness that is less serious than E. coli. She never learned where she got it from, but she remembers the pain.
But if Stan had food poisoning, where did he get it? Cindy Pawlow worried it was something she did. Was it the Hamburger Helper she fed the kids Tuesday? Or the ice cream they got out one night? Her mind raced for an answer. Her worst thought: Maybe Steven and Nathan were next.
While Stan was in the hospital, she and her husband scrubbed bleach over the toilet, door handles, light switches and faucets - anything Stan might have touched.
Four days after being in the hospital, Stan Pawlow took a turn for the worse.
The E. coli infection raged inside his slender body. His pain was at a different level. He screamed. Cindy Pawlow cried as she tried to comfort him. Two days later, on Thursday, Sept. 4, the pain suddenly disappeared. Cindy Pawlow believes it was a miracle powered by prayer. She didn’t know how else to explain it. “It was a horrible, horrible, scary night,” she said, “and everything turned.”
First identified in 1982
E. coli 0157:H7 is a relatively new pathogen - new to medicine. The bacteria strain, which occurs naturally in the feces of cows, was first identified in 1982 after limited outbreaks in Oregon and Michigan. It gets into the food supply most commonly during the slaughter of cattle, when the infected matter can splatter on meat. It is found most often in ground beef, causing it to be known in some places as “hamburger disease.”
In 1993, the pathogen leaped into the public consciousness with the nation’s largest outbreak. Four children died and hundreds were sickened after eating at Jack in the Box restaurants on the West Coast. That outbreak was linked to tainted ground beef.
The resulting public outcry increased scrutiny of the mutant microbe - everything from tougher meat inspection standards to safe handling instructions on packages of raw hamburger.
Efforts to keep the pathogen out of the nation’s food supply appear to be working. Last month, the U.S. Department of Agriculture reported that fewer ground beef samples tested positive for E. coli than in past years. And the number and severity of outbreaks is declining. Yet, the incidence of E. coli poisoning persists and, in recent years, has held steady.
Ravaged by toxins
Patty Timko’s stomach hurt even to touch. It was Monday, Labor Day, and she’d already been to a hospital in Washington, Mo., two days before during a visit with her boyfriend’s family. But her father rushed her to Barnes-Jewish Hospital on Monday when it was clear she was getting worse.
Her intestines had been ravaged by the E. coli’s toxins. But the doctors didn’t know what was wrong with her. Timko remembers little of what happened that day: a gel being rubbed on her stomach for an ultrasound, a funny-tasting liquid she had to drink before a CAT scan.
It took four days before Timko’s parents heard a doctor say “E. coli 0157:H7” for the first time. The lab results were finally in. But the mystery of where she got it persisted. And Timko was in no shape to be questioned.
Her kidneys were no longer able to purify her blood. As she was being wheeled to a dialysis unit, a hypersensitivity to sound kicked in. Footsteps thundered in her ears. She shuddered as bags were zipped up. Lying back on a gurney, she shouted at nurses when they pulled back a curtain on metal rollers.
“Please, make them be quiet!” she pleaded.
When the dialysis was over, Patty’s mother stuffed gauze in her daughter’s ears to dampen the thunderous sounds for the ride back up to the room.
Timko’s eyes saw double. Two, not one, sets of lighted numerals appeared on the elevator. Her right eye was lazy, leaning inward toward her nose. And the whites of her brown eyes were bloodied.
There were the nonsensical hallucinations: claws were coming out of her hands. She imagined she was helping build the Gateway Arch.
And the small convulsions that made her go rigid in bed washed over her.
At one point, her mother remembers looking into a doctor’s face and seeing nothing but uncertainty. “He could not give us an ounce of hope,” Phyllis Timko said.
The Baja Beach Burrito
The next day, Friday, Sept. 5, Patty Timko suffered her devastating seizure.
By coincidence, the St. Clair Health Department, alerted to the outbreak earlier in the week, moved to close Habaneros a couple of hours later.
The Timkos didn’t know that the restaurant had been shut down until they heard about it on the evening news. The Pawlows, too, didn’t know until they saw it on TV that night.
But Patty Timko’s family still didn’t know if she’d eaten there.
They thought they’d found an important clue with a Jack in the Box receipt. She and her boyfriend had eaten there the Wednesday before she went to the hospital, but after she started feeling ill.
Not until Thursday, Sept. 11, was Patty Timko lucid enough to hold halting conversations with her family. The hallucinations and convulsions were gone. But she was still on a ventilator. She couldn’t talk. So the family used a board with the alphabet on it.
Finally, they asked her: Where did you eat that week?
She responded by pointing out the message: Jack in the Box.
No, they told her. Was it Habaneros?
She nodded.
What was it?
Steak, she wrote. And then she tried spelling out more, but her arm was shaking violently. She grabbed a piece of paper and a pen and began writing: Baja Beach Burrito.
She said she even had the receipt.
The answer had been in Patty Timko’s purse the entire time. The critical clue was a simple piece of paper smudged with grease. It was dated Aug. 24 at 3:10 p.m. The total was $5.73.
Timko was released after 11 more days in the hospital. But the effects of E. coli 0157:H7 still haunt her.
She is retaining too much fluid, causing her feet and ankles to swell. At home, she has to prop up her legs. It’s too early to know if her kidneys suffered long-term damage.
She must take anti-seizure medication for the next four months, just in case. Until then, she can’t drive.
A neurologist has warned the family that Timko shows signs of slowing in her brain. She’s been told she might have trouble concentrating and remembering. Her eyesight is now a problem - she’s going to need glasses - although the double vision has disappeared and the laziness in her right eye has corrected itself.
But Timko remains upbeat, even as her parents worry. A former honors student at Belleville East High, she says she’ll just have to try harder at Southwestern Illinois College, where she hopes to earn an accounting degree.
Answers are unlikely
Hellinga, the Springfield resident, says he’s back to normal. He takes a laid-back approach to having been poisoned by E. coli.
“It’s kind of like being struck by lightning,” he said. “You can’t fathom it’ll happen again. You have to recognize that it’s rare.”
Eastwood is more cautious.
“Every once in a while you wonder, what if it’s still in there?” she said.
Still, Eastwood has maintained her sense of humor. She jokes that her water bill for August will be astronomical. And Eastwood likes to say that Reed, the friend who listened to her rave about Habaneros, will no longer allow her to suggest restaurants.
The Pawlows no longer eat out. And Cindy Pawlow doesn’t consider it a casual experience when her husband cooks out on the grill. She doesn’t look at food the same way.
“I used to be really safety-conscious and germ-conscious,” Cindy Pawlow said. “And this has made it worse.”
Stan appears to have regained his health, but he still asks at every meal if his food contains E. coli. The name of the sixth victim of the outbreak has not been released by the health department.
The investigation by the St. Clair County Health Department continues, although more answers are unlikely. The Habaneros workers all tested negative for E. coli, meaning they didn’t somehow spread the infection.
The meats also failed to turn up anything. That wasn’t a surprise, either, since the samples were collected nearly two weeks after the outbreak, not unusual in such studies. A restaurant like Habaneros would easily go through any suspect meat in that time. Test results from the produce are pending.
More than 60 people who ate at Habaneros during the time of the outbreak were questioned about what they ordered. The health department looked for a link between the E. coli illness and any one of 23 food items served at Habaneros.
“No food has been identified as a single source,” said Mark Peters, the health department’s assistant director.
So cross-contamination is the likely culprit, although health authorities have no idea how. Perhaps a small amount of tainted ground beef dripped juices on the lettuce that was used in another dish. Or maybe the lettuce itself was tainted. Or maybe the peppers.
Budinick is struggling to revive his once-hot restaurant. The same week that Timko was released from the hospital, Habaneros was allowed to reopen in the St. Clair Square food court. Business is down as much as 40 percent since the outbreak for all restaurants in the food court, perhaps because of the misconception that the eateries share kitchens.
On the day Habaneros reopened, a health inspector used a thermometer to probe chicken fillets cooking on the grill. A restaurant employee - in a yellow shirt with Habaneros’ slogan: Fast, fresh, fabulous - wiped down counters and windows with disinfectant.
“We are clearly the safest place after going through what we went through,” Budinick said, as a steady trickle of customers ordered food.
The experience has left Budinick frustrated and angry.
“It doesn’t appear we did anything wrong,” he said. “We were victimized as well.”
No matter what the health department finds, one question will always linger for both the restaurant’s owner and the victims of the E. coli 0157:H7 outbreak.
It is a question voiced by Phyllis Timko.
“Why us?”
For that, there is no answer.