BRIAN DEER:
MATTHEW AND THE BURGER BUG Page 1
The
Sunday Times Magazine (London) May 17 1998
By
Brian Deer
Matthew
Bell lay on the sofa in the front room of his home
and snuggled against a cushion half as big as himself
as he gazed at Batman Forever on video. He was crazy
about superheroes in serious outfits - Batman,
Spiderman, Fireman Sam - and cut quite a figure
himself as a blond-haired Superman at his local
toddlers' group in Torrisholme, Morecambe. But on
this Monday afternoon - it was nearly 4pm - his
attention to the movie faltered. He had started to
feel odd sometime earlier in the day and now he had a
pain in his tummy. Matthew grasped the cushion in a
vain search for comfort and wished the hurting would
go away.
His
mother, Rachael, was in the kitchen next door,
grilling fish fingers for tea. As she laid out three
plates, her youngest son, Tom, trotted between the
rooms. It had been an exhausting day, like every day
for this lone mother with two small children. On
Friday, they had been for milkshakes at Brucciani ice
cream parlour on the Morecambe promenade. On
Saturday, Stuart, the boys' father, a painter and
decorator, had come over and taken them all to
McDonald's. Yesterday, they had played at a sea-front
sandpit. And today they picked apples at an
allotment. When Matthew complained, "Mam, my
belly hurts," it seemed like just another
routine stress.
Had
Rachael known then what she found out later, she
would have been terrified. Matthew, three years and
nine months old, was showing the first symptoms of
infection with the same kind of E-coli organism that
is currently the subject of an inquiry in Scotland,
after an outbreak in November 1996 traced to a
Lanarkshire butcher's shop killed 21 people. As that
Monday afternoon turned to evening, vicious toxins
produced by the bug stuck to and attacked her child's
gut. He started to suffer from diarrhoea and
agonising stomach cramps. And he would soon become
seriously ill.
A
full explanation of what was happening to Matthew is
still beyond medical science. The particular variety
of the Escherichia coli bug that he had picked up -
called O157:H7 - is a freak mutation of a normally
harmless germ, and only surfaced in the 1980s.
Despite a string of devastating outbreaks around the
world, it never used to be thought to be a big enough
threat to be worthy of major research. But last year
the number of laboratory-confirmed infections in
Britain suddenly jumped by 80%, to more than 1,500
cases, and experts are now alarmed. "It may have
peaked," says Hugh Pennington, professor of
bacteriology at Aberdeen University and the
government's chief adviser on the subject. "But
it may get 10 times worse."
No
parent thinks of killer epidemics when their child
has a stomach upset. On that afternoon, last
September, Rachael, 32, thought that Matthew just
needed a rest and would soon be up and about. She was
not, in any case, the type to bother doctors or elbow
her way to the front of hospital queues. Until she
stopped work to look after the boys she had been a
quality checker in a local factory which made toilet
seats, cooker handles and switches. Her response was
the same as that of young mothers' everywhere: she
gave Matthew Calpol, a junior paracetamol, and waited
for his tummy ache to pass.
Her
son, too, was not a complainer. Despite being less
than four years old, he had somehow assumed a
prematurely adult role in their two-storey
end-of-terrace house, opposite the post office on
Lancaster Road. He had even been in on the birth of
his brother, Tom, who was 19 months his junior. At
night the boys shared an attic room and they played
together every day. But he barely slept on that
Monday night and on Tuesday he was again on the sofa.
His mother was watchful and his brother was confused.
But Matthew was hero-brave.
By
Wednesday, it seemed to Rachael that he had more than
a stomach upset. Matthew's diarrhoea now contained
traces of blood, which was being shed from his gut as
the poison from the bug caused the lining to ulcerate
and swell. She called the night doctor, who came at
3am. He was a young, dark-haired Lancashire man. He
examined the child and ruled out appendicitis.
Without tests he could not tell her more.
"If
it gets any worse, you should phone me," he
advised her. Then he left on his out-of-hours round.
When
she looked back later, Rachael felt that he had
failed her. But most doctors would have acted no
differently. Despite the growing number of
high-profile food-poisoning reports - especially the
Lanarkshire outbreak, which affected 400 people - and
sporadic cases of sickness, brain damage and even
death, few general practitioners have ever
seen a case or learnt to spot the danger signs. There
are plenty of other causes of diarrhoea, moreover,
such as salmonella and campylobacter, which (at 6500
and 56,000 reported cases last year) swamp infections
by the new E-coli.
North
Lancashire's doctors were especially backward in
their readiness to deal with the problem. Because the
organism is still only gaining a foothold, it has a
remarkably patchy distribution of infection - many
some places, few in others. Scotland, for instance,
has more cases than England, with the east more
affected than the west. Canada is worse hit than the
United States, with its west suffering more than its
east. There had recently been a small outbreak 20
miles south of Morecambe in Garstang, traced to
unpasteurised cheese, and another during 1991, linked
to a McDonald's restaurant in Preston, but there was
no sense of any local alert.
By
Thursday, however, Rachael had seen enough and Stuart
drove them over to the Royal Lancaster Infirmary,
where they went to the emergency department. The
blood in Matthew's diarrhoea was worse than before
and now he was now vomiting up anything he ate or
drank. He looked pale and tired from lack of sleep
and nutrition, but still he made little fuss. He was
taken to the paediatric ward, ward 34, on the ground
floor of the main hospital building. A consultant
examined him and nurse took a stool sample to be
tested in the hospital laboratory.
Rachael
was told that the test would take days. At 5pm that
Thursday, it was judged that nothing more could be
done at the hospital, and Matthew was discharged.
Rachael was told the problem was gastro-enteritis,
and given a patient information leaflet. "This
is a common infection in childhood which causes
diarrhoea," it explained. "There is often
some vomiting as well. Most children will recover by
4-5 days, but sometimes it takes two weeks until
everything is back to normal."
She
was reassured, as any mother would be. But on
Saturday morning - day 6 of Matthew's illness - she
took him to see her GP. The boy now had a yellow
tinge in his eyes, said that his back hurt and that
his "wee won't come down". Also by now he
was beginning to complain that he was feeling very
sick. "Why can't the doctor make me
better," he kept saying, when again they were
told that there was no treatment for his condition,
and he had returned to the sofa at home.
The
following day, Sunday, Rachael phoned the hospital
for the findings of the laboratory test. "We've
had the result back this morning," a nurse told
her. "It is E-coli O157."
Rachael
was shocked. She had heard of E-coli. She had seen it
on television. "That was what they had in
Scotland," she said, now alarmed. "What
should I do?"
But
although young children with E-coli are at the
greatest risk of complications from the infection,
the nurse had been given no guidance on any action
and couldn't offer any advice. "It doesn't mean
a lot to me," is how Rachael recalls the nurse's
response.
*****
