Real Life Impacts: The Story of Mora Lou Marshall
Mora Lou’s Salmonella Infection
Mora Lou Marshall was an 86-year-old widow who was one of many to endure the ravages of a Salmonella infection caused by contaminated ConAgra peanut butter in 2007. Because of her age at the time she became ill with Salmonella, Mora Lou suffered a prolonged acute illness that resulted in a gradual decline of her overall health and vitality, leaving this formerly independent woman virtually bedridden until her death in 2011.
The last few years of Mora Lou Marshall’s life were brutally painful primarily because they stand in such stark contrast to the way she lived her life. Fiercely independent from a young age, and singularly devoted to her family’s well-being, Mora Lou was never one to impose on family or friends to address her own wants and needs. She lived her life by her own rigorous standard of self-sufficiency.
Mora Lou’s friends and family universally speak of her as a true Southern lady. She loved to have her hair done, and her makeup was always as impeccable as her manners. To a person, members of Mora Lou’s extended family revere her, each with fond memories of a beautiful woman who somehow managed to combine her Southern charm and class with her self-proclaimed tomboy characteristics. David recalls that his mother taught him how to start campfires, to fish, and to prepare multi-course meals.
Mora Lou was a special woman who stayed involved with her church and always kept a busy social calendar.
In November of 2006, at the age of 85, Mora Lou came to live with her son David and his wife Terri. Mora Lou was immediately happy in her new surroundings. She had recently survived colon cancer, and continued to have episodes of diarrhea, but she remained basically independent in her activities of daily living. David and his family fully expected Mora Lou to remain with them for many years. David had even considered putting an extension onto his home so that his mother could have her own space.
We thought since she was independent, then the best thing to do was to add on a mother-in-law suite to our home with a small bedroom, den and kitchen. I started sketching plans and even went down to the city permit office to see if there were zoning ordinances for this add-on. We considered buying her a small house so she could have her own place and a yard to work in.
Plans changed permanently with the onset of Mora Lou’s Salmonella illness in December of 2006, and the loss that Mora Lou’s family has suffered as a result is monumental. Between the onset of her illness and her death in 2011, she remained hospitalized or in a long-term care facility. Mora Lou never returned home.
Mora Lou’s Salmonella Infection
Mora Lou Marshall was a Peter Pan peanut butter devotee beginning in September 2006, when, during a dental appointment, her dentist recommended that she eat a tablespoon of peanut butter every day for supplemental vitamins and nutrients. Doing so was no burden to Mora Lou—she had always loved peanut butter, and the affordability of Peter Pan made it her product of choice between September 2006 and February 2007.
Mora Lou first started to feel ill with nausea, then vomiting and diarrhea, on December 29, 2006. Despite feeling ill, the only thing she tried to eat was Peter Pan Plus peanut butter, which, unbeknownst to her, was the source of her illness.
On January 2, 2007, David and Terri entered Mora Lou’s room and found her nearly incoherent. They could not get her to stand. The muscles in Mora Lou’s legs were simply too weak to support her own weight. David recalls:
Mom was very sick. Terri and I found Mom unable to walk to the bathroom, very weak in speech, and blood pressure very low. She was at the bottom. It was about 4 a.m. and we summoned the Shreveport EMT. Mom went to the hospital and would not return to live with us again.
Once at the emergency room, Mora Lou was examined and admitted with a diagnosis of diarrhea. The following day, Mora Lou submitted a stool sample for culture. The sample grew both Salmonella and Clostridium difficile.
Hospitalization for Salmonella Infection
Mora Lou received antibiotics and IV nutrition throughout much of her brief stay at the medical center. She underwent various diagnostic procedures for low back pain caused by a recent fall, and an MRI of the region showed some compression and disc degeneration. She nevertheless held fast to her dietary habits, bringing a jar of Peter Pan peanut butter with her to her hospital room. Unaware at this point that his mother even had a Salmonella infection, much less that the peanut butter was its source, David made sure that the jar stayed by Mora Lou’s bedside so that she could access it whenever she wanted some.
As Mora Lou’s first Salmonella-related hospitalization came to an end, her doctors noted that although she had made some minor improvements, she continued to be highly debilitated. Her low back pain continued to limit her mobility, and her overall health was declining due to the combined effect of her Salmonella infection and an already weakened state.
Long-Term Care Necessitated by Salmonella-Related Injuries
Mora Lou’s doctors determined that she would not be able to return home. She remained too ill to care for herself, and thus had to be transferred to an acute long-term care facility, on January 5, 2007. There, Mora Lou was placed under strict quarantine to avoid further transmission of her infection.
Most of Mora Lou’s time at the long-term care facility was characterized by only one thing: lying in bed. Unable to move on her own, she could only leave bed for short amounts of time to sit in a wheelchair. Even this small movement would make her exhausted, and she would have to return to bed soon after.
Eating was now next to impossible. She struggled to get down even a few bites of food. Food no longer seemed appealing, and her appetite was virtually nonexistent. She had some respiratory difficulties, and needed careful assistance to even eat a small bite of food. She often took anti-nausea medication to ensure she could keep down the tiny amounts she could eat.
Mora Lou worked with a rehab team with the goal of regaining sufficient mobility so she could go home to her family, which her doctors first believed was an attainable goal. As time passed, though, it became clear that Mora Lou’s recovery would not come as easily as hoped. Returning home seemed less and less likely, and by the end of January she was discharged to a nursing home.
On arrival at the nursing home, Mora Lou immediately let the nursing staff know that her downturn at the end of December 2007 had been frighteningly sudden. Though she had had gastrointestinal problems for months, never before had she suffered as intensely and frequently from diarrhea as she had since the onset of her Salmonella infection. Mora Lou made it known, in no uncertain terms, that she was ashamed of her helpless condition. Life spent merely resting in bed, to a woman who had lived as Mora Lou had, was no life at all.
Ironically, Mora Lou’s family brought her the jar of Peter Pan Plus peanut butter and spoon, so she could continue to eat it in the nursing home. They had no idea at the time it had caused Mora Lou so much misery. And in a cruel twist of fate, Mora Lou again tested positive for Clostridium difficile on February 7, 2007. The course that had begun with her initial hospitalization for the Salmonella illness now continued unmercifully with this persistent opportunistic infection.
On February 16, 2007, a staff member entered Mora Lou’s room and found her slumped over in a recliner. She was unresponsive after attempts to rouse her. She was rushed back to the medical center, where she was readmitted.
A Return to the Hospital
Mora Lou’s admitting diagnosis at the medical center was weakness with inability to move her legs and inability to eat. Soon after admission, she underwent numerous diagnostic studies of her brain and nervous system. After much debate, it was decided that she should receive a feeding tube to help supplement her nutrition. Her doctors and family feared that without such a device, her limited ability to eat would cause her to continue to waste away.
Several days later, the Marshall family heard of the Peter Pan peanut butter recall. David requested that Terri check the jar that Mora Lou had at the nursing home to see if it could possibly be a match. When they gathered up the two jars of peanut butter belonging to Mora Lou, they noted both were coded with the same numbers as the Peter Pan peanut butter being recalled for Salmonella contamination.
On February 23, Terri and David received confirmation that Mora Lou tested positive for Salmonella Tennessee, the same strain implicated in the Peter Pan outbreak.
Mora Lou’s Second Hospitalization for Salmonella Infection
Upon Mora Lou’s return to the hospital, she presented with significant weakness, severe malnutrition, and ongoing colitis. She also now suffered from dementia and depression - when she was lucid.
Despite the best efforts of the staff, correcting Mora Lou’s malnutrition proved challenging. She became weaker and weaker, and was entirely dependent on her feeding tube. Mora Lou also did not progress as hoped in her physical therapy sessions. After not seeing any functional change since admission, physical therapy stopped due to her extensive weakness.
After several weeks of hospitalization, Mora Lou was stabilized and she moved back to the nursing home, where she stayed until her death.
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