Tetanus: When Gardening Becomes Life Threatening

Karen Marie Kline
Santa Fe, New Mexico 87507

October 9, 2004
Dr. Fitzpatrick, Whole Life Clinic
404 Brunn School Road, Building C
and Alice Sisneros
Galisteo Road, Suite
Santa Fe, New Mexico 87505

Dear Dr. Fitzpatrick and Alice Sisneros,

The results are not yet back from the tetanus test ordered by Whole Life
Clinic, so I don’t yet know whether or not I have tetanus.

What I do know, is that I was in EXTREME pain when my muscles began
contracting at Whole Life Clinic on Thursday morning. That was when a
Whole Life Clinic health care provider called an ambulance to take me to
the Emergency Room.

Today, two days later, the pain is so intense when I stand, that I can not
handle more than a minute or two, and bending is beyond my capacity to
withstand the pain.

Significantly, the pain restricts my activity so severely that all I am able to
eat is Saltines which require no preparation.

Making myself a cup of coffee or green tea is such a painful undertaking
due to the amount of standing required, that if I make one cup of each a
day, it is a tremendous triumph over the pain.

I am writing to note that the hospital gave me a pain killer in the I.V., and
then several hours later gave me two 250 mg Erythromycin and a
prescription for same.

One of the hospital nurses showed me a medical book that said antibiotics
stop the toxins from forming. Apparently the toxins attach to nerves or
something.

Because tetanus, if this is tetanus, is a virus, the antibiotic doesn’t kill the
tetanus, it stops the toxins. I don’t pretend to understand this, I just know
that this sounds pretty simple and I’m pretty angry that you failed to give
me a prescription for antibiotics on the first occasion that I came to each of
you.

I came to you, Alice, on October 1, 2004, when you refused to see me. In
the past when I asked you if I could pay in the future, you said no, that I
should go to the Emergency Room, that they take people who can’t pay.

I came to you, Dr. Fitzpatrick, when I called your home over the weekend.
That was October 2, 2004 after a pharmacist had told me I needed to get a
toxoid test and that I needed antibiotics which she couldn’t give me without
a prescription.

I came to you, Dr. Fitzpatrick, again on Monday, October 4, 2004. At that
time a tetanus test was ordered at TriCore, to be done “STAT” which I was
told meant right away. Later that day, when I learned that it would take ten
days to get the results, I got scared because of the level of pain, and went to
the Emergency Room.

At the Emergency Room, after waiting an hour or so, I called you to see if I
could get a prescription for the antibiotics, since bad muscle cramps were
making my wait in the Emergency Room difficult. I was told, no, you
would not give me a prescription without seeing me and that I should stay at
the Emergency Room.

Two or three hours later, the cramps stopped. Even when I moved around,
the cramps did not return. So I left, thinking that whatever it was, was gone.

I felt great, in comparison to the days preceding.

The next morning, Tuesday morning, I felt great until I had been up about
three hours, but by then I was far from home, trying to do things I need to
do to save my home and income property from foreclosure. By the time I
got home, the pain was severe and similar to the pain I had prior to having
my appendix out. The pain receded when I was in bed, but returned
immediately upon getting up.

Thursday morning, I felt certain I needed the antibiotics that the pharmacist
had mentioned. By then I’d figured out how to type, “tetanus symptoms”
into Google. I got a list of pages of symptoms and treatment. The
symptoms sounded like what I was experiencing. The treatment was said to
be antibiotics.

I went to your office on Thursday morning, taking with me a letter to which
I had attached a check for $90.

I saw a doctor whose name I forget because the muscle contractions were
so severely painful that I screamed as each one attacked. I feel that the
doctor was thoughtless to have me lay flat when I’d told her about the pain
I was having. She could have checked the tightness of my muscles while I
was sitting.

Because the contractions were so severe and painful, she called an
ambulance to take me to the Emergency Room.

The ambulance came and took me to the Emergency Room.

I also believe that the severity of the contractions and extreme worsening
that was allowed to take place, have made my health much worse.

If I did not have a notebook computer, so that I can write this while I’m in
bed, I could not write this because I have too much pain when I’m up.

Sincerely,

Karen Kline

Copy: St. Vincent Hospital, Governor Bill Richardson, Representative Tom
Udall, Senators Domenici and Bingaman, KOAT, KOB, KRQE.

Karen Marie Kline

Santa Fe, New Mexico 87507
                                                                         October 10, 2004
Dr. Bardwell, Admitting Doctor,
Emergency Department, St. Vincent Hospital
465 St. Michael’s Drive
Santa Fe, New Mexico 87505

Dear Dr. Bardwell,

I am feeling worse than I did before Thursday morning when I began having the
muscle contractions that were so violent and painful that I couldn’t move and was
screaming and Whole Life Clinic called an ambulance to take me to the
Emergency Room.

The reason I say I’m feeling worse, is that my stomach muscles feel as if I just
had my appendix out; I can’t stand up long enough to make myself a cup of
coffee because the pain so rapidly becomes unbearable; I became exhausted from
sitting in the car (while the lady delivered some of the summonses – not all
because I began to have so much pain); I become as fatigued from thinking as I
do from actually being up; the muscles in my back hurt as bad as the labor pains
that began in my back when I had my son; my eyes burn; I have to sleep sitting
up just as I did before being in the Emergency Room; and I seem to be getting
weaker -- my car door has long stuck, but now it’s like I’m trapped in my car
because I don’t seem to have the strength to open it like I did before Thursday,
and when I lift my little notebook computer, it feels as if I’m lifting a stack of
books. If I didn’t have this notebook computer that I can use in bed, I couldn’t
write this because sitting at my desk caused immense pain in my back muscles.
I can’t go into my garden and pick vegetables because I can’t bend down without
major pain. I can’t cook things to eat because I can’t bend to turn on the faucet
to wash utensils and pots because there’s a tiny stretch involved and it’s so
painful and because it feels as if the muscle contractions will begin again. The
bending to turn on the faucet is really minimal yet it is major painful.

And all of this is after taking the prescribed amount of Ibuprofen.

Before Thursday, October 7, 2004, I wasn’t taking any Ibuprofen because I was
taking Aspirin because I’d been nauseated and I was afraid the nausea was
because of my heart. I didn’t think it would be good to take Aspirin and
Ibuprofen together.

Yesterday I thought I might feel better if I sat in the sun for a bit. So I moved a
chair about 10 feet so it would be in the sun. That minimal exertion caused me to
start trembling so that I decided I’d better go in and lay down again.

I had to stay in bed four out of seven days before the severe muscle contractions
that forced me to have to be taken to hospital by ambulance. Now I’m in bed all
of the time except when I go to the bathroom.

When I told you in the Emergency Room how much better I was, it must have
been the muscle relaxant or pain killer that was put into my I.V. that made me
feel better. Once that wore off, there wasn’t any improvement. In fact, I feel
worse.

Because this is so, I must make it clear that I strongly object to the fact that the
doctor who saw me, Dr. William Raboff, required me to have a psychological
evaluation before he would prescribe any medical remedy.

Because of my TBI, it was very confusing to have the I.V. in my hand, and to be
in the Emergency Room and to be feeling better... and to have to work out
whether there was anything that had been done that might make me feel better in
terms of my original complaint. I mean, it was just so hard to be able to work out
that nothing had really been done to address whatever was causing the violent
muscle contractions. I had to actually ask a nurse or tech about this. The person I
asked confirmed that nothing had yet been done to relieve whatever the
underlying problem was.

When I asked Dr. Raboff about the results of the tetanus test, he said the results
weren’t back but that even if they were, the test wouldn’t show whether I had
tetanus because if I’d ever had a tetanus shot, then the results would be positive
and that would be meaningless because all it would be showing was that I’d had a
tetanus shot. I asked if that was even if my last shot was 30 years ago, and Dr.
Raboff said yes.

Dr. Raboff at no time touched my toe, even though I said that it had hurt when I’
d bumped it against the washing machine on Tuesday, (October 5, 2004).

Dr. Raboff did not ask me about my life style, like whether or not I was exposed
to the earth where tetanus might be contracted. (Because I grow so much of my
own food, and move my compost pits periodically, I am constantly getting dirt on
my feet because I constantly wear sandals.

I am also concerned that when the psychologist, Paolo Guidici, came to see me,
he had been told that I had come to the Emergency Room by myself. The fact
was that I’d been brought there by an ambulance.

I am concerned that Paolo Guidici appeared to have been told by Dr. Raboff, that
I said I had tetanus. (Paolo Guidici wrote that I said I had tetanus.) I was and am
afraid I have tetanus. That’s why I got the tetanus test at TriCore after I called a
pharmacist on the evening of October 2, 2004, and she’d said that the only way
to know was to test for toxoids. I don’t know what those are, but maybe they are
the tetanus antibodies. I asked several times in the Emergency Room whether
they had gotten the test results. If I “knew” I had tetanus, I wouldn’t need a test
because I’d already be certain. I consistently said I thought I might have tetanus
because of the darning needle I jammed into my toe by accident. I didn’t say, “I
have tetanus,” because while I am afraid that I have it, I don’t know that I have it.
Not only that, I explained that I have some TBI brain damage and that saying
things clearly is hard. In the beginning it was really hard to talk because of the
pain.

My concern is that I have a very serious disease that should have been given
immediate attention. It’s such a serious disease that I think it might have been
wise to err on the side of caution and to give me the antibiotics immediately rather
than withholding antibiotics until after I’d been screened by a psychologist.

When I asked what else might be causing the muscle pain, I was told a trauma
could do that. But I haven’t had a recent trauma and, no other explanation was
offered.

So, if Dr. Raboff didn’t think I have tetanus, what did he think was causing the
severe muscle contractions, and what did he do to provide medical care for the
cause as he saw it?

I am in extreme stress as a result of my condo being built over an old privy pit
and the other unit owners not paying their share of fixing the common element
defect. Because of their refusal I am in foreclosure on my home and on my
income property. I write this because Paola Guidici said he’s noted that I have
“moderate” stress.

When PNM was threatening to shut of my electricity this spring it was so scary
that the stress caused me to get tinnitus. I think the stress caused my tinnitus
because I was shaking from apprehension and then the ringing started. The
ringing has been so loud that there have been two times when I could understand
how someone could kill themselves because of it. In fact, a family friend of a girl
in a therapy group that I went to, had killed himself with a bullet into his head. I
don’t think this stress is moderate.

I don’t have the money for healthy food. My garden is great, but the growing
season is fast approaching its end, and besides that I can’t bend down to pick
things now, much less work in my garden.

I don’t think it is a moderate stress when people you know refuse to pay what
they owe when they can see the extreme damage their refusal causes. It’s
stressful to be in poverty. But it’s way more stressful to know that the people
who are causing ones poverty, know they are causing the poverty. (The papers I
filed in the foreclosures are relatively clear in showing the facts and I will post
them on my web site as soon as Yahoo! replaces the SiteBuilder program I was
using before it went bad.)

If I continue to be this sick, though, I don’t know how I will do the legal things
necessary to save my property, especially since I’ve had to battle to get the
district court to accommodate my disability.

Which reminds me, Dr. Raboff did not seem to understand TBI. He kept asking
me if I’d had a head operation. He didn’t seem to have any concept of how the
pain could make it extremely hard for me to answer him the way I could if I were
not disabled and not in pain. He made no attempt to accommodate my disability.
I am concerned that he did not want to consider whether or not I might be in an
early stage of tetanus. He seemed to think that the fact I did not have some sort
of facial nerve disorder from tetanus, was conclusive proof that I did not have
tetanus.

He actually said that tetanus was very rare and I couldn’t have it.

When I realized how worrying and risky it was that he had taken that position, I
spent a lot of time organizing how to tell him about the B12 I take because of my
B12 malabsorption illness. I felt it was imperative to make the point that if
someone with less healthy levels of B12 were exposed to tetanus, then they might
have more severe symptoms earlier on than I had them.

Tomorrow I will complain to St. Vincent’s Mental Health and Psychiatric
Services about the ten areas in which Paola Guidici made factual errors. While his
errors may reflect what Dr. Raboff told him, I believe he had a duty to report
facts, not hearsay.

My concern which I want to raise with you, is the influence Dr. Raboff may have
had in instigating the errors. If Dr. Raboff formed faulty impressions and failed to
ask appropriate diagnostic questions of me, and then influenced the psychologist
by relating to him false concepts of facts, then that is a serious failing and
negligence and it caused false statements to be made about me in my records.
But worse, Dr. Raboff may have failed to do an adequate job of giving medical
care to someone who had symptoms related to tetanus and whose factual history
involved a puncture wound.

I remain very worried because I don’t feel any better, and in fact feel worse.
I’ll carry on taking the prescription and Ibuprofen, and if I still don’t feel better on
Tuesday, I’ll call you then.

10/11/04        I am scared because when I woke up this morning my back
muscles felt the way they did last Thursday, the 7th, which was the day they
contracted so painfully for such a long time.

I have a stiff neck from the tension of the worry. But that’s rather normal
because of all the tension in my life: foreclosures, but before that the
condominium privy pit that was expensive to remedy and the other owners
refused to pay their shares, plus just finding out I have brain damage. I knew
something was wrong, but to actually find out that it’s for sure, that’s very
stressful.

I was also thinking, I wonder if I would have gotten so much worse if the
Emergency Room experience had not been so stressful, like being refused medical
attention for my underlying medical problem until after I’d had a psych
evaluation. I do not understand why they would not let me have water or
anything to drink when I was so thirsty. I asked several times. When the techs
had a hard time drawing my blood and they kept saying that the flow stopped, I
asked if that could be because I had so little liquid in my body. I told them and
the nurse that I’d not had anything to drink that morning so that I wouldn’t have
to go to the bathroom while I was out. I didn’t get anything to drink until the shift
change and Karlene came on duty. She brought me something to drink. I believe
that was over five hours after I was brought in and began asking. Each tech that I
asked said they’d have to ask the doctor. So, did Dr. Raboff deny me water? And
if so, for what reason?

Sincerely,

         Karen Kline

Copy: St. Vincent Hospital, Governor Bill Richardson, Representative Tom Udall,
Senators Domenici and Bingaman, KOAT, KOB, KRQE.