Dorothea B A Team Effort

"We both felt relieved that so many different disciplines—the infectious disease team, the radiology team and the surgical team—were involved in my care . . . I felt like we were all in it together.”

Thanks to the Expertise and Dedication of Several Specialists, a Patient Recovered from a Dangerous Infection

Flu season was in full force, so when Dorothea Berkhout began experiencing chills and a high fever in January 2018, she initially assumed she was just one of the latest victims. Two weeks later, the Associate Dean at the Edward J. Bloustein School of Planning and Public Policy at Rutgers University began to feel worse, not better. She saw her primary care physician, who ordered a chest X-ray and routine blood tests to look for signs of infection.

When the X-ray revealed fluid in her chest and the bloodwork showed liver abnormalities, her physician sent her to the Emergency Department (ED) at Robert Wood Johnson University Hospital (RWJUH). Thea arrived on a Friday evening. The ED team sprang into action and diagnosed her with multiple liver abscesses, masses filled with pus that can be life-threatening. The abscesses had grown so large they were pushing against one of her lungs, causing fluid to develop there as well. The next day, a team of RWJUH and Rutgers Robert Wood Johnson Medical School specialists discussed Thea’s condition, including infectious disease expert Tanaya Bhowmick, MD; liver cancer specialist Miral Sadaria Grandhi, MD; and interventional radiologist John L. Nosher, MD.

“The most common cause of a liver abscess is a bacterial infection—typically one caused by a group of bacteria known as Streptococcus,” says Dr. Bhowmick.

Worried that the abscesses would burst,causing the bacteria to spread throughout Thea’s body, interventional radiologist Leonard Bodner, MD, inserted a drain—a thin catheter—into her liver to remove the pus. In addition, interventional radiologist Michael Censullo, MD, removed fluid from her lungs, which was caused by pressure from her liver. But it wasn’t until Monday that the team discovered the source of the infection—a bacterium known as Streptococcus intermedius, which is typically found in the mouth or gastrointestinal tract.

The RWJUH team prescribed antibiotics, and multiple catheters removed fluid from Thea’s body. Yet her recovery was grueling.

“I lost 10 pounds in the two weeks I was in the hospital because I had no appetite,” she recalls. “I had to be put on a feeding tube for a week.” Even after she was discharged, Thea had to return to the hospital we ekly over the next five weeks so her physicians could ensure that the pus was still draining from the abscesses.

A Major Medical Decision

In March, Thea landed in the hospital again. Although the abscesses had partially cleared, they had consolidated into one large area. The abscess had become reinfected with a difficult-to-treat bacterium (methicillin-resistant Staphylococcus aureus, also known as MRSA), and she’d stopped responding to the antibiotics. Once again, the abscess was pushing against one of her lungs, causing fluid to build up. Her medical team had to make a major decision: try a different antibiotic or perform surgery to remove the diseased part of her liver.

“We had to weigh the magnitude of the infection against the risk of complications from major liver surgery,” says Dr. Nosher.

Ultimately, the team decided to switch Thea to vancomycin, one of the few antibiotics effective against MRSA.

“Vancomycin can only be administered intravenously when it comes to liver infections, and I was adamant that I wasn’t going home with a port,” says Thea.

She remained in the hospital for five days.

After she was discharged, Dr. Bhowmick put Thea on another powerful antibiotic—Linezolid—and Thea returned to work.

“I left the hospital and went straight to an important budget meeting with the Rutgers chancellor,” she recalls.

A Grateful Patient

In May 2018, Thea was pronounced infection-free.

“I’m so grateful that I didn’t have surgery, which would have been riskier,” she says.

Although she’d never been treated as an inpatient at RWJUH, she raves about the care she received. “Everyone on staff, especially the nurses, was great, and I will never forget that the head of dining services came to see me to find out what he could make that would get me to eat,” she recalls. (She didn’t have an appetite, but he made extra meals for her husband.)

Thea is also grateful for her physicians.

“Dr. Nosher always made an effort to explain what was going on so that I felt involved in every step of the process,” says Thea, whose father was a general practitioner in Paterson. (Thea has always held physicians in high regard.) “My husband used to joke that every morning there was a ‘flock of doctors’ in my hospital room, but we both felt relieved that so many different disciplines—the infectious disease team, the radiology team and the surgical team—were involved in my care. I was especially impressed that they brought in Dr. Grandhi, a liver cancer specialist who was there to consult about a possible biopsy and surgery. I felt like we were all in it together.”

It’s a mentality, says Dr. Nosher, that’s unique to RWJUH.

“Every decision we make is informed by feedback from our entire team,” he says. “Even if we’re not physically present in the hospital, someone from each specialty is on call 24/7 to provide insight,” he says. “Thea’s case was complicated, and I don’t think she would have recovered—and had such a successful outcome—without it.”

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