Real Life Impacts: The Story of Linda Rivera
Linda Rivera’s E. coli O157:H7 Infection
In May of 2009, Linda Rivera was a wife and mother leading an active life with her husband of almost ten years, Richard. Their marriage, on September 25, 1999, had created a blended-family, with each one contributing three children.
From all accounts, nothing mattered more to Richard and Linda than their children. As Linda’s mother recounts:
Linda and her husband Richard are totally devoted to the boys and involved in all of their activities. They volunteer hours, thousands of hours of time to help get money for the sports and for their equipment and so forth. They attend all the games and have cheered them on. She put 25 hours a day into those children. And no matter how tired she was if it was in her power to do it, she would do it. And this was on a daily basis.
Linda dedicated a lot of her time to helping out with sports-teams on which her boys competed, such as the high school’s wrestling and soccer teams. All the boys had to do was ask, and Linda would stop what she was doing to help.
Linda Falling Ill with E. coli O157:H7, and Nearly Dying
Linda was 57 years old in May 2009. In addition to be physically fit, Linda did not drink or smoke. She had also just received news that her annual physical exam and routine blood-work had revealed that she was in excellent health.
On May 3, Linda was going about her normal routine when she began to fall ill. “I felt like I had the cold, the flu, something like that,” she said. “It seemed like it would pass but I started throwing up. I even had blood in my stool.” There was also nausea, which was followed by painful abdominal cramps.
By May 5, Linda’s condition had worsened to the point that she had to be taken to the emergency room where a doctor thought Linda was suffering from a case of acute gastroenteritis, and decided to treat her with IV fluids, and prescribe medication for pain, nausea, and vomiting. She was also observed in the ER for a few hours, before being sent home.
Unfortunately, it was not long after Linda returned home that her diarrhea and vomiting drastically worsened. As Richard recalls: “She was getting up every three to four minutes.” Still, Linda persevered, trying to remain hopeful that she would soon be feeling better. Richard hoped the same thing too. That was why it was such a shock when, early the next morning, he found his wife downstairs on the floor curled up in the fetal position. He rushed her back to the hospital.
The ER nurses noted profuse diarrhea, and a stool specimen was sent to the lab. She was once more started on IV fluids, and then given medication for nausea and pain. After blood samples were obtained and sent for testing, she was sent for a CT scan of her abdomen. The results of the CT scan showed evidence of colitis. The doctor on duty found Linda’s presentation to be quite alarming, and started her on IV-antibiotics. She was then admitted to the hospital for more comprehensive testing.
Linda’s Long Hospitalization for E. coli O157:H7 Infection and its Complications Begins
Once admitted to the hospital, multiple studies were conducted in attempts to determine the cause of Linda’s illness.
On May 6, 2009, a CT angiogram was done on Linda’s abdomen, as well as an MRI. Multiple organs were noticeably swollen, but for the moment the cause of Linda’s suffering was still largely unknown.
The next day, May 7, a gastroenterologist was called in for a consultation on the diagnosis of colitis. The doctor reviewed Linda’s history of recent-onset nausea, vomiting, and bloody diarrhea, now of four days duration, and looked at the results of the CAT scan. The doctor agreed with the diagnosis, but did not offer any new insight into the cause of the colitis. There was, however, a confirmation of a falling platelet count, thrombocytopenia.
Linda continued to be hospitalized and was not improving. She continued to have bloody diarrhea, and blood work showed deteriorating kidney (renal) function.
In light of the deteriorating kidney function, aggressive IV-hydration was recommended to further treat severe dehydration, which was thought to be contributing to her renal failure. Doppler studies of Linda’s renal arteries were ordered, as well as an ultrasound of both her kidneys and abdomen. No obstruction was found, but there were notable changes in the renal arteries suggestive of renal disease.
At the same time, an oncologist was called in for consultation because of concern for Linda’s worsening anemia. In addition to ongoing renal failure, the doctor diagnosed Linda as suffering from possibly hemolytic uremic syndrome (HUS), a condition known to be related to E. coli infections. The doctor advised placement of a catheter for the purpose of dialysis, and he also recommended a blood transfusion.
That afternoon, the stool specimen collected on May 6 confirmed the diagnosis, when it was found to be culture-positive for a heavy growth of E. coli O157:H7. The sample was sent to Southern Nevada Public Health Lab for confirmation.
With the stool-culture results having confirmed an E. coli O157:H7 infection, yet another specialist was called in to consult on Linda’s case—this time a general surgeon.
Surgery to Save Linda
On May 8, Linda was taken to the operating room, where part of her colon was removed. A colostomy procedure was also performed.
The day after surgery, May 9, Linda, who was requiring mechanical ventilation, underwent therapeutic apheresis for the first time. Once apharesis was done, she underwent a session of hemodialysis, which occurred later that same day.
On May 12, now four days post-surgery, doctors ordered a CT scan of Linda’s abdomen. Although the scan showed expected changes from the colectomy and colostomy, it found the interval development of fluid-collection around both lungs (pleural effusion), as well as solid areas where there was no air movement (atelectasis).
Nonetheless, Linda was still scheduled to be weaned off the ventilator later that day—or, at least, there was going to be an attempt to do so. But first she needed to complete apheresis and dialysis.
Trying to Breathe On Her Own, and Then a Possible Stroke
Linda’s chest x-ray early in the morning of May 13 revealed that the effusions and edema around her lungs were largely unchanged. Later, the ICU nurse attempted to remove her from the ventilator, causing Linda to become restless and anxious. As the weaning-attempt proceeded, a change in blood gasses forced an abrupt end to the procedure.
Apheresis proceeded as scheduled.
By the next day, Linda’s family members were beside themselves with worry and fear. They had hoped the surgery six days before would be the turning point that would return Linda to good health. Then they had hoped that her being removed from the ventilator would be the turning point. Now, this dearly loved mother, wife, and daughter lie in bed sicker than before, neither breathing on her own, nor showing any sign of getting better. As one of her sons recalls of this time-period:
She was there on a ventilator for like a week. That’s when I didn’t know if she was going to come off of it. At that point I kind of felt guilty because I didn’t really get to express my feelings towards her, my loving feelings towards her. And it scared me a lot; I had never been without my mom before. She had been a huge part of my life. That’s when it hit me first.
In the face of this, the emotional pain grew as family clung to waning hope. It was especially devastating when they learned that Linda might have suffered a stroke, and that the plans for a second attempt at removing her ventilation-tube were being put on hold.
The next morning, May 15, Linda was sent for an MRI, which showed a normal-appearing brain.
After apheresis around midday, an EEG was done. It confirmed an alteration in cognitive abilities and a decline in level of consciousness.
The one somewhat positive thing was that the doctors made a successful attempt at getting Linda off the ventilator. Accordingly, the orders for that afternoon were to extubate her, and then start her on oxygen to keep her blood oxygen levels at least at 95%, using a continuous positive airway pressure (CPAP) machine. She was also to be given racemic epinephrine, which is often used in nebulizer form for pediatric asthmatic patients.
Ten Days of Praying for Signs of Improvement
“This terrible ordeal that Linda’s going through, it’s not only affecting her but it’s been a terrible nightmare for the whole family. Her husband Richard has been by her side constantly, day and night. Her boys have steadfastly stayed beside her, and no matter up or down, they tell her she’s a fighter. Richard won’t leave her side; unless someone else comes, he won’t budge, and she is never left alone.”—Linda’s Mother
By May 16, Linda had been hospitalized for ten days, and remained in critical condition. She no longer required mechanical-ventilation to breathe, but the full-face CPAP mask and noisy machine hardly seemed to her family to be a significant improvement. An early-morning chest x-ray confirmed that swelling and fluid collection in and around her lungs had not changed. And it was still necessary for her to daily endure apheresis and dialysis.
Over the next ten days, little changed in Linda’s condition, which was both good and bad. She maintained satisfactory levels of oxygen-saturation in her blood, but only because of CPAP ventilation. She continued on daily dialysis and apheresis. Repeat chest x-rays found no changes of significance in fluid accumulation in and around the lungs, and swelling of her body (edema) neither improved, nor got markedly worse.
However, Linda’s cognitive condition was an area of increasing concern. Doctors noted that she would stare blankly, mumble unintelligibly, and could not follow commands. Such confusion remained her default condition as her hospitalization continued. In the words of Richard’s brother, who has a background in medicine, Linda was now:
“cognitively impaired from a combination of metabolic derangements induced by critical illness and pharmacologic (medication) effect. It is hoped that her body moves toward metabolic equilibrium and her liver helps metabolize out the medications, as well as temporary dialysis support washes out toxic metabolites, she will have restored cognition. This will take time and patience. For both Linda and Richard, this is a walk down a long road to recovery that will test and strengthen the heart of their relationship along all the way”
Planning for Discharge to a Rehabilitation Facility:
“Linda narrowly escaped death these past few weeks. Many have died after being a lot less sick than her. She has been the subject of a lot of prayers...”—Richard’s Brother
By May 26—after 20 days in the hospital—Linda’s condition had remained stable enough that doctors decided she could be discharged to a rehabilitation facility, where she was to have physical and occupational therapy. At the time of her discharge, Linda was cleared for an oral diet, although she remained on parenteral (IV) nutritional supplementation.
On the morning of May 27, after early-morning dialysis, a chest x-ray, and a brain MRI, Linda was discharged from the hospital and transferred to a Las Vegas rehabilitation facility. Unfortunately, before any treatment plan could be put into place, Linda developed severe chest pain and shortness of breath. So, on May 30, she was rushed to the hospital for emergency treatment of respiratory distress and signs of fluid-overload. Once admitted, she was transferred for emergency hemodialysis.
In the Hospital Again
When Linda presented at the hospital, a chest x-ray showed pulmonary edema consistent with fluid overload. This, combined with the fact that Linda was unable to take a breath and had difficulty speaking reinforced a sense of urgency in starting Linda on dialysis to remove as much retained-fluid as possible.
The first dialysis session resulted in the removal of five liters of fluid. Seven liters were removed on May 31, and five liters on June 1. The aggressive dialysis seemed to have stabilized Linda’s condition.
Although the life-threatening risks created by the fluid-overload had been mostly abated, Linda continued to suffer mightily from incessant vomiting. She had been vomiting so much, and so violently, that there was blood present in the vomit. An endoscopy was scheduled for the next day.
A repeat chest x-ray continued to show no improvement in either the pulmonary edema or congestive heart failure. There was, as a result, the need for another session of dialysis, which this time removed three liters of fluid.
On June 6, Linda underwent an endoscopic procedure—an esophagogastroduodenoscopy (EGD), a scope of the throat, esophagus and stomach. The procedure revealed a hernia and extensive stomach inflammation. A stomach tube was recommended with low-to-intermittent suction to remove excess stomach acid.
Over the next four days, Linda underwent dialysis twice more, and each session removed two liters of fluids. On June 12, Linda also received a blood transfusion because of a low red blood cell count. She also continued to suffer from poor kidney function and fluid accumulation and infiltrates in and around her lungs. On top of this, there was a growing indication of gallbladder disease, including the apparent blockage of the flow of bile from the liver to the gallbladder. But, fortunately, this was not felt to require surgery at this time.
With Linda neither improving, nor getting much worse, watchful waiting was the order of the day. On June 15, it was decided that Linda was stable enough to return to the rehabilitation facility.
Linda was admitted to the rehabilitation facility on June 16, and would spend the next thirty days there. She had been transferred to the facility “for the failure to thrive on total parenteral nutrition and [to receive] IV antibiotics.” During her stay, she had finished a prescribed course of antibiotics, and, as described in the discharge report, “slowly progressed, and is now tolerating regular diet.” But Linda was also “debilitated,” and still required “acute rehabilitation.” She was therefore being transferred to another rehabilitation center, in Henderson, Nevada.
Another Rehabilitation Facility, Another Setback:
Over two months after falling ill with her E. coli O157:H7 infection, Linda was admitted to the Henderson rehab facility on July 17.
In addition to the other diagnoses, doctors at the facility added “severe disuse myopathy”—that is, acute muscle weakness from critical illness. To address this, doctors ordered comprehensive rehabilitation training, to include: physical therapy (PT), occupational therapy (OT), and 24-hour nursing care. Linda also was to remain on a clear liquid diet for the moment for her nausea.
The next seven days proved to be both frustrating and futile. Several attempts were made at PT and OT, but severe abdominal pain and nausea kept Linda from actively participating in a meaningful way.
On July 20, sessions of OT and PT were tried again, but Linda was miserable with nausea and vomiting and unable to participate. That morning, around 9:20 AM, she reported having difficulty breathing. Because Linda’s painful symptoms did not improve, she was moved back to the hospital for acute care.
To the Hospital for a Third Time, and a Second Surgery
“There were a lot of times I didn’t think I’d make it. You start thinking all sorts of things. I even asked my husband, am I dying? But it’s hard to always wonder if you’re dying or not.”—Linda Rivera
Linda was admitted to the intermediate care unit on July 24.
Over the next two days, Linda underwent a CT scan of the abdomen, which showed fluid around her gall bladder, and a CT scan of the brain due to “altered mental status.” She also had an HIDA scan, which is an imaging procedure that tracks the production and flow of bile from the liver to the small intestine. Based in part on the results of the HIDA scan, a surgeon was called in for a consult. His impression was that Linda had acute cholecystitis (inflammation of the gallbladder), and advised a gallbladder removal, or cholecystectomy.
On July 26, Linda was to the operating room to remove her gallbladder. Due to extensive inflammation and adhesions causing limited visibility, the operation had to be an open procedure, rather than a laparoscopic procedure.
Four days after surgery, Linda was deemed to be doing well enough, albeit barely, that she could be managed on home healthcare.
One Day Home, Then Mounting Disaster
On August 3, just three days after being sent home, Linda was once more acutely ill, and was taken back to the emergency room. She improved with administration of morphine and was again discharged home. She then struggled for another five days to stay there, but by August 8, she was again back at the emergency room. This time she was so dehydrated that she could not walk and was readmitted to the hospital.
A Fourth Time in the Hospital, Then Rehab, Round Three
“It was really difficult this whole time because I was truly watching Linda disintegrate into nothing. I mean you could see the protein and all the muscle going out of her fingers and her legs. Watching her suffer and wiggle in bed is horrible.”—Richard Rivera
Linda would remain in the hospital for ten days. She would be seen by a number of specialists, including a gastroenterologist, nephrologist, and an infectious disease doctor. A few new concerns were raised—for example, elevated liver enzymes and severe esophagitis. But mostly, Linda was facing still the same old the challenges: abdominal pain, nausea, vomiting, poor kidney function, severe de-conditioning, malnutrition, and difficulty breathing.
On August 18, her attending physician felt that Linda was stable enough to be discharged from acute hospital care to a rehabilitation facility.
In the days that followed, concern increased about Linda’s “altered mental status.” A specialist was called in due to continuing concern for “altered mentation.” It was noted that Linda was weak and did not verbalize. A subsequent EEG was mildly abnormal, revealing: “Metabolic, degenerative, infectious, ischemic, traumatic, dementing, or other generalized encephalopathic conditions.”
For good or bad, Linda’s condition remained stable, meaning she was neither getting worse, nor getting better.
Hospitalized Again: Ending up on Life-Support
“The day that I can remember that was the hardest day was the day that I found out that she was going, we had a choice to put her on life support or not. The doctor said that if we don’t she would pass away over the weekend. And it was a Friday so she had one day, two days. She just looked like a body, she didn’t look like herself.”—Linda’s son
On September 11, Linda unexpectedly developed a fever, and this prompted doctors to immediately readmit her to the hospital with a direction to push IV fluids and antibiotics. Admitting diagnoses were sepsis, bilateral pneumonia, fungal UTI, and elevated liver enzymes. They were also to rule out cholangitis (infection of the bile duct), stage II decubitus ulcer, anemia, de-conditioning, and encephalopathy/delirium secondary to the sepsis.
On same day of her admission, a specialist, who had been called in for a respiratory consultation given the suspected pneumonia, saw Linda. With her complex medical history and her inability to communicate, Linda’s condition was unmistakably dire at this point. The doctor told Richard that Linda’s respiratory status was beyond serious, and he recommended that she be intubated and mechanically ventilated. He considered her prognosis quite guarded, at best, and urged a quick decision.
This was not the first time that Richard and Linda’s sons faced the prospect of losing her. She had been given last rites before. But this time the decision the family faced—faced for Linda and for themselves—was whether to let her go, to be free of her suffering. As Richard recalls:
“I had gotten all the kids together, her parents and her sister. We all decided that we loved Linda so much, and not to give her a second chance at life would be stealing a lot from the world. And so we did, we put her on life support that night. And the hardest part was when the doctor said she might not come out of this; she may never become conscious again. So we all went in and said our goodbyes to Linda and all circled around and prayed for her. I envisioned losing my best friend and my wife, and it was the hardest thing that I ever had to do. I wouldn’t wish that upon anyone”.
Watching and Waiting and Praying
“Whenever she has enough awareness to know how she’s feeling, most of the time she is really scared. There have been points when she knows she’s getting worse and she knows there’s a greater chance of dying than living, and it scares her a lot.”—Linda’s son
The next five days were touch-and-go, filled with stress and anguish for the family. Linda was being closely monitored, with frequent chest x-rays, and continued on IV-antibiotics.
Because she was still in respiratory failure on September 22, Linda’s doctors decided that a tracheostomy tube was needed. The surgery was done at the same time as placing a percutaneous endoscopic gastrostomy (PEG) tube, inserted into the stomach for feeding.
Stabilized—Not Getting Better, Nor Getting Worse
“It was really hard not having her home. Richard, that’s his job, he’s always at the hospital every day, 24/7. Or, here for an hour trying to sleep or at the school. It’s just hard doing things without your mom.”—Linda’s son
By September 25, Linda’s condition was stable on the ventilator, and it was decided that she could be transferred back to the Hospital. Her transfer notes repeated the same long list of life-threatening infirmities, and the sixteen medications that she was getting at the moment. The situation had become a soul-wearying story that seemed never to end.
On November 11, after what had appeared to be a relatively long period of stability, one of Linda’s doctors took a decidedly pessimistic view of the probability of a recovery. After examining her and evaluating her liver, Linda was described as “encephalopathic and poorly responsive.” While recommending the continued monitoring of her liver function, it was now thought that Linda’s liver was failing for good.
The family was stunned. Richard’s brother writes:
“Linda is not a liver transplant candidate so the only thing really left is supportive care. Her prognosis overall remains essentially terminal, from a medical standpoint…. Rich remains realistic, recognizing the doctors can do only so much. There really is nothing else to write here.”
And so the family continued to watch, wait, and pray. They also noted the bitter irony in the fact that it had been the liquid-nutrients—fed to her to in order to keep her alive—that had caused her liver failure.
A New Year Arrives, Bringing but Small Hope
As the first month of the New Year drew to a close, Linda was beginning to slowly improve. The improvements were small, but notable. Over the next few months, things ebbed and flowed with Linda persevering through bacterial pneumonia, intermittent hallucinations, and the return of abdominal pain.
And then, on April 12, 2010, Linda was discharged at last from the hospital, and transferred to a new state-of-the-art rehabilitation facility in San Francisco.
Finding the Long Road Home
At the San Francisco rehabilitation facility, Linda was to receive state-of-the-art rehabilitation-care from a multidisciplinary team of doctors, occupational and physical therapists, nutritionists, nurses, and specialized medical assistants. Richard knew that it would be a “long journey,” but it was one that he was committed to making with Linda in order to try to get her home. It was thus necessary for him to move to San Francisco to be by Linda’s side, while the boys remained back in Nevada to finish their senior year of high school.
On April 13, Linda started physical, occupational, and speech therapy. Evaluation by a neuropsychologist also occurred. The doctor diagnosed a decrease in cognitive function—something that Linda was well aware of, and the source of intense frustration, leaving Linda quite depressed.
Linda continued to be cared for at the San Francisco rehabilitation facility over the next several months. On May 7, the occupational therapist noted slow progress improving range of motion, while the continuing lack of strength in her hands kept her from being able to hold onto things. Describing how this made her feel, Linda stated:
Sometimes I get angry, but if it wasn’t me it would have been somebody else probably. Somebody had to get sick. I’m not angry anymore, I was angry, I was very angry. One of the most difficult things for me has been the loss of control. I can’t control my hands, I can’t hold a cup, and it goes right through my hands. I can’t hold it tight. And people look at you funny. You have your hands it looks like you should be able to drink and hold it. I’m working on all of this very hard.
Throughout May and June, Linda and Richard continued to struggle together in rehabilitation. Despite nearly constant pain, Linda found solace in thing such as being able to stand for 15 minutes. Richard was there to watch Linda brush her teeth and to learn to drive her new power chair. Notes from therapy from May and June document Linda’s struggle:
“…would freeze or “zone out” in the middle of brushing teeth and need max cues to initiate motor movement again. …”
Linda’s Prognosis: Overall
Looking at the overall picture regarding Linda’s future, doctors are not optimistic:
It is very doubtful she will ever return to her previous good health given her persistent severe debility and damage to her kidneys and liver and her persistent cognitive impairment, weakness and contractures. It is likely she will require assistance for her activities of daily life for the reminder of her life and it is clear she will require continued multidisciplinary rehabilitation therapy indefinitely just to maintain her current diminished state of functioning.
Linda’s Prognosis: Kidneys
Weighing in on Linda’s condition in July of 2010 is one of the world’s leading E. coli medical experts, who, in the conclusion of his report, does not mince words, writing:
Linda Rivera, has survived the severest multiorgan (bowel, kidney, brain, lung, gall bladder, pancreas) case of E. coli mediated HUS I have seen in my extensive experience. But her survival has come with a great price—namely the burden of irreversible multi-organ damage.
Furthermore, the doctor detailed “the litany of medical events that characterized the acute phase of her E. coli O157:H7 mediated HUS,” and “the long-term consequences caused by her…infection.” Such consequences notably include chronic brain damage and chronic progressive kidney damage, with eventual stage 5 chronic kidney disease.
Proceeding with his detailed analysis, the doctor offers the sad but not surprising opinion that Linda is already “in the low end of stage 3 chronic kidney disease (CKD).” As a result:
Her advanced chronic kidney failure will, more likely than not, progress through stage 4 to stage 5 CKD (end-stage renal disease [ESRD]), and will, in the process, progressively take its toll on her health:
She is already anemic, and will, as her renal function declines, experience progressive anemia.
She is already osteopenic and will experience additional loss of bone density as her renal function worsens.
Her high blood pressure will return as she experiences additional kidney damage (from hyperfiltration injury).
She will experience a progressive reduction in her ability to excrete waste products and maintain fluid and electrolyte balance, and will experience uremic poisoning.
All of this will result in Linda and her family being soon forced to face difficult life-and-death choices. The doctor explains: “As her renal failure worsens and she develops stage 5 CKD (ESRD), her two options will be palliative care or dialysis (she will not be a candidate for transplant[.]). It is not possible at this time to accurately predict when she will reach stage 5, but it is my opinion that it will be within the next 5-15 years.”
Linda’s Prognosis: Gastroenterology
To assess the numerous and complicated issues related to Linda’s gastrointestinal disease and injury, an eminent gastroenterologist was asked to evaluate Linda’s case. After detailing the course of her illness, the doctor noted that many of the life-threatening problems that Linda continues to suffer from may also be due to permanent damage to her liver. For that reason, another specialist was asked to comment, to provide an expert opinion on the condition of her liver, and to evaluate her as a transplant candidate. In his report, the doctor states:
Based on the current data, I am concerned that Mrs. Rivera has evidence of cirrhosis. The cause of her cirrhosis is secondary to multiple factors including sepsis, ischemia and biliary obstruction. These multiple factors combined with her poor nutritional status have contributed to her cirrhosis.
Linda’s Prognosis: Neurologic and Psychological
To assess the psychological effect of Linda’s E. coli O157:H7 infection, a neuropsychologist was called in. He reports:
During brief examinations at several points during the two days of evaluation, Linda was lethargic and minimally responsive to verbal commands. She was oriented to her name and partially to place information when given multiple choices. She was unable to sustain attention to verbal commands or repeat short phrases. She did not follow one-step motor commands. At times she responded verbally with one or two word answers to a series of three questions before becoming less responsive and fixating her gaze in the right upper visual field. At one point, when asked what she was looking at she responded “a bright light”. Her speech was extremely limited and she often repeated the last word of a question. She did not spontaneously greet anyone or spontaneously initiate any verbal behavior, with the exception of pain complaint.
Linda’s Prognosis: Pain, Suffering, Emotional Distress, and Lost Enjoyment of Life
“It has definitely been an emotional roller coaster for all of us. “The boys truly did have to grow up. They have kind of been taking care of themselves on their own, which really breaks Linda’s heart. From my standpoint, I miss the times when I used to come home from work and just sit on the couch with her and hold her in my arms. So, yeah, it really has changed our life and turned it completely upside-down. When I think about the future, I don’t know what the quality of life Linda’s going to have. I don’t know if she’s going to be bedridden. But I see the future with her at least being able to hold her hand and kiss her head.”—Richard Rivera
Linda’s Medical Care Costs
Linda’s Medical Expenses from May, 2009 – August, 2010 alone totaled over $6.2 million.
The costs of Linda’s future medical care range from nearly $16 million to just over $61 million in 2010 dollars. Estimates vary based on medical procedures required and life expectancy.