Caregiving 101 — Bad news needs to shared, even if awkward and unpleasant

12/10/2013 4:08 PM

12/10/2013 4:08 PM

Miss Manners? Dr. Oz? Dear Abby? I had a dilemma on my hands, and I wasn’t sure where to turn for advice. Just what is the proper way to inform your houseguests that you’ve exposed them to a superbug?

You know superbugs — those pesky, antibiotic-resistant, super-contagious bacteria that cause massive infections that can eat away at skin and muscle, put people in the hospital for weeks and drain their health. How do you tell your cousin and his wife and three children (one of whom is immune-compromised) that they’ve been exposed to that?

We’d made plans months earlier for them to visit us. They knew that we were caregivers for my father-in-law (FIL) and that FIL would be here.

Then FIL developed a severe case of shingles. Aware of the shingles-chicken pox connection, we informed my cousin and his wife of the situation. They confirmed that all three of their boys had received two doses of the chicken pox vaccine, and they consulted their family physician. We all agreed they would visit as planned.

Meanwhile, FIL’s shingles sores were not healing well. At my request, a skin swab was taken and sent to the lab.

Our guests arrived. We took a few extra precautions: no direct physical contact between FIL and the guests, a separate chair for FIL’s exclusive use, lots of hand washing.

And then we received some disturbing news. The lab culture indicated that the sores on FIL’s arms weren’t just from shingles. FIL had a MRSA infection.

I flew to the computer and the phone, gathering information from every source I could think of. In a nutshell, MRSA infection is caused by a strain of staph bacteria (Methicillin-resistant Staphylococcus aureus) that’s become resistant to the antibiotics commonly used to treat ordinary staph infections. It usually begins as a painful skin boil and is spread by skin-to-skin contact.

I suddenly felt itchy. My husband, son and I had lots of skin-to-skin contact with FIL. We had definitely been exposed.

But what about our guests? Further research revealed that the bacteria can also be picked up from surfaces, clothing and even pets. Uh oh.

On a positive note, some health worker friends said that MRSA is common in hospitals but that most healthy people don’t suffer ill effects from exposure to the bacteria.

On a downright horrifying note, I read that MRSA sores start as small red bumps resembling pimples, boils or bites but can quickly turn into painful abscesses and that sometimes the bacteria burrow deep into the body and cause life-threatening infections in bones, joints, wounds and the bloodstream, heart valves and lungs. Eek!

Out came the bleach and the rubbing alcohol and the disinfectant skin cleanser. Into the hot wash went every scrap of fabric that FIL had touched. I rushed around cleaning, wiping and spraying, with occasional breaks to do more Internet research and alarm myself even further.

Mostly I stewed about how to tell our guests, who were enjoying the day at Union Station and Crown Center, blissfully unaware of lurking superbugs. Within minutes of their return, I spilled the story.

They were so gracious! Having three kids with many medical conditions, they’d experienced a lot, including exposure to some bad germs. They reassured me that we were all healthy and our odds of avoiding infection were good.

Our guests left the next day (as planned, not because of the MRSA).

Weeks previously, we had requested records from FIL’s last hospital stay. Ironically, they arrived in the mail that very day and indicated that FIL had MRSA when he was released.

We took extreme precautions until FIL’s infection was cleared up and a nasal culture declared him MRSA-free. None of the rest of us — caregivers, family or visitors — broke out in bumps or boils. I cautioned my son to avoid kissing his girlfriend for at least six months, to be on the safe side, and I’m pretty sure he complied. Not.

We were fortunate to avoid further MRSA infections, but things could have gone very differently. When the hospital discharged FIL to my husband, they should have informed him of the risk. Dozens of people were needlessly exposed.

Full disclosure is critical.

What does this mean for caregivers?

It’s difficult to track down records from doctors and hospitals and other care providers, but you have to do it.

The news may be awkward and unpleasant, but you have to share it.

When you have information pertinent to other people’s well-being, put on your best face — and just spill it.

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