Iain Harken’s fevers have always run high.
“103 or 104 degrees is high temperature for a teenager, but not high for Iain,” his mom, Joy Harken, explained. So late last July, when Iain’s temperature spiked, Joy assumed it would disappear in a day or two, just as it always had when her 14-year-old son was fighting off a bug. She gave him Ibuprofen, which brought his temperature down, and stayed home from work to care for him.
But several days after its onset, the fever still showed no sign of breaking, and Iain’s leg started to hurt. Iain, a multi-sport athlete, missed one baseball game and worried about missing another—an scheduled exhibition match at Target Field.
“As the week went on, it started to get worse and worse,” Iain said. “By Sunday I couldn’t put any weight on it.” Late Sunday afternoon, Joy brought him to an urgent care clinic near their home in St. Michael, Minn.
Two hours later, after a battery of tests and a blood culture, Iain was in an ambulance, en route to University of Minnesota Masonic Children’s Hospital. Doctors suspected Iain had developed sepsis, a potentially life-threatening complication that occurs when your body responds to a severe infection.
At Masonic Children’s Hospital, Iain was seen by Infectious Disease Physician Bazak Sharon, MD.
Sharon suspected Iain had a bone infection in his leg, and an MRI scan confirmed that an infection had indeed lodged itself in Iain’s right tibia, one of two bones in the lower leg. The culprit? Methicillin-sensitive Staphylococcus aureus (MSSA), a common and hardy bacteria found nearly everywhere. After further testing, Sharon discovered that the infection was also present in Iain’s bloodstream, which had triggered his sepsis.
Typically, Sharon would prescribe a 4- to 6-week antibiotic regimen to beat back the infection, but on Monday night, just hours after Iain arrived in the hospital, his condition took a surprising turn for the worse.
“Iain started struggling to breathe and his fevers were over 105. I knew, because his temperatures weren’t registering on the thermometers anymore,” Joy Harken said. Overnight, the advanced infection took its toll on several of his bodily organs, which began to shut down. Iain’s skin became mottled as his blood collected in his body core—an automatic response designed to protect his vital systems. Despite medication, Iain’s pain was intense.
“I was in the worst pain ever—by far the worst pain of my life,” Iain said.
A rapid response team evaluated Iain. As his condition continued to deteriorate, they decided to move him into the hospital’s Pediatric Intensive Care Unit for further care. As care providers rushed back and forth, a chaplain stood by Iain’s head, praying.
Enter Orthopaedic Surgeon Fernando Peña, MD. After consulting with Sharon and other providers, Peña decided to take an aggressive surgical approach.
“We knew that he was getting toxic from the infection, from the infection’s accumulation in his tibia,” Peña said. To eliminate the infection at its source, Peña operated on Iain, making a window in his leg to drain and clean the infectious site on the bone. The procedure is called a debridement.
The surgery was effective, and Iain’s condition improved. For more than 24 hours after the surgery, Iain remained sedated and intubated to allow him to rest comfortably, breathe easily and begin healing. But the stubborn infection continued to wrack his body. Over the next several weeks, Peña performed the same procedure two more times, while Sharon monitored Iain’s infection status and his antibiotic regimen. During the third debridement, Peña made a hole in Iain’s tibia to ensure infectious material in the bone would not accumulate.
“The infection just was so heavy in his system, and had built up in so many areas. It had settled into his bone, and it was all over his blood. It was very persistent,” Joy said.
To keep the infection site draining properly and promote healing, Peña installed a wound vacuum in Iain’s leg. The vacuum is a small electric pump that draws fluid out from the infected area. Eventually, the pump and a steady stream of antibiotics via an intravenous PICC line in Iain’s arm wore down the infection. In late August, Iain’s care team removed the wound vacuum and the PICC line. But the infection lingered and began to regain strength days later, so doctors placed a second PICC line to administer antibiotics. By October, 10 weeks after Iain’s initial hospitalization, doctors took out Iain’s PICC line for the second and final time.
Staph infections aren’t uncommon, Sharon said, and healthy teenagers are usually well-equipped to handle them. The virulence of Iain’s infection was unusual, however, and it became clear early on that Iain’s body could not fight it, Peña said.
“We are constantly fighting infections in our body, and when the body cannot handle it, the infection reproduces and grows,” Peña said. “It was basically a perfect storm with an aggressive infection. Nobody expected this. One day he was fine and two days later he was in the ICU.”
But when the unexpected struck, Iain was in the right place at the right time. Doctors at University of Minnesota Masonic Children’s Hospital have experience handling worst-case scenarios and take a multi-disciplinary approach to problem solving, Peña said. Together, Peña and Sharon coordinated their care for Iain, and attended to the needs of his family, too.
“In these situations, the family is under so much stress. We don’t want you leave them without any support,” Sharon said. “You have to ‘treat’ the whole family and be available for them at all times.”
“Iain’s lucky to be alive, and we’re blessed that he’s alive—that’s what really hits home for me,” Joy said. “Our care team was really attentive to our needs as a family, answering our questions and preparing us for different things.”
Though he missed his exhibition baseball game and an entire football season, Iain spent the winter and spring prepping for the spring baseball season, and looks forward to getting active once more. In the mornings, he lifts weights before school, then stays late to catch up with classwork he missed while in the hospital.“It changed my perspective,” Iain said of his hospitalization. “God is always with us. It’s going to get better if you just fight through it, and now I’m almost back to 100 percent.”