Flesh-eating bacteria takes arm but not will

IOWA CITY - The fall off the curb onto her right elbow Feb. 25 felt awkward. But, thought longtime nurse Rhonda Muhlenbruch of Iowa City, certainly not life threatening.

Not until Feb. 26 when the pain became excruciating, when she felt extreme nausea and began vomiting, when her veins closed. And then Feb. 27 when her blood pressure fell to 50 over 30, when her heart beat 200 times per minute, when her organs shut down, when her skin became jaundiced, when black blisters covered her elbow, when doctors huddled in the emergency room to determine the cause.

Necrotizing fasciitis, they theorized. Flesh-eating bacteria.

“I've never been this sick,” Rhonda told her only daughter, Abbey, as the family was called to the intensive care unit at Mercy Iowa City. “I'm going to die, but don't cry.”

By 7 p.m. that night Rhonda had been transferred to U of I Hospitals and Clinics. By 8 p.m. her right arm had been amputated above the elbow.

That was just the first of five surgeries. More of her arm was cut off. Part of her side. Part of her breast. The bacteria's rapid growth had to be stopped. If not, Rhonda would die.

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In 1989, about nine months after being hospitalized for nine weeks to give birth to twins, Abbey and Benjamin, Rhonda suffered chronic sinus problems. Several surgeries later a horrible headache sent her to the emergency room. Within two hours she was in a coma. She underwent a spinal tap.

Bacterial meningitis.

“I nearly died at that time,” she says. “I had a white light episode then. I saw my mom who told me to turn around and go take care of my babies.”

Her mother had been gone seven years. Rhonda would be in and out of the hospital for eight weeks. She would pass a psychological test to ensure she was stable enough to return to nursing.

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Walking up her Iowa City condominium stairs, Rhonda, 49, steadies herself by pressing her left palm against the wall. The right side railing does no good because she has no right hand or arm.

“One of the most frustrating things is trying to spread peanut butter on a piece of bread,” she says.

Or, the fact that her house this Thanksgiving morning will not be filled with the aroma of frying bacon and onions as she prepares homemade stuffing for the traditional family feast.

“I can't make Thanksgiving dinner,” she says through tears. “Some of that is just taking hold.”

For Rhonda, delayed grieving mixes with anger as she fights with her insurance company for a motorized prosthetic arm.

With medical costs approaching $1 million, Rhonda has nothing but praise for her insurance. That is, until it determined she only needs a simple prosthesis, one that won't even bend at the elbow, instead of a $116,000 electronic arm with moving fingers.

“What are these prosthesis for if not for people like me?” Rhonda says. “In order to be the best person I can, the most productive I can be, I need this prosthesis. I'll be back on the tax rolls. I won't be a burden to the government.”

She and husband, Terry, have written to government officials, including President Obama, figuring they have nothing to lose.

In the meantime, even though medication helps, phantom pain prompts Rhonda to scratch an arm that isn't there.

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Rhonda and Terry thought tough times were behind them. Married since 1983, they'd built a 5-bedroom home and watched children Michael, 25, Nick, 22, and the twins, 20, grow up.

But Terry lost his job as a sale representative for a national roofing company and they had to sell the house and he became shipping coordinator for IAC in Iowa City until he was laid off in May, although he was recalled last week.

Rhonda, a former pediatrics, surgical, ER and visiting nurse, was working for a hospital billing program company. But damaged vocal chords from tubes in her throat ruined her voice, making her return impossible.

As Rhonda fell on her right side, she protected grandson, Brayden, 11 months old, by holding his head in her left hand.

“One of the hardest things,” she says today, “is I can't pick up the grand babies. I can't baby-sit them by myself because somebody has to put them in my lap.”