By Steve Sternberg, USA TODAY
Joan Bishop's thoughts trend toward disaster. Earthquakes, hurricanes, "dirty bombs," weapons of mass destruction, killer pandemics — she has studied them all.
But Bishop, 46, of Fairfax, Va., says her expertise did little to stop the H1N1 pandemic from landing on her doorstep. Despite taking all the recommended precautions, two of her three daughters, Beri, 10, and Bailey, 13, contracted swine flu. Each posed a different challenge because their unique risks — Beri's autism and epilepsy and Bailey's asthma — made them more difficult to treat.
H1N1 AND KIDS: Swine flu strikes most vulnerable hardest
INTERACTIVE: Swine flu map, flu IQ quiz, video and latest news
What's more, Bishop says, her expertise intensified her concerns about her children.
"I know too much," she says.
The worst-case scenarios
A disaster preparedness expert for the consulting firm Booz Allen Hamilton, Bishop has helped draft pandemic plans for the Department of Defense and the Department of Health and Human Services. She has absorbed the medical literature and studied the case histories.
As her children grew sicker, she was overwhelmed with anxiety over what might happen next. She couldn't shake the worst-case scenarios that were running through her mind.
"I knew what was happening medically. I've read the autopsy reports. Seeing those was scary," she says.
The Bishop family's ordeal illustrates one of the central paradoxes of the pandemic. Unlike seasonal flu, H1N1 has taken a disproportionate toll on children.
Beri's symptoms set in on Nov. 1, when H1N1 vaccine was still in short supply. Right after Halloween, Beri developed a high fever and respiratory symptoms.
Her pediatrician diagnosed Beri with flu complicated by pneumonia. She prescribed antibiotics and the antiviral drug Tamiflu. But Beri, who already was taking medication for seizures and an inactive thyroid, was gripped with anxiety about taking any more pills.
"She was paralyzed with fear of choking, because she was coughing so much," Bishop says.
Her parents' urging to follow the doctors' orders hardened her resistence. Soon she refused to take any medication at all. "I was stressed that she was not taking her antiviral and antibiotics," Bishop says. It was Beri's refusal to take her anti-seizure medication "that almost did me in," her mother says. "You can't have a seizure on top of this," she implored her daughter.
Her parents tried liquid Tamiflu, Bishop says, but that didn't help: "It tasted like gasoline." The usual advice — "put it in applesauce" — didn't work. Ultimately, she ended up washing the drug down with big gulps of cola. She still refused to take her antibiotics, so doctors began giving them to her intravenously and through injections. Eventually, the medicine helped, and Beri began getting better.
Then, in the first week of December, back from a family vacation in California, Bailey got the flu, complicated by an ear infection.
She was diagnosed on Sunday, Dec. 6. Doctors prescribed Tamiflu and antibiotics. By Wednesday, Bishop says, her father took Bailey back to the doctor. "She was having severe symptoms for someone who had been on Tamiflu for four days." A chest X-ray was negative.
Bailey's ordeal worsens
By Friday, Dec. 11., Bailey's temperature hit 103 degrees and stayed there. She began coughing so persistently that she couldn't sleep. In the early hours of Dec. 12, her parents took her to an urgent-care center because she couldn't breathe. A doctor prescribed oral steroids, drugs known to ease airway congestion.
Based on a new chest X-ray, Bishop says, the doctor diagnosed pneumonia. But three subsequent X-rays and a CT scan of Bailey's chest proved inconclusive. One clue to Bailey's misery may lie in the autopsy research Bishop cites.
The studies, by Jeffrey Jentzen at the University of Michigan and James Gill of New York University and Jeffrey Taubenberger of the National Institute of Allergy and Infectious Diseases, show that unlike most flu viruses, H1N1 can settle deep into the lungs. "We're not sure why," Jentzen said in a recent interview.
A new crisis began on the morning of Christmas Eve, after a visit with Santa Claus at a local mall. Bailey began wheezing, and despite treatments with nebulizers at home, her blood oxygen level began dropping. A doctor recommended that Bailey be admitted to Inova Fairfax hospital, where she stayed for two days.
Since then, she has been sustained on steroids, given orally and through inhalers. "She's better than she was, but she's not back to her full capacity," Bishop says. "Her asthma is worse than before."
Doctors allowed Bailey to stop taking the oral steroids in January. She is slowly getting better, Bishop says, but it may be months before she fully recovers.
Joan Bishop's thoughts trend toward disaster. Earthquakes, hurricanes, "dirty bombs," weapons of mass destruction, killer pandemics — she has studied them all.
But Bishop, 46, of Fairfax, Va., says her expertise did little to stop the H1N1 pandemic from landing on her doorstep. Despite taking all the recommended precautions, two of her three daughters, Beri, 10, and Bailey, 13, contracted swine flu. Each posed a different challenge because their unique risks — Beri's autism and epilepsy and Bailey's asthma — made them more difficult to treat.
H1N1 AND KIDS: Swine flu strikes most vulnerable hardest
INTERACTIVE: Swine flu map, flu IQ quiz, video and latest news
What's more, Bishop says, her expertise intensified her concerns about her children.
"I know too much," she says.
The worst-case scenarios
A disaster preparedness expert for the consulting firm Booz Allen Hamilton, Bishop has helped draft pandemic plans for the Department of Defense and the Department of Health and Human Services. She has absorbed the medical literature and studied the case histories.
As her children grew sicker, she was overwhelmed with anxiety over what might happen next. She couldn't shake the worst-case scenarios that were running through her mind.
"I knew what was happening medically. I've read the autopsy reports. Seeing those was scary," she says.
The Bishop family's ordeal illustrates one of the central paradoxes of the pandemic. Unlike seasonal flu, H1N1 has taken a disproportionate toll on children.
Beri's symptoms set in on Nov. 1, when H1N1 vaccine was still in short supply. Right after Halloween, Beri developed a high fever and respiratory symptoms.
Her pediatrician diagnosed Beri with flu complicated by pneumonia. She prescribed antibiotics and the antiviral drug Tamiflu. But Beri, who already was taking medication for seizures and an inactive thyroid, was gripped with anxiety about taking any more pills.
"She was paralyzed with fear of choking, because she was coughing so much," Bishop says.
Her parents' urging to follow the doctors' orders hardened her resistence. Soon she refused to take any medication at all. "I was stressed that she was not taking her antiviral and antibiotics," Bishop says. It was Beri's refusal to take her anti-seizure medication "that almost did me in," her mother says. "You can't have a seizure on top of this," she implored her daughter.
Her parents tried liquid Tamiflu, Bishop says, but that didn't help: "It tasted like gasoline." The usual advice — "put it in applesauce" — didn't work. Ultimately, she ended up washing the drug down with big gulps of cola. She still refused to take her antibiotics, so doctors began giving them to her intravenously and through injections. Eventually, the medicine helped, and Beri began getting better.
Then, in the first week of December, back from a family vacation in California, Bailey got the flu, complicated by an ear infection.
She was diagnosed on Sunday, Dec. 6. Doctors prescribed Tamiflu and antibiotics. By Wednesday, Bishop says, her father took Bailey back to the doctor. "She was having severe symptoms for someone who had been on Tamiflu for four days." A chest X-ray was negative.
Bailey's ordeal worsens
By Friday, Dec. 11., Bailey's temperature hit 103 degrees and stayed there. She began coughing so persistently that she couldn't sleep. In the early hours of Dec. 12, her parents took her to an urgent-care center because she couldn't breathe. A doctor prescribed oral steroids, drugs known to ease airway congestion.
Based on a new chest X-ray, Bishop says, the doctor diagnosed pneumonia. But three subsequent X-rays and a CT scan of Bailey's chest proved inconclusive. One clue to Bailey's misery may lie in the autopsy research Bishop cites.
The studies, by Jeffrey Jentzen at the University of Michigan and James Gill of New York University and Jeffrey Taubenberger of the National Institute of Allergy and Infectious Diseases, show that unlike most flu viruses, H1N1 can settle deep into the lungs. "We're not sure why," Jentzen said in a recent interview.
A new crisis began on the morning of Christmas Eve, after a visit with Santa Claus at a local mall. Bailey began wheezing, and despite treatments with nebulizers at home, her blood oxygen level began dropping. A doctor recommended that Bailey be admitted to Inova Fairfax hospital, where she stayed for two days.
Since then, she has been sustained on steroids, given orally and through inhalers. "She's better than she was, but she's not back to her full capacity," Bishop says. "Her asthma is worse than before."
Doctors allowed Bailey to stop taking the oral steroids in January. She is slowly getting better, Bishop says, but it may be months before she fully recovers.
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