BANGOR, Maine — Matt Nichols cradled his newborn daughter, Ruby Ann, in his arms Wednesday morning, gazing into her sleeping face.
When Matt, 29, accompanied his pregnant wife to Eastern Maine Medical Center on Aug. 1, he said he never could have imagined he’d raise their first child on his own after a vicious infection claimed the life of his wife just days after giving birth. Heather Nichols, healthy and also 29 years old, had carried little Ruby through a normal pregnancy. She’d researched the ins and outs of pregnancy and childbirth, preparing herself to become a mother.
After 20 hours of labor, Heather gave birth with Matt at her side. A framed photo in the couple’s Bangor apartment shows her beaming, holding Ruby in her arms.
But, as Matt explained, things soon took a turn for the worse after the young family returned home. Matt said Heather had undergone an episiotomy, a small surgical incision that enlarges the vaginal opening to assist with childbirth, and the swelling and pain, while expected, worsened overnight.
The next morning, she returned to the hospital expecting a prescription for some medication. But Heather never left.
As Matt, Heather and their loved ones would discover over the following days, Heather had contracted a rare and rapidly spreading bacterial infection called necrotizing fasciitis, he said. Commonly known as “flesh-eating bacteria,” the infection ravages muscles, fat and skin tissue, typically entering the body through a break in the skin, such as a cut or scrape.
The disease can be caused by several types of bacteria, most commonly group A Streptococcus, otherwise tolerable germs commonly found in the throat and on the skin. Infections from group A strep are usually easily treated, but in some cases produce toxins that can destroy the tissue they infect.
“This one just came completely out of left field,” Matt said. “Everybody I knew had never even heard of it.”
While necrotizing fasciitis is rare, its precise prevalence is hard to pin down because the condition itself doesn’t have to be reported to public health officials.
It occurs in fewer than 1 in 100,000 reported hospital infections, said Dr. James Raczek, chief medical officer at EMMC.
Raczek said he could not confirm whether the hospital recently had recorded a case of necrotizing fasciitis. Asked to comment on Heather’s case, he declined, citing patient confidentiality rules.
In an email Wednesday afternoon, EMMC spokeswoman Jill McDonald wrote: “I can confirm that Heather Nichols is deceased.”
In Maine, hospitals are required to report cases of group A strep that lead to serious illness, including necrotizing fasciitis. Some other bacteria that can result in the condition do not have to be reported, however.
The Maine Center for Disease Control and Prevention has not received any reports recently of group A strep resulting in necrotizing fasciitis, according to Dr. Stephen Sears, state epidemiologist.
In cases of unanticipated deaths, hospitals typically must report to state licensing officials and the Joint Commission, a hospital accreditation organization.
Raczek said he couldn’t comment on whether EMMC had recently made such reports, but described how the hospital responds to unexpected deaths in general.
The hospital assembles a team of clinical experts to carefully review the case and look for answers to what caused the death, whether it was under the hospital’s control and what can be learned, Raczek said.
With an infection, the hospital attempts to determine where it originated, whether at a facility outside the hospital, as the result of hospital care or from a germ already present on the patient’s body, he said.
“Very often it’s difficult to determine,” Raczek said.
About a quarter of patients diagnosed with necrotizing fasciitis die.
Healthy patients, such as Heather, typically have the best shot of surviving the disease. The first line of defense is powerful antibiotics, but the drugs may not reach all of the infected areas. Quick removal of the dead tissue is critical to halting the infection.
Those who survive may face organ damage and amputation.
But Heather’s condition rapidly worsened. After one operation to remove some of the decaying tissue, she still suffered from serious pain and swelling. She needed another surgery, but told Matt to go home and get some rest. The doctor would call him when she was in recovery, she said.
Two doctors called, and Matt for the first time heard the words “necrotizing fasciitis.” They told him Heather would be flown to Boston for reconstructive surgery the next morning and instructed Matt to buy some formula for Ruby, he said. With all the medications pumping through Heather’s body, she wouldn’t be able to breastfeed.
Heather remained stable in the intensive care unit that night. Just before 5 a.m. the next morning, the hospital called Matt, urging him to come in because her condition had deteriorated.
“From what we were being told and from what we were seeing, she didn’t have long at all to live at that point,” Matt said.
Heather was pumped full of medications and her stomach was cut open to relieve pressure from fluid buildup, he said. At one point, she opened her eyes and nodded her head some, Matt said, but she was otherwise unresponsive.
“The way it was explained to me, that’s stuck with me quite a bit, was that the medicine in her body was fighting to keep her alive but she was fighting to die,” Matt said.
Heather, breathing through a machine, almost certainly wouldn’t survive another surgery and the medications wouldn’t keep her alive beyond the day, Matt said he was told by doctors. He decided to have all the tubes removed and to try to keep her as comfortable as possible.
She died on Aug. 8.
Matt looked down at Ruby in his arms as he described his wife’s final hours. He was somber but reserved. Heather’s death hasn’t hit him yet, said his mother-in-law, Rose Woodward, who was at the apartment helping him with the baby, along with Matt’s mother.
“We all got to come in and say goodbye,” Matt said. “Stand around her and pray.”
Ruby spent some precious time with her mother, at home after the birth and also at the hospital, he said. The baby girl was never sickened by the infection.
Necrotizing fasciitis isn’t generally contagious, though people with underlying health conditions are more at risk.
“They said [Heather] fought it a lot stronger than most people do,” Matt said. “It was the same thing with the pregnancy, there were doctors there … who said that she was one of the toughest people they’ve ever seen at giving birth.”
Matt and Heather, who both studied education in college, had been married for just over two years. They met when he was working at a Portland day care. She convinced a friend to bring her to Matt’s class to “observe,” he said.
“It wasn’t true, she just came in to meet me,” he said, smiling.
Heather liked organization, Matt said, sitting in front of neatly stacked storage bins of baby clothes clearly labeled “0-3 months,” “hats” and “mittens.” She was well prepared for Ruby’s arrival, and had she known about necrotizing fasciitis, she would would have researched the condition, he said.
That’s why Matt said he chose to speak out about the dangerous infection, just a day after his wife’s funeral. Word spread of Heather’s death online after a friend, unbeknownst to Matt, launched a fundraising effort to help Matt and Ruby. Local media have called, and Matt said he wants to use the attention to spread awareness of necrotizing fasciitis, without causing undue panic.
Matt said he’s not trying to “bury the hospital.”
“In reality, it could happen to anyone, but it’s best to know ways to prevent it, as much as you can … I’m sure there are people trying to figure out how to prevent it and how to stop it, but it needs to be brought a little more to the forefront,” he said.
The fundraising effort took off, collecting $10,000 in just three days. The money will cover Heather’s funeral costs and any additional funds will be set aside for Ruby’s education, Matt said.
“Hopefully we’ll be able to put her through college and she won’t get stuck with all the bills like me and her mom did,” he said.
Heather had insurance, so Matt hasn’t been left with significant hospital bills, he said. He has had to miss several days of work at the Bangor child care center where he’s employed.
He’s sorting through some of the practical problems left behind in the wake of Heather’s death, including sifting through all the household bills, a task Heather used to handle. Friends and family have surrounded him. Even his two-year-old dog, a boxer-German shepherd mix named Scarlet, is rallying to his side.
“She sleeps on Heather’s side of the bed sometimes,” he said. “Puts her head on the pillow and everything.”
Matt hopes by speaking out about his wife’s death, he’ll help someone else, he said.
Ruby, after briefly opening her eyes, nodded off in his arms.
“There you go, back to sleep,” he said to his daughter. “Aren’t you a little diva?”
To view the fundraising website for Matt and Ruby Nichols, visit www.gofundme.com/3vp788.
About necrotizing fasciitis
Healthy individuals with a strong immune system who practice good hygiene and proper wound care are at extremely low risk of getting necrotizing fasciitis, according to the U.S. Centers for Disease Control and Prevention.
Symptoms often start within hours after an injury and may include complain pain or soreness, similar to a pulled muscle. The skin may be warm with red or purplish areas of swelling that spread rapidly. Some patients may develop ulcers, blisters or black spots on the skin.
People with necrotizing fasciitis often describe their pain as severe and far out of proportion to how painful the area appears when examined by a doctor, according to the U.S. CDC. Fever, chills, fatigue or vomiting may follow the initial wound or soreness.
Anyone with such symptoms after a wound is urged to see a doctor immediately.