Resolutions and Relapses, Part 1
Originally Written 1/1/2021
Reposted 12/31/2023
Valerie looks haggard, but composed. Then when I ask, “How are you?” she dissolves into tears.
“It’s back,” she sobs. “It’s back!”
Her words make me feel sick, and several thoughts flash through my mind. Is she really having a relapse of her infection? How will I possibly cure her this time? And the final thought – really more of an overwhelming impulse – is to wash my hands!
Valerie’s first case occurred after her gallbladder surgery. She got a post-operative wound infection that required potent antibiotics in the hospital. The wound improved steadily, but she developed profuse diarrhea. At the same time her white blood cell count and temperature soared, indicating a different infection that was somehow resisting even the “big gun” antibiotics. In fact, in a cruel irony, the wonder drugs were actually the cause of the problem. Here is how her bouts with the bacterium have unfolded:
1. She tested positive for Clostridium difficile infection (often referred to as C diff), a severe intestinal disorder that is usually triggered by a course of antibiotics. We treated her with an uncommonly used oral medication (vancomycin) and she seemed to be cured.
2. Ten days later the explosive diarrhea abruptly struck again. Within hours, she was too weak to stand. This relapse required a longer course of therapy, and though she lost 15 pounds, she again seemed to recover.
3. The third flare-up necessitated an even more complex regimen suggested by a colleague in infectious diseases. Valerie’s diarrhea subsided, but she never really got back to full strength or regained the lost weight.
4. Now this is the fourth case, the fourth round against a stubborn opponent in the prize fight of Valerie’s life.
As I wash my hands and hand her a tissue to dry her eyes, I am fearful that C diff will finally land a knockout blow.
Old and New Microbial Menaces
The bacterium Clostridium difficile is in the same family as tetanus. But while tetanus is mostly a historical horror in the developed world (thanks to vaccines), its cousin C diff has come into its own in the USA over the last few decades. The pathogen preys on the sickest patients, who have to take the most antibiotics. Prolonged, complicated treatment regimens, expensive hospitalizations, and death can follow.
The germ can be spread between caregivers and patients. To add to the horror, C diff is a spore-forming bacterium, which means that the ubiquitous hand sanitizers we put so much faith in will not protect against catching or transmitting it. Hence the urge to wash my hands!
The spore-forming ability also makes it especially resistant to eradication and prone to relapse.
Relapses
I hope you have not experienced a C diff infection. But I suspect you know all about the discouraging reality of relapses. Very likely at some point you have made a resolution (New Year’s or otherwise) to rid your life of a certain sin or bad habit, only soon to realize in despair, like Valerie with her C diff, “It’s back!”
- You thought you had defeated that clinging resentment.
- You believed you had eradicated the stubborn jealousy and self-pity.
- You worked hard to root out the tenacious itch of lust.
- You were convinced you had triumphed over the recurrent cycle of self-condemnation.
- You fought valiantly to suppress anger.
- You had faith that you had conquered your besetting sin or your unwanted habit.
Then your sin, your weakness, or your bad habit came back, like a sickening recurrence of diarrhea (as a doctor, I am allowed to make analogies that cannot be spoken of from the pulpit in church. Let’s be honest, the comparison is fitting).
“Do not be overcome with evil,” says Romans 12:21a. But practically speaking, how does that work? How can we avoid relapses?
Keep reading in parts 2 and 3 to find out how antibiotics can actually cause infections, how we can possibly cure such illnesses, and what finally happened to Valerie. More importantly, let’s see how a different way of experiencing God’s grace can give us some victories in our seemingly endless battles with sin.
Dr. Bill Maynard