On a Saturday morning last month, two weeks into their daughter's ordeal with a massive staph infection, Ernie and Regina Escobar got the news no parents want to hear from the doctor in charge of Megan's treatment at Sutter Memorial Hospital in Sacramento.
Dr. David Smith, head of the pediatric intensive care unit, told the parents they should prepare their family for the worst, although the medical team was not giving up.
The Modesto couple broke the news to their three other children the next day, which upset the youngsters, especially their 10-year-old son, Matthew.
The parents decided they should firmly believe their daughter would live. After all, 12-year-old Megan always had been their healthiest child.
"We decided that with any sign she was getting better we were going to be positive," Ernie Escobar recalled. "We knew she was going to make it. It wasn't an option."
Megan Escobar, a seventh-grader at Somerset Middle School, became sick Nov. 6 from a methicillin-resistant staphylococcus aureus infection. The bacteria resistant to common antibiotics is linked to an
increasing number of infections in health care settings and public places where people are in close contact.
To students and parents who don't know the family, she was the unnamed girl in the letter Somerset sent parents last month urging awareness of MRSA. She was the subject of prayer chains at local churches and became "Miracle Megan" to the Sutter hospital staff, who threw her a party before sending her home last week.
"We have seen a couple of other kids that have been as severe as her, but we weren't sure if she was going to make it," said Katie Cyprus, an intensive care nurse at the hospital. "When she first came in, we could tell by the way she was breathing, her blood pressure and heart rate that she was in trouble."
15-inch scar on right leg
Megan, who was released from the hospital Dec. 13, has a 15-inch scar on her right leg and lingering complications, but otherwise is doing well, her parents said this week.
The Escobars said they don't know how she got the infection that started in her right knee and spread through her body. She hadn't been under medical care and didn't appear to have the kind of MRSA skin infection that has occurred among area schoolchildren this fall.
It started on a Tuesday when Megan complained to her Somerset physical education teacher that her leg hurt. After school, her parents took her to the Sutter Gould urgent care clinic on Coffee Road, where she had a temperature of 102. The doctor said she may have viral arthritis. She was sent home to rest and take Tylenol, the Escobars said.
Megan was limping that Wednesday and Thursday, her head ached and she would get so thirsty she got up in the middle of the night for water, she said.
That Friday, her father had to carry her to the car to take her back to the same-day clinic. Her breathing was labored, and Escobar said he pressed for a thorough examination. Megan was taken by an ambulance to Memorial Medical Center based on an X-ray showing she had pneumonia.
It soon was apparent the knee was septic and, on Nov. 9, she was airlifted to the children's center at Sutter Memorial Hospital.
"I wasn't scared. I actually liked the helicopter ride," said Megan, who was aware of what was going on. "But it hurt."
By the time she reached the hospital, her leg had ballooned to twice its normal size and her vital signs were flattening out. Doctors made a large incision in her calf to relieve the pressure.
She was put on a respirator and doctors induced a coma to spare her the pain of being poked and pierced as they battled the infection.
Doctors were not sure what bacteria was causing the infection for about a week, until an MRI revealed it was in her knee bone and she tested positive for MRSA.
Megan's fever shot to 105.8 as the infection spread through her blood and into her lungs.
Hospital staff said it was one of the three most severe staph infections they've seen in the pediatric ICU in five years. The other two patients survived, they said.
"Their whole body gets poisoned," said Dr. Daniel Falco, a pediatric specialist who assisted with Megan's treatment. "The kidneys don't work. The heart doesn't work well and the lungs don't work well. All the systems in the body are affected."
The hospital's pediatric ICU is treating patients with MRSA every week, Falco said. Most of those patients have skin infections or abscesses that are easier to treat.
Megan was placed in her own room with a sign on the door instructing personnel to gown up before entering, a contagious disease precaution. For almost five weeks, the Escobars spent their waking hours in the room near Megan, who had eight IV lines in her arm and one in her neck.
She was given intravenous vancomycin and two other antibiotics used to combat MRSA, plus medicines to assist her heart and a vacuum tube to drain her leg wound.
Toxin levels rise
Although some strains of staph are increasingly resistant to drugs, the bacteria in Megan's body were in places out of reach of antibiotics, Falco said.
The reason for Megan's dire condition was the toxins the infection was releasing. The Escobars said they were told the level of toxins in her blood was 380 times above normal. The infection also was destroying the blood-clotting agents in her blood, causing her to bleed from her IV lines.
During his meeting with the parents Nov. 24, Smith had said he still had some tricks up his sleeve. He soon had an expensive piece of equipment rolled into Megan's room. Like a kidney dialysis machine, but more advanced, the equipment receives blood from a shunt in the patient's arm, filters the toxins and returns the blood to the patient's body.
The hospital had acquired the equipment some time ago, but it seldom was used for children, staff said.
As the machine did its work in the next few days, the Escobars paid attention to the arcane numbers the doctors used to measure the inflammation in Megan's body. Their hopes were restored as the numbers descended from an extraordinary peak of 3,800 to 625, 250, 125 and then within normal range, Ernie Escobar said.
Five weeks in hospital
During her five-week hospital stay, Megan had an operation to drill out the infected bone in her knee and procedures for her inflamed lung tissue.
After she'd been in the coma for 3½ weeks, doctors decided to wake her up early this month. Megan said she awoke to a roomful of doctors and smiling nurses whom she didn't recognize. It was as if she had simply slept through the night, she said.
"I thought it was the next day after I went into the hospital," she said. She couldn't speak, but when her parents came into the room, she gave them a wave.
Megan regained her speech in a couple of days and physical therapy taught her to walk on the injured leg. On Dec. 13, her parents drove her home to a crowd of cheering relatives and neighbors gathered outside the family's north Modesto home.
Regina Escobar said it was the support from hospital staff, family and friends that helped them through the crisis.
"The support from everyone was just incredible," she said, noting a hospital social worker arranged for 25 members of their family to have Thanksgiving dinner at the Ronald McDonald House. "The people at the hospital had a genuine caring for people."
The Escobars don't know how their daughter contracted the infection. Doctors suggested the bacteria could have festered in a bruise, she could have ingested it or it was the kind of staph infection never fully understood.
Megan is settling back into home life. She enjoys playing with her beagle, Frankie, has gotten reacquainted with the PlayStation and looks forward to watching her older brother, Greg, play basketball at Downey High. She also has a younger sister, Hannah, who had her ninth birthday while Megan was in the hospital.
Still has pneumonia
Megan still is recovering from pneumonia and has twice-a-week blood tests. She will take oral antibiotics until mid- January and her sodium levels are down, so she gets to eat pretzels and other salty snacks.
Doctors have said Megan should be home-schooled for eight weeks before they consider whether she can return to school. She said she misses school and won't be embarrassed to show her scar to her friends.
On Thursday, she rolled up her pant leg to reveal the black line of the scar. "Yeah, it will be cool," she said.
Her parents said they haven't taken extra precautions around Megan since her return home, other than watching out for any skin irritations and teaching her siblings to wash their hands regularly. While MRSA can spread in households, no other family members have had signs of infection.
The family has insurance covering 80 percent of the hospital bill, which amounted to $810,000, Ernie Escobar said.
He said he believes his daughter's case was rare and illustrates what the bacteria can do. But he doesn't want it to change the family's lifestyle.
"We live with staph all around us," he said. "If you are going to get it, you are going to get it."
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or 578-2321.