"If you have knowledge, let others light their candles at it ."
—Margaret Fuller
Twelve-year-old Lauren had just finished sixth grade in May 1999, and her summer plans were already arranged. She eagerly looked forward to another fun-filled July vacation in southeastern Wisconsin visiting family and friends she hadn’t seen since the previous summer. Reflecting over the many changes that had occurred in her life over recent years, she said, “It was hard to believe that it was only two years ago that I called Wisconsin my home.”
The pleasurable memories of her young childhood—rollerblading, swimming, camping, riding bicycles, the theater, county fairs, and countless giggly, sleep-over parties with her girlfriends—endeared her to Wisconsin. Lauren lived an active life seemingly insulated from sorrow. “It was all that I knew until my father became ill with cancer,” she recalled.
Lauren’s father first became ill when she was seven years old. He was diagnosed with melanoma and underwent numerous procedures, including facial and brain surgery. Lauren was always hopeful that he would get well, but the disease advanced rapidly, and his death seemed inevitable. She witnessed all phases of his decline, including his move to a nursing facility. She stood crying as hospice care nurses supervised his transfer out of the house and into an ambulance.
Two months later, she stood with her mother alongside his bed on the eve of his death. She stepped closer and clasped his cold hand. Leaning toward his ear she said, “I love you, Daddy.” He surrendered his last breath to his Maker, and when Lauren realized this, she broke down in uncontrollable tears. It was her first introduction to the harsh realities of serious illness and premature death.
Lauren’s life had been irrevocably altered. Her laughter was never the same after her father’s passing. Her times of joy were always shortened because she realized that other girls could go home to their fathers, but she could not. She bore her grief quietly and privately, and only her poetry book knew the secrets of her heart. However, with acceptance and pragmatism, she reasoned that life could only improve from that time forward—after all, there’s nothing worse than death, is there?
Blue Mountains of Oregon
About a year later, Lauren’s life changed again. Her mother remarried, and her family relocated to the Blue Mountains of northeastern Oregon to start a new life. Of course, she felt mixed emotions leaving Wisconsin and those she loved, but she also realized that life there was devoid of much of the happiness she once enjoyed. She knew her mother was trying to restore some of what they had lost when her father died, so she embraced the hope that her new life would bring them happiness.
They traveled with all their worldly possessions across the Great Plains over a route similar to the Oregon Trail. Defying the snow storms typically forecasted for January, they arrived at their destination after four days of travel. It was well into evening when they pulled to their stop. Lauren was awestruck by the vast, diamond-dotted sky. With her face close to the front windshield and wide open eyes, she saw giant shadows in every direction—mountains—capped with fluorescent looking, blue-white snow. She stepped out of the truck to gaze further at the breathtaking view, and with a sigh, she pondered what her life would be like in this isolated country.
Two days later, she was introduced to her new fifth grade class at the elementary school. She was wary and did not look forward to the smaller school or the chore of building new friendships. As Lauren became acquainted with the rural town, she soon began to realize that she “wasn’t in Kansas anymore." The rich amenities and conveniences of her former Wisconsin hometown were starkly absent in this new place, home to only a few residents.
The grocery store was also the post office, the tavern and the gas station. A spotted mare tied to a hitching post outside was a common sight. The nearest, larger town that offered any amenities now required a special trip referred to as "going to town." At this point, she simply wanted to turn around and go back to Wisconsin. She realized, however, that her past life there was dismantled, and that she had to go forward with acceptance.
Over the next year, Lauren’s new friends introduced her to the pastimes of the great Northwest—riding horses, camping in the mountains, rattlesnake hunting, attending rodeos, and swimming in the rivers. The girl, formerly unaccustomed to solitude, soon discovered the orchestral sounds of crickets and yipping coyotes. She learned to draw some companionship from reading mystery novels, and she returned to writing prose. Slowly, Lauren was transformed. “I have never lived in the country before. I didn't think I'd like it, at first, but it was so beautiful here,” she admitted.
Revisiting Wisconsin
Though a fondness for her Oregon home was forming slowly, summer vacations in Wisconsin were still the highlight of each year. After all, her older sister lived there, as well as her grandparents and other relatives and friends. She looked forward to seeing them all, but by the same token, she always promised her Oregon friends that she would write during her absence. She faithfully wrote and affectionately signed her postcards "from Wisconsin with love."
During one such vacation in July 1999, Lauren experienced the beginning of a medical nightmare that neither she nor her family could ever have anticipated. It all began during a three-day visit to her girlfriend's country home in Walworth County. One morning, she woke to find two small, red, itchy spots on her lower left leg. At first she thought they were mosquito bites. However, three days later those two spots grew into well-defined rings, and Lauren felt very ill. She asked her host to take her back to her mother with whom she confided, "Mom, my neck and back hurt so bad—I can hardly move. My eyes are sore, and I'm so tired." Her mother felt her forehead and found that she was very warm despite having taken acetaminophen to bring down her fever.
Lauren took a cool bath, but nothing seemed to bring the fever down. Her mother immediately drove her to the emergency room at the local hospital. There, Lauren’s fever measured 103.3º and was accompanied by chills, fatigue, extreme light sensitivity, headache, nausea, sore muscles, a stiff neck, backaches, and joint pains. Those two conspicuous bull’s-eye marks had grown and looked like erythema migrans (EM) rashes, the classic marker of early Lyme disease.
The attending emergency room (ER) doctor knew that EM rashes were a sure sign of Lyme disease. He felt confident of his suspicions after consulting a large medical book back in his office. Lauren’s case looked pretty clear cut, but he wanted to get a second opinion from a pediatrician.
As the two physicians examined Lauren’s leg, they consulted together over a probable diagnosis. "It appears to be a spider bite," said the pediatrician as he examined the two red rings on Lauren's leg. "What about Lyme disease?" asked the ER physician. "No, I don't think so. Lyme disease is not too common around here. It's probably just an insect bite of some kind," responded the pediatrician. He wrote a prescription for a 21-day course of amoxicillin to cover her localized infection and instructed Lauren to follow up later with her doctor in Oregon.
The emergency room physician, on the other hand, remained unconvinced that Lauren did not have early Lyme disease. He made the following note on his discharge diagnosis: "Fever, etiology to be determined. Rule out Lyme disease."
This was exactly what Lauren's mother intended to do once Lauren could be seen by her family doctor in Oregon. While they were still in Wisconsin, though, Lauren's mother received some advice from her brother-in-law, a pharmacist. He told her that Lyme disease should be treated aggressively with at least six weeks of antibiotics. While amoxicillin was used, her brother-in-law advised her that doxycycline was usually the drug of first choice because it was also effective against several other tick-borne infections. With this information, her mother became concerned about the therapy that Lauren had received. She was eager to follow up on her misgivings with their family practitioner.
Lauren showed minor improvements during the 21 days of treatment. She tried, with difficulty, to resume normal activities for the remainder of her vacation in Wisconsin, but her painful symptoms persisted. "I still had pain in my knees, ankle, and right hand," Lauren noted. "I knew something was really wrong because the medicine didn't seem to be helping me." It was obvious that Lauren's situation needed reevaluation.
As soon as Lauren and her mother returned to Oregon, they went to see their family doctor. Upon examining Lauren, the doctor could still detect the faint bull's-eye marks on her leg, and so he extended the prescription of amoxicillin for five additional weeks. Since the Infectious Disease Society of America (IDSA) guidelines state that early Lyme disease is cured with about a month's worth of doxycycline or amoxicillin, he felt sure Lauren would recover fully. However, that's not how Lauren's story turned out.
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