Frances L. Pittman waited a year for her lung. She remembers feeling elated when she got a phone call at dawn three years ago and learned that an organ donor had given her a chance to beat her progressive lung disease.
Her husband, Marshall, floored their Buick LeSabre across the city to Johns Hopkins Hospital, then held her hand as orderlies wheeled her into the operating room. After the lung transplant was completed, she awoke and scribbled on a pad to her husband: "It's over. I love you."
The new left lung allowed the 51-year-old grandmother from Baltimore to breathe better, travel for the first time in a year, attend her political club, play and laugh with her three grandchildren.
But it wasn't over.
Last year, she started experiencing shortness of breath again and returned to Johns Hopkins on Oct. 8, Oct. 9 and Jan. 7 for tests of her new lung. Three times, doctors slid a snake-like instrument, a bronchoscope, down her throat. During the winter, she said, she became sick with coughing and fever.
Last week, her doctor warned her that the bronchoscope used in her exams might have spread a potentially dangerous bacterium into her new lung. She fears that the faulty instrument might have caused her illness and endangered that lung.
Pittman is one of more than 400 patients to whom Johns Hopkins mailed letters last week warning that they may have been examined with a defective scope made by Olympus Optical Co. of Tokyo. The company ordered a recall of 14,000 of the devices Nov. 30 because they had a loose part that harbored and may have spread bacteria.
Hopkins kept using the faulty instruments on patients for two months after the recall date because Olympus' notice to Hopkins was sent to the wrong address and got lost in the mail for a month and a half.
Doctors at Hopkins, who blame the company for a botched recall effort, don't know how many people might have been sickened by the flawed devices. In Pittman's case, the source of the bacterium and her breathing problems is not clear, her doctors say. Her surgeon suggested that her body may be rejecting the new lung.
Investigators know that two of the 400 people died of pneumonia, and they suspect that the lungs of 100 more people may have been infected or exposed to the bacterium.
A step forward, then back
"I am very upset and distressed by this because I don't know how this infection will affect the longevity of the new lung that I waited so long to get," said Pittman, speaking slowly between hissing inhalations from the tubes curling out of her oxygen tank.
"It's almost as if you get a good thing going, your life gets better," she says, pausing to inhale. "And then they take it away from you."
Her husband, Marshall Pittman, said he's bothered by the idea that doctors may have used a flawed medical device on his wife after its recall date.
A doctor's doubts
But the surgeon who performed her transplant, Dr. Stephen Yang, said the bronchoscope is unrelated to the breathing problems Pittman is reporting. "This whole thing is ridiculous," Yang said of attempts to link the instrument to her illness. "She's got rejection [of her lung], and that's it."
Friends say Pittman has been stoic about her health problems. She's a scholarly book lover and amateur genealogist from Northwest Baltimore who was one of 11 children of a longshoreman and school dietitian.
She married Marshall Pittman, a Vietnam veteran who works as a coordinator of veterans services for the state.
They raised two children and have three grandchildren.
Search for family roots
Friends describe Frances Pittman as the kind of person who would prefer to spend a free afternoon prowling through the stacks of the National Archives in Washington, hunting up bits of information about her family's history, stretching back to their years in slavery in Southern Maryland.
"I spend so much time on it because I want the rest of my family to know their roots - where they came from and what they did to survive," said Pittman. "We have a lot of successful young people in the family, and I feel they need to know how people had to work to get them where they are today."
For more than 15 years, she worked in customer service at a Federal Express office in Columbia, answering phones, helping customers with billing questions.
Inspiration to others
She was an inspiration to her co-workers because she had enough energy to take night courses at the Johns Hopkins University, said longtime co-worker Airuel Singletery, 40. Pittman earned an undergraduate degree in 1990 and followed that up two years later with a master's degree in behavioral science.
Pittman began to experience breathing problems in 1986. Pittman said her doctors diagnosed sarcoidosis, a chronic but little-understood autoimmune disease that causes inflammation of the lungs and other organs. The disease made it progressively harder for her to breathe and walk distances, and she took a medical leave in 1997.
Her doctors at Johns Hopkins told her she needed a lung transplant. She waited on a list for a year, feeling both hope and fear when doctors in March 1999 told her they had a donor for her.
During a six-hour surgery, her surgeon cut under her left arm, removed a rib and replaced her left lung.
"At first, after the surgery, it was great, she could do everything," said Shirley Robinson, a retired teacher who volunteers with Pittman in a small political organization, Woman Power.
"She could attend our meetings, go to church, get around and visit with friends," Robinson said.
But then her friends noticed her becoming ill and having breathing problems again last summer and fall. Terrified of germs that might overwhelm her weakened immune system, she avoided public places, kept her grandchildren out when they had sniffles. She wouldn't even kiss her mother when she had a cold.
Pittman went to Hopkins on Oct. 8 for a bronchoscopy to see whether she was rejecting her lung, according to her medical records. After giving her an anaesthetic, a physician slid the pencil-thin device into her right nostril. But the doctor was unable to take an adequate sample of her lung tissue.
Pittman returned the next day for a more successful test, and this time doctors detected no evidence of organ rejection. They also found no signs of rejection during a third bronchoscopy Jan. 7. However, cultures taken from her turned up Pseudomonas bacteria, according to her medical records.
Her pulmonologist, Dr. Jonathan Orens, said her case is complex. Although samples of liquid taken from her lungs through the scopes did grow Pseudomonas bacteria, it's unclear whether the bacteria came from her lungs or the scopes, Orens said. Doctors don't know whether the bacteria were growing in her lungs or whether she had a "pseudoinfection" - a false positive because of a contaminated device, Orens said.
Case is complex
Doctors don't know which of the 400 patients were examined with the defective instruments because the brand or model numbers were not recorded in their medical records, said Dr. Paul J. Scheel Jr., vice chairman of medicine at Hopkins.
Scheel said the hospital's investigations are complicated because many of the patients involved are seriously ill - suffering from AIDS or cystic fibrosis or recovering from lung transplants - and might have harbored the bacteria before doctors slid scopes down their throats.
"Pseudomonas infections can cause pnuemonia ... that means fever, cough, shortness of breath," said Scheel. "But these are also the kind of kind of sick patients who were probably feeling these symptoms before they came in."
Sorting out responsibility
All of this makes for a great deal of anxiety for Pittman and the other hundreds of patients who were sent letters by Hopkins.
Pittman has hired a lawyer, Marvin Ellin, who is sorting through the records and trying to figure out who is responsible.
"She would never have consented to the exams with the bronchoscopes had she known the risk of infection," said Ellin. "She doesn't know if she will have to lose the lung she waited so long to receive."