Michael Cofnavage took care of his ailing 74-year-old mother in the beige, vinyl-sided house in Aberdeen where he grew up. Working as a security guard, he earned enough money to shop for them both, always remembering to buy food for her crested yellow parrot, Oscar.
But last fall, Evelyn Austin began to worry about her 56-year- old son. He lost more than 20 pounds and was so lethargic he rarely pried himself off the couch.
She urged him to see a doctor, and on Oct. 16, he learned he had AIDS, probably from unprotected sex, according to his medical records. His family was shaken but hoped that he would live for years with the newer therapies available, according to his sister, Rosemary Queen.
But Cofnavage died of pneumonia at Johns Hopkins Hospital on Feb. 13. His treatment for AIDS was complicated by a hospital-acquired lung infection caused by a dangerous strain of the bacteria pseudomonas, according to his medical records.
Two months after his funeral, his family received a letter from Hopkins that made them wonder whether a defective medical instrument - an Olympus bronchoscope - might have accelerated his death by infecting him with pseudomonas.
"Either Mr. Cofnavage died from the pseudomonas, or he died with pseudomonas taking away his energy to battle his underlying illness," said his family's attorney, Robert K. Jenner, who represents the families of 13 patients who died after receiving bronchoscopies at Hopkins.
Cofnavage was one of 100 patients who tested positive for pseudomonas after being examined by the scopes at Hopkins between June 1 and Feb. 4.
Hopkins administrators say that many of those patients died but that they were already gravely ill from a variety of diseases. Investigators at the hospital believe that only a small number - two to five patients - died primarily from pseudomonas infections contracted from Olympus bronchoscopes. Jenner wonders if the number might be larger.
Hopkins had been using four bronchoscopes of a type that had a loose part that sometimes harbored and spread pseudomonas, which is often deadly for patients with compromised immune systems.
Olympus learned about the problem in September when cultures taken from 17 patients at a Tennessee hospital tested positive for the bacteria. The company issued a recall Nov. 30. But the notice sent to Hopkins got lost in the mail, and the hospital continued using contaminated scopes until Feb. 4.
Cofnavage was admitted to Hopkins on Nov. 1. Doctors at first diagnosed pneumocystis carinii pneumonia, which often attacks people with AIDS, according to his medical records.
To find out more, the doctors performed bronchoscopies on him Nov. 2, Dec. 14 and Jan. 18, slipping a snake-like scope into his lungs and flushing them with salt water. A day after the first exam, Cofnavage's lungs tested positive for pseudomonas.
On Nov. 7, his temperature spiked, he suffered severe shortness of breath, lapsed into acute respiratory distress and was rushed to the intensive care unit. His doctors noted that he was battling a second variety of lung infection - a rare strain of pseudomonas.
The medical team treated Cofnavage with antibiotics and AIDS medications. But his condition continued to deteriorate, and he suffered blood infections, among other problems.
He died in the hospital Feb. 13. His death certificate listed pneumonia and HIV.
On April 30, the family received a letter from Dr. Edward F. Haponik, director of clinical operations at Hopkins.
The letter expressed regret that Cofnavage died and said that a contaminated Olympus scope might have been used on him. But the doctor wrote that it was impossible to know if the device infected him with pseudomonas, or if the bacteria was in his lungs before he entered the hospital.
"As you know, Mr. Cofnavage was critically ill, and it is not possible to know for sure if pseudomonas, however contracted, contributed to his death," Haponik wrote.
Queen said she knew her brother would die eventually. "But I wonder if he might have lived longer and suffered less if this bronchoscopy problem didn't happen to him," she said.
His mother, who now struggles alone with heart disease and diabetes, watches TV with Oscar, as she used to with Michael, and remembers how much they both loved the bird. "I'd mention Oscar to my son in the hospital, and he'd always smile, even when he was doing very badly," she says. "I miss my son's company a lot."