Despite having interviewed the parents of the stricken child for my Eating Well article, l’d yet to actually meet someone who’d suffered a serious case of foodborne illness. This was in part because I didn’t want to succumb to what felt to me like the clichéd structure of most food-safety stories, which so often begin with the dramatic and heartrending retelling of an innocent victim who’d been struck down in the prime of his or her life simply by eating the wrong hamburger or piece of lettuce. And it was in part because over the course of researching this book and thinking about the issues at hand, I’ve become rather intractable in my belief that the presence of pathogenic bacteria simply isn’t the most dangerous aspect of our food system.
But it also occurred to me that foodborne illness remains the vector by which most people are introduced to the concept of food safety and that acute illness is still an important piece of the puzzle. To write an entire book about food safety and come no closer to an incident of foodborne illness than a dumpster-diving anticapitalist who puked after he drank fruit juice out of the trash seemed a little specious.
So I found myself dialing Bill Marler’s phone number yet again, in hopes that he might provide me with a likely candidate. Now, perhaps I should have expected this, but nonetheless I didn’t: Asking Marler to connect me with a victim of food-borne illness was like asking a chef what I should eat for dinner. “What do you want?” Marler asked me. “Hamburger? Spinach? Raw milk? You want a kid or an adult? E. coli okay with you?” At first, I thought he was making a joke about the tragic depth and breadth of his clients, and I started to laugh. But Marler was quiet, and I soon realized he was utterly serious.
Which is how I came to find myself knocking on the door of Chris, Holly, and Margot Standish at 9:30 on an exceedingly warm September morning. The door was attached to an attractive red-clapboarded colonial-style house in the town of Glastonbury, Connecticut, located a few miles southeast of Hartford.
Glastonbury is an affluent community of about 32,000. As of 2007, the median household income was over $100,000, and in the summer of 2010, even during the depths of the national real estate malaise, the median sale price of a home was $353,500. The Connecticut River borders the western edge of town, and Main Street is lined with houses that date as far back as the late 1600s, most of them beautifully restored to their historic splendor. It is, in short, a really, really nice place, and in some vague way I can’t quite define, I was surprised that someone from such a pleasant and obviously well-off community could contract a foodborne illness. But of course, that’s ridiculous: Bacteria don’t discriminate on the basis of socioeconomic status. Or any other status, for that matter.
Chris and Holly Standish are in their forties, well educated and gainfully employed (assistant director of grants and contracts at the University of Hartford and fund-raising consultant to nonprofit agencies, respectively). They moved to Glastonbury in 2005; financially speaking, it was a bit of a stretch for them, but they lucked into a nice house that needed a little work and were able settle into a neighborhood that, on pretty much every front, resembles the epitome of the American dream: affluent, friendly, picturesque, secure. The deeply historic nature of Glastonbury must have been particularly appealing to the Standishes, for Chris is a direct descendent of Myles Standish, who traveled to America on the Mayflower and was hired by the Pilgrims to serve as military advisor for Plymouth Colony.
The Standishes have one daughter, Margot. She is 10, and she is the reason I found myself knocking on their door on that September morning. On June 26, 2008, Margot drank a glass of unpasteurized milk purchased at Glastonbury’s Whole Foods Market. Like most people who consume raw milk, the Standishes are the sort of food consumers who seek out nutritious food and are willing pay a premium for it. At the time, they believed that raw milk, which they’d consumed for about 6 months, fit perfectly into their food-related ethos.
The milk they were drinking was produced nearby at Town Farm Dairy, a modest enterprise owned by the town of Simsbury and managed by the Friends of Town Farm Dairy, a nonprofit group of local volunteers who had saved the 70-acre farm from financial ruin a half decade prior. The farm’s mission was entirely noble: to provide food to the town’s neediest residents, educate the local community in matters of small-scale agriculture, and achieve economic viability. They kept a herd of about 35 cows and sold milk directly from the farm and at local retail outlets (Connecticut is one of 10 states that allow raw milk sales at the retail level). Chris and Holly felt good supporting such an enterprise, and they believed in both the health benefits and the safety of the raw milk the dairy provided to its customers.
And so when, on June 28, Margot became ill, they didn’t think much of it. After all, her illness began as countless childhood illnesses begin: with diarrhea and intestinal cramping. She was drinking water but not eating, and the Standishes assumed they were dealing with a garden-variety stomach bug. A day or two of bed rest, some dry toast and lots of fluids, and Margot would be back to her precocious self.
But Margot didn’t get better, and on the first of July, they called her pediatrician. “There’s a bug going around,” he told them. “It could last 10 days or so.” So they waited through another hellish week, carrying Margot from bed to bathroom and back again, their daughter wailing in agony as intestinal cramps wracked her young body. Finally, on July 8, with no improvement in their daughter’s health, Chris and Holly took her to the ER, where a nurse drew Margot’s blood. “And that,” said Chris, “is when the shit hit the fan.”
That’s because Margot had hemolytic uremic syndrome (HUS), that potentially deadly complication of E. coli O157:H7. Her kidneys had all but stopped functioning, and she was prepped immediately for surgery to insert a PICC (peripherally inserted central catheter), an intravenous line that is threaded through a patient’s veins until its tip rests next to the heart, at the cavoatrial junction. When patients need prolonged intravenous therapy, PICC lines are used to reduce the inflammation and pain associated with traditional intravenous access. Margot’s chances of survival were pinned at 50 percent; Chris and Holly were told to prepare for the worst.
The worst did not happen, a fact that was made abundantly clear to me as Margot led me on a high-energy, narrated tour of the Standish residence. She is a slight girl with straight blond hair of medium length. She wore glasses, wool-lined slippers, and a shirt that read I ♥ candy. In her room, a neat affair despite the presence of dozens of stuffed animals (I was informed that she kept another 100 in the attic and 23 in the basement), she introduced me to Mr. Mouse, a tiny stuffed mouse for which she’d handwritten miniature business cards that could be read—and just barely—only with the aid of a magnifying glass. “Visit my website www.mrmouse.com [inactive]. Willing to look at things you can’t,” read one. Another: “$20 off, no expenses paid.”
“Twenty dollars off means you only have to pay a penny,” Margot explained.
“You mean the regular price is $20.01?” I asked.
“Yes. He’s a very particular mouse.”
I found Margot to be utterly charming, exceptionally intelligent, and possessing a fine sense of humor. (“I like all animals.” A pause. “Except ones that bite me.”) She implored me to eat nasturtium petals (a favorite of hers, and not bad, actually) harvested from the front yard, and she brought me a perfectly ripe cherry tomato grown in the garden by the front door. “Hey, do you want to taste a sweetness?” she asked, her small palm extended to offer the tomato. Her health is by all accounts excellent; she is thin, but not unnaturally so. She is not on dialysis, nor does she take any medications. Considering how close she came to death by HUS, these are minor miracles. It is all but certain that her kidney function has been compromised, but tests will wait until she has gone through puberty, when a more reliable, long-term measure of her kidney health can be applied.
It is true that Margot may yet suffer long-term health consequences from her illness. It may just be that they haven’t yet revealed themselves; for instance, pregnancy is hard on the kidneys, and should Margot ever decide to have biological children, she could experience dangerous complications. But that is a concern that may (or may not) be realized many years from now, and for the time being, she is by all accounts and appearances a happy, healthy, and delightfully imaginative 10-year-old.
And so at the time of my visit, the greatest consequence of Margot’s illness seemed to be the psychological scars it has wrought on Chris and Holly. Another casualty is Margot’s fondness for pudding, a mainstay of her hospital diet. “I used to like pudding, but just so happens that I ate the pudding, I threw up the pudding, and now I don’t like it,” she told me. Then, to be sure I wasn’t getting the wrong impression, she offered this assessment. “When I wasn’t throwing up, it was really fun being the hospital.”
To be sure, there is no pudding to be found in the Standish residence, and certainly no raw milk, nor raw cheese, even that which meets the FDA mandate of a 60-day aging process. The Standishes don’t eat out much anymore, because they feel they can’t trust food that’s prepared behind closed doors, and they no longer purchase ground beef. Instead, they buy cuts of meat and grind their own, which Chris then cooks with the aid of a high-end meat thermometer that he reluctantly admitted cost $100. Vegetables and fruits are scrubbed relentlessly. “I just assume someone peed on it,” Chris told me.
We sat and talked in the sunroom; right outside the screen door, Margot was painting a rock with mushed-up dogwood berries. Bad Company played on the stereo, as it had since I’d arrived an hour prior. Chris, who is tall and thin and keeps his hair just long enough that he could pass for an aging rock star himself, sat across from a sofa where Holly and I were perched. She is of medium height, with neatly trimmed hair going gray. She smiles widely and frequently and possesses a trusting warmth that she has clearly passed on to her daughter.
The changes to their dietary habits seem only logical, particularly given what they now know about foodborne pathogens. More damaging is the nagging sense that perhaps Margot has been affected in ways that may not yet be known. One of the unseen side effects of HUS is that fragments of red blood cells can become lodged in the small vessels of the brain. This was likely the cause of Margot’s hallucinations during her 2-week stay in the hospital. “At one point she gave me this piercing look and said, ‘It’s all a game,’ ” Chris told me. He gave a little involuntary shudder. “That’s what haunts me . . . wondering what happened under the surface that we can’t attribute.” Even after Margot recovered from the initial physical damage of HUS, her performance in school suffered in ways that were difficult to explain, though she has since rebounded.
Not long after Margot became ill, Chris and Holly, with the help of Bill Marler, sued Whole Foods. They were awarded a settlement, one stipulation of which is that they not speak disparagingly of Whole Foods to the press. Immediately upon my arrival, they had me sign a statement that reads, in part, “To any inquiries regarding the fact or settlement of any lawsuit their response will be, ‘The parties have agreed that it is in their mutual best interest not to discuss or comment on the dispute in any manner.’ ”
Although we did not speak specifically about their settlement with Whole Foods, it was clear to me that the Standishes have struggled with their role as claimant. They were careful to explain that Connecticut does not award pain and suffering damages, and that money from the settlement was retained in Margot’s name, not theirs. As someone who will likely suffer from diminished kidney function for the remainder of her life, Chris explained, she will need to maintain a generous health insurance policy. The money would help her do that. But they seem keenly aware that not everyone is likely to have empathy for their position. “I know people on the other side of the issue look at us and say, ‘Well, you were the damn fools who bought the stuff,’ ” Holly said. “But it was presented to us as being safe. We’re not milking the system.” If she was aware that she’d just punned, she made no indication.
Not surprisingly, Chris and Holly Standish have thought an awful lot about how food is produced and distributed in this country. And not surprisingly, this thinking, coupled with their daughter’s illness, has made them distrustful of the food system at almost every level. “Clearly, it’s not working very well for us to have faith in a system that’s not going to protect us,” Holly said. I understood that when she said “us,” she meant the broader “us,” not the “us” that comprises Chris, Holly, and Margot Standish. Because by now, Chris, Holly, and Margot Standish no longer have that faith or the expectation that the system will protect them.
There are varying degrees to their lack of faith: Raw dairy owns a special spot atop the hierarchy of their distrust, but it clearly infuses almost every contact point between them and their food. They have come to believe that most food in this country is produced with profit—not safety, not nutrition—as the primary motivation, and that the lack of transparency into our food system has created an environment that only increases the risk for outbreaks of foodborne illness. Despite their negative experience with a small-scale producer, they believe that localized production is an important component of a safe food system. They are in general pro–food rights, including the right to obtain and consume raw milk, but this position seemed tenuous, as if they were caught between a broader pro-rights ethos and the fact that their only child almost died from drinking unpasteurized milk.
“We have become more educated, and as we’ve become more educated, we’ve become more skeptical,” said Chris. They are skeptical of the industrial food system, skeptical of the claims made by raw milk proponents, skeptical of the Connecticut Department of Health (which they found to be frustratingly noncommunicative during their ordeal), and skeptical of the public’s ability to make sound food choices, particularly given the aforementioned lack of transparency.
When I asked them how, given their experiences and the resultant sense of distrust, they managed to eat anything at all, Chris answered without hesitation. “I guess we’re all in denial on some level.”
I’d asked if we might visit Town Farm Dairy, which ceased operations shortly after one of its cows tested positive for the same strain of E. coli that sickened Margot, about a month after she entered the hospital. We all piled into Chris’s Honda and wheeled through downtown Glastonbury, where a “fitness fair” was under way on the small town green. “Hmm . . . ,” said Chris. “A fitness fair. Why is everyone sitting down?” I liked his sense of humor, which leaned to cynical but was not overly acidic.
We detoured briefly to the Whole Foods where the fateful milk was purchased and where the Standishes still shop on occasion. The store was busy but not crowded, and the abundance was overwhelming in its color and variety. We breezed past piles of California strawberries and South African grapefruits on a beeline to the dairy case. There was no raw milk to be found; in late March, not long after I visited Mark McAfee, Whole Foods Market permanently discontinued raw milk sales nationwide. Just past the dairy case stood a display of Veggie Booty, the puffed rice and corn snack that was recalled in 2007 following an outbreak of a rare salmonella serotype known as “Salmonella Wandsworth.” There were 69 reported cases in 23 states. Just past that, a pump bottle of antimicrobial hand soap was situated in the middle of an aisle.
A half hour later, we pulled into the barnyard of the former Town Farm Dairy, now known as the Community Farm of Simsbury. There were no cows to be seen, but a flock of chickens was scratching in the dirt behind a sprawling colonial farmhouse, and through the opening between the house and barn, I could see a few sheep. A group of boys was gathered around a wheelbarrow; one boy hung half in, half out. His playmates were tugging at him, but whether they were trying to push him into the wheelbarrow or haul him out of it, I couldn’t tell. A collection of pumpkins was spread across the lawn.
It was the first time the Standishes had visited the farm since Margot’s illness. I hadn’t known this, or I might not have had the courage to ask. Their unease was palpable. We sat in the car for a minute, as Chris and Holly debated whether or not to park. In the back seat next to me, Margot was engrossed in a book.
“Do you want to get out?” Holly asked.
Chris was quiet for a moment, as he surveyed the scene. “Nah, I don’t. I don’t want to get out.”
He put the car in gear, and we pulled away.
I left the Standishes feeling a little lost. Perhaps this was why I’d originally felt somewhat ambivalent about devoting a chapter to a victim of foodborne illness; after all, what can we really learn from the Standishes’ ordeal? That raw milk can make you sick? But I knew that, just as I knew that pasteurized milk could make you sick (remember that the most recent deaths associated with dairy in this country were linked to pasteurized milk), or spinach, or eggs, or hamburger, or pretty much anything at all.
Maybe I’d hoped to make a point about scale. A total of 14 illnesses were linked to the same outbreak that sickened Margot; the source point of the E. coli was a single Jersey cow. It’s impossible to know exactly how many people might have been sickened by that single cow if the scale of the dairy’s operations were larger, but we know that it only takes a few bacteria to make someone sick, and we know how readily E. coli can grow and spread. There is little question that the regionalized aspect of the farm kept many people from getting sick. Of course, opponents of raw milk could rightly point out that pasteurization would likely have kept anyone from getting sick.
Or it could be that Margot’s illness is a lesson in traceability. Remember, it took the CDC nearly 4 months to determine the source of the salmonella outbreak that sickened 1,800 people last summer. On July 16, 2008, the Connecticut Department of Health notified the state’s Department of Agriculture of a possible link between the farm’s milk and the outbreak. A week before that, the farm had voluntarily halted retail sales after its own private tests showed elevated coliform bacteria in the milk. This was less than 2 weeks after Margot drank that fateful glass. There is little question that the small-scale, regionalized nature of Town Farm Dairy’s operation and customer base enabled a relatively speedy resolution to the outbreak.
Or perhaps the real story is the issue of trust in our food, and how the Standish family has lost so much of theirs, and how if the rest of us only knew what happens out of sight, we too would lose whatever trust remains. The Standishes thought they were doing the right thing, thought that they’d chosen a healthy product, purchased from a retail outlet that would never sell an unsafe food. This wasn’t the creation of some faceless multinational corporation. This was a wholesome food produced by well-meaning people and sold through an outlet that has become synonymous with health and vitality. And yet Margot still got sick.
These are all valid points. I suppose any one of them would be reason enough to justify telling Margot’s story. But in the end, what mattered most to me were the Standishes themselves and my own recognition, however belated, that the victims of foodborne illness are real and good people, not so different from me and you. This is an absurdly obvious truth, but still it had managed to elude me, in no small part because I’d never spent time with anyone who’d been seriously sickened by a foodborne pathogen. Before I met Margot, the whole notion that one could be made acutely ill from eating contaminated food had seemed somewhat vague and theoretical. Before I met Margot, I’d pretty much dismissed as lawyerly rhetoric Bill Marler’s contention that if only our policy makers would take the time and trouble to actually sit down with a victim of foodborne illness, they might be willing to take substantive action. Because meeting Margot and her parents had been affecting in a way I had not anticipated.
But I also recognized a danger, and it is the same danger that I believe has hijacked our national conversation around the subject of food safety. To focus on the relatively small number of people who fall victim to pathogenic bacteria can cause one to lose sight of the larger picture, with all its ongoing and tragic consequences. The hundreds of thousands of Americans who die every year at the hand of diet-related disease can themselves seem like an abstraction, but they are all too real. The overwhelming and overwhelmingly rapid consolidation of our food system into the hands of corporate entities that are intent on turning any final fragments of transparency opaque does not have a sweet face imploring me to sample a nasturtium petal or cherry tomato. The connection between the drug-resistant bacteria that kill tens of thousands of Americans every year and the way our food is produced is real, urgent, and downright perilous; it is also not about to tell you that, except for the throwing up, the hospital was pretty fun.
What I came to understand, as I drove north on my way home from Glastonbury, Connecticut, is that the story of foodborne pathogens and the very real, very charming, and very innocent people who are sickened by them is important not because it presents a comprehensive accounting of the dangers imposed on us by our food. Rather, it is important for exactly the reason I’d been so affected by meeting Margot and her parents: It engages us. It makes it real. It makes us feel. And maybe, just maybe, that feeling is exactly what will compel us to take action.