Nails That Failed: A Medically Factual Mystery

Nails That Failed

A Medically Factual Mystery

J. John Portera, D.M.D.

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© 2013 J. John Portera, D.M.D. All rights reserved.

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Published by AuthorHouse 11/13/2013

ISBN: 978-1-4918-3302-5 (sc)

ISBN: 978-1-4918-3301-8 (hc)

ISBN: 978-1-4918-3303-2 (e)

Library of Congress Control Number: 2013920266

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Contents

Dedication

Author’s Note

Prologue

Chapter One

Chapter Two

Chapter Three

Chapter Four

Chapter Five

Chapter Six

Chapter Seven

Chapter Eight

Chapter Nine

Chapter Ten

Chapter Eleven

Chapter Twelve

Chapter Thirteen

Chapter Fourteen

Chapter Fifteen

Chapter Sixteen

Chapter Seventeen

Chapter Eighteen

Chapter Nineteen

Chapter Twenty

Chapter Twenty-One

Chapter Twenty-Two

Chapter Twenty-Three

Chapter Twenty-Four

Chapter Twenty-Five

Dedication

I dedicate this book to the families, friends, and loved ones who have lost a beloved one to the deadly organism, Naegleria fowleri. It is my fervent hope the facts I have presented may serve as a warning to those individuals who often participate in recreational activities where the water’s temperature is seventy-two degrees and higher. This temperature is highly conducive for these lethal single-celled organisms to thrive. If an individual persist in their preference to swim or engage in water activities afforded in ponds, lakes, stream, and rivers throughout the Deep South, one precaution may be to wear swimming gear that covers the nostril openings.

Personally, although the medical literature makes no implication about the eyes being an entry route for the deadly Naegleria fowleri to reach the brain, I advise eye cover. Neither recommendation submitted is a guarantee, but perhaps a common sense proposal for possibly preventing another fatality. One must keep in mind if this amoeba is inhaled into the nasal passageways, death—for statistical purposes—is a one hundred percent outcome; symptoms starting within four to five days, and death after ten to twelve days. There is no known medical treatment to alter this outcome—only a miracle.

Author’s Note

The novel’s front cover photographic image of the single-celled organism, Naegleria fowleri, was taken by Dr. Francine Marciano-Cabral—professor of Microbiology and Immunology at Virginia Commonwealth University School of Medicine. I gratefully acknowledge her generosity in allowing me to reprint the electron microscopic image to use on my book’s cover. It leaves nothing to the imagination why this amoeba is designated as the brain-eating amoeba. Its human-like features, although horrific, causes one to conjure a catastrophic outcome. Looking ghoulish, and heralding ten days or less of hell, a victim could conceivably cry out— if not comatose—for death’s door to open.

The medical information presented throughout this novel is factual. If errors are encountered, they are not the fault of the medical professionals who corroborated my knowledge concerning the contact, development of symptoms, diagnosis, treatment protocol, and fatal outcome of those characters that died of the rare brain infection described herein. A medical misstatement or error solely belongs to me, the author. A mistake might have been misinterpretation of the medical information provided to me, or possibly due to the creative license I deemed essential for enhancing this story.

These characters are fictional but, as an author admitting the truth about his creative work, I admit some of the characters I’ve presented—at times— similarly resemble the lives and incidents reflecting knowledge I personally possess.

Naegleria fowleri is a single-celled living organism designated as an amoeba. Only one species of Naegleria infects humans—fowleri. It is found existing in more places than humanity might like to acknowledge but, fortunately, it must be inhaled into the nasal passageways to reach the brain. This method of contact usually occurs while an individual is swimming in warm water ponds, rivers, streams, and lakes throughout the Deep South. Most recent case reports have been in Florida—the setting of this novel—and other southern United States locales where daily water temperatures range from the mid-seventies, to higher. If nasal inhalation of this organism is deep and the organism’s stage and concentration is optimal, a rare and fatal brain infection designated as Primary Amebic Meningoencephalitis (PAM) occurs. The illness is considered fatal because the victim has slightly under a one-hundred percent chance—over ninety-nine percent—of dying within ten to twelve days after inhaling the organism. The Centers for Disease Control and prevention (CDC) has indicated 1 person out of 128 Naegleria fowleri infected victims in the USA— from 1962 through 2012—has survived. This is why medical professionals classify the disease as terminal. It is a horrific way to die.

During the past thirty days, national televised broadcasts confirmed one issue relative to this book. It is directly related to the timely nature of the medical information I present, as each death from Primary Amebic Meningoencephalitis (PAM) has been caused through inhalation into the nasal passageways of water contaminated with Naegleria fowleri. The National News Media, in September 2013, reported a death from contact with Naegleria fowleri amoeba. It was in Louisiana’s St. Bernard’s Parish. A four-year old inhaled the deadly amoeba while playing in the public water system and subsequently died of PAM. I have no personal information concerning the chlorination content of the Public Water System in St. Bernard’s Parish. But, fortunately, the risk of death from Naegleria fowleri is relatively low—unless inhaled into the nasal passageways. The CDC have reported 31 Naegleria infections in the United States during the ten-year period from 2003 to 2012.

Another aspect, and admittedly, indirectly confirms validation of an imaginary and novel idea I envisioned six years ago. I felt a nasal spray for administering a local anesthetic to numb teeth, without using a needle, could become reality. And I uncovered—while researching the dental literature for writing this book—actual plans existed for initiating experiments to determine if spraying local anesthetics into the nostrils of mice would work. That information, independent of my imagination, was presented in the literature for the first time three years after my work was almost complete.

This creative project required several years to complete, after my initial idea. I had to methodically combine the medical corroborative information I received as text messages, emails, and even informal conversations. Some personal interruptions involving life events, some happy—and others not so happy—admittedly slowed completion.

My present thinking about the fictional dental product I conceived and presented in this story may become a future reality, instead of remaining a sole moment when my imagination motivated me to mesh fact and fiction into this timely presentation. Prevention of future Naegleria fowleri fatalities may also become a reality. Perhaps weaving the fictional characters—their suffering, their conflict, and an extreme redemptive resolution—was woven into a fabric foreshadowing this potential reality? Another way to convey this might be recalling the cliché; life is sometimes stranger than fiction.

These final statements refer to another FACTUAL aspect of this book—the narcissistic sociopathic traits of one major character. Her behavioral traits created a powerful influence on the story’s final outcome. She is a female narcissistic sociopath and her spouse clearly conveys the consequences of life with her. She makes the account I present herein conceivable because, historically, these female types have created various versions of this precise presentation in real life. And I feel compelled to expose and explain the traits this type of female demonstrates, in order for the novel’s final redemption of conflict to be better understood.

Professional advice to anyone in a relationship with a sociopath is—get away from this person! The admonition means no talking to them. No emails, no texts, no phone calls, no type of communication. Why such inflexible counsel? The answer is simple—Treatment of narcissistic sociopaths seems futile. Improvement is not realistic because these individuals think nothing is wrong with them. They relentlessly try convincing the partner they’re the crazy one—not them. The problems are always that of someone else. These individuals lack a conscience; experience no guilt, no shame, and no remorse. They project their guilt to their partner, lack empathy and are pathological liars. They are incapable of love, only feigning or faking it for a while—if potential to obtain their selfish goal seems probable. When their sense of entitlement is denied, they look for a new man to fulfill their desires. One in twenty-five individuals in USA are sociopaths.

Narcissistic sociopaths always have a ‘secret agenda.’ Some appear to be sexual addicts, as each of her new and multiple sexual partners is rationalized as the fault of the existing partner—I did it because I’m angry about my partner’s ‘mistreatment. Factually—the narcissistic-type female sociopath uses their sexuality and experienced expertise in using it the power to seduce, control, unravel, and destroy a man’s life. This female, during the seductive stage, uses speech affectation to appear more polished than she is. Her vocal tone, during the seductive stage, is soft and sexually suggestive. At the end of a relationship, it becomes harsh and loudly contemptuous. Her outward appearance reaches increased concern during the seductive phase. She needs a new wardrobe and often demands the partner she’s leaving to purchase it. Beneath her skin-deep superficiality, this female type possesses a cold, dark heart and hates men.

When seduction is achieved, the man’s power, prestige, self-esteem, even his intellect and innate attractiveness, becomes under total control of this scheming sociopath. On the subconscious level, this sociopath is seeking revenge and its sweet taste. Professionals indicate this female targets her victim to possess and control the attributes initially attracting her to him. Paraphrasing the writings of one Ph.D., this female uses a *psychological phallus capable of conquering any man—although she uses her natural female anatomical attributes to physically seduce. Realistically, it’s more about control and power than sexual.

The narcissistic sociopath often pitches a tantrum of cursing, intimidation, threats, and humiliating statements until the man is beaten down. Ironically, her threats are what she’s find most humiliating and hurtful to her. But lack of empathy allows her use of threats to defend and excuse her own deceitful behavior. If she uncovers a man’s emotional weak point or character flaw, she’ll pound it until she visually sees the hurt and damage being done. If a man is unfortunately involved with this type, he should never become emotionally attached, but detached—playing their game with her mindset.

Narcissistic female sociopaths move from one partner to another and often say—in a non-meaningful manner—to her present partner, I love you and, no, I’m not having sex with anyone else. Her lie is spoken with hard, focused eyes showing no emotion. They have a grandiose self-image and can discard a partner easy as trashing an empty soft drink can. This is often done after her deceptions and lies are discovered by the former partner. The new partner is often one who has been hidden from open view as part of her infamous secret agenda. Customarily, these females don’t have long term relationships—unless engaging in multiple infidelities and has one or more potential partners on the sidelines. Sex with a sociopath is how a new partner succumbs. Then, the cycle of a new victim becomes a matter of time. This is a lifelong pattern and professionals reveal a female who, as a child, was a daddy’s girl. The literature also indicates these females grew up at odds with the mother, one who sees the mother as a psychological competitor—and, perhaps subconsciously, a competitor for the father’s physical affection and doting.

Escaping this type of female is the only answer. If this advice is rejected, a new partner becomes a new victim. Life with a sociopath is a hellish nightmare of lies, deceptions, verbal abuse, disdain, and a final disillusioning destruction. If one escapes their powerful, persuasive enticement, psyche scars remain along with a deep-seated, inner directed anger for not seeing through her sooner. If one suspects being involved with a narcissistic sociopath, researching the traits being demonstrated is a must do—early identification of a sociopath saves a lot of grief and regrets.

*Linda Martinez-Lewi, Ph.D. J. John Portera, D.M.D

September 2013

Prologue

"‘Death,’ some terminally ill individuals have said to me on more than one occasion, ‘can be merciful when it comes with an advance announcement.’ I can comprehend how some of these fatally ill patients might’ve made the statement with a less than enthusiastic sense of gratitude, through understanding their choice of the word ‘merciful’ was used because their forewarning would’ve given them time to put the affairs of their life in order before the drape of death dropped—covering their life’s final scene with the inevitable and inescapable darkness that is the fate of all humanity.

"But, death can come merciless and in sudden silence. Then, surviving family and friends have described it to me as a metaphor—spoken in common language but, even so, actually quite eloquent. ‘Death came to our family in camouflage, dressed in a cloak of curious circumstance and place. It was like a crouched tiger, silently and suddenly springing on our loved one from a place where it wasn’t expected to be, but was there.’ And that’s precisely how it struck the first individual, eighteen-year-old Earl Barley, often referred to as T.B. by his classmates.

"During the next three months, it would strike three more times. Again, no warning was given when it senselessly stole the lives of Annette Ford, Ray Mier, III, and lastly, that of seventeen-year-old Terry Torrance.

"Death found these unsuspecting victims in Florida. ‘Each of those individual’s deaths possessed a mysterious aura around it,’ one neurologist said to me after the death of Annette Ford. It was something that began to taint the thinking of medical minds as they treated these four patients during their final days of life. Initially, the doctors focused on the similar symptoms, diagnostic tests, and the treatment protocol for what they were uncovering. One medical spokesperson said, in a televised statement, ‘this illness seems to suggest a common origin, and I can tell you resolution resides in our discovery and utilization of the one miraculous medication we need and must find. I’m sure it’ll only be a matter of time before we uncover it, but I understand this is little consolation to the grieving families at this time.’

"But, the physicians subsequently seemed to change their thinking and approach, asking the immediate family members to begin focusing on the last two weeks of their deathly ill loved one’s activities. Later, those same doctors began sensing and scrutinizing a peculiar thing about the time of year and average daily water temperature when these individuals were becoming sick and dying didn’t. Something just didn’t seem to correlate with the medical professionals initial conclusions. A doctor at a hospital in Fort Myers said, ‘We need to re-evaluate the aspect of time and temperature—scrutinizing the period prior to the final ten to twelve days after these patients began showing symptoms of sickness. Yes, we’re compelled to sift through this critical period of time, collecting and analyzing the information with a microscopic-like focus.’

"Finally, these men of science found themselves entertaining a conclusion that these horrific deaths could’ve been caused by more than a mere mishap. Each of the victims had become sick after being exposed to something that medically easily lent itself to pointing toward what appeared to be obvious things and places to investigate—perhaps too apparent. This then led the doctors toward surmising something other than what one infectious disease specialist stated as, ‘Perhaps the common sense medical deductions we’ve been holding on to, is incorrect and all of us must now take nothing for granted. This is behavior pattern we professionals are often guilty of demonstrating whenever an etiology—a cause or origin—of a certain illness and type of death appears apparent.’

"It was quite soon after this most recent medical conjecture became public knowledge that I became an active and integral part of this intriguing investigation. I, from my professional experience, always turn toward that which eliminates each and every extraneous piece of information. I accept nothing but the facts. What follows is my most recent written account, detailing one of my investigative and forensic forays into the human heart—a place where I’ve never found divinity dwelling.

I would be remiss if I didn’t tell you I waited three years to begin writing about this particular investigation. I did this, as I’ve done with each of my publications concerning actual cases I’ve participated in, and later wrote about. It’s always seemed to me a few years can cool off human passions. Rage is oftentimes not as hot with passing time, and grief of the heart can cease to be an open wound. ‘Father Time’ and ‘Mother Nature’ always seem to be the best medicine, or consolation for anger and a broken heart.

Dr. Matteo DeLucca (fictional narrator)

25 December 2008

Chapter One

Orlando, Florida, 2004

T here were some classmates of Earl Tar Baby Baley who insisted the senior year, stand-out athlete at William R. Boone High School in Orlando, received his nickname from his perennial suntan. Most of his fellow classmates, those afraid of being reprimanded by school officials, cautiously chose to use T.B., while others, particularly the jocks on campus, stuck to Tar Baby.

His skin color, year round, was closer to a caramel-like hue than the reddish bronze skin of many Caucasians exposed to the intense, semi-tropical, Florida sun. Those classmates who remained steadfast in their belief his service as a lifeguard at the swimming pools throughout the greater Orlando, Florida area, since age fifteen, played the primary role in creating his dark skin. This allowed them to defend their nickname for Earl—if called on the carpet by school officials or reprimanded by a parent that insisted the sobriquet had racial or bigoted undertones.

But another account of how Earl received his nickname came from his football teammates—particularly from the African-American players. They maintained it was Otis Pit Bull Blair, the first team junior fullback, who bestowed the nickname on Baley. The story proposed its origin came the first time Baley showered after a practice session during his freshman year, Blair made his historical observation when he said—Dude, your pecker is dark as a brother’s. You gotta be part Tar Baby, man!

While the origin of Earl’s nickname remained unclear, there was one thing about him eliciting general agreement—his physical size. At age fifteen, he stood six-feet tall, and by age eighteen he grew two more inches. Barley’s six-feet, two-inch frame tipped the scales at a solid two-hundred and twenty pounds. It was all muscle.

He possessed another trait, one leading to innumerable physical altercations while on and off the playing field—his short fuse. Earl Baley’s love of contact sports and swimming was only exceeded by two things—his fervor for fist fighting and hunting.

His dark skin, muscularity, thick jaw, hawk-like nose, beady green eyes, and the scar from a poorly performed surgical procedure to correct a congenital harelip, contributed to his overall badass look. Baley not only looked tough, he had often proven to be mean as a rattlesnake on steroids. Earl had never lost a fight, not until one Sunday night at a local hangout, when a defensive end teammate named Ed Stump Jones cold-cocked him with a right jab. It knocked the tar out of Tar Baby, rendering him unconscious.

Stump Jones later said, Baley always won his fights by getting in the first blow, but this time, I beat the sumbitch to that first punch. Besides a few minutes of unconsciousness, the blow left badass Baley with a split lip, a swollen nose, and an angularly fractured, upper front central incisor tooth.

One might conclude Earl would have left his fractured tooth as it was—perhaps adding to his sinister looks—but he felt the broken tooth was a cosmetic detraction to his otherwise perfectly aligned, pearl-white teeth. As a result, his vanity motivated him to be in the Orlando dental office of Dr. John A. Manselli the following Monday.

It was the Monday after Thanksgiving, and if Baley’s name hadn’t been readily recognizable by Orlando’s sports fans, it’s doubtful he would have gotten an appointment with Manselli, a busy, and well-known cosmetic dentist in Orlando. He was also an avid fan of Boone high school football.

Dr. Manselli was better known to his relatives and high school classmates at Grana High School in Mississippi, as Big John. Acquaintances, from his teenage years, say the nickname came from his unusually large physical stature at age fifteen. John, like Baley, physically matured earlier than other males of the same age. Big John became the Grana Bulldog’s first team fullback during his freshman year, standing six-foot tall in his bare feet and weighing two-hundred and fifteen pounds while wearing only a jock strap.

Big John was a natural nickname for the first generation American-born Italian, but some relatives and former teammates maintain the nickname was subsequently shortened to Big.

Dr. John and Baley distinctly shared the commonality of being star high school football players but, unlike Earl, Manselli lost his chance for a scholarship to play collegiate football. A helmet to helmet contact cost him a full scholarship to play ball at Ole Miss after the injury proved to be a partially detached retina. It happened during his senior year’s final football game. But Baley had been more fortunate and none of his injuries, even this most recent one, would prevent him from receiving a full-time football scholarship to Florida State University.

The two men developed instant rapport the Monday afternoon when Boone High School’s superstar was seated in Manselli’s dental chair, and Baley began recalling the previous Friday night’s altercation. His play-by-play recall of the event was entertaining and enlightening to Dr. John and his auxiliary staff. And there’s little doubt their similar athletic backgrounds contributed to the immediate connection between the two men.

Dr. John, that sumbitch got me with a sucker punch. As you can see, I ain’t got the prettiest face in the world, but my teeth have always been my pride and joy. Doc, can you fix this tooth without hurtin’ me? Man, I hate needles but I ain’t gonna sit here and say I’ll whup your ass if you hurt me—you’re bout as big as me and you damn sure got the upper hand right now. Just don’t let me see that friggin’ needle.

Manselli grinned, a grin many females in his earlier life described as being able to melt iron and with his steel blue eyes softening with empathy for the frightened tough guy, as he reassured Baley there would be no pain associated with the dental procedure. He also told Baley he would make the tooth look like new without grinding on it.

Earl, it appears you’ve also sustained some damage to your nose from the blow. I’m saying this due to the sound of your speech and the obvious swelling of your nose. I can see you’re not breathing very well through your nose and this could be a problem for you when I isolate the tooth with what dentists call a rubber dam.

Is that gonna keep you from fixin’ my tooth, doc? Anyway, what the heck is a rubber dam?

Dr. John explained, in the simplest terminology he could use, a rubber dam was a piece of latex rubber-—placed over a metal frame, and it allowed him to keep a tooth dry while he worked on it. Earl, the rubber dam allows me to obtain a drier area when placing the filling material, and therefore a better chance of obtaining an ideal restoration for your tooth. But it can also cause some mouth breathers to feel a sense of suffocation. And, at the moment, you’re definitely breathing through your mouth more than through your nostrils—

Before the dentist could continue, Earl interrupted him. Well, doc, I sure as hell don’t want to feel like I’m suffocating. So, what’s your plan for nipping that in the bud?

Manselli smiled and responded with, Earl, believe it or not, I’ve just started using a new dental product—it’s a type of nasal spray being manufactured for this type of situation. One portion of the spray’s solution will open up your nasal passageway for an hour or more, and it’ll do it without some of the common side effects associated with decongestants.

Dr. John noticed a look of puzzlement on Baley’s face and realized he would need to speak in simpler terms. Let me put it this way Earl, the spray is going to make your breathing much easier, without raising your blood pressure or making your heart beat faster.

Manselli, perceiving his young patient had understood, proceeded with a thorough description of the new dental product. He told Baley, Besides this spray being a good decongestant; the developing company claims it’ll numb teeth without using a needle.

The dentist was eager to proceed with his second evaluation of the spray, since he had been one of the first dentists chosen to evaluate the first test run of the product. Now, with Earl Baley in his dental chair, Dr. John continued explaining to his young patient why his nasal condition—along with his innate fear of dentistry—made him an ideal candidate for administering it, and thereby allowing another assessment of the company’s revised spray solution.

He told Baley, Earl, I’ll be the first to admit patients, by in large, hate the rubber dam isolation because it forces them to keep their mouth open throughout the procedure. But, as I’ve said, it is indispensable in obtaining the best possible dental restoration; it’s particularly useful and effective when we’re working on a fractured front tooth like yours. Besides, since this spray will allow you to breathe easier through your swollen nose—I feel it’ll relieve some of your anxiety.

Doc, this all sounds mighty damn good, but I’m sitting here wondering if this ain’t too good to be true. But, if it’s all you’re claiming it to be, I guess some dude has gotten filthy rich, huh?

Earl, I’m proud to say an old acquaintance of mine owns the company that’s making this product. In fact, he recently relocated from Jacksonville, and is now living in Tampa. I got to know him quite well when I was teaching dentistry at the dental school in Mississippi, but as badly as I hate to admit it, that was a number of years before I opened my practice here in Orlando, the fifty-six-year-old Manselli said, while rolling his eyes upward in recognition of his age.

Anyway, Dr. John continued, you’re going to be the lucky dude who’s about to receive treatment from one of the first sprays modified by the company four months ago. Actually, I almost had to beg the friend who’s manufacturing it for the samples I have, since these were supposed to go to a dentist in Fort Lauderdale. I guess it’s another example of why having a friend in the right place is always a good thing—particularly when the friend owns the company, John Manselli said with a grin.

So, I’m gonna be a guinea pig, doc?

Not at all, Earl, Dr. John chuckled and hastened to respond, "Actually, I was one of seven dentists who tested the company’s initially produced sprays. The only reason my friend’s company modified the product, after its introductory period, was to obtain a stronger concentration.

"Those first sprays seemed to be ineffective, so I suggested the concentration be strengthened. I say this because, as I told the company’s president, the enhanced nasal breathing only lasted about twenty-five minutes, but the numbing effect of the company’s claim just wasn’t what I, and other testing dentists thought it ought to be. I felt the spray’s numbing benefits should last at least an hour, and I’ve been assured this latest production will meet the criteria.

"Earl, I’m compelled to advise you the company’s research indicates there’re no harmful side effects, but FDA acceptance or approval hasn’t been obtained at this point in time, so you’ll need you to sign your name on this form confirming you’ve given me permission to use it.

I personally believe this method of numbing teeth will soon be one of the hottest dental products to come along since tooth-colored fillings for back teeth. In fact, I believe in this product so much I’ve decided to assist the company with opening up the dental marketplace in Florida’s panhandle, and I’m even making a personal financial investment. You ready for me to get started, my man?

Yeah, you can do anything you need to, doc, or use whatever you’ve got—that’s gonna make this easier on me—just don’t hurt me with that damn needle!

Needle, did you say needle, Earl?

Course I said needle, doc! You gonna try and make me believe tooth doctors suddenly quit usin’ needles?

Yes, believe it or not, big boy—wow, I can’t believe I didn’t make it clear this spray is truly making it unnecessary to use the needle. Earl, I thought you—

Doc, damn, I thought you were kiddin’ me. So, you’re standing there with a bold face and tellin’ me there ain’t gonna be no needle used to fix this cracked tooth. C’mon, doc, I ain’t ignorant, dude.

Well, Earl, the solution should make you numb for forty-five minutes to an hour. And, in your case, I think it’s worth a try. Now, as I asked you a minute ago, are you ready to find out, Earl?

"Doc, there’s gotta be pure magic in