Special Photo Hannah Rinehart and her husband of two years, Mark, a math teacher at South Gwinnett High School are seen here. Doctors believe Hannah contracted a rare infection from bacteria commonly found in dog saliva, which resulted in the amputation of her hands and feet.
SNELLVILLE -- In the ICU at Northside Hospital in Atlanta, Mark Rinehart sanitized his hands on Friday, chatted with a nurse and looked over his unconscious wife. Thin and pretty, her brown hair swept into a high ponytail, she breathed through a tracheostomy tube, her lips parted. Mark pinched a white sheet covering his wife and lifted up.
The feet that had carried Hannah Rinehart on missionary trips to Mexico and Poland, where she developed an affinity for delicious perogies, were gone. The hands she used for gardening around the 1950s ranch they share in Decatur, for playing with their puppy, the finger for her wedding ring -- all of that was gone, too. Instead what Mark saw were four gauze-wrapped bulbs: the remainder after an unfathomable subtraction, the choice that had become the only option.
Mark is trying to look at his wife as much as possible, to blunt the shock by the time she revives, possibly some time today. But seeing what's missing pinches his face with pain.
"I can't really look at her too long," said Mark, 27, dropping the white sheet.
In Hannah, a 32-year-old patient care technician at DeKalb Medical Hillandale, a rare bacterial infection has struck again this summer, claiming another ambitious young woman's extremities. Oddly, Hannah shares a South Gwinnett High School connection with Aimee Copeland, whose plight brought the term "flesh-eating bacteria" into the national lexicon, and whose name became synonymous with perseverance. Copeland graduated from the school; Hannah's husband teaches math there. Both women have sacrificed much to microscopic villains born in strange places.
Mark catches himself wondering when he'll wake up from this, when he'll snap back to late June, when he and his wife were pressure-washing their home, which is girded by Japanese maples.
After a day sweating in the yard, Hannah developed aches and a 103-degree fever. With an icy bath, the fever broke, and they shrugged the symptoms off. But by the time Hannah, a cancer survivor, went to see her oncologist for a scheduled meeting, Mark had to carry her into Northside Hospital. She was admitted to the ICU on July 2 and hasn't left since.
In the ensuing weeks, Hannah has been inanimate, save for a nod when Mark asked once if she knew how much he loved her. She was oblivious to their second wedding anniversary on July 10.
On July 3, a Tweet from Mark served as the first public distress signal: "Please pray for my wife ... She is in ICU w/ bacterial infection affecting all her vital organs. We need prayers of faith."
For two weeks, Hannah's family and friends were in limbo as doctors tried to root out the cause. Blood samples untainted by antibiotics were sent to a Mayo Clinic lab, where the culprit was finally revealed as capnocytophaga, a bacteria found in the saliva of mammals, especially dogs. It almost never causes infections.
"It was basically like being struck by lighting," Mark said, "it doesn't happen."
After much deduction the family feels certain the bacteria came from "Brownie," the Rinehart's 1-year-old Labrador retriever mix, a rambunctious shelter rescue that uses its owners as chew toys. The dog had been a present for Mark, a second lieutenant in the Army National Guard, when he graduated officer candidate school last year. There was no specific bite on Hannah. No real blood. No wound.
On Thursday night, Hannah joined an unfortunate sorority of amputees that includes Copeland, who contracted her bacteria, Aeromonas hydrophila, when a homemade zip line snapped May 1, sending her crashing into a river near the University of West Georgia, where she studied psychology. Copeland was gashed in the fall, and the infection would claim her leg, foot and both hands. Flesh-eating Aeromonas cases are so rare that only a handful have been reported in medical journals in recent decades.
Ditto for Hannah's bug.
According to the LSU School of Veterinary Medicine, most people who develop capnocytophaga infections were bitten by dogs, leading to septicemia, or blood poisoning. While the infection doesn't eat flesh, per se, about 30 percent of people who develop its septicemia die.
A 2006 study by the California Department of Health Services found that co-existing conditions in capnocytophaga patients can include Hodgkin lymphoma, which Hannah developed at age 18. Other studies have found that more than 40 percent of patients have no obvious risk factor. Four years ago, Swiss doctors counted only 160 reported infections since the bacteria's discovery in 1976.
On the eve of Hannah's surgery, the family was visited by Dunwoody resident Paul Springer, whose wife Becky lost her hands and feet in 2008 to amputation -- another consequence of septic shock but from a different bacterial disease, Haemophilus Influenzae Type B. Unlike with Hannah and Aimee, doctors have no idea how she contracted it.
Springer told Hannah's family that, over time, they will hardly notice Hannah's new look. Cancer treatments had left Hannah bald before, so her mother said she is used to strangers curiously peeking. After her second bone-marrow transplant, which put her cancer in remission for nearly seven years, Hannah stepped to the forefront of the cancer awareness cause, giving speeches at Relay For Life events.
"She has always been a radiant person," said her mother, Teresa Johnson, who owned a Buford real estate company with husband Doug, and raised Hannah in Suwanee before moving to Cumming. "She has had a passion for helping other people -- she's got the most kind, caring heart."
A husband's devotion
The bacteria has derailed Mark's life, too. To this teacher, summer doesn't really exist. He has converted a corner of the ICU family waiting room into his "dorm" -- an Army-issued cot, Styrofoam cooler, sack of potato chips and a camouflage backpack. Home.
Mark is so wont to leave that friends on Friday had to shop for him at Macy's -- new clothes for school pre-planning sessions that begin Monday, and which he plans to attend. (Gwinnett Public School officials say they are working with Mark in his "difficult time.")
"(Mark has) been ... a knight in shinning armor," said Hannah's brother, David Johnson, 33, who owns a commercial real estate company. "A lot of guys in their 20s are not capable of stepping up to the plate in a situation like this."
In a society dependent on minute-by-minute information feeds, Mark has shrugged off fatigue to assume the role of social network newscaster. His airwaves, as with Copeland's family, are Facebook posts. With a mind schooled in arithmetic and a frantic curiosity in medicine, Mark's posts can read like lab reports: "Just came out of Hannah's room. Levophed (vasoconstrictor) has been taken off Hannah's IV, and replaced with Precedex (painkiller). Hannah was asleep."
Mark often posts alone, in the ICU's two-table cafeteria, pecking away at Hannah's iPad, a present from her husband inscribed with lyrics from their first dance song at the wedding: "It Is You I Have Loved All Along." He can't describe the comfort he finds in Hannah's swelling cache of Facebook friends, in the prayers they send.
The Rinehart's first encounter was an accident. Mark and Hannah met at Cross Pointe Church in Duluth, when he was chatting with her younger brother, Daniel, a Navy man, about the military. Daniel gave his approval, and "it was all downhill from there," Mark laughed.
In happier times, Hannah liked it when her husband, a former UGA marching band member, played keyboard and piano and sang to her. They had a silly hobby of watching the Food Network (Mark's preference) and HGTV (Hannah's) and trying to guess what hosts were really thinking. Squabbles over the remote control were common.
As the hospital stay bled from days to weeks, Mark's upbeat postings yielded to a harsh reality: Septic shock was taking its toll, blood was clotting en route to Hannah's feet and hands, where tissue had become necrotic, releasing toxins into her blood that could take her life.
A hand specialist and orthopedic surgeon impressed Mark, promising to save as much of Hannah as possible. Maybe an ankle, a wrist. Posted Mark: "Should Hannah be found not in need of surgery tomorrow, I will be the first dancing in the streets. Yet to not respond to the situation as it stands now would not be a display of faith, but rather a crude act of negligence."
The surgery was schedule for a 3 -1/2 hour block, beginning at 4 p.m. Thursday. More than 20 people -- friends, family and ministers -- gathered around the waiting room and Mark's makeshift dorm.
At the last moment before surgery, doctors granted Mark permission to remove a splint from Hannah's hand. Though her hand was dry, black and cold, her fingers gnarled, Mark wanted to hold it once more, a gesture he hopes his wife will appreciate one day.
In the end, Hannah lost her hands up to the forearms, her legs from 15 centimeters below the knee, the standard length for prosthetics. But all the necrotic tissue is gone. "Whatever the case, she's a beautiful woman," Mark said hours later. "Nothing we do to her is going to change that."
Slowly, apprehensively, they came to observe a modified Hannah. Her parents said nothing could intellectually prepare them for seeing a child in that state.
"We'd been talking about it for three days, and when we walked in it was such a shock," said her father, Doug Johnson. "We're still just trying to cope with this type of change."
Mark is now faced with the incomprehensible task of explaining the amputations to his wife, who may not even recall falling sick. There are no instruction manuals for this. He has consulted with a nurse practitioner at the hospital and has placed calls with Army officials who have broken similar news to reviving soldiers.
What's certain is that Hannah will awaken to a devoted network of supporters. Her best friend, Kerrie Touchstone, a Rome physical therapist, is in the process of organizing a fund to help the young couple. The women were in each other's weddings. They often talked about taking their families, when they had them, on vacations together.
"I know right now that looks difficult," said Touchstone, "but I know those vacations can happen."