To her long list of medical accomplishments, Jackson ob-gyn Dr. Freda McKissic Bush can now add celebrated research subject.
She recently became the subject of a scientific paper entitled: “Lazarus Effect of High Dose Corticosteroids in a Patient with West Nile Virus Encephalitis: A Coincidence or a Clue?”
Published in “Frontiers of Medicine,” the article is co-authored by neurologists Dr. Art Leis of Methodist Rehabilitation Center (MRC) and Dr. David Sinclair of Mississippi Baptist Medical Center.
While Bush’s recovery is the focus of the treatise, it’s a bit of poetic license to compare her experience with that of the Biblical Lazarus. She was not raised from the dead.
But the 71-year-old retired physician said she was “on my way out.”“I was going to die, it was as simple as that,” she said.
Bush was suffering from West Nile virus (WNV) encephalitis, a swelling of brain tissue that is one of three neuro-invasive forms of WNV infection.
In the years since WNV first arrived in the United States in 1999, the Centers for Disease Control (CDC) and Prevention has recommended treating infections with only standard supportive care.
But during 16 years of studying neuro-invasive forms of the disease, Leis came to favor prescribing high-dose steroids for the most severe forms of the disease.
The approach seems to quell the body’s immune system attack of inflammation on healthy tissue. But Leis was cautious about using it at first. “It is counter-intuitive to weaken the immune system when a patient has encephalitis,” Leis said.
To be on the safe side, Leis initially delayed steroid treatment until at least two weeks from the onset of WNV. By 2018, he’d begun to rethink that timeline.
The CDC had found that WNV rapidly cleared the body in people with normal immune systems. And Leis’ own experiences with immune-suppressive treatments had not raised any red flags.
“To my knowledge we don’t have any cases where treatment with high-dose steroids initiated acute worsening that would suggest the virus had spread,” Leis said.
When he was consulted on Bush’s case in July 2018, Leis believed her condition demanded an aggressive approach, as did Sinclair.
“She was in the ICU in a semi-comatose state for a while,” Sinclair said. “It was very clear her whole brain was involved and the risk of disability at that point was extremely high—if not death.”
Leis and Sinclair say they sought to publicize Bush’s case because they believe scientific scrutiny of the approach is needed.
“We’re trying to look at deciding whether patients will improve spontaneously or if steroids are helpful,” Sinclair said. “This really needs to be studied in a manner where we have a control group who receives the current standard of care intervention.”
In the meantime, Leis will continue to contribute as a scientist who has long been on the front lines of WNV research.
In 2002, he and fellow MRC scientist Dr. Dobrivoje Stokic were the first in the world to link WNV to a polio-like paralysis. And over the years, MRC has been a valuable resource for physicians treating West Nile virus infection, as well as a support group site for survivors and their families.
Leis knows well the lifelong impact WNV infection can have. In his office is a five-drawer file cabinet full of patient data, as well as thank-you notes from people he’s helped.
For those who have the more severe forms of West Nile virus infection, over half have persistent or delayed symptoms, such as severe, disabling fatigue, persistent headaches, sleep disruptions and trouble concentrating,” Leis said.
Some even experience disruption of their autonomic reflex system, which controls everything from blood pressure, cardiac rhythm, sweating, bowel and bladder control to gastrointestinal mobility.
Recently, Leis obtained disease-specific privileges at several metro Jackson hospitals, which will make it easier for him to consult with acute care physicians.
And Sinclair, for one, believes there’s no one better than Leis to help guide the care of WNV patients.
“I think I’m one of a dozen young neurologists in the state who look toward his expertise in the area of neuro-virology,” Sinclair said. “He has cared for the most West Nile virus patients and dealt with the most severe consequences of that illness. He’s someone I could turn to for advice on cases like that.”
Like most long married couples, Lee and Freda McKissic Bush are deeply aware of each other’s moods.
So on the morning of July 17, 2018, Lee quickly realized something was amiss with his normally talkative wife.
The retired ob-gyn barely whispered yes or no to his questions. And she did not look well.
“I stopped getting ready for work and starting paying her attention,” he said. “Her torso was really burning up.”
After trying unsuccessfully to reach Freda’s doctor, Lee decided to rush her to the emergency room at Mississippi Baptist Medical Center in Jackson.
Much later she would ask him: “Why didn’t you call an ambulance?”
“Too slow,” he said.
Freda was well-known at Baptist, having delivered babies there since 1987. But when she arrived that morning, none of the staff had ever seen her like this—nearly unconscious and going downhill fast.
Her medical team quickly began a litany of tests. But it would be almost a week before Lee learned the source of his wife’s suffering.
She was diagnosed with West Nile virus encephalitis, a life-threatening form of the mosquito-borne disease.
What’s worse, Lee was being told the condition carried no treatment. “They said we’d have to wait and see what happens. And I said: ‘That’s my wife you’re talking about.’”
The couple had gotten married in 1969 after only three months of dating. In the years since, they’d reared four children, balanced two demanding careers and supported causes they believed in.
What loomed ahead was more opportunities to give back, as well as time to spend with their 11 grandchildren and two great-grandchildren.
Surely, this wasn’t to be the end of a union between two people who’d shared so much—including the challenges of each growing up the fifth of nine children.
An engineer by training and a successful businessman, Lee went into problem-solving mode to save his wife.
“He took matters into his own hands and said: ‘Somebody has got to tell me something,’” Freda said.
After some networking, website searches and phone calls, Lee learned one of the nation’s foremost West Nile virus researchers worked just down the street at Methodist Rehabilitation Center.
Lee arranged a meeting with Dr. Leis, a senior scientist with MRC’s Center for Neuroscience and Neurological Recovery. And he’ll never forget seeing him for the first time.
“He walked into this huge waiting room at Baptist and I said: ‘Here comes my angel doctor.’ He said: ‘Angel? Why did you call me that?’ I said: ‘Because you are my angel.’ He said: ‘I don’t know if you know this, but my first name is Angel.’”
Leis advocated treating Freda with high-dose steroids, but he warned it could be risky.
“He said steroids will stop her brain from swelling, but it will also stop her immune system—which is kind of dangerous,” Lee said.
But Leis said he was willing to take the chance because he knew Lee would provide the close observation Freda would need during steroid therapy.
When anyone would urge Lee to leave his wife’s side for a well-deserved respite, he’d say: “I’ll leave when she leaves.”
“He made a decision that his job was taking care of me,” Freda said. “He wouldn’t go to work, and he slept in a chair.
“When I realized how much dedication he had given to me, I boohooed. I was overwhelmed. I tell people if I thought I loved him before, it doesn’t compare to now.”
As Freda began to regain consciousness, “she didn’t know who she was or where she was, but she was awake,” Lee said.
And he made it his mission to keep her roused. “I am playing spiritual music, dancing around and walking around her bed praying,” he said.
Baptist staff offered spiritual support, too. “Every doctor who came by said we’re praying for her,” Lee said. “They would pat me on the shoulder and leave out.”
The Bushs’ adult children also came through for their parents. While their son took over for his dad at NCS Trash and Garbage, his three sisters rotated two-week caregiving shifts. And one of Freda’s sisters traveled from Washington, D.C., to lend a helping hand.
Freda spent three weeks at Baptist, including 15 days in ICU. Next came another 24 days at MRC, working on skills to regain her independence.
It wasn’t easy for the accomplished physician to acknowledge her deficits.
“I spent a lot of time crying,” she said. “I had already retired from medicine, but I was still very active. I was on a lot of boards and was working with the Medical Institute for Sexual Health in Austin. And to think now I couldn’t do anything, couldn’t even remember. I spent a lot of time crying because I wasn’t me.”
Lee, on the other hand, never lost hope.
“She is my miracle in slow motion,” he said. “The best thing for me was seeing in her eyes she was getting better and all the miracle steps in the right direction. When she could look at me and smile and say, I love you. Those were the nuances that kept me going.”
Today, Freda continues to progress. And while she’s chafing for more independence—she and Lee laugh that they never spent so much time together—she’s grateful for his commitment.
“I have to give credit to the Lord,” she said “He put us together, and he kept us together. I say I’m so sorry I got West Nile, but I’m so glad God gave me Lee Bush.”
