Twenty years ago, 623 people in the western U.S. fell ill with a little-known bacteria called E. coli O157:H7. Ultimately, four children would die from their infections; many others suffered long-term medical complications. The bug was later traced to undercooked hamburger served at Jack in the Box restaurants. This outbreak thrust foodborne illness onto the national stage as a real and present threat, sparking a sea change in the way Americans and the government treat this issue. To commemorate the 20th anniversary of the 1993 Jack in the Box outbreak, Food Safety News has produced a series of retrospective stories chronicling the outbreak itself and how food safety in America has changed since that time. Brianne Kiner will celebrate her 30th birthday at the end of this month, on what will be a vastly different occasion from her tenth birthday, which was spent in the hospital fighting for her life against an E. coli infection that kept her there for six months. Nine-year-old Brianne arrived at Seattle Children’s Hospital on Wednesday, January 13, 1993. The previous week, she had eaten at the Jack in the Box in Redmond, Washington twice, ordering a hamburger both times. Then, that Sunday, she had begun to suffer from severe gastrointestinal symtoms. On Wednesday, during a visit to the doctor’s office, her mother noticed blood in her urine. An ambulance was dispatched to the clinic to pick her up. At the hospital, Brianne was admitted to the intensive care unit, where her condition began to worsen. She developed hemolytic uremic syndrome, a complication of E. coli infection that results in kidney failure. One by one, her major organs began to fail. After a week in the hospital, Brianne slipped into a coma. Over the next 40 days, as she remained unconscious, doctors told her parents many times that they didn’t think she would make it. But on February 24, she regained consciousness, and her condition began to improve. It would be more than four months before Brianne left Children’s Hospital. After three strokes, 10,000 seizures, failure of every major organ, brain damage and muscle atrophy, she would need to relearn everything that had previously come easily to her – walking, talking – even chewing. Brianne left the hospital on June 28, 189 days after she had been admitted, a survivor ready to move forward. Earlier this month, Brianne looked back at that time, telling Food Safety News what she remembers – and doesn’t remember – and how the experience has changed – and not changed – her life. — Q: Do you remember how it felt when you first got sick, and when you went to the hospital? Were you scared? Were you in a lot of pain? A: No, I don’t remember getting sick at all. I don’t even remember the Christmas or Thanksgiving before. I was a healthy kid that was going to school, went to bed one night and woke up the next morning in a hospital bed. I don’t even remember waking up from my coma and I haven’t a clue when I started being able to remember things after that. I was more confused than scared. What did scare me was my family forgot to mention to the hospital that I was a needle-phobic. So it caught the hospital staff off guard when I started screaming when they approached me with a needle one day. I guess that helps illustrate just how sick I was when I arrived at the hospital. Q: How was the recovery process in the hospital? What kept you going through all the physical therapy and learning to walk again? A: I don’t know, typical I guess. I didn’t have an option. I was a kid in a hospital being told to do things by adults so I did them. You aren’t really given much choice when a physical therapist shows up in your room and you do therapy whether you want to or not. Also, I’m one of those people where if I overhear someone say I can’t do something, god damn it I’m going to prove them wrong. I’ve always been small and people assumed I couldn’t do or handle things and I spent a lot of my life focusing on confronting and working on improving myself in areas that people thought I couldn’t do or handle even before the whole E. coli thing. I’ve been a fighting underdog my whole life. To me it was as natural as breathing at that point. I wanted to walk again and I was I going to do it no matter what other people said. I think sometimes people interpreted my determination as impulsiveness, but it wasn’t. I was on a mission. Q: Do you remember finding out about the larger outbreak? How did you feel? Lucky that you had survived? Angry at what had happened to so many kids? A: Yes and no. I remember how I found out about how I got sick. Literally I was just watching the news one day. I was mad as hell because this was only a few months before I got discharged. I had already eaten many hamburgers at the hospital at that point. I didn’t know that is what made me sick and hamburgers were my favorite food at the time. I shouldn’t have had to find out that way. It wasn’t until I went to Washington, DC that it became clear that more people other than me got sick. I know in interviews it was mentioned that other people got sick, but hearing about it is different than seeing it. I was oddly isolated in the hospital from the other E. coli patients. Now let’s be clear, this wasn’t an imposition of the hospital. It was an accidental self-imposed isolation. When my sisters came to the hospital I wanted to be with them and they wanted to go to the teen center to hang out. They were 19 and 15 at the time. So I went there instead of going to the area where the kids my age would have been. Even when they weren’t there I just kept going to the teen center ’cause it was what I knew and where I was comfortable at that point. And also the people there were used to me going there so no one complained. I didn’t really get the chance to process how I felt about it until much later–even after Washington, DC. It was my first time out of Washington State in my life. I was overwhelmed by the whole trip and I ended up getting pneumonia on the airplane on the trip back and was hospitalized for another three weeks. So I didn’t really get the chance to process it until years later. I can’t tell you exactly when. I wouldn’t say I felt lucky about it because I think part of me realized there wouldn’t have been any other outcome. The doctors didn’t know me and if they had they would have realized the same. In fact, I got a get well card from a student at my elementary school. During my first or second grade year we were paired up with a forth grader for a project. Sadly, I don’t remember her name, and I’m paraphrasing this from memory. I still have the card. It’s in one of many boxes in my basement relating to this whole ordeal. She wrote, “I’m not going to tell you to get better because I know you. You’re a fighter.” When you’ve got that kind of tenacity death doesn’t take you easily. Everybody else knew I was supposed to die, but I think people forgot to tell me and if they had I wouldn’t have listened. Strangely, I don’t consider the whole E. coli the biggest or hardest thing I ever had to do. In fact, I consider it one of the easiest things I’ve done in my life. I’m sorry if that insults or bothers anyone, but that is reality. I can’t really say I was angry about it. I had too much crap going on. Bad things happen. It’s the nature of the world. I was more angry with the adults in my life at the time. I had so many therapies and interviews that I wasn’t being allowed to be a kid. I felt more like a medical object who was being placed in front of the cameras. I just wanted to be kid. By the time I did get time to process it and be angry there were already other E. coli outbreaks. Some people–including me–only learn the hard way sometimes. People aren’t perfect and hence the things we create aren’t perfect, either. Combine those two things and the reality is not just E. coli, but all foodborne illnesses are never going to go away completely and forever. There will be a natural waxing and waning to it. It’s sad, but it’s reality and you can’t get angry at that. Prep for the worst and hope for the best is all we can do. In the end it’s up to the people cooking the food to be educated about food safety and vigilant about it. Q: Have you kept in touch with any other victims from the outbreak or their families? I understand that you met Roni Austin, the mother of the first Jack in the Box E. coli victim who died? A: Like I said before, I was oddly isolated in the hospital and because I had so many things scheduled I literally didn’t see them out of the hospital except at interviews or such. I’m also really bad at long-distance relations of any form. I assume people are busy and time flies. I do miss people, but I’m never sure how to reconnect. Even when an opportunity arises somehow it manages to slip by. Yeah I did (meet Roni Austin). I was looking forward to that, too. Especially after reading the first chapter of the book (Poisoned). It’s odd when I meet people involved with the whole E. coli thing because they already know me because of all the media and I’m sorry to say I don’t have the faintest idea who they are. Then I feel bad about it, but how could I know them? The whole exchange just becomes awkward. I wouldn’t mind staying in touch, but I’m just done with the whole E. coli thing. I’d rather hear about the book they are currently reading than talk about the anything E. coli-related. Q: What health issues do you confront on a daily basis as a result of your illness? A: As far as E. coli-related health issues…just diabetes. The only time I deal with asthma now is when I have a cold, so that doesn’t really count anymore. Literally just diabetes. That, I’d say I got lucky with. I do consider myself to be really healthy now. Q: How do you feel about the progress that’s been made in regulating E. coli in food since the outbreak? Seven E. coli strains have been named adulterants now. Do you think there’s more to be done with beef? With other foods, such as vegetables? A: I don’t follow it that closely. Why just seven? But the fact that those seven are considered adulterants is a good thing. I’m not sure if there are things legally that can be done. It’s up to the people cooking the food. Every safety regulation could be put in place from when the calf being born to being slaughtered and processed until it hits the grill, and nature could still find a way for E. coli to get in there. The same is true for fruits and veggies and other foodborne illnesses. It’s ultimately up to the person cooking the food. Don’t blindly trust that the food is safe. Do your best to make sure it’s safe by cooking/washing it properly and if you choose to undercook something, acknowledge that you are taking a risk and if you or someone else does get sick that you had an opportunity to prevent it. I’d like to reiterate that in restaurants and grocery stores you do need to trust that the food is safe, but don’t blindly trust. Q: How do you react when you see stories of other foodborne illness outbreaks, particularly E. coli, on the news? A: I don’t. There have been too many outbreaks and cases now for me to react. I can’t emotionally get upset about it. That isn’t fair to me. I accept that they are part of reality and if there is a reaction it’s that another person has learned the hard way, but that is what it took for them to learn that lesson. People shouldn’t have to get sick or die for another to learn, but it happens and that’s reality. Bill Marler, managing partner of the Food Safety Law Firm Marler Clark, which underwrites Food Safety News, represented Brianne and her family.