Reflections on the care of a patient severely poisoned by 'rogue' botulinum toxin and rendered paralysed for a protracted hospital stay

Just before the Thanksgiving weekend in 2004 an unlicensed physician in Florida administered a raw botulinum toxin type A to himself and three other individuals. Three of the four ended up totally paralysed requiring long term care in intensive care units and rehabilitation services. This report chronicles the daily struggles of one such patient through her stay in acute care hospitals. Five years later this patient still struggles with both physical and mental effects from her ordeal. The story is presented from both the physician's and patient's viewpoint. It provides useful insight into the management of an unusual illness and will prove of invaluable background for anyone involved in treating such patients.