After her mother's death five years ago, Rosario Rivera took on the burden of watching her four younger siblings, making sure they ate breakfast and got to school.
The 21-year-old Ceres resident was attending school to become a medical assistant and better her life, proudly wearing the uniform the school gave her.
Rivera's chances were cut short last week, when she became the first to die from swine flu in Stanislaus County. She died July 1 from complications of pneumonia at Doctors Medical Center in Modesto.
Family members said they didn't know she was stricken with swine flu until a county public health nurse told them Monday.
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"Even though she was struggling for money and food, you would always see her with a smile," an aunt said. "She never showed the stress she was going through."
Her death left family members wondering if they had been exposed to the influenza virus that has caused 170 deaths nationwide.
"About 100 people went to visit my daughter and the doctors never told us she was sick with that," said Guillermo Rivera, Rosario's father. He noted that relatives were hugging and kissing the young woman and "were with her until the end."
Rivera got sick about two weeks ago and went to the hospital June 26 because of a severe headache and pain in her stomach, her father said.
Her breathing became extremely labored at the hospital and the next day — her birthday — doctors put her in the intensive care unit at DMC for treatment of pneumonia.
Her father brought balloons and roses to the hospital but found doctors had put a tube in Rivera's throat and hooked her to a machine to help her breathe.
Rivera's condition steadily declined and she was pronounced dead July 1. The initial record of her death said she died from pneumonia caused by an "unknown organism." The family was making funeral arrangements Monday when county public health officials told Rivera's father it was swine flu.
Rivera was one of the four cases of H1N1 influenza in the county, all reported in the past three weeks. The other patients have recovered. County officials said they notified the Rivera family as soon as they got the test results, which came five days after her death.
Doctors Medical Center officials said they could not comment on the case because of patient confidentiality, but said the hospital follows the state's contagious disease guidelines for swine flu.
The hospital met with public health officials Monday and notified employees to reinforce the heightened level of awareness for H1N1, a spokeswoman said.
Dr. Eric Ramos, medical director at DMC, said a patient coming to the hospital may not have obvious signs of flu. If it's suspected they could have swine flu, those patients are put in rooms by themselves and given masks. Masks are worn by nurses attending to the patients.
People with flu symptoms are told not to visit patients in the hospital, and people visiting patients with the flu are advised to take precautions. "We are probably going to be using more masks as the number of cases increases," Ramos said.
Rivera's death leaves a void for three younger brothers and a sister who looked to her for guidance. Her brother Angel, 18, said at her funeral Tuesday that she became more than his big sister after their mother died in 2004, within a year of having heart surgery.
County health officials, who never released the patient's name, said the patient had pre-existing health conditions that made her more susceptible to swine flu. Rivera had diabetes, family members said, but she was energetic and excited when she started attending Kaplan College in Salida a month ago.
"She really liked to wear the uniform and was excited about the classes," said Erika Gonzalez, a cousin, adding it was sad she wouldn't fulfill her dream.
Guillermo Rivera said no other family members seem to have the flu.
"Nobody is sick right now," he said. "My granddaughter went to the hospital because she had a fever, but we called the hospital just now and they told us it is not the swine flu."
Olivia Ruiz, managing editor of Vida en el Valle, contributed to this story.
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or 578-2321.
Stanislaus County health officials expect that cases of swine flu, or H1N1 influenza, will increase in the coming weeks and months. Here is what you need to know:
The illness: H1N1 influenza is as contagious as seasonal flu bugs. It's mainly spread by coughing or sneezing and infected droplets coming into contact with another person. People also can pick up the virus from a doorknob or other infected surfaces.
Symptoms: Fever, cough, sore throat, body aches, headache, chills, fatigue. Patients may have diarrhea and vomiting. Symptoms are usually mild to moderate; most patients fully recover.
- Cover your coughs and sneezes with an elbow, sleeve or tissue. Coughing into hands can spread germs to others.
- Wash hands often with soap and water, or use an alcohol-based hand cleanser.
- Avoid touching your eyes, nose and mouth, even after washing your hands.
- Avoid close contact with sick people.
- Stay home if you are sick.
- Treatment: Most people recover without needing medical attention. Seek immediate medical attention if you or a child have these warning signs:
- In children, fast breathing or trouble breathing; bluish or gray skin color; not drinking enough fluids; severe or persistent vomiting; not waking up or interacting; being so irritable the child doesn't want to be held; flu symptoms improve, then return with fever and worse cough
- In adults, difficulty breathing; pain or pressure in the chest or abdomen; sudden dizziness; confusion; severe or persistent vomiting