Friday, November 1, 2013

Up, Up and Away

I was rolled into the emergency room of my local hospital in the wee hours of December 3, 2011. The facility is brand new, staffed with many skilled and compassionate doctors and nurses, some of whom I knew socially from my years as a doctor’s wife. They misdiagnosed my illness at first. Doctors told my family that I was merely dehydrated because I had gastroenteritis – the stomach flu – and that with IV fluids and rest I would be fine.
I don’t blame those doctors for the misdiagnosis. Yes, their mistake nearly dispatched me to the great beyond, but if I had been in their position I probably would have reached the same conclusion. Why?  Because the disease that was killing me is extremely rare. Necrotizing fasciitis, an infection caused by a flesh-eating strain of strep-A bacteria, strikes fewer than 800 people a year in the United States, according to the Centers for Disease Control. And nearly all of those cases are caused by a wound that became infected.
I didn’t have a wound. I didn’t have a cut or scrape or bruise or bump. Also, I didn’t have any underlying medical conditions that could have weakened my immune system, leaving me vulnerable to infection. So of course doctors wouldn’t think I was being eaten alive by killer bacteria.
Do you remember a May, 2012 news story about a Georgia graduate student named Aimee Copeland, who got cut on a homemade zip line and fell into a river? The wound on her leg was deep and required 22 staples to close, and days later she was diagnosed with necrotizing fasciitis. Doctors eventually had to amputate both of her hands, one leg, and her other foot.
I remember seeing Aimee’s story on TV. Oh, boy do I remember it. I had been home from the hospital just two months when her ordeal became a media event. I cried and cried for her, knowing all too well what she was going through and what lay ahead. I was so angry on her behalf. She was just 24 years old! She’d barely gotten started with her life! What the hell?

Booksigning, Summer 2011

After Aimee’s illness was publicized, hardly a month has passed without me hearing of a new victim. A mother of newborn twins in South Carolina contracted the illness in the maternity ward. An eleven-year-old boy from Queens, New York, received a minor cut on his arm in a school basketball game and was dead four days later. I recently found out there have been several cases of flesh eating bacteria in my town. The mother of one of my daughter’s classmates died from it just weeks before I got ill. A local pediatrician had a teenager die on the exam table. A middle-aged man showed up in the ER and couldn’t be saved.
So just what is happening here? That’s a bigger issue than what I can address in my little blog. Some scientists believe it’s a sign that the overuse of antibiotics has created super bacteria. The CDC says the occurrence of flesh-eating bacteria is not on the rise, despite the headlines. One thing everyone seems to agree on how the disease works.
Every human being is covered in bacteria. I’ve known that little fact since high school biology class, but it’s one of those things I decided I’d rather not think about. Now I think about it every day. Streptococcus-A, the same bacteria that causes strep throat, lives on everyone’s skin all the time. In other words, we humans are just another link in nature’s giant food chain. Our skin – the skin we routinely wash, exfoliate, moisturize, disinfect, protect, and obsess about – is crawling with bacteria no matter what we do. If you get a cut, bacteria can enter the body. Most of the time, you get some redness and swelling (called cellulitis) before it heals.
 I was stunned the first time I heard the words “flesh-eating bacteria” from a doctor. I thought . . . but I keep a clean house! I wash my hands with Howard Hughes-like regularity! This makes no sense! Apparently, being a clean person won’t protect you, and if you get necrotizing fasciitis, you have a twenty-five to seventy-five percent chance of dying from it, according to varying estimates.
Necrotizing fasciitis is the Tyrannosaurus-rex of cellulitis. Bacteria (strep-A in my case and in most cases of the disease) moves from the surface of the skin to the inside of the body, reproduces at a rapid rate, and then gives off toxins and enzymes that eat away at soft tissue and fascia, a sheath of tissue that covers muscle. My infection spread enough that the muscle and bone were destroyed as well, but if the disease is diagnosed quickly or is limited in its scope, patients can recover with little permanent damage. In more advanced cases, such as mine, necrotizing fasciitis causes excruciating pain, high fever, dangerously low blood pressure, organ system failure, and usually results in amputation.
So there I was in my local ER for most of December 3, 2011. I don’t recall much, really, though I do have one surreal memory. A nurse was running at my side as I was being rushed down a hallway on a gurney. I saw florescent lights passing in a blur overhead. She began yelling, “She’s crashing! She’s crashing!” Then the nurse began calling out what I figured were blood pressure numbers, which were getting smaller and smaller. The last number I heard was “40.” Without a “1” in front of it.
From here on out, most of what I will relay about the next couple months of my life will be secondhand. The information comes from my family, friends, medical records, Arleen’s emails, and diffuse, bizarre flashes of memory. So bear with me, please.
 Here’s what I’ve managed to piece together about that visit to my local hospital. I was in the ER when a surgeon on call stopped by to see me. He is guy I know socially, a doctor who had been over to the house several times to watch college football. He is a Penn State alum and my ex-husband and I went to Northwestern. The two schools are Big 10 conference rivals – well, if NU is having a decent season. But I digress.
So my surgeon friend ordered more blood tests. He began to suspect that something other than gastroenteritis was going on with me. He examined me thoroughly and found a small red and purple patch of skin behind my left knee. Everything happened fast after that.
Test results showed my white cell count was off the charts. My fever went above 105 degrees. They flipped me upside down on a table to keep blood pressure in my brain. The surgeon friend called my ex-husband to tell him I was in septic shock and on a helicopter headed to the University of Maryland’s Shock Trauma unit in Baltimore. My daughter, Kathleen, saw her father blanch white at the news.
Though it was a short trip via helicopter, John, my ex-husband, later told me he expected me to die in transit. It was what his twenty-plus years as a physician told him would be the likely outcome.
I don’t remember anything about that helicopter ride, the pilot, or the medical personnel who kept me alive on the trip. Whoever you are, thank you. 

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