"Ok everyone, put your books away. I am giving you all a pop quiz. I hope you studied chapter 6 like I told you to yesterday!"
We've all felt it - that dreadful feeling you get in the pit of your stomach. Your heart races, you start sweating, and your stomach leaps up into your throat so you can't breathe and you feel like you're choking. It's that sense of foreboding that something really REALLY bad is either happening now or is going to happen really soon.
It's bad enough for anyone to get that feeling at all, but when a surgeon gets it, there's a very good chance that someone is going to die very soon. You'd better hope you aren't nearby when that happens, because it may be you.
Spooked yet? Stay with me, intrepid reader.
I got a call from one of my primary care colleagues who had an elderly patient in hospital with a small wound on her ankle. He thought it looked infected, so he asked me to take a peek. It sounded routine enough, and since I was already in the building, I told him I would happily swing by and see her.
Are you getting that feeling yet? NO? Keep reading.
I checked her vital signs before entering her room, and a few things caught my eye: 1) her blood pressure was a bit low even though she had a history of high blood pressure, and 2) her heart rate was a bit high even though she was taking medication to keep her heart rate low.
Uh oh, that feeling was definitely starting. Bah, it's probably nothing. Right?
I introduced myself and asked to see her ankle. She politely and pleasantly said that she had scraped it on a desk a few days earlier, and the pain just wouldn't go away. "I've always been a quick healer, so I'm not sure what's going on." When I examined her wound, it was only a centimeter or two long (less than an inch), but it didn't look right...it just didn't look right. It was definitely infected, but instead of pus coming out, there was some grayish, foul-smelling drainage that looked like dirty dishwater.
OH. SHIT. SHIT! SHITSHITSHITSHIT
I put my finger in the wound, and as I gently probed the wound, her skin started to fall apart, basically unzipping up her leg in front of my eyes. This was bad. Very very bad. Extremely bad. This was no ordinary wound - this was necrotising fasciitis, also (inappropriately) called the "flesh-eating" disease.
I quickly (but carefully) told her that she needed emergency surgery, that she may lose her leg, and that she very well may die. This was no time for beating around the bush or tiptoeing around the issue, it was a life-threatening emergency, so I had to be brutally honest with her. I told her this is an extremely fast-moving infection, and she looked terrified (I certainly couldn't blame her), but she understood and asked me to do everything I could.
Once I got her in the operating theatre, the extent of the damage became grimly and immediately evident. I opened up her lower leg, only to find that all the muscles below her knee were already stone dead. I extended the incision upwards, and the infection had already reached her mid thigh. I quickly made the only decision I could - I had to amputate her leg just below the hip. Unfortunately it was the only option I had to save her life. Without it, the infection would reach her torso within minutes, and when that happens, it's all over.
Despite being in her 80's, she survived the operation, and five days later she was transferred to a rehabilitation hospital where over the next few weeks she would learn how to function with only one leg. She was saddened at losing a leg, but very grateful that that was all she lost.
I often say that surprises in my line of work are almost always bad. Fortunately they usually aren't this bad. But when I get that feeling - THAT feeling - I'd strongly advise you to run the other way. Fast.