Monday, 20 May 2013

That sinking feeling

"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.

24 comments:

  1. Ergh. This was graphic and vile and completely hideous. Nicely done.

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    1. We're all lucky there wasn't a picture.

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  2. Isn't there a way for people to know that what they have is worse than a cut or a normal infection? I thought the symptoms of necrotising fasciitis were severe enough, usually, for people to know that it's not an every day infection.

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    1. Funny...I was wondering the exact same thing, and my name is also Amber! This story scared the living daylights out of me. I have plenty of bumps, bruises, and cuts right now - How would someone know if one of them were to be life threatening?

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  3. Doc I was just thinking about requesting a post about that sinking feeling yesterday! Fricken psychics man…..

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  4. This comment has been removed by the author.

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    1. He doesn't want us to know where he lives for confidentiality reasons. Why can't you respect that and just drop it?

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    2. Jeez, creepy stalker much?
      Are you going to go visit him or something? Will it make his stories any less interesting? Who cares where the dude lives!
      Keep in mind this dude has a family & patients, plus with all the crazies out there I can certainly see why he would want to protect his family & his patient's privacy by not revealing his location.

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    3. I live in Vancouver and judging by what I've seen and read, you're wrong. He wants to protect his and his family/patients identity so I think ot would be better to just drop it and stop guessing. Just respect what he wants and have fun reading his posts :)

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    4. As far as I know it has already been established that he lives on Mars. It's the only option that even remotely makes sense.

      #1: His highest priority regarding this blog is to keep his family and patients safe. So the timezone he set on here is the best reason to assume that he does not live anywhere near the american west coast (neither north nor south), so that is out.

      #2: He could be from Europe, but than his english is far too good to be from a non-english speaking country, and doesn't "sound" (read?) british.

      #3: He coould be from Asia, but see #2: english far too good.

      #4: He could be from Africa, and while there are english speaking parts there, he somewhere else said that his dad and granddad where surgeons (or at least doctors) too, and i don't think that most parts of Africa had first-world surgery three generations back.

      #5: He could be from Australia or New Zealand, but then he would say "barbie" and "arvo" a lot more.

      #6: He could be from Antarctica, but there are no major cities there, so I don't think so.

      So, now that we have ruled out every single continent on Earth, you just have to agree with me that Mars is the only option left. Doc, please say "Hi" to the rover when you meet him!


      On topic: that disease sounds scary. How do you find out in time that you have that instead of just a sore ankle?

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    5. You missed a continent! But yes I agree, Doc has his right to privacy and we should respect that, it might be fun to guess where he resides but don't post comments on his site with those speculations

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    6. No, I just handled North America and South America both in #1 because it's the same argument ruling them out :)

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    7. I know you aren't going to believe me, but somebody hacked my account. Really.

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    8. You're right we don't or at least I don't. Sorry bud.

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    9. But there are no major cities on Mars either...

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  5. Yesterday, I received a notification that my account had been hacked from Atlanta. Sure enough, when I looked at all of my favorite YouTube videos, the hacker had posted "stalker" comments claiming to know the identity of the uploader, vandalized several Wikipedia articles, and posted a comment here, so I did the only sensible thing – I changed my password. Hopefully this won't happen again; you can be assured that I have no desire to violate your privacy.

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  6. Hey Doc, could you make a post on the most bizarre case you've had to do, or maybe your first case as a doctor??

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  7. Doc, Can you please explain to me how someone can get necrotising fasciitis? It doesn't make any sense how she could have simple gotten scraped and then she get necrotising fasciitis.

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  8. I just Googled " necrotising fasciitis" and now I feel like I'm going be sick...Don't Google it.

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    1. i take on your challenge! I just ate too

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  9. OK, this is just getting weirder by the minute. Account hackers? Fake names? Necrotising fasciitis? Oh, and, by the way, what is that bruise on my arm? Is it going to kill me?

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    1. I just noticed that the person who's account was hacked was: Sue DoNym. The person who commented about it? Psu DoNym. Yes, this is weird. At least you found your twin, Psu.

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  10. DocBastard hasn't posted anything in five days.

    OH. SHIT. SHIT! SHITSHITSHITSHIT

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  11. I regretted looking the name of this disease up. I regretted it even more when my stupid device switched to google images without my permission. I woke up the whole house with my scream of disgusted horror, followed quickly by an eloquent "HOLY FUCKING FUCK! WHAT THE CHRIST IS THAY?! AHHHHH!!!"

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