I was phoned from Underberg recently, the doctor there wanted me to see a woman who he thought had a severe gangrene-type infection around her lower back area. He told me she was an American tourist on an off-road bike Safari who’d just come down Sani pass out of Lesotho.
Awaiting her arrival, I dreaded what was coming my way. Was it necrotising fasciitis? An often lethal disease, necrotising fasciitis is an infection that spreads like wildfire through soft tissue, destroying everything in its path. Treating it involves potent antibiotics, life support and the aggressive removal of all affected tissue – resulting in disfigurement and even the amputation of limbs.
It was a very busy day in theatre, so when Sandy arrived in casualty I rushed to quickly assess her between seeing patients. I’ll never forget the hopeless first impression I had of her: A lonely woman, unaccompanied, with dirty biker’s clothes and hair, and the smell of death emanating from the soiled linen-saver she was lying on. I only needed a glance to confirm my worst fears. This was a serious case of necrotising fasciitis. Sandy was in septic shock and not even aware that I was there.
I immediately transferred her to ICU where she was washed, dressed in theatre clothes and we began treatment. This included medication to support her blood pressure which was ominously low from impending septic shock.
Two hours later she was sitting upright in bed, a twinkle in her eye. She cheekily asked, “‘Are you the good-looking young doctor who’s supposed to look at my bum?” I was stunned to see a glimpse of the person inside this critically ill body. But it was no time for light-heartedness, her situation dire and now I had to tell her about the hard facts of her situation: She’d need to be taken into emergency surgery and a significant amount of her body will be physically cut away. She’d need a colostomy and, even with all this, there was no guarantee we’d be successful in saving her life. Unflinching, she looked me squarely in the eye and in an upbeat voice said, “Well, I guess we’d better get on with it then!”
Somehow Sandy’s invincible attitude had given me hope. But first, I had to phone her husband, Terry, sitting half a world away in California with their 15-year-old son and tell them what was going on. The information was met calmly and he wished my well for the surgery. It was only later that he admitted to freezing up inside the minute I explained the seriousness of Sandy’s condition.
We started operating at 10pm and finished just after midnight. I remember there was a moment during surgery when hope failed me. The infection had spread all the way to the inside wall of her pelvis and about 2 kg of tissue had to be cut away to get around the necrotic tissue. My assistant shook his head in resigned defeat, and expressed concern, “We’re not going to win this one”. I had to completely loosen up the bottom section of her bowel from all its attachments. Finally, using long retractors we were able to clear the infected tissue away 15 cm into the pelvis, stopping the rapidly spreading gangrenous disease dead in its tracks. After the huge operation Sandy remained on life support in ICU for two days before she finally woke up. By this stage Terry had arrived. He stayed by her side through the three difficult weeks in hospital that followed. The surgery had left an enormous wound cavity that had to be washed and dressed daily. At all times they both displayed courage, humour and a very hands-on approach to getting Sandy better.
It was during this time that I got to know Sandy and Terry well. I learned that, as a family, they’ve adventure-toured the globe extensively on their off-road motorcycles and were featured on numerous TV shows. Watching some past episodes I wasn’t surprised to see Sandy as the exceptionally confident, engaging, lovely and dynamic woman she is.
Meeting Sandy was a reminder of how often I encounter people at very serious crossroads of their lives. Are they going to beat this cancer? Are they going to survive this illness or injury? It’s in this space that the protective wall of feeling safe in one’s own body is momentarily broken, exposing the real, vulnerable person inside. And it’s this courage, humour and grace that I see in these situations that is one of the most beautiful parts of my job.