Flesh-eating Bacteria Survivor

by Vance "Bo" Salisbury

 

On May 9, 1998, while playing indoor soccer with folks from our church, I was kicked in the left ankle. The following day, Mother's Day, I followed my usual routine, taking our dog Rosie for a walk before church. At about 10 AM, my ankle began to hurt and by 11:30 AM I was in severe pain. I took some aspirin and we joined our friends, the Richeys, for lunch at Fred's Chinese Restaurant. At about 2 PM I could no longer stand the pain and went to the local Emergency Room with my wife, Denise, and friend Mark Richey, a radiologist. The ER doctor examined me, but it appeared to be a routine sports injury, so I was released and given some prescription pain reliever.

The Symptoms

The following day, Monday May 11th, I was still in terrible pain and the ER nurse told Denise to double the dosage of pain medication. By the afternoon, the pain was unbearable, I was nauseous and crawling from room to room, because I had no strength. Denise called our family physician, Dr. Scott Kellermann, who told us to come to his office immediately. By this time I was perspiring and my blood pressure was dropping. Scott admitted me to the hospital where I was observed and tests were taken through the night. The following morning I experienced multiple organ failure and was to be transferred, via helicopter, to the UC Davis medical center in Sacramento CA. However, a late spring storm bringing snow kept the helicopter grounded, so I was taken by ambulance.

The Diagnosis

When I arrived at the UCD ICU, Dr. Susan Murin was the attending physician. She and Dr. Jeff Jones interviewed my wife and I, resuscitated me, inserted various catheters and the breathing tube. Dr. Jones made the diagnosis of necrotizing fasciitis, but the surgeons on hand were skeptical -- until the blood work arrived from my local hospital, confirming his opinion. Dr. Murin later told me that Dr. Jones was heard gloating "I'm the man" for the next few days, because he was the first to make the diagnosis based upon the symptoms.

The Treatment

My case was turned over to the world renowned surgeon and "father of modern trauma care," Dr. F. William Blaisdell. He and his team put me on a powerful combination of antibiotics and began debridement of my leg, removing everything down to the muscle in five separate operations. I spent ten days on the ventilator and was in a coma for most of that time. To be certain that all of the bacteria was gone, the flesh was removed from the top of my toes to the top of my left hip and it was discussed whether my foot should be amputated or fused at a 90º angle, because there was literally nothing left between my ankle and Achilles' tendon. I went into toxic shock and was expected to die. The bacteria marched up my left leg, destroying all of the soft tissue down to the fascia (the membrane between the muscle and outer soft tissue). My condition was grave for some time and amputation of my leg became a very real option. You may view the post-operative photos, but they are very graphic.

The Cure

I was transferred to the Burn Unit ICU, Dr. Kellermann canceled all of his appointments for four days and joined my friends and family at the hospital in fasting and prayer. People all around the world lifted me up to Jesus and He answered those prayers by saving my life and performing a few miracles. On day four, the bacteria halted at the top of my thigh -- Dr. Kellermann believes it was a miracle. That day, the surgeon brought Dr. Kellermann in to show him that the infection had moved all the way up into my lower back. The outside border and time of the examination had been written on my skin with a marker. "We are taking him in for a final debridement, but he is not going to live. It's like trying to stop a freight train with tissue paper," the surgeon confided. One of the nurses in the burn unit ICU gave my wife the same grim prognosis, motioning with her hand up the left side and lower back. At the time, Denise could not comprehend that my death was virtually assured because of the size and location of the infected area; She thought the nurse was simply keeping her updated. Two hours later, the surgeon emerged from the elevator and sat down with everyone in the waiting area. "I've been a surgeon for many years," he softly said, shaking his head over and over. "I've never seen anything like this. We searched for hours and the infection is completely gone." Dr. Kellermann cast all sense of professional propriety aside, and began leaping and shouting "Praise the Lord!" Scott gathered everyone together for a prayer of thanksgiving and as he recorded in his journal, "We talked about how a miracle had been witnessed by us today and from this time forward, Bo's life and all our lives would be forever changed."

The Turnaround

I remained in my coma that evening, while Denise and friends celebrated with a feast and belly dancing! Taking this sudden change of events as a sign that things were turning around, they decided to go to dinner at a local Moroccan restaurant. What they didn't know was that belly dancers entertained the customers every night at 7:30 PM. So, as my family and friends broke their fast on gyros, roasted chicken, flatbread, couscous and yogurt, middle-eastern music began blaring and two belly dancers came swirling out of the kitchen and gyrated around the table. Ironically, I continued on in my morphine induced, Dali-esque dream world. I had eight skin graft operations in all, peeling skin with the Dermatome from my entire body, except head, arms and a strip up my back, so that I was almost completely "skinned" at one time. Skin was removed three times from my stomach. Dr. Kellermann was amazed at the success of the grafts. When 40% of the grafts take, that is considered exceptional. 90% of my grafts took the first time! Dr. Kellermann remarked, "I don't know what they [the surgeons] would call it -- I call it a miracle."

Making Progress

My ankle was still in trouble after most of my leg had been grafted. The plan was to release me from the hospital, gain back some strength and return to have the plastic surgeon perform a flap to fill in the big hole in my ankle. Dr. Blaisdell summed up the situation in these words; "his tendon is hanging in the breeze." However, the Lord touched my ankle and when my cast was removed five days later, everyone was amazed to find the tissue had quickly and miraculously "granulated" from my ankle and was touching my tendon -- an occasion for rejoicing by all the nurses in the Burn Unit and surgeons, Dr. Kathrin (Mayer) Troppmann and Dr. James Morrison. The rest of my leg was making good progress by this time. After five weeks, I was in the trauma ward and Dr. Jones popped his head in the door. "I just had to meet you," he exclaimed. "I'm the one who intubated you, when you came into the ICU. I was surprised when I kept seeing your name come up on the surgery roster." As far as he was concerned, I was a dead man! Later, Dr. Murin informed me of "Murphy's Law" of medicine; She and Dr. Jones thought Denise and I were a nice, cooperative couple -- therefore, I probably wouldn't survive!

Going Home

When I was released from the hospital in August, the plan was to gain strength and return to close up my exposed tibia, patch a spot on my Achilles' tendon and have the plastic surgeon perform releases, which would certainly be necessary around my joints. Well, the home health nurse was amazed when my tibia closed over one night and half of the open areas on my thigh healed! My tibia healed, to the disappointment of Dr. Morrison, who remarked "that spot there is just crying out for me to drill some more holes." At one point, holes were drilled to the marrow in my tibia to create a blood supply for the tissue to grow over and he was anxious to try it again! Finally, my skin grew so well and is in such good condition, I did not require further surgery. Hallelujah!

Happy Ending

I was at UC Davis for three months. I laid completely still on my back and became totally deconditioned, to the point that I could not stand for more than a few seconds without becoming nauseous or fainting. My brachial plexus was damaged, so my right arm no longer worked. I began rehabilitation in late July, was released in mid-August and returned home. At one point, Dr. Blaisdell told me that I would not have any range of motion in my ankle and would walk in a wooden way. I am happy to report that my ankle is fully functional. I achieved my ultimate physical therapy goal by getting up on my surfboard. However, it was very difficult because of the injury to my arm, so I sold my board and bought a body board. I began running and on June 2, 2002 I ran in the Gold Country Races 5k with Denise. I finished 13th overall and won a third place medal in my division (duffers and geezers). Finally, I was able to travel with my daughter Emma to Uganda in 2000 and again in 2001, where my leg was a wonder to all! We met Dr. Kellermann and his family there, treated people in makeshift medical clinics, ministered to children in orphanages and trained local pastors. I am enjoying my work as a Postmaster once again. I have also resumed serving as a pastor and am writing a book about the entire experience. I praise and thank God for His grace and mercy! Update 2010: Tennis! I never imagined I'd ever play tennis, but thanks to my friend Ryan and a racquet from Donna, I'm back in the game. The backhand and serve are pretty weak, but it's just a joy to be able to get out on the court.

A Rosey Picture

Since my story appeared on the Web, I have received hundreds of comments; most have been very favorable. Once in a while, someone will write to insist that my survival and recovery were more likely the result of excellent medical care than divine intervention. They feel that I am slighting the people who worked so hard to save my life, by attributing so much to the mysterious workings of God. Whether or not I was saved by miraculous intervention is up to you, the reader, to decide. I remain convinced that it was God's grace, through both miraculous and "ordinary" means, that saved my life. By "ordinary," I mean the extraordinary skill and efforts of the healthcare professionals, who cared for me and encouraged my family and friends through the entire ordeal. I am grateful to have had the best surgeons, physicians, nurses, physical/occupational therapists, friends and family in the world! All played a big part in my recovery and it is my goal to improve on the investment of their time, years of training, hard work, emotional involvement and material support. Throughout my stay at UC Davis, I was in continual awe of the professionalism and work ethic of everyone there. Denise and I continue to stay in touch with a number of the surgeons, rehab doctors and nurses. Some have been featured along with us on the Discovery Health Channel and Dr. Murin is the subject of a chapter on medical professionals in a recently published book by Scholastic.

I will, occasionally, receive an angry message from someone who has lost a friend or relative to necrotizing fasciitis. They feel that I am presenting an overly rosey picture or that I really cannot comprehend the pain they are suffering in their loss of a loved one. Others think I got off pretty easy, because of the good results I've seen and, because I didn't lose any limbs. First, let me say that I have a number of fairly serious, lingering health problems, which resulted from this experience. And, I have lost loved ones myself and experienced grief. It may not have been as great or debilitating as what others go through, but that does not diminish my desire and sense of responsibility to offer what little bit of compassion and understanding I can to those affected by NF. I think it is best to accentuate the positive in my experience and give as little space as possible to the many physical problems that remain, as a result of my bout with NF. I have chosen to dwell on the successes and to seek a positive outcome from this catastrophic experience. I encourage others to strive to overcome the ravages of this deadly disease and not remain its victim, like those I often hear from who are doing well. Their prescription goes something like this: "This kind of experience will either make you a bitter person or a better person."

 

Job 19:25 - 27 And as for me, I know that my Redeemer lives, And at the last He will take His stand on the earth. Even after my skin is destroyed, Yet from my flesh I shall see God; Whom I myself shall behold, And whom my eyes shall see and not another.