Afghanistaph, MRSA Edition

First off, I need to credit my friend John Siegel with the terrible pun that was just too good to pass up as the title of this blog entry. Also I want to give a warning that this entry isn’t for the squeamish or those that are easily grossed out. Also, because I wrote it while sitting in a hospital bed with nothing else to do, it’s probably way longer than most of you care about. So feel free to skim it or just look at the gory pictures.

On a normal Monday afternoon, I went to the gym and to grappling like I am wont to do every Monday. One of my friends pointed out that it looked as if I had been bitten by something on my left shin as there was a reddened area about the size of a quarter. It didn’t hurt or really bug me so I acknowledged his observation and then forgot about the incident. 

Later that evening, my shin started to hurt and burn like it tends to do when I get bitten by a bee. After a restless night, I woke up and the redness had spread to a few inches in dimension and the entire limb was starting to swell. This is about the time that I began to think that maybe it was a bug bite from something poisonous, most likely spider or similar, that was affecting me like a bee sting would (for those that don’t know, I’m allergic to them and my leg was behaving in the same manner as it would for a bee, but on an exaggerated time scale).

By Tuesday afternoon, walking was becoming a little painful and I’d started to feel some flu like symptoms. I asked around the camp to see if anyone had any anti-histamines, thinking they would solve the issue. No one did, but my NCOIC ordered me to go to medical the next morning if the leg wasn’t feeling better by then. That night, we had some friends over, one a combat medic, who agreed that she thought it looked like a spider bite of some sort and said to go to medical when it opened in the morning for antibiotics.

Wednesday morning rolled around and I limped over to medical on a worse looking leg. The medics looked at me a little weird when I told them I thought I had a spider bite, but they noticed the redness and swelling and gave me some antibiotics and sent me on my way with the traditional “come back if it doesn’t improve.”

I took the pills, tried to stay off the leg if I could, and it didn’t do anything but get worse. So after some debate with myself for feeling dumb to keep going back to medical for what I thought was trivial, plus some internet research where I came to the conclusion that this was a staph infection and not a spider bite, I went back Thursday morning. The medics looked at the leg again and said it was worse and they were sending me to the German Hospital on base (the medics are a small clinic set up in a tent that handles most minor injuries) for IV antibiotics.

And here is where the fun really started. I arrived at the hospital (which is actually really nice and set up quite well, only having the issue of most of the practitioners being German or Hungarian and not speaking a lot of English). Thinking I’d only be there for an hour or so to get antibiotics, I hadn’t told my OIC or NCOIC where I was headed (the last they knew I had gone to the clinic). I was greeted by a German neurosurgeon who took a look at my leg and said “that needs surgery, but I’m a Neurologist so if there’s something wrong with your head…” I replied, “There’s definitely something wrong with my head, but that’s way past fixing.”

Later an American anesthesiologist came by and told the German no surgery, a Hungarian said surgery, and meanwhile there are two German nurses and an American nurse in the background telling me that Dr. Brown, the American surgeon, would be here shortly to talk to me. I think everyone was bored and I was the most interesting case with the amount of superfluous doctors that came by to share their opinions before Dr. Brown finally arrived and then told me that surgery was going to be needed.

After hearing what the doctor was going to do and about the dangers of anesthesia, I was wheeled down the hallway, asked to hop on a table, and then woke up about 45 minutes later back in the original ER room I’d started in.  A little bit after that I was wheeled to a room that was to become my home for the next two and a half days…so much for the quick in and out I’d planned.

At first, I only had one roommate, Denette, an American solider from a nearby base that came for some antibiotics two days before me and was thrown into surgery as well. I think they like to put everyone through surgery here. Denette was very nice and good company in the world of tedium consisting of blank white walls and broken TVs when you hadn’t brought anything with you because you thought you’d be home in time for lunch. 

A few hours later, a Swedish girl, Jo Jo, was added to our room as an overnight guest as she’d come in with a terrible case of pan-sinusitis (pretty much where pus and mucus harden in the sinuses behind the nose, eyes, and forehead causing intense pain and pressure build-up).  She was another patient that thought she’d only be there a few hours only to learn that she was going to be an overnight guest as well.

 

Me in my disposable scrubs

 

My OIC and NCOIC showed up in the late afternoon asking what happened. I asked how’d they’d found me and was told that one of the others in camp, Dave, had gone to them and was like “Has anyone seen Robby? She left for the clinic four hours ago.” It’s good to know that I only have to be missing for four hours before someone starts to wonder where I’ve run off too. I gave my bosses a rundown of the situation and let them know that I was now a prisoner of the Hospital for the next few days. They in turn told me they’d tell my company and bring back some necessities to help get me through the boredom of the next few days.
 

The most entertainment that we had that first day was at about 10 pm, when my doctor came to take a look at my leg and realized that the swelling was still getting worse, even after the surgery. He called a CAT scan technician (although the device looked more like an ultrasound machine) who apparently was completely unaware of the concept that pushing hard around a fresh wound hurts like a bitch. 

The technician uncovered the bandages and we got to see the doctor’s handiwork. This is where my definition and the doc’s of a “small incision” differ greatly. The cut in my leg was about two inches in length and went down about an inch into the leg. The doc told me this was all dermis and subcutaneous and didn’t get to muscle (which didn’t make me feel that much better as now I have a notion of just how much fat you can have on the top of your shin where it doesn’t seem possible to have more than a centimeter or two before hitting bone). Denette and Jo Jo both pulled out their cell phones and started snapping pictures as this was “cool” and so I could have something to gross people out with later.

Wound about 8 hours after surgery

 

The doctor changed my antibiotics and by the next morning the leg was looking a little better (even if it still felt awful). During patient rounds where all the doctors come and stare at you like a science fair project and spout out all the ways they would treat you if you were their patient, there was an argument as to why a culture hadn’t been taken of my leg. Dr. Brown acquiesced, took a sample, and it was sent to the lab.
 

A day passed, Denette was granted freedom, and Jo Jo and I became good friends as we shared in our joint misery of being stuck in the hospital. Most of the people from my lab stopped by at varying times baring gifts of DVDs and chocolate and staying to chat for a bit. It wasn’t all bad, and the leg was steadily getting slightly less painful. 

By my third day since setting foot in the hospital, I was ready to leave and the doctor was liking the direction the leg was headed. Right after his visit where he’d come in to tell me that I could go home the next day, the nurses arrived and told me that I had a serious virus and was being moved to isolation. As you can bet, this new development caused a bit of anxiety and a call for Dr. Brown to come back and explain.

Turns out that they got the results of the culture back and I had MRSA, which is the antibiotic resistance strain of staph (yeah me, apparently I don’t like to do anything by half). So even though the surgery had gotten most of the virus out and I was doing better and had been around people for the majority of the last two days, I was now, per hospital policy, being moved to a different room where it was supposedly safer for everyone. In five minutes I went from a normal patient to a leper. Awesome. 

My new room was next door to my old room and had a guy roommate, who turned out to be someone from my grappling group that had acquired MRSA on the forearm about the same time that I acquired it on my leg. Somebody was grappling infected and we were both paying the price. The only difference between my first room and this one, besides losing Jo Jo as a roommate, was that now people were supposed to wear gowns, gloves, and masks to come in. About three people in total did that while I was there. Everyone else either came in with nothing or just gloves or just a mask. All this lead me to the belief that the isolation thing was more for saying that you’re doing it than for actually following the guidelines, but still it doesn’t make you feel any less of a freak. 

Luckily I was only there for one more day and then I was released. To be outside again, sleep in my own bed, and not be woken up at 6 am for no real reason was awesome. I went back to work and besides a detour to the medic tent every day to get my bandage changed; I thought I was done with all this.

A week after my release and even though there was a hole in my leg, it wasn’t really hurting and I seemed to think things were going fine, but the doctors were not so sure. Apparently, the wound wasn’t showing any signs of reinfection or of getting worse, but it also wasn’t showing signs that it was getting better. The doctors’ suggestion, be readmitted to the hospital under bed rest and with a Wound-Vac for a few days to see if that improved the wound significantly.

So back to my isolation room I returned (this time without any fellow inmates to keep me company). I was hooked up to a Wound-Vac and left on my own. A Wound-Vac is a pretty cool device, but pretty sadistic at the same time. A piece of special foam is cut to the shape and size of the wound and stuffed inside. This is then taped over with clear plastic and a hole it cut out in the middle. A plastic tube is attached on one end to the foam in your wound and to a suction pump on the other end (slightly reminiscent of The Machine in The Princess Bride).

The machine is turned on and instantly a vacuum seal forms over the wound and all the nasty shit that’s in it is sucked away. The part they don’t tell you is that until all the nerve endings get used to the constant pressure being exerted on the open wound, it hurts a lot and causes your limb to spasm randomly. This lasted for about two hours and I was ready to yank it out again. The idea of the Wound-Vac is that it’ll clean the wound out faster and expedite the healing processes. I hope so or else I just endured some extra pain and the loss of a few days’ pay just so the doctors could play with a different toy.

I was released from the hospital on the third day (the doc was trying to convince me to stay for an extra two days, but I said no…not worth the loss of pay or the boredom of being trapped there). 

The German hospital has some sort of deal worked out with insurance companies that they only charge you for your overnight stays and not for any other treatments. The fee is 200 Euros a night, which when you think about it, is relatively low. The problem lies in that no one at the hospital actually deals with insurance or with money. They send you to the billing office and tell you someone there will deal with it. 

So I hobble to the business office with my OIC in tow (he sprung me from the hospital) and the lady greets me with, “So you’re paying this in Euros or American Dollars?” The bill is $793. I tell her that I have an insurance card and that they’ll cover it. She tells me “Cash only!” Seriously, do the Germans honestly think that people on a base in nowhereland where almost everything is paid for you and the most you can get in cash is $100/month, just randomly are going to be able to pull out a bill fold, pull off some hundred dollar bills and be done with it? What world are they living in? I don’t even know anyone in the US that carries $800 with them in cash just randomly. 

Some calls to my bosses to inform them of the situation and a trip back to the hospital to talk to someone high on the food chain leads to the bill disappearing into the red tape of bureaucracy to maybe one day reappear, but who knows. 

And thus, with the exception of four-five more weeks of limited movement freedom while the hole in my leg closes; my torrid affair with MRSA has come to an end.
 

 

 

Wound and dressings about four weeks after surgery