Maggots Can Be Good For You

I wrote the following magazine article about the bad infection I went through last winter. The article has been published online at a medical magazine called “You & Me.” Click on their title for a link it. They trimmed it from 3100 words to 1900 words, but they kept the entire heart of the article. Plus, they published a gruesome photo of my leg which I won’t subject you to here.

 

INFECTION:

MAGGOTS CAN BE GOOD FOR YOU

by Vic Warren

  

Monday, November 26, 2012. The array of I.V. bags dripping into my vein includes saline, pain killer, and three or four antibiotics. I’m not aware of much of this beyond the rich sensation that I’m lying in a bed instead of sitting in the wheelchair where I waited for two hours on an extra busy afternoon at Kona Community Hospital’s Emergency Room.

The nurse has covered me with a warm blanket, but my teeth are still chattering, and my body is shaking with fever. The nurse also told my wife, Laurel, to go home and pack an overnight bag. Laurel explains to me that Michael Dunlap, the doctor in charge of E.R., took one look at the nasty wound on my left ankle that has my whole lower leg glowing bright lobster red, and passed on his fears to her. He’s called for a medivac to fly us from Kona to a hospital in Honolulu. He said the spreading wound has reached the life-threatening stage.

The source of all this mayhem was nothing more than a delicate little cut not much more than a quarter inch long, which made the unfortunate choice of getting infected by some vicious streptococcus bacteria. Strep is never good, but when it finds a weak spot undermined by poor circulation, trouble is guaranteed even when the patient’s healing spirit is willing.

Forty minutes later, two paramedics in khaki show up with a gurney.

“We’re ready to go now, sir,” says the shorter man. “I’m Craig, and this is Matt. We’re going to take you to the airport.”

He grabs the bouquet of I.V. branches and attaches it to a shorter, more compact standard on the gurney. The two men carefully pick me up and deposit me, then double wrap me in a sheet and blanket. They strap me on, and I focus on the ceiling as I’m rolled from the E.R. room, rattled over a couple of thresholds and lifted through the doorway. They lower the gurney to the pavement, and I can see the shine of drizzle ahead in the parking lot, Mt. Hualalai’s sharing of its liquid wealth sliding down its slopes. The warm mist is like a refreshing wake-up call.

Craig and Matt pick up the gurney and slide it home into the rear of the ambulance. Craig climbs in next to me and locks my moveable bed into place.

“How you doin’?” he asks.

“Never this bad before,” I answer. “From my toes to my knee, my left leg feels like it’s on fire.”

“Oww!” he grimaces, “I’ll pump up the pain killer.” He looks ahead at Matt in the driver’s seat and says, “Let’s do some miles for this poor guy.”

The engine is already running. Matt turns on the lights and the siren and pulls out of the parking lot north on Highway 11. The siren cries through Kealakekua, and Craig says, “We’re due at the airport about the same time as the plane, but just in case he’s early.”

I look toward the rear of the ambulance and am surprised to see a couple of 1950s West Coast jazz posters displayed on the doors of the glass cases on the sidewalls. “I like the posters,” I say.

When we reach the divided lanes of Queen Ka’ahumana I look out the back window and whistle.

Because of the observatories on Mauna Kea’s summit, the entire island is built for low-level light. The lights on Queen K are like many other island lights, dark on top and bright yellow under. I’ve seen them dozens of times before, but seeing them in reverse, each glossy stripe of yellow receding into the distance, they create a whole new image of the highway after dark.

“Nurse tells me we’re picking up your wife at the airport,” says Craig.

“I guess so,” I say, rubbing my chin. “No one talked to me, but she’s not here in the ambulance, is she?”

“Hmmm, I think I should call her. What’s her cell phone number?”

I give him the number, and he calls it, and Laurel picks up immediately.

“Hi, this is Craig, Laurel. Matt and I have Vic with us in the ambulance. Where are you? Good. Just walk south past the end of the arrival area, and you’ll see a big cyclone fence with a gate in it. We’ll be there in five.”

Matt pulls off the main airport drive and stops. Craig swings the back door open and climbs out. Then I see Laurel silhouetted in the open door. She’s put on a jacket, even though it’s plenty warm in North Kona.

“Move to the front,” says Craig, taking her duffle bag. She slides up the seat facing me and gives me a smile, touching my cheek with her hand.

“Are you okay?”

“No. But better now that you’re here.”

Matt pulls ahead to the gate and waves at the guard. The gate dings open, and we drive out onto the tarmac.

“Our bird has landed,” announces Craig.

*

Dr. Nicolas Nelken is the vascular surgeon who’s going to operate on the blood vessels in my left leg to create enough flow to heal the wound on my ankle. On Thursday, the 29th, he comes into the room and pulls up a chair. He wears a ponytail and a Van Dyke beard and has a professional bearing that makes his look work.

I’m very happy to be talking to him about moving forward. It’s taken three days of antibiotics to bring me to the point where I can speak coherently, and the pain killer level can be reduced.

He crosses his long legs and says, “We have two ways to go on this. I’ve looked at the ultrasounds and decided that your femoral artery is the problem. It looks like what should be a powerful torch is behaving more like a candle. From your groin to your knee, we have blockage. Surprisingly, the three smaller arteries in your lower leg look pretty good.”

He stands up and looks down at my leg. “I want to do an angiogram to get a better look at that large artery. If it looks good enough, we can perform an angioplasty and open it enough to work well. If it’s blocked too severely, we’ll find a good vein and bypass the femoral to get your blood moving down your leg.

“Any questions?”

“When do you think you’ll be doing the surgery?”

“We’re looking at Tuesday, the 4th. Are you free then?” he asks, grinning.

“I’ll have to check my calendar, but I think I can make time,” I answer, smiling back.

*

I need to stop right here to fill you in a little on my medical history, so you’ll understand why I have to joke about this.

I came down with Type 1 diabetes when I was in my mid-twenties. My dad and my sister had both died of it, so I took it very seriously. In spite of keeping good control, the diabetes hit my eyes with diabetic retinopathy, but thanks to an excellent program at the University of Washington Medical Center, I got laser treatments that saved them. In the late 90s, the diabetes knocked out my kidneys, and I had to go on dialysis. It turns out, I was one of the very fortunate ones—in 2002, UCLA gave me a double transplant, not just a kidney, but also a pancreas, so I lost the diabetes after 33 years. I’ll take anti-rejection drugs for the rest of my life, but what a trade-off.

*

I wake up in a room I haven’t seen before. Judging by the banks of instruments and flashing lights on the wall, I could be guest starring on a TV sci-fi drama.

Except for two things. First, the bed. It’s a very comfortable, adjustable bed with lots of levers and buttons on it. But if I were in a starship med center, there wouldn’t be a bed. I’d be suspended in zero gravity to lessen the stress on my injuries. And I’d be surrounded by a 78 degree aura to keep me comfortable, not covered with a blanket. And second, the porthole in the wall would show me a small piece of deep space. This room has a picture window. I can see blue sky with patchy clouds and the top of the peaks surrounding Moanalua Valley.

I decide I must be in the hospital’s post-op area or in intensive care. And that’s confirmed when a nurse with the name tag Teresa comes in to check on me.

“How’s the pain, sir?” she asks immediately.

“Surprisingly, it’s only a two or three, not the tough stuff I was expecting.”

“Well, you’re still feeling the post-op combo Sam gave you. Let me know if it gets worse. Excuse me, but I need to check your bandage,” and she gently pulls the covers off my left leg.

The bandage from my groin to below my knee is like nothing I’ve ever seen. It looks like it could be polished leather more than two inches wide sealed by a darker section half an inch wide that surrounds it.

Teresa presses her fingers lightly along the edge.

“Quite a bandage, isn’t it?” she asks. “The shine in the material is silver that speeds healing. And the stitches on your wound are all self-dissolving. Any pain?” she asks, pressing on the bandage.

“Not at all.”

“Good. Your operation went really well. Doctor will be in shortly, and so will your wife.”

She goes to the door. “If you need anything, just buzz. Otherwise, enjoy the rest. We’ll get you something to eat a little later.”

I’m just about to drop off asleep when the door opens again, and Dr. Nelken comes in. He’s wearing his blue scrubs.

“Hi, doctor. Looks like you’re having a busy day.”

“Right you are. Surgery is not a nice, neat job where things come in measured doses.”

He crosses to my bed and says, “Let’s take a look at your and my handiwork,” and pulls the blanket from my leg. “Looks very clean, but I had some excellent help. How’s the pain?”

“Nothing much, I’m happy to say.”

“If it gets worse, let the nurse know right away. You shouldn’t put up with pain. It just gets in the way of healing.”

“So did you do the angioplasty?”

“I told you that was a possibility, but when I got in there, it was obvious that it would have to be a bypass, which fortunately went very well. We knew that there was blockage in your femoral artery. That artery, in fact, is harder than a pencil. Completely blocked, thanks to diabetes and years of smoking. It’s fortunate you quit smoking when you did, or you wouldn’t be alive today.”

He pulls the blanket back over my leg and says, “How do you like the ingenious bandage? It not only protects, it heals, as well. We’ll take it off in five days, and your sutures will heal and disappear on their own. I can see that the bypass on your right leg was a lot more complicated.”

“Yeah, it was only four years ago, but a lot of it was staples, and because of the stress on it, the ankle was hand-stitched.”

There’s a short knock at the door, and Teresa puts her head in. “Doctor, Mr. Warren’s wife is here. Is it all right if she comes in?”

“Of course she may. We’re just about done, anyway.”

The nurse opens the door, and Laurel comes in and smiles when she sees me looking somewhat conscious.

“Hi, doctor. Is he all right?”

“We have an excellent patient here. You know yourself what kind of things he’s survived, and thrived on. He has a new bypass replacing his femoral artery. When this is done, he’ll have two good legs instead of the failed ones he had just a few years ago.”

“That’s wonderful to hear.”

“I’ll let you alone now. Mr. Warren, I’ll see you later, but we’ll have Dr. Roedel checking in on you daily.”

*

Viki Lai Hipp is a wound nurse. Her official title is Wound, Ostomy and Continence Nurse. She’s a major part of the progressive attitude of Kaiser Moanalua Medical Center. And her talents were a huge help to my coming through this rough period of my life and weathering the storm.

The first time I met her, she arrived with one of the doctors to look at the wound, now that the vascular surgery team had performed a femoral bypass to give me the blood flow I needed to heal. After unwrapping the bandages and gauze, she studied the open wound which covered about fifteen square inches of my lower leg and told me they were going to use something to help it heal. Honey!

Reflecting back, I know that even in ancient times, honey was used for its medicinal properties. And today, she was applying honey over my leg. Not just any honey, but leptospermum honey, honey from bees feeding on the flowers of the manuka, or New Zealand tea tree, which I find out is famous for its ability to work against many bacteria.

As she spreads it on, its soothing feel relaxes me. She covers it securely, wraps it in gauze and says, “We’ll let it work for two days, then unwrap it.”

Two days later, everyone who looks at the results of the honey is impressed. After cleaning the honey off and looking at the improvements, she feels that a second treatment of honey is called for.

In two more days, she cleans off the honey and tells me about the next step they are recommending. Honey can’t hold a candle to the exotic nature of this treatment. For the squeamish, it’s called MDT. In plain words, it’s maggot debridement therapy. Still used in only a few places, it’s one of the most effective treatments for infected wounds, especially for diabetics. And, even though I haven’t had diabetes for eleven years thanks to my pancreas transplant, I still suffer from what diabetes did to me.

An Irvine, California company called Monarch produces disinfected phaenicia sericata larvae, sterile common green bottle fly larvae that are administered to the wound in small nets of between one and two hundred. Maggots are not interested in healthy tissue, so they only eat the diseased areas in their surroundings. They are sterile, so they bring nothing foul with them. When they’re applied, they are about the size of the tip of a ball point pen, but kind of transparent, almost like tiny pearls.

They’re wrapped securely in a nylon sleeve which allows them to breathe, and then further wrapped in thick gauze to help control the increased seeping from the wound. After two days and one gauze changing, my leg is unwrapped, and the maggots wet-vac’d and disposed of. They’ve grown to the size of fuzzy grains of rice, and the wound is much freer of necrotic tissue.

Viki decides that we’ll probably need to clean the wound with MDT four times. Six days later, Viki and Dr. Philip Bruno, an infectious disease specialist, are happy with the results and recommend that I start using a wound vac. This machine is connected to a sponge covering the wound. It draws seepage from the wound and encourages blood flow in the area and is attached by a plastic tube to a power source the size of a small vacuum cleaner that sits by my bed.

For four days, I’m leashed to the machine, and when I go for my daily walks throughout the hospital, I attach the vacuum to my walker, which groans at the extra weight. Laurel and I are relieved when we hear that they’ll be providing me with a home wound vac and sending me home on December 21st. We won’t have to celebrate Christmas in the hospital!

            It’s an interesting feeling, saying goodbye to people that I know so well, yet hardly know at all. I know nothing of their lives aside from the fact that they are good with a scalpel, or administering pain killer, or bringing me an extra blanket. And they don’t really know anything of me. They’ve seen me at my worst, howling with pain, vomiting, fouling my bed. And they’ve seen me heal, and rejoiced in that healing. But they’ve never seen me at my best. They aren’t familiar with the way I live. My likes or my dislikes. My taste in music or food.

As I shake their hands and look in their eyes, smiling with congratulations at my leaving the hospital, I know that I will probably never see them again. I want to hold them close and not say goodbye. After all, they’ve saved my life. At the very least, my leg.

*

We’re given boarding passes when we leave Moanalua, and I go through the lengthy procedure of taking a five-pound shoulder bag, the wound vac that’s cabled to my leg, through security at the airport.

It seems strange to get off the plane at our home airport in Kona. My memories of the flight over are vague indeed. I’m also not used to walking just anywhere and choose my steps carefully crossing the parking lot to our car. It’s not too bad climbing the stairs to our condo, but the pile of nearly four weeks of mail is a little disconcerting. Fortunately, I don’t have too many deadlines keeping me from it over the next couple of days.

I’m scheduled to see Dr. Paul Faringer in two and a half weeks. He’s the plastic surgeon who will be doing a skin graft to finish the wound. Oh, I forgot to mention—I have to fly back to Honolulu for the skin graft. Happily, it’s just an outpatient trip, and I’ll be home the same evening.

In the meantime, I’m wearing the wound vac, and home health nurses are changing the connection every two days.

*

January 28, 2013. I meet with Dr. Faringer for a follow-up look today. He’s very pleased with the way the graft has taken. The donor site for the skin from my left thigh is also healing very nicely. And the best news of the day is that I can shower and wash the healing ankle. I’ve been taking nothing but sponge baths for two months.

 

#

2 Responses to Maggots Can Be Good For You

  • Diane Moss says:

    Dear Vic,
    What an interesting and moving article. I can’t believe all that you went through. Thank God for all the wonderful doctors & nurses that helped you through this scary journey. And, for Laurel’s support at your side. I am so glad that you have survived, and are now thriving. God’s Blessings to you and Laurel,
    Diane Moss

  • Vincent J. Patti says:

    Thanks for this uninhibited, informative, harrowing and touching account Vic. More than anything it makes me happy that you and Laurel have each other.

    Now, I also get happy about bandages and baby flies.

    Congratulations on getting published once again.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Click here to read the true story about Yamashita's Treasure, the inspiration of the book.

STAIRWAY-PRINT-COVER 2014 (Custom) (Custom)

Buy in Kindle or Paperback

"If one wants to follow a captivating couple pursue their careers in exotic climes brilliantly described,
Stairway of the Gods
is just the right way to do it."
Gordon Osmond at Bookpleasures.com

“The author, Vic Warren, skillfully weaves in actual political events into his tale, making it seem so real. I can’t help but congratulate him for making me stop at parts and ask, is this fiction or fact? I would highly recommend it to readers who enjoy a gripping tale of high adventure.”
From All Books Review

Read What Else They’re Saying About Stairway of the Gods

Vic Warren is an award winning Art Director, credited with creating the "Eskimo portrait" as the aircraft tail logo for Alaska Airlines. If you need help in designing your book cover, check out these designs.

Stairway of the Gods continues to impress. The book's cover just won the Best Self-Published Book Cover Design Contest sponsored by A&A Printing.