John Vokoun can never forget the date – August 5 – that he was diagnosed with the dreaded "flesh-eating disease," necrotizing fasciitis. "The part I can never remember," he added with characteristic humor, "is the next sixteen days." As John hovered between life and death, decisions were made and actions boldly taken by heroes of modern health care that would spare John's right leg from almost certain amputation – and save his life from the often fatal bacterial infection.John and his wife Rose were at home in Papillon, a suburb of Omaha, Nebraska, unpacking from a vacation when sudden, sharp pain gripped his right hip. "I immediately insisted on going to the local hospital," John said. "That’s how Rose knew it must be serious!"
Initial surgery was performed at Omaha's Methodist Hospital. As the two-surgeon team uncovered extensive decay and damage, the urgency of the crisis was apparent. "I remember one doctor suggesting that, well, I’d never walk again," said John. "The next thing, these two surgeons, who were so different in their personalities, together came to a life-saving conclusion at the critical moment. They decided that my only chance at survival was moving me to a hospital that provides hyperbaric oxygen (HBO) treatment." The high-pressure HBO system forces rejuvenating oxygen all the way into a deep wound, down to the bone.
"Two seconds later, I was life-flighted to Nebraska Medical Systems, the nearest health care network with advanced wound care technology. I was rushed to Clarkson Hospital in Omaha and my leg was oxygenated using an HBO chamber."
The critical operation could not be postponed. As John tells it: "The surgeon worked long hours, removing dead and deteriorated muscle tissue from my leg, from above the hip down to six inches below the knee. I lost a lot of leg that day - the better to save what was left!"
"After surgery, I was moved to Clarkson’s intensive care unit, where I spent sixteen days in my personal dead zone," John recalled. "The next things I saw were a nurse looking up my nightgown and a calendar on the wall calendar that said August 21. I thought, 'There’s some mistake here - somebody tore off too many pages!' The nurse was on duty, of course, and had been checking my leg regularly since the operation. It turned out she was a friend of my family, too - small world."
"The second nurse to arrive I can never forget," john said. "It was my first encounter with Sue Eastman, Nebraska Medical's 'Wound Queen,' and I was not delighted at first to make her acquaintance. The wound along my leg was pretty wide open - it was my personal Grand Canyon, somebody said - and the gap had to be filled with five big pieces of gauze. That was part of the advanced treatment to promote healing. These dressings had to be changed regularly, and that's where Sue came in. Imagine pulling adhesive tape from a highly sensitive area every couple of days. You can see how I always greeted Sue with, 'Going to hurt me, are you?' She'd say, 'For your own good, John, maybe so.'"
Wound care requires time, John learned. "I remember the rest of my stay according to which hospital room I was occupying at the moment."
Numerous skin grafts were necessary to help close the "Grand Canyon" and protect the growth of new tissue. "I had two surgeries that borrowed skin from nearby areas around the groin," John recalled. "Another surgeon constructed a flap of skin from my abdomen and my gluteus maximus to fill in the crater known as my right hip."
But then came a downturn: John's wounded leg became infected by methicillin-resistant Staphylococcus aureus (MRSA) bacteria, a frequent foe of wound-care patients in intensive care.
John and his doctors had battled back the deadly flesh-eater and freed his body from the morbid grip of gangrene. "There's a 20 percent survival rate from necrotizing fasciitis with gangrene," John said. "I'd beaten those odds - and now this!"
What new factor was making John's wound vulnerable to infection? To find out, doctors stabilized his condition with additional antibiotics while they performed more diagnostic tests. "And so," John said, "that's how I discovered for the first time in my life that I am a diabetic!" Undiagnosed diabetes was opening the door to new infections. "My blood sugar level was almost off the charts," John recalled.
No sooner was the diabetes under control than another complication surfaced. An alert nurse suspected clots - potentially life-threatening obstructions - in John's bloodstream. Tests confirmed the worst. John had clotting in both legs, even though he had been walking regularly as a preventive measure at this stage of recovery.
A blood clot could be lethal if it lodged in a lung. To trap clots, a small metal filter was surgically inserted in John's vena cava, the large vein that carries blood back up towards the heart and lungs. In addition, John was put on cumidin, a powerful blood-thinning medication, to prevent further clotting.
The path to recovery had been tortuous for John, a 51 year old business owner impatient to get back to a normal, active life. "I had more and more bouts with self-doubt," he recalled. "I never passed up a chance to say a prayer. I was saved time and again by skilled people - good, caring people who went the extra mile. I thought, 'I can do the same. They have shown me what it takes to pull through.'"
John is back home now, his health much better regulated with regular exercise and increasing strength. "I started mowing the lawn as soon as I was robust enough," he recalled. "That lawnmower had come to represent everything I wanted to be able to do again." Released from his last physical therapy a few months ago, he shows up at work by 8 a.m. most days. "You'll find me on the rear dock," he said, "helping to load the trucks if possible, and pushing heavy loads. I stay on my feet."
Sue Eastman, the wound care specialist at Nebraska Medical, likes to hear that. "John survived the loss of three-quarters of the tissue of one leg thanks to VAC-supported surgery," she said. "After eight months of rehabilitation, he is back at work with a functional leg, if not a beautiful one."
