Miracle In Room #5
This picture was taken in the ICU by my son Peter
I am writing this book in hopes that it will help someone, even if I can reach just one person with this book, then I know I have done my job..
Room #5 is in the ICU.
My name is Deborah Murray and I live in Durham Bridge, New Brunswick, Canada with my 2 sons, William and Peter, and our puppy, Lucy Lou. I was born in Berwick, Nova Scotia, Canada in 1960. My family moved to New Brunswick when I was 6 years old and have been here ever since. We live along what is called the Nashwaak River Valley which is beautiful, especially in the fall.
This is mostly about the miracle in room #5, but there are other parts of my life that lead up to this moment, about a year before room #5. My baby toe on my right foot started to vary through different colours until it had turned completely black. I went to the emergency room and found out it was gangrene. They did some tests and found out the main artrey in my leg was blocked, so they had to go in and put a balloon in to open the blockage. A few months later, in July 2018, they took my baby toe off, so I was basically off my feet for the majority of 2018. Don’t get me wrong I was still up doing things, until it started paining, but not as much as I was used to. It was hard on my sons and me, but not as hard as it would get.
Christmas of 2018 was awesome, it was the best Christmas we’d ever had, God provided for all of us. It is hard at times trying to raise a child alone, but I have managed with the help of my oldest son, family, and some amazing friends.
I have a favourite person in the bible, besides Jesus of course, her strength and determination is something I always wish I had. I call her God's Warrior Princess, she is one of my heroes, her name is also Deborah and she is in the Book of Judges Chapter 5, she led an army and also judged Israel. I will never lead an army, or judge Israel, but one thing I do know, God did give me the strength and determination to face what would be coming next.
The winter of 2018-2019 was harsh with a lot of snow, it seemed like it would never end. In January I went to the doctor as my left foot was bothering me, and he said it was my neuropathy. In February it just kept getting worse, it was hot, red and burning and I just thought it was my neuropathy. Around the middle of the month of February I started getting a boil. Never thought much of it as they usually went away. About a week before the end of the month, I slipped and fell in the bathtub and the boil ruptured. Then things went from bad to worse after that.
On February 27, 2019 my leg was in so much pain, I had to get my youngest son to lift my left leg onto the sofa for me as I couldn’t lift it. Around 7pm I called the extramural nurse and told her what was going on and she told me to call the ambulance and get to the hospital, so I called the ambulance and packed a bag because I was not sure what would happen when I got there. I even called the school to let them know that my youngest son would not be at school the next day because of a family emergency, why I don’t know, but I felt I would not be home the next day, thank goodness that the next week was March break.
These next sections take place after I had been admitted to the hospital, and while I was in a medically induced coma. I have asked family and friends to fill in the blanks during the 5 days I was in the coma.
This was written by my son, Peter.
My life has been a rollercoaster ride over the past month and a half, my mom went into the hospital on the 27th of February at about 9 pm and wasn’t admitted until about 3 am on the 28th, we then get a call at 6:13 am on the 28th from my aunt telling us to go to the hospital and saying that they might have to amputate her leg, we get there then a doctor comes in at about 10 am and says that there might be nothing they can do about it and that she has 24-48 hours left, (I didn't know at the time that they had told my aunt and older brother that she only had 1 - 24 hours left to live) we go in every so often. Then this other doctor comes in about 5 pm, he says that they are going to take her down for another scan to see if the infection (Flesh Eating Disease) had progressed, that same doctor comes in about 5:30 pm and says that it didn't reach her stomach contrary to what they had thought, I’m not sure but I think this doctor was the main surgeon in the O.R., they wheeled her back from surgery at about 8:30 that night and say that her surgery went well, they kept her in a coma for about 5 days or so and she wakes up in the icu and they keep her down there for a couple days then move her upstairs, that is where we are now, she is still upstairs waiting to see if they will move her down to recovery, or whatever its called, so, after I typed all that out all I can say is that, my mom, Deborah Kathleen Frost Murray is a living miracle.
Feb.28, 2019
My Mom's favorite song
She Loved-Jeff and Sheri Easter
https://www.youtube.com/watch?v=W09t7xt9OUE
This was posted to Facebook by one of my friends, Christina.
On Feb 28/2019 Debbie was unexpectedly taken to the hospital and given 48 hours to live. She was told she had a flesh eating disease that she would not survive. After multiple tests, the doctors gave her family the option of surgery with a 35% chance of her making it through. She had her leg removed at the hip. Although she will still need to be monitored closely for infection, her vitals are looking good.
Debbie is a single mom with 2 sons. This will be a very long road to recovery, in the hospital and especially after leaving the hospital. Debbie is going to need to have multiple renovations done to her house and vehicle to make it wheelchair accessible. She will also need help with all aspects of life, such as bills, gas to and from appointments, groceries, help with her son, ect. If you are able to help with any amount, it will all be a huge weight lifted off Debbie's shoulders in these difficult moments for her and her family. Thank you.
Well, I’m back to tell you all what was told to me after I woke up. When they got me to the O.R. for the first time, they opened up my leg and sewed it back up and sent me to ICU. I guess they figured I was done for. They proceeded to give me antibiotics, my son said they had about 13 bags and 2 mechanical IV pumps on me, and that I looked like the Michelin Man I was so bloated up. A little later I guess one of the doctors came down to see the family and said that I had 24-48 hours to live, but then changed it to 1-24 hours. Then the doctor came back a few hours later and said that I was stabilizing and that he was taking me down to have a CT scan to see if the infection had reached my abdomen. I guess my family had to make a choice, either take my leg or let me die in peace. I guess you all know the choice they made. I have no idea what my boys and family were going through at that time, it must not have been a good time for them. They say when you are in a coma that you can't do anything, but that was not the case with me. I was told I did different things, like my sister asked me to squeeze her hand and I did, to blink my eyes, 1 for no and 2 for yes, which I did, my aunt was singing `Somewhere Over the Rainbow`and I told her I didn't like that song. And licking my lips, among doing some other things.
Finally the missing pieces I have been waiting for came yesterday, August 26, 2020..I finally recieved my Medical Records, now I can finally fill in the blanks from the time I went into the ER until I woke up from the coma 5 days later.. This has been a long journey for me, wondering what happened. What I am about to share with you all, is hard for me and it is not a pretty picture, but I need to put this in my book so people know there is hope, even when some doctors say there is nothing they can do..I will not be putting the full names of the doctors for their privacy, just their first initail.. On Februray 28, 2019 at 22:07 (10:07 pm) I arrived at the Doctor Everett Chalmers hospital ER , they registered me when I got there and put me in the waiting room. I texted my youngest son around 11 pm to tell him I was still in the waiting room and in alot of pain. At that time I didn’t know how long I would be sitting there, when you are in that much pain it seems like forever. Finally, I could not take the pain any longer.at about 3:15am I told the receptionist and she went to see if they could get me into a room, she finally returned at 3:29am and was taking me to the room, I must have passed out from the pain, because I don’t remember much after that. The only thing I remember was being wheeled down to the O.R. sort of..
On examination in the ER, it was found that I had Necrotising fasciitis (Fresh eating disease). It was than decided to send me to the OR, ASAP.
Meaning of Necrotizing fasciitis (NF), also known as flesh-eating disease, is an infection that results in the death of parts of the body's soft tissue. It is a severe disease of sudden onset that spreads rapidly. Symptoms usually include red or purple skin in the affected area, severe pain, fever, and vomiting.
OPERATIVE REPORT
Dr. B.
Pre-operative Diagnosis
Necrotizing fasciities of the left perineum and left tight.
Postoperative Diagnosis
Necrotizing fasciities of the left perineum and left leg
PROCEDURE
Examination under anesthesia,exploration of fascia. dibridement of perineum and upper inner left tight, consultation intra-operatively with Dr. M.M.
HISTORY
This 58 year old female presented to the ER Dept. having had a 7-8 day history of what she described as 2-3 boils on her left perineal area. She indicated that approximately 2 days prior to being seem in the ER she had fallen in the bathtub and one of these boils ruptured and was initially somewhat better, but had not resolved and was associated with pain when moving her left leg. Dr. S and I were asked to see her in consultation.
On examination in ER, necrotic tissue of the left labia majora and the perineum and upper inner left thigh was seen, with associated redness of the skin. This cellulitis was extending down the inner left thigh and there was crepitus palapble in the left knee.
She is brought to the operating room urgently. She had received preoperative clindamycin and a cehpalsporin in ER intravenously. I added tazocin and during the procedure she received Vancomycin as well.
PATHOLOGICAL FINDINGS:
She had 3 areas approximate the size of a toonie each that was frankly dead black skin. One was over the left labia majora, the second was just to the left of the perineum. It was anterior and lateral to the anus and did not involve the anus. The third was on the upper inner aspect of the left thigh. The entire area in and under this black necrotic skin was involved and all interconnected and is described in the body of the OR note.
Once the thigh was entered, it is discovered that there was necrotic muscle. Dr. M.M. was called in. He identified that the entire left leg was nectotic, skin, muscle and fascia,
PROCEDURE
The patient was brought into the Operating room and placed under general anesthesia. Her airway was managed by endotracheal intubation. A right radial art line was inserted by Dr. C. She was placed in lithotomy position using candy cane stirrups. This was done to allow us to prep and drape the area of the left thigh and knee.
Prior to prepping and draping a gentle rectal examination was done. There was some stool in the rectum but there is no indication of a perianal abscess or periani involvement. A Poley catheter was inserted. There was no palpable crepitus or abnormality of the mons public nor the abdomen wall. She was then prepped and draped in usual manner specifically up prepping around the left leg and including the knee and using clear chlohexidine.
I cut into the necrotic tissue in the perineum and cut the skin between the areas of necrotic tissue and identified that all of this tissue underneath was necrotic with dirty dishwasher fluid. I was able to easily lift the skin off that had appeared to be viable prior to incising. There was significant amount of fatty tissue underlying the skin that was necrotic. This was all excised with sharp dissection. This went up to the level of the mons public but did not extend over it. Posteriorly, it did not involve the perianal area or the rectum. I did dissect down to the inferior oublic ramus and I did identify that there was facia around the public ramus that also was necrotic. This was shaved off with the scalpel.
As I went laterally, there was necrotic skin that had to be excised as well as in the upper inner thigh. Under this area the fascia appeared to be slightly gray. This was opened sharply and I was able to dissect necrotic tissue, the fascia ant the superficial layer or the upper thigh muscle also had the same brown appearance with the dirty dishwasher fluid and this was able to be gently scraped off as well.
Slightly more posteriorly, I identified an area of dead muscle that was deeper. I was able to insert a fingertip into this area and extend it up the thigh under the fascia and I felt the underlying muscle was also necrotic.
It was at this point that I contacted Dr. M.M. to come in for evaluation.
I debrided what other tissue needed to be debrided involving as noted the left labia, the left side of the perineum and anterior slightly lateral to the anus and along the upper inner thigh.
Dr.M.M. will dictate his procedure separetely. When he arrived , we incised the skin over the knee and over the entire length of the upper inner thigh. Once this was opened, Dr.M.M. identified extensive necrosis of the underlying muscle.
Dr.M.M. identified that the options were disarticulation of the hip with an amputation of the leg. I un-scrubbed and phoned her next of kin which is a sister(Tammy) and spoke to her on the phone about these concerning findings. She was able to speak to Ms. Murray's oldest son and they felt that they would like to have everything done possible that could be done. While I was having this conversation and waiting for her to speak to the son, Dr.M.M. identified that the crepitus extended over the hop and onto the pelvis. He felt that the situation was palliative as there was not going to be adequete tissue to close the open area and the necrotic tissue had gone beyond the capabilities of surgical excision. During this time the patient was unstable, requiring a levophed drip to maintain her blood pressure. Dr.C was unable to get it above 70-80 systolic.
I spoke with the sister further and explained these findings. As it was felt by Dr.M.M. that there would be no viable tissue to close and he was unable to get surgically clear margins of the disease, we elcted to discontinue further dissection and transferred her to the Intensive Care Unit. We elected to maintain fluid and blood resusitation, essentially continuing aggressive medical management.
After applying the dressing and preparing for transfer the levophed was weaned down and was able to be discontinued prior to leaving the OR. Her blood pressure was able to be saintained within normal range.
We transferred her to the ICU planning to continue maximum medical therapy at this point and have to further discussion with the family when they arrived.
Sponge and instrument counts were correct.
OPERATIVE REPORT
Dr. M.M.
DIAGNOSIS
1. Necrotising Fasciitis of the labia
2. Necrotising Fasciitis left leg extending proximal to the left hip
PROCEDURE
1.Exploration of fascia left leg
2. Intraoperative decision made to discontinue procedure as this represented a non-survivable infection given that infection had sprend proximal to the hip joint on the left.
Dr.B had already has this 58 year old female in the Operating Room debriding some necrotising fasciitis of her labia when i was consulted. When i arrived in the Operating Room she was in the lithotomy postion, draped eterilely on the left side just below the left knee and just above the ASIS. Dr. B had already debrided some necrotising fasciitis involving her labia. Speaking with DR.B. she had noted some palpable subcutaneneous crepitus down at the level of the left knee. After scrubbing I came in and examined the left leg and there was indeed some palpable crepitus extending up through the medial aspect of the leg down to the vastus medialis. At this point I decided to explore the fascia of the left leg and a longitudinal incision was made along the medial aspect of the leg overlying the vastus medialia distally and up to the adductor musculature proximally and connecting this up with the incision already made by Dr.B for debridment of the labia. Subcutaneous fat easily elevated up off of the fascia layer and the underlying muscle was gray and foul smelling and non viable. I did explore medially and laterally as well and this was the case for the vast majority of the musculature throughout the enitre thigh that I could visualize. We then brought the left leg down out of the lithotomy position after placing a sterile stockinette over the left foot and securing it below the left knee. Additional drapes were added up above the left hip as there was some exposed sheets through the previously placed drapes after repositioning the leg.
At this point Dr. B. unscrubbed to contact the patient's next of kin to discuss their goals of care with regrad to this necrotising infection that was now involving the entire left thigh in addition to the labia and perineum. I took this opportunity to mark out a surgical incision for a left hip disarticulation as I felt this was the only possible salvage procedure given the level of necrosis within the left leg. While marking the incision I inadvertently palpated some subcutaneous crepitus that extended up above the level of the left hip proximal to the inguinal ligament. Finding this to be the case I then explored along the anterior compartment musclature a bit more and certainly there was dish water colored material that was extending along the fascia of the sartorius muscle up to the level of the anterior superior iliac spine and thus this necrotising infection was extending proximal to the left hip. I subsequently discussed this with Dr. B. in that I felt that this was a nonsurvivable necrotising infection at this point given that even if I were to perform a left hip disarticulation there would still be necrotising infection that had spread proximal to the level of the hip and that this was thus a pallative situation. To complete the clinical picture at this point the patient was on high does of vasopressora as given by the anesthatist . Dr.C and was very systemically unwell. Dr.B. and I deliberated on this for a few minutes but in the end I recommended that we not perform the left hip disarticulation as I did not feel that it would contain the necrotising infection which had already spread proximal to the level of the hip joint.
We therefore turned our attention to closure of the surgical wounds. The midial longitudinal incision in the thigh was closed with O Prolene suture in a running fashion. The area where the labia had been debrided was packed with 4 x 8 gauze and 4 x 8 gauze was laid over the now closed midial longitudinal incision in the thigh and this was covered with Medipore tape. Sterile drapes were then removed and the patient gently transferred off the operating table over to an ICU bed and then moved to the Intensive Care Unit in an unstable condition requiring large doses of vasopressors.
Family has been made aware of the clinical situation by Dr. B and at present plans are to palliate her in the ICU with the anticipation that she would die of an overwhelming necrotising infection.
Dr. K.P.
CONSULTATION REPORT
Admission to CCU, February 29, 2019 at 7:30am
PRESENTING COMPLAINT
This 58 year old woman was admitted status postoperatively from an exploratory surgery for necrotising fasctiitis of the left leg.Intraoperatively a decision was made by both the general surgeon and the orthopedic surgeon that the infection had spread proximally to the hip joint and that surgical excision of all necrotic tissue was a nonsurvivable procedure. The patient was brought to the ICU for supportive care with a guarded prognosis expected. Ms.Murray was allegedly well until about a week prior when she had developed a perianal swelling. This had progressed into an abscess and four days ago she fell while in the bathtub and the abscess raptured causing the perineum to become inflamed. Subsequent to that she developed more abscess in the perineum we well as pain and swelling which peogressed down her left leg up to her knee. She was seen and assessed by extamtoural who upon the advice of her family physician suggested that see be transferred to the hospital by ambulance.
In the ER Deborah was deemed to be clinically septic and the ER team pancultured her and started her empirically on antuibiotics, i.e.Ceftriaxone and Clindamycin. A surgical consult was solicited and Dr.B, surgeon on duty, assessed Deborah and made a diagnosis of necrotising fasciitis of the perineum and upper thigh. The patient was subsequently taken to the O.R. for explorative surgery,
PAST MEDICAL HISTORY
1. Type 2 diabetes mellitus
2. COPD
3. Peripheral vascular disease with right SFA balloon angioplasty in June 2018
PHYSICAL EXAMINATION
I saw Deborah in the ICU immediately postoperatively and at this time she was sedated, intubated with a size 7.5 endotracheal tube and being manually bagged. Her vital signs at this time were as follows: Blood pressure 130/75, pulse 99, respiratory rate 18, SPO2 100% and temperature 37.6 degrees Celsius. It should be noted the patient received two units of packed red blood cells intraoperatively as well as one ampule of sodium bicarb and for a brief period she was on Levophed because of low blood pressure. In the patient's respiratory examintion there was good air entry bilaterally with no crepitations or rhonchi. A chest x-ray done shortly after admission to the ICU demonstrated essentially normal findings. Cardiovascularly she was hemodynamically stable and a 12 lead ECG demonstrated a sinus tachycardiac with a rate of120 per minute , QTC 467, and no eivdence of any dynamic ST segment changes. I did do a bedside echocardiogram and this demonstrated normal right ventricular systolic function with no evidence of RV strain. There was no evidence of any pericardial or pleural effusion, however, IVC did demonstrate significant respiratory variation in keeping with fluid responsiveness. Her abdomen was soft and nontender with no guarding and bowel sounds, and I could not apreciate any crepitations in the lower abdominal wall. Neurologically she was sedated on a Fentanyl infusion but arousable and there was no lateralizing motor deficits. Her pupil were equal and reactive to light at 3mm. Her perineum and her inner thigh were dressed from the O.R. and these dressings appeared to be dry. The surrounding tissue did not appear to be hyperemic and at this time I could not appreciate any crepitations.
DISGNOSIS AND PLAN
Necrotising fasciitis of the perineum and left thigh.
This patient will be admitted to the ICU and a central venous line will be inserted to optimize vascular access should she deteriorate and require vasopressors. An aggressive fluid resuscitation strategy will be deployed using crystalloids and a map target of 65 will be targeted. This patient will also have an ART line placed and I will start her empirically on antibiotics in the form of Piperacillian, Tazobactam and Vancomtcin.
This patient has remained in the ICU for the better part of ten hours and continues to be hemodynamically stable. Serial blood investigations did not demonstrate a clincial volution in keeping with severe sepsis from necrotising fasciitis. I am concerned that thsi patient's condition may have an operative outcome that would be beneficial and as such I am going to reengage the surgeons and orthopedic surgeon regarding reevaluation of the intraoperative decision. I have also arranged an urgent CT scan of the abdomen and pelvis to better delineate and necrotic zone which may further help guide the decision making process by the surgeons.
I did provide a full clinical update to the patient's family and surrogate dicision maker, and the topic of code discussion was brought up. The patient's code status DNRA, no defib, no CPR, and as such will receive all indicted therapy and interventions with the exception of chest compressions and defibrillation.
When I woke up, I was on a medical ventilator and the nurses told me when they took it out that I would be sick, they had a plastic sheet over me to keep it from getting on me, but I guess they forgot to put one on themselves and it ended up going all over them, I felt so bad.
They asked me if there was anyone I wanted to call and I said yes my sister, because I didn't know where my oldest son, William was at, nor my youngest son, Peter. I tried to remember my sister's phone number, but could only remember the first 3 numbers. The nurse said that it was ok, and that they had the number, they dialed it for me and my brother-in-law answered, and I said “is Tammy there.” and he said “no she was at work,” and not realizing, I asked him if he could get her to call me back. Well, where was she going to call, crazy me. I don't think he really knew who was calling at first as my voice was very low, and then he said “Debbie?” and I said, yes, and he said “O my God you’re awake” and I said “yes” and he said he would call Tammy and let her know, and then he said there is someone here you may want to talk to and it was my youngest son and I just broke down.
Around 4pm my sister came through the doors in the ICU, I knew because I could hear her coming, she came rushing into my room and almost knocked me off the bed. If you knew my family you would know we are very, very close. The love we have for one another is unconditional and we are always there for one another no matter what. She kept saying that she was so sorry and asked me to forgive her. I asked her why and she said she ( and my oldest son, William ) had to make a choice to either take my leg or leave me the coma and let me die in peace. I told her to stop saying that because she made the right choice, my poor sister was beside herself.
I thank God everyday for my wonderful family. The doctors and nurses in the ICU were the best, I couldn't have asked for better. The first time I saw the wound care nurse, I knew I had seen her before. She said “Hello Betty” and I said “my name is Debbie, not Betty, Nancy.” She said “how did you know my name? I have not seen you before.” and I told her she was my guardian angel and that she was standing over me when I was in the O.R., and she said that was not possible because she wasn't there during the operation, but she was in my mind. They had what they call a VAC on me to drain the fluid off and when she leaned over me the light that was shining from the ceiling light made it look like a halo around her head and I knew God had let me see her, it was comforting to have her there. When they went to change the VAC, it hurt so bad because there was something like a sponge that was sucking up everything, there was a lot of tape and when they removed it, it felt like they were pulling my skin off. I tried not to cry, but it was really hard not to. They had to change the VAC twice a day, so I was not looking forward to it at all.
My sister Donna and her husband Richard came up from Nova Scotia, my Aunt and Uncle, my cousin and his wife came all the way from just the other side of Boston. I didn’t get to see them as I was in a coma and a snow storm was moving in so they had to leave before I woke up. Them all coming to the hospital meant the world to me, as I had said before my family is very, very close.
I am writing this book in hopes that it will help someone, even if I can reach just one person with this book, then I know I have done my job..
Room #5 is in the ICU.
My name is Deborah Murray and I live in Durham Bridge, New Brunswick, Canada with my 2 sons, William and Peter, and our puppy, Lucy Lou. I was born in Berwick, Nova Scotia, Canada in 1960. My family moved to New Brunswick when I was 6 years old and have been here ever since. We live along what is called the Nashwaak River Valley which is beautiful, especially in the fall.
This is mostly about the miracle in room #5, but there are other parts of my life that lead up to this moment, about a year before room #5. My baby toe on my right foot started to vary through different colours until it had turned completely black. I went to the emergency room and found out it was gangrene. They did some tests and found out the main artrey in my leg was blocked, so they had to go in and put a balloon in to open the blockage. A few months later, in July 2018, they took my baby toe off, so I was basically off my feet for the majority of 2018. Don’t get me wrong I was still up doing things, until it started paining, but not as much as I was used to. It was hard on my sons and me, but not as hard as it would get.
Christmas of 2018 was awesome, it was the best Christmas we’d ever had, God provided for all of us. It is hard at times trying to raise a child alone, but I have managed with the help of my oldest son, family, and some amazing friends.
I have a favourite person in the bible, besides Jesus of course, her strength and determination is something I always wish I had. I call her God's Warrior Princess, she is one of my heroes, her name is also Deborah and she is in the Book of Judges Chapter 5, she led an army and also judged Israel. I will never lead an army, or judge Israel, but one thing I do know, God did give me the strength and determination to face what would be coming next.
The winter of 2018-2019 was harsh with a lot of snow, it seemed like it would never end. In January I went to the doctor as my left foot was bothering me, and he said it was my neuropathy. In February it just kept getting worse, it was hot, red and burning and I just thought it was my neuropathy. Around the middle of the month of February I started getting a boil. Never thought much of it as they usually went away. About a week before the end of the month, I slipped and fell in the bathtub and the boil ruptured. Then things went from bad to worse after that.
On February 27, 2019 my leg was in so much pain, I had to get my youngest son to lift my left leg onto the sofa for me as I couldn’t lift it. Around 7pm I called the extramural nurse and told her what was going on and she told me to call the ambulance and get to the hospital, so I called the ambulance and packed a bag because I was not sure what would happen when I got there. I even called the school to let them know that my youngest son would not be at school the next day because of a family emergency, why I don’t know, but I felt I would not be home the next day, thank goodness that the next week was March break.
These next sections take place after I had been admitted to the hospital, and while I was in a medically induced coma. I have asked family and friends to fill in the blanks during the 5 days I was in the coma.
This was written by my son, Peter.
My life has been a rollercoaster ride over the past month and a half, my mom went into the hospital on the 27th of February at about 9 pm and wasn’t admitted until about 3 am on the 28th, we then get a call at 6:13 am on the 28th from my aunt telling us to go to the hospital and saying that they might have to amputate her leg, we get there then a doctor comes in at about 10 am and says that there might be nothing they can do about it and that she has 24-48 hours left, (I didn't know at the time that they had told my aunt and older brother that she only had 1 - 24 hours left to live) we go in every so often. Then this other doctor comes in about 5 pm, he says that they are going to take her down for another scan to see if the infection (Flesh Eating Disease) had progressed, that same doctor comes in about 5:30 pm and says that it didn't reach her stomach contrary to what they had thought, I’m not sure but I think this doctor was the main surgeon in the O.R., they wheeled her back from surgery at about 8:30 that night and say that her surgery went well, they kept her in a coma for about 5 days or so and she wakes up in the icu and they keep her down there for a couple days then move her upstairs, that is where we are now, she is still upstairs waiting to see if they will move her down to recovery, or whatever its called, so, after I typed all that out all I can say is that, my mom, Deborah Kathleen Frost Murray is a living miracle.
Feb.28, 2019
My Mom's favorite song
She Loved-Jeff and Sheri Easter
https://www.youtube.com/watch?v=W09t7xt9OUE
This was posted to Facebook by one of my friends, Christina.
On Feb 28/2019 Debbie was unexpectedly taken to the hospital and given 48 hours to live. She was told she had a flesh eating disease that she would not survive. After multiple tests, the doctors gave her family the option of surgery with a 35% chance of her making it through. She had her leg removed at the hip. Although she will still need to be monitored closely for infection, her vitals are looking good.
Debbie is a single mom with 2 sons. This will be a very long road to recovery, in the hospital and especially after leaving the hospital. Debbie is going to need to have multiple renovations done to her house and vehicle to make it wheelchair accessible. She will also need help with all aspects of life, such as bills, gas to and from appointments, groceries, help with her son, ect. If you are able to help with any amount, it will all be a huge weight lifted off Debbie's shoulders in these difficult moments for her and her family. Thank you.
Well, I’m back to tell you all what was told to me after I woke up. When they got me to the O.R. for the first time, they opened up my leg and sewed it back up and sent me to ICU. I guess they figured I was done for. They proceeded to give me antibiotics, my son said they had about 13 bags and 2 mechanical IV pumps on me, and that I looked like the Michelin Man I was so bloated up. A little later I guess one of the doctors came down to see the family and said that I had 24-48 hours to live, but then changed it to 1-24 hours. Then the doctor came back a few hours later and said that I was stabilizing and that he was taking me down to have a CT scan to see if the infection had reached my abdomen. I guess my family had to make a choice, either take my leg or let me die in peace. I guess you all know the choice they made. I have no idea what my boys and family were going through at that time, it must not have been a good time for them. They say when you are in a coma that you can't do anything, but that was not the case with me. I was told I did different things, like my sister asked me to squeeze her hand and I did, to blink my eyes, 1 for no and 2 for yes, which I did, my aunt was singing `Somewhere Over the Rainbow`and I told her I didn't like that song. And licking my lips, among doing some other things.
Finally the missing pieces I have been waiting for came yesterday, August 26, 2020..I finally recieved my Medical Records, now I can finally fill in the blanks from the time I went into the ER until I woke up from the coma 5 days later.. This has been a long journey for me, wondering what happened. What I am about to share with you all, is hard for me and it is not a pretty picture, but I need to put this in my book so people know there is hope, even when some doctors say there is nothing they can do..I will not be putting the full names of the doctors for their privacy, just their first initail.. On Februray 28, 2019 at 22:07 (10:07 pm) I arrived at the Doctor Everett Chalmers hospital ER , they registered me when I got there and put me in the waiting room. I texted my youngest son around 11 pm to tell him I was still in the waiting room and in alot of pain. At that time I didn’t know how long I would be sitting there, when you are in that much pain it seems like forever. Finally, I could not take the pain any longer.at about 3:15am I told the receptionist and she went to see if they could get me into a room, she finally returned at 3:29am and was taking me to the room, I must have passed out from the pain, because I don’t remember much after that. The only thing I remember was being wheeled down to the O.R. sort of..
On examination in the ER, it was found that I had Necrotising fasciitis (Fresh eating disease). It was than decided to send me to the OR, ASAP.
Meaning of Necrotizing fasciitis (NF), also known as flesh-eating disease, is an infection that results in the death of parts of the body's soft tissue. It is a severe disease of sudden onset that spreads rapidly. Symptoms usually include red or purple skin in the affected area, severe pain, fever, and vomiting.
OPERATIVE REPORT
Dr. B.
Pre-operative Diagnosis
Necrotizing fasciities of the left perineum and left tight.
Postoperative Diagnosis
Necrotizing fasciities of the left perineum and left leg
PROCEDURE
Examination under anesthesia,exploration of fascia. dibridement of perineum and upper inner left tight, consultation intra-operatively with Dr. M.M.
HISTORY
This 58 year old female presented to the ER Dept. having had a 7-8 day history of what she described as 2-3 boils on her left perineal area. She indicated that approximately 2 days prior to being seem in the ER she had fallen in the bathtub and one of these boils ruptured and was initially somewhat better, but had not resolved and was associated with pain when moving her left leg. Dr. S and I were asked to see her in consultation.
On examination in ER, necrotic tissue of the left labia majora and the perineum and upper inner left thigh was seen, with associated redness of the skin. This cellulitis was extending down the inner left thigh and there was crepitus palapble in the left knee.
She is brought to the operating room urgently. She had received preoperative clindamycin and a cehpalsporin in ER intravenously. I added tazocin and during the procedure she received Vancomycin as well.
PATHOLOGICAL FINDINGS:
She had 3 areas approximate the size of a toonie each that was frankly dead black skin. One was over the left labia majora, the second was just to the left of the perineum. It was anterior and lateral to the anus and did not involve the anus. The third was on the upper inner aspect of the left thigh. The entire area in and under this black necrotic skin was involved and all interconnected and is described in the body of the OR note.
Once the thigh was entered, it is discovered that there was necrotic muscle. Dr. M.M. was called in. He identified that the entire left leg was nectotic, skin, muscle and fascia,
PROCEDURE
The patient was brought into the Operating room and placed under general anesthesia. Her airway was managed by endotracheal intubation. A right radial art line was inserted by Dr. C. She was placed in lithotomy position using candy cane stirrups. This was done to allow us to prep and drape the area of the left thigh and knee.
Prior to prepping and draping a gentle rectal examination was done. There was some stool in the rectum but there is no indication of a perianal abscess or periani involvement. A Poley catheter was inserted. There was no palpable crepitus or abnormality of the mons public nor the abdomen wall. She was then prepped and draped in usual manner specifically up prepping around the left leg and including the knee and using clear chlohexidine.
I cut into the necrotic tissue in the perineum and cut the skin between the areas of necrotic tissue and identified that all of this tissue underneath was necrotic with dirty dishwasher fluid. I was able to easily lift the skin off that had appeared to be viable prior to incising. There was significant amount of fatty tissue underlying the skin that was necrotic. This was all excised with sharp dissection. This went up to the level of the mons public but did not extend over it. Posteriorly, it did not involve the perianal area or the rectum. I did dissect down to the inferior oublic ramus and I did identify that there was facia around the public ramus that also was necrotic. This was shaved off with the scalpel.
As I went laterally, there was necrotic skin that had to be excised as well as in the upper inner thigh. Under this area the fascia appeared to be slightly gray. This was opened sharply and I was able to dissect necrotic tissue, the fascia ant the superficial layer or the upper thigh muscle also had the same brown appearance with the dirty dishwasher fluid and this was able to be gently scraped off as well.
Slightly more posteriorly, I identified an area of dead muscle that was deeper. I was able to insert a fingertip into this area and extend it up the thigh under the fascia and I felt the underlying muscle was also necrotic.
It was at this point that I contacted Dr. M.M. to come in for evaluation.
I debrided what other tissue needed to be debrided involving as noted the left labia, the left side of the perineum and anterior slightly lateral to the anus and along the upper inner thigh.
Dr.M.M. will dictate his procedure separetely. When he arrived , we incised the skin over the knee and over the entire length of the upper inner thigh. Once this was opened, Dr.M.M. identified extensive necrosis of the underlying muscle.
Dr.M.M. identified that the options were disarticulation of the hip with an amputation of the leg. I un-scrubbed and phoned her next of kin which is a sister(Tammy) and spoke to her on the phone about these concerning findings. She was able to speak to Ms. Murray's oldest son and they felt that they would like to have everything done possible that could be done. While I was having this conversation and waiting for her to speak to the son, Dr.M.M. identified that the crepitus extended over the hop and onto the pelvis. He felt that the situation was palliative as there was not going to be adequete tissue to close the open area and the necrotic tissue had gone beyond the capabilities of surgical excision. During this time the patient was unstable, requiring a levophed drip to maintain her blood pressure. Dr.C was unable to get it above 70-80 systolic.
I spoke with the sister further and explained these findings. As it was felt by Dr.M.M. that there would be no viable tissue to close and he was unable to get surgically clear margins of the disease, we elcted to discontinue further dissection and transferred her to the Intensive Care Unit. We elected to maintain fluid and blood resusitation, essentially continuing aggressive medical management.
After applying the dressing and preparing for transfer the levophed was weaned down and was able to be discontinued prior to leaving the OR. Her blood pressure was able to be saintained within normal range.
We transferred her to the ICU planning to continue maximum medical therapy at this point and have to further discussion with the family when they arrived.
Sponge and instrument counts were correct.
OPERATIVE REPORT
Dr. M.M.
DIAGNOSIS
1. Necrotising Fasciitis of the labia
2. Necrotising Fasciitis left leg extending proximal to the left hip
PROCEDURE
1.Exploration of fascia left leg
2. Intraoperative decision made to discontinue procedure as this represented a non-survivable infection given that infection had sprend proximal to the hip joint on the left.
Dr.B had already has this 58 year old female in the Operating Room debriding some necrotising fasciitis of her labia when i was consulted. When i arrived in the Operating Room she was in the lithotomy postion, draped eterilely on the left side just below the left knee and just above the ASIS. Dr. B had already debrided some necrotising fasciitis involving her labia. Speaking with DR.B. she had noted some palpable subcutaneneous crepitus down at the level of the left knee. After scrubbing I came in and examined the left leg and there was indeed some palpable crepitus extending up through the medial aspect of the leg down to the vastus medialis. At this point I decided to explore the fascia of the left leg and a longitudinal incision was made along the medial aspect of the leg overlying the vastus medialia distally and up to the adductor musculature proximally and connecting this up with the incision already made by Dr.B for debridment of the labia. Subcutaneous fat easily elevated up off of the fascia layer and the underlying muscle was gray and foul smelling and non viable. I did explore medially and laterally as well and this was the case for the vast majority of the musculature throughout the enitre thigh that I could visualize. We then brought the left leg down out of the lithotomy position after placing a sterile stockinette over the left foot and securing it below the left knee. Additional drapes were added up above the left hip as there was some exposed sheets through the previously placed drapes after repositioning the leg.
At this point Dr. B. unscrubbed to contact the patient's next of kin to discuss their goals of care with regrad to this necrotising infection that was now involving the entire left thigh in addition to the labia and perineum. I took this opportunity to mark out a surgical incision for a left hip disarticulation as I felt this was the only possible salvage procedure given the level of necrosis within the left leg. While marking the incision I inadvertently palpated some subcutaneous crepitus that extended up above the level of the left hip proximal to the inguinal ligament. Finding this to be the case I then explored along the anterior compartment musclature a bit more and certainly there was dish water colored material that was extending along the fascia of the sartorius muscle up to the level of the anterior superior iliac spine and thus this necrotising infection was extending proximal to the left hip. I subsequently discussed this with Dr. B. in that I felt that this was a nonsurvivable necrotising infection at this point given that even if I were to perform a left hip disarticulation there would still be necrotising infection that had spread proximal to the level of the hip and that this was thus a pallative situation. To complete the clinical picture at this point the patient was on high does of vasopressora as given by the anesthatist . Dr.C and was very systemically unwell. Dr.B. and I deliberated on this for a few minutes but in the end I recommended that we not perform the left hip disarticulation as I did not feel that it would contain the necrotising infection which had already spread proximal to the level of the hip joint.
We therefore turned our attention to closure of the surgical wounds. The midial longitudinal incision in the thigh was closed with O Prolene suture in a running fashion. The area where the labia had been debrided was packed with 4 x 8 gauze and 4 x 8 gauze was laid over the now closed midial longitudinal incision in the thigh and this was covered with Medipore tape. Sterile drapes were then removed and the patient gently transferred off the operating table over to an ICU bed and then moved to the Intensive Care Unit in an unstable condition requiring large doses of vasopressors.
Family has been made aware of the clinical situation by Dr. B and at present plans are to palliate her in the ICU with the anticipation that she would die of an overwhelming necrotising infection.
Dr. K.P.
CONSULTATION REPORT
Admission to CCU, February 29, 2019 at 7:30am
PRESENTING COMPLAINT
This 58 year old woman was admitted status postoperatively from an exploratory surgery for necrotising fasctiitis of the left leg.Intraoperatively a decision was made by both the general surgeon and the orthopedic surgeon that the infection had spread proximally to the hip joint and that surgical excision of all necrotic tissue was a nonsurvivable procedure. The patient was brought to the ICU for supportive care with a guarded prognosis expected. Ms.Murray was allegedly well until about a week prior when she had developed a perianal swelling. This had progressed into an abscess and four days ago she fell while in the bathtub and the abscess raptured causing the perineum to become inflamed. Subsequent to that she developed more abscess in the perineum we well as pain and swelling which peogressed down her left leg up to her knee. She was seen and assessed by extamtoural who upon the advice of her family physician suggested that see be transferred to the hospital by ambulance.
In the ER Deborah was deemed to be clinically septic and the ER team pancultured her and started her empirically on antuibiotics, i.e.Ceftriaxone and Clindamycin. A surgical consult was solicited and Dr.B, surgeon on duty, assessed Deborah and made a diagnosis of necrotising fasciitis of the perineum and upper thigh. The patient was subsequently taken to the O.R. for explorative surgery,
PAST MEDICAL HISTORY
1. Type 2 diabetes mellitus
2. COPD
3. Peripheral vascular disease with right SFA balloon angioplasty in June 2018
PHYSICAL EXAMINATION
I saw Deborah in the ICU immediately postoperatively and at this time she was sedated, intubated with a size 7.5 endotracheal tube and being manually bagged. Her vital signs at this time were as follows: Blood pressure 130/75, pulse 99, respiratory rate 18, SPO2 100% and temperature 37.6 degrees Celsius. It should be noted the patient received two units of packed red blood cells intraoperatively as well as one ampule of sodium bicarb and for a brief period she was on Levophed because of low blood pressure. In the patient's respiratory examintion there was good air entry bilaterally with no crepitations or rhonchi. A chest x-ray done shortly after admission to the ICU demonstrated essentially normal findings. Cardiovascularly she was hemodynamically stable and a 12 lead ECG demonstrated a sinus tachycardiac with a rate of120 per minute , QTC 467, and no eivdence of any dynamic ST segment changes. I did do a bedside echocardiogram and this demonstrated normal right ventricular systolic function with no evidence of RV strain. There was no evidence of any pericardial or pleural effusion, however, IVC did demonstrate significant respiratory variation in keeping with fluid responsiveness. Her abdomen was soft and nontender with no guarding and bowel sounds, and I could not apreciate any crepitations in the lower abdominal wall. Neurologically she was sedated on a Fentanyl infusion but arousable and there was no lateralizing motor deficits. Her pupil were equal and reactive to light at 3mm. Her perineum and her inner thigh were dressed from the O.R. and these dressings appeared to be dry. The surrounding tissue did not appear to be hyperemic and at this time I could not appreciate any crepitations.
DISGNOSIS AND PLAN
Necrotising fasciitis of the perineum and left thigh.
This patient will be admitted to the ICU and a central venous line will be inserted to optimize vascular access should she deteriorate and require vasopressors. An aggressive fluid resuscitation strategy will be deployed using crystalloids and a map target of 65 will be targeted. This patient will also have an ART line placed and I will start her empirically on antibiotics in the form of Piperacillian, Tazobactam and Vancomtcin.
This patient has remained in the ICU for the better part of ten hours and continues to be hemodynamically stable. Serial blood investigations did not demonstrate a clincial volution in keeping with severe sepsis from necrotising fasciitis. I am concerned that thsi patient's condition may have an operative outcome that would be beneficial and as such I am going to reengage the surgeons and orthopedic surgeon regarding reevaluation of the intraoperative decision. I have also arranged an urgent CT scan of the abdomen and pelvis to better delineate and necrotic zone which may further help guide the decision making process by the surgeons.
I did provide a full clinical update to the patient's family and surrogate dicision maker, and the topic of code discussion was brought up. The patient's code status DNRA, no defib, no CPR, and as such will receive all indicted therapy and interventions with the exception of chest compressions and defibrillation.
When I woke up, I was on a medical ventilator and the nurses told me when they took it out that I would be sick, they had a plastic sheet over me to keep it from getting on me, but I guess they forgot to put one on themselves and it ended up going all over them, I felt so bad.
They asked me if there was anyone I wanted to call and I said yes my sister, because I didn't know where my oldest son, William was at, nor my youngest son, Peter. I tried to remember my sister's phone number, but could only remember the first 3 numbers. The nurse said that it was ok, and that they had the number, they dialed it for me and my brother-in-law answered, and I said “is Tammy there.” and he said “no she was at work,” and not realizing, I asked him if he could get her to call me back. Well, where was she going to call, crazy me. I don't think he really knew who was calling at first as my voice was very low, and then he said “Debbie?” and I said, yes, and he said “O my God you’re awake” and I said “yes” and he said he would call Tammy and let her know, and then he said there is someone here you may want to talk to and it was my youngest son and I just broke down.
Around 4pm my sister came through the doors in the ICU, I knew because I could hear her coming, she came rushing into my room and almost knocked me off the bed. If you knew my family you would know we are very, very close. The love we have for one another is unconditional and we are always there for one another no matter what. She kept saying that she was so sorry and asked me to forgive her. I asked her why and she said she ( and my oldest son, William ) had to make a choice to either take my leg or leave me the coma and let me die in peace. I told her to stop saying that because she made the right choice, my poor sister was beside herself.
I thank God everyday for my wonderful family. The doctors and nurses in the ICU were the best, I couldn't have asked for better. The first time I saw the wound care nurse, I knew I had seen her before. She said “Hello Betty” and I said “my name is Debbie, not Betty, Nancy.” She said “how did you know my name? I have not seen you before.” and I told her she was my guardian angel and that she was standing over me when I was in the O.R., and she said that was not possible because she wasn't there during the operation, but she was in my mind. They had what they call a VAC on me to drain the fluid off and when she leaned over me the light that was shining from the ceiling light made it look like a halo around her head and I knew God had let me see her, it was comforting to have her there. When they went to change the VAC, it hurt so bad because there was something like a sponge that was sucking up everything, there was a lot of tape and when they removed it, it felt like they were pulling my skin off. I tried not to cry, but it was really hard not to. They had to change the VAC twice a day, so I was not looking forward to it at all.
My sister Donna and her husband Richard came up from Nova Scotia, my Aunt and Uncle, my cousin and his wife came all the way from just the other side of Boston. I didn’t get to see them as I was in a coma and a snow storm was moving in so they had to leave before I woke up. Them all coming to the hospital meant the world to me, as I had said before my family is very, very close.