Richard Boehm

Here it is midnight and I sit here mesmerized and comforted by all the survivor stories. Our story may be a little different as I am telling it through my eyes...the spouse of a survivor. I do this so that my husband can soon finish this story in his own words. He is still in the hospital recovering. But, he is alive and I need a place to say thank God out loud for those who understand what we go through during this time. As seems common in most of these stories my husband seemed to have the flu two weeks ago on a Sunday. Neither of us felt good and we spent a day on the couch together. While I got better he seemed to be a bit better but tired. One day he would be good and the next not so good. He had a fever on Thursday and Friday. However, he felt well enough on Saturday night to go out. We had plans to go boating with friends the following Sunday, but we cancelled because he had fevers spiking to about 103. Tylenol would take the fever down but the minute it wore off the fever would climb back up. By late Sunday afternoon he developed severe muscle cramps in his calf and elbow joint pain in his left arm. He is a dentist and knew this type of pain in combination with a fever was just not right. We called our family physician who told us to call back tomorrow if the pain did not subside. However, two hours later when he could barely walk on his calf was about the time we decided not to wait and hauled him to the emergency room. Sunday afternoon was a busy day in the emergency room and we waited about three hours. They took a chest X-ray and determined he had pneumonia. They were going to send him home with antibiotics but his O2 levels were very low. Since they would be unable to bring his stats back up in the emergency room they decided to admit him. Thank god is all I can say. Once they decided to admit him they gave him a dose of Leviquin (antibiotic) and we waited for a room. In the meantime his elbow started swelling and the pain became excruciating. It was unbelievable how fast it happened. They give him morphine for the pain which immediately makes him violently ill. He looks up at me and my heart just crumbles..he says..."this is the worst night ever". Little did he know. They take him to his room and he can not sleep due to the pain in his arm. Monday morning the preliminary blood tests come back and it turns out they find bacteria in his blood stream. Which bacteria we do not know at this point. They need to grow the bacteria culture. In the meantime, he is still being given antibiotics to treat him for pneumonia. Unfortunately, this is not helping the cause. The antibiotic is killing the bacteria but the toxins they are releasing are beginning to take a toll on his arm and leg. At this point, his arm is now twice the size as the night before and his calf has a weird red rash that is ever expanding. We are told he has a severe case of cellulitis. His blood pressure keeps dropping and now he is on a daily dose of Heperin to help keep the blood circulating through his arm and leg. They keep pumping him full of fluids to help the blood pressure. The fever is relentless. 103 consistently with chills. It is now Tuesday and the bacteria cultures can be read. It turns out he has strep A bacteria running through his bloodstream. An infectious disease control specialist is brought in. He asks the routine questions such as have you been out of the country; come in contact with birds; have you been bitten by a spider; do you have any cuts? We answer no to all of the above. He is stumped right now. However, he immediately changes the dosage of antibiotics and is now cocktailing VPen and Clindomycin. This will help with the toxins the bacteria is releasing. He also orders an MRI on the left arm Tuesday morning. The MRI is done at 8pm at night. (pss...if they ever ask if you are claustrophopic..say YES. Sedation for MRI is a great thing). An orthopedic surgeon from the elbow up does a preliminary read and thinks it looks OK. Meaning probably no surgery. The surgeon will be operating room until about 2 am and will check back with the radiologist after surgery for a more thorough read. They wake my husband up at 3 am and tell him it really doesn't look good from the forearm to the elbow. They are calling more specialists in and will have more news in the morning. Hubby is eating lunch on Wednesday and the nurse comes in and pulls the tray away. He is done eating right now as he needs to go into surgery ASAP. The surgeon is en route as we speak. What is happening? How do we go from pneumonia to needing surgery like RIGHT THIS SECOND? The surgeon at least has a chance to talk to us before heading down to surgery. He can not definitively tell us anything until he does the surgery and can inspect the extent of the infection. However, they have now gone from using the term cellulitis to flesh eating bacteria. I FREAK OUT. Best case scenario is the redness dissipates while on the table and he is in his own room after recovery. Worst case scenario he is in ICU on vents and dies six hours or a day later. The objective is to keep ahead of the infection. All the time I am thinking how does this happen? He has been here since Sunday. Why if he was in the hospital did it take so long to figure this out? He is trying to be strong for me. We fight. He is too optimistic. I have been online too much and am too pessimistic. We are in holding waiting for surgery. The surgeon has just reread the transcripts from the MRI. The arm is bad but the leg is put on watch and see. There may be something in the leg but not enough at that time to really warrant surgery. We tell the surgeon we are done taking the wait and see attitude. Open the leg and drain it regardless. Keeping ahead of the infection is the objective so we don't want to take any chances at all. He agrees to open the leg. He totally understands we are in a better safe than sorry state right now . I am trying so hard not to cry. To be strong. He is trying to make me feel like it is no big thing. All the staff is asking me if there is anyone here with me...family or friends or just anyone. I say no because we never expected this. I don't want anyone with me right now. I just want to be with him. As I am leaving he tells the staff to make sure that the minute the surgery is over, and not a minute longer, someone better come out there and tell me what the result is. I call his parents at their lake house in Michigan. It is now time for them to leave and come home right now. Mom is a nurse so she knows this is not good. The hardest call I have to make is to my kids. I have to tell them to come now as this may be the last chance they get to see their dad. I call my parents. I leave them to call anyone else. I can't deal with it right now. Two hours later the surgeon is finished. We have excellent news..best case scenario just happened. He is in recovery and should be in his own room shortly. I give the news to those who are waiting with us in the surgery waiting area and I send some of our family away only allowing our children to stay. It has been a trying time and I want my husband to rest. We go to his room awaiting his return from surgery. There are more people waiting in the room. I try to send them away and here comes my husband. He is awake and alert. He feels 100 times better after having the infection cut and drained from him. He entertains his guest for an hour and then I send them away. I am absolutely amazed how much better he already feels. I stay the night with him. Little does he know I am up all night checking him. Looking for redness, checking for fever, watching the monitors all night long. He has an excellent night. He only gets up to go to the bathroom due to all the water he drank after surgery. He takes no pain medications at all. They take him back into surgery on Thursday for a second cleaning and debridement. Everything still looks OK. The infection has not spread. After surgery on Thursday his temp starts spiking a tiny bit. It is funny how something like this would not be a big deal at home. He went from 103 before surgery to almost normal afterward. He started spiking to 100 a couple times on Thursday and immediately my mind thinks INFECTION. Just like that...in big, capital letters...italized like lightning bolts. That has now become the worst word in our vocabulary; it is a scary word. It strikes me right then and there how certain things become a priority in your life. Maybe two weeks ago it was mortgage, water bill, college payments. Now it is all about vital signs and stats. O2 readings, blood pressure, temperature, redness, infection...on and on and on. The world seems very small right now. I am hooked into the machines that tell me every minute how my husband is doing. That is my world right now. That is his world right now. Everything else is trivial. He is due home in three days. They will be closing his wounds on Tuesday with some more follow up visits to try to keep closing. We are lucky. We are looking at some very minor plastic surgery to close on small spot on his forearm. There was no muscle involvement that would impair any ability in his left arm and hand. This was especially relieving news since he is a dentist and his livelihood is derived from his hands. I am now thrust into two different worlds, both of which are alien to me. I live in the hospital by day and sometimes night. But, when I come home I can not really call it home. There is something missing. I put this story out here from my point of view because I am sure there are many out there like me. We are the spouses, family, loved ones of those inflicted. We want a place to turn for information and understanding. But, sometimes it is just not about understanding the disease but trying to understand the whole process from beginning to end. Just knowing we are not alone is comforting. My hope is my husband will be able to use both of his hands to finish this story with a happy ending. Richard Boehm's Update September 9, 2004 My name is Rick Boehm. My lover, best friend, and wife of over 21 years is Nancy Boehm. I am writing [with both hands] 8 days after being released from the hospital to give you the follow-up story. We live in a small near-western suburb of Chicago, IL, called Lisle. Very well situated for the sick, as I had my choice of 4 Emergency rooms within a 15 minute drive to go to, 18 days ago. Wow! Only 18 days ago. That's when the worst 4 days of my 40 year life started. By the way, I just turned 40, 4 days ago. And a very happy birthday to me. Nancy has the whole thing down for you, so I won't bother with rehashing most of it except the details that I feel might help save someone else from going through this. The hospital went to that fateful Sunday was Edwards Hospital in Naperville, IL. The infectious disease specialist, Dr. James Augustinsky, who, once learning it was strep A, on day three, had the nurses [who were all excellent, caring professionals, by the way. Without their diligent, watchful eyes, I might not be typing this at all. Thank you, Jason, Cindy, and everyone else on the short stay ward] start drawing pen lines on my skin every few hours to mark the progression of the spreading infection. That's when it started hitting home with me. Watching the enemy creep up my arm, slowly, but surely. Despite all the IV antibiotics, I was losing an inch of my arm and leg every 8 hours. This must be how a general feels in the war room, as he watches his army retreat, his territory getting smaller all the time as the enemy takes what was once his. My first visit from the Orthopedic surgical team was that evening. He would be there all night operating on a few patients. He looked me over and stated he was watching me and would be looking over my test results as they became available. He visited 3 times night, each time with a more concerned look about him. As he was leaving at 2am, he said he was sending a hand surgeon in to look me over first thing in the morning. Five hours later, Dr Robert Welch, was bedside, looking over the pen marks, ultrasound, MRI, and 2 day old x-rays. He said we would be operating soon, probably that evening. He ordered more blood work, new x-rays, and left for his office, stating he would call the Radiologist at lunch to check on my new x-rays. My lunch tray arrived at 11:30am, but I wasn't hungry. The nurse walked in at 12:30pm and took it away stating the word had just come down that they were canceling someone else's elective surgery downstairs, and that my surgeon [Welch] had canceled his afternoon patients at his office to get my ass in the OR. Well now, that sounds bad to me. I called Nancy and told her what was going on and she was there within minutes. They sedated me slightly for the ride downstairs about 45 minutes later, where we had 15 minutes to talk to Dr Welch. He was a straight shooter, because I asked him to be honest, not optimistic. I asked for best and worst case. Hearing someone you respect say you might not make it is very sobering. Nancy and I had 15 minutes together, alone. Seemed like 2 to me. I tried to tell her I would be fine, but reality was too close and closing in. Off to the OR we go..... I woke up in recovery, minutes after Welch had been talking with my family in the waiting area. Guess I made It. Welch visited the next morning as I drank breakfast, and said he was going in again that night just to be sure. I asked why it was necessary. Not questioning, mind you. Just curious. He said it was because the last pen line was in my armpit, and that if we had waited another 6 hours, I might be staring up at a mortician at this point. He wanted to be sure we stopped it cold. Fine by me, doc. It's very hard to argue with the man whose judgment had saved your life the day before. So, here I am, home, safe and fairly sound. I had my follow-up visits with both doctors and I am clear to drive and possibly return to work in two weeks. My appetite is back to normal now, and I hope to leave the 10 pounds I lost off for good. It will be a while before I get back on my Harley, but I went to the DMV yesterday to apply for a custom license plate. It will read "6 HOURS". Not that I will ever forget, but it's a good reminder of how close I came. Hopefully, others will realize that this bug is a force to be reckoned with....the sooner you get to a good hospital, with good doctors and staff, the more likely you will be typing a survivor story, instead of someone else typing you obituary. God bless you....I've obviously already been. Rick