These Three Remain: How Faith, Hope and Love Defeated the Flesh-eating Bacteria
By Vance Salisbury
And now these three remain: faith, hope and love. 1 Corinthians 13:13a (NIV)
I am a flesh-eating bacteria survivor. That simple phrase seems to communicate, even to complete strangers, that I am an extraordinary case. With little or no knowledge of the disease or the "chamber of horrors" I endured for months, the label itself announces that I have been snatched out of the jaws of death. Sometimes the declaration arouses a look of pity, while others are obviously distressed by the grotesque images instantly flooding into their minds.
Nearly everyone, as soon as they gain their composure, have the presence of mind to ask two questions. First, how did I get the disease? I tell them plainly, "I don't know." I have some theories, but no one knows for sure. I can tell this troubles them, because it leaves the possibility that they too could someday be "arbitrarily" assaulted by this horrible killer. Then, I am asked, "what did you learn from this? Do you live your life any differently now?" I usually reply, "I learned what I already knew." What do I mean by that?
The Christian writer, C.S. Lewis, says the same in his "A Grief Observed," which amounts to a jumble of the thoughts and emotions he was troubled by, following the death of his wife, Joy. Lewis points out that there are a number of Bible truths, which a Christian knows and affirms; yet they often remain intellectual verities until they must be lived out. This is how it was with me and I am grateful that I had been given advance warning, through the Scriptures, of the "cup" I would have to drink myself. Lewis writes:
Bridge-players tell me that there must be some money on the game, "or else people won't take it seriously." Apparently, it's like that. Your bid,for God or no, for a good God or the Cosmic Sadist, for eternal life or nonentity, will not be serious if nothing much is staked on it. And you will never discover how serious it was until the stakes are raised horribly high; until you find that you are playing not for counters or for sixpences but for every penny you have in the world. Nothing less will shake a man, or at any rate a man like me, out of his merely verbal thinking and his merely notional beliefs. He has to be knocked silly before he comes to his senses. Only torture will bring out the truth. Only under torture does he discover it himself.
1 Corinthians 13 is well known both to saint and secularist. It has been transformed into the "Love Is" sentiment at many weddings and is enshrined on garish posters or refrigerator magnets. Yet, "under torture," this and many other oft-recited passages of the Bible came to form the basis of my emotional and physical survival, as well as the guiding principle for those who would care for my family and myself. The faith, hope and love of our "neighborhood" within the Christian community, was mobilized, directed and energized by these three virtues and this is the story of how that happened.
It was a Saturday evening and I was exhausted. But, I was looking forward to an aggressive game of indoor soccer and a good time afterwards. The court at Samba Soccer was full of our church family. We gathered in a circle for prayer and began with the teens holding down the goal at the north end of the arena. The ball moved up and down the court a few times and I became exhausted immediately. I thought to myself, "I'll conserve energy and stay down at their goal." Just then, the ball came down and I was in the box with about five players from both sides, furiously trying to get clear for a shot. I looked down and saw someone kick my left ankle -- the pain was sharp. I limped for a few moments and left the game to relax in the bleachers.
We lost the friendly skirmish with the youth group that Saturday night, but a silent, life or death, contest was just beginning in my bloodstream. An army of bacteria, Group B Streptococcus, was battling my immune system and on the verge of completely overrunning my defenses. I thought I had merely suffered a minor athletic injury, but the advance forces were already wreaking havoc on my immune system. The bacteria were secreting a toxin, over- stimulating my T Cells and producing a chemical power surge of cytokines, chemical signal carriers, which swiftly traveled through my blood vessels, destroying the inner walls.
By the following afternoon, blood was pooling into the surrounding tissue. Starved of precious oxygen and under the attack of cell-destroying enzymes, the soft tissue below the skin of my left ankle and calf was beginning to die. The Strep teamed up with anaerobic bacteria and was now full, blown necrotizing fasciitis, the flesh-eating bacteria made famous by tabloids and TV newsmagazines. The invading bacteria turned the tide and were on an aggressive offensive, which would eventually accelerate to destroy one cubic inch of flesh every hour.
After a fitful night's sleep, I awoke to intense pain in my left leg. My wife, Denise, called in sick for me and told my replacement that I would be in sometime during the afternoon. In fact, I would not be back to work for another eight months. My immune system was in full retreat now, heading into "overwhelming sepsis." As the infection chewed up my flesh, toxins were secreted into my compromised bloodstream for delivery to the rest of my weakened, dehydrated body. If left unchallenged, the war would eventually end in a total victory, sending me into toxic shock with organs failing one by one, culminating in my death. By evening I was entering the death spiral; my kidneys and liver were failing. In the early hours the following morning my blood pressure dropped to nothing and by mid-day I experienced acute respiratory distress syndrome, failure to breathe on my own.
I was admitted to the hospital by our family physician, Dr. Scott Kellerman, who came to my room and asked if I had problems with my kidneys in the past. The blood work looked suspicious. "Well," he said, "we'll deal with that later, but let's keep an eye on your ankle." Later, my nurse returned with an assistant and they had a concerned look on their faces. I said, "I'm dying, huh?" She slowly replied, "Well . Your leg is real bad." Somehow, my body was telling me I was in deep trouble.
I awoke the following morning in the Intensive Care Unit with my daughter and friend Dr. Mark Richey. I was mysteriously slipping away and about to be life-flighted to the University of California Medical Center at Davis (UCDMC). Camille, our oldest daughter, was attending the local community college and it was the week of final exams. She tearfully asked if she should go to school or stay with me. Camille's concern provided the rare opportunity to confess my faith in Jesus Christ before dying. By the grace of God, I was able to make that confession and step into eternity, willingly and without hesitation. I told Camille to trust in Jesus, that was her pressing need. Whether I went to be with the Lord or remained, I would be fine, so she should go to school. My friend Mark, a physician, patiently took down some final instructions about the disposition of some of my research notes and resources, without any objections or assurances that I would be fine. He was not optimistic about the outcome.
But the triumph of faith would not be complete until the last prayers for my life were uttered and answered. People all over the world prayed for my healing. But, it was Dr. Kellerman's experience, which demonstrated the kind of faith, which God describes as the "fervent prayers of a righteous man." After my transfer, Dr. Kellerman returned to his office for his regular appointments. While treating a patient, a voice seemed to tell him to leave immediately, drive to UCDMC and pray for me until I was healed. Scott excused himself, left the patient in the room and immediately drove the fifty-mile journey to the medical center. En route, the voice came again; "no eating - just prayer!" He arrived to find Denise, despondent and waiting for news from the ER. Dr. Kellerman simply held her hand, prayed with those gathered for six hours and then returned to our local hospital for a night on call. For four days, he cancelled all of his appointments, fasted and drove to UCDMC to pray with friends and relatives assembled there around the clock.
Dr. Kellerman related how he felt as if he was in a tug-of-war on top of a great pinnacle, wrestling with God for my life. It seemed as if the Lord would say "pray!" and then pull harder than ever. Later, Scott would understand that it was God's way of leading him into more serious, faithful prayer. When others engaged in small talk or prayed in a hopeless tone, he became impatient and prayed more seriously, believing that I would not die.
The bacteria destroyed the soft tissue up to my mid thigh and the cure, if there was to be one, was twofold. I was treated with a powerful combination of antibiotics to keep the infection from spreading or injuring other parts of my body, while surgeons aggressively removed the dead flesh and went out ahead into healthy tissue to halt the advance of the bacteria. Finally, all the soft tissue down to muscle, bone and tendons had been removed from the top of my toes to the top of the hip on my left leg. At this point, the surgeon brought Dr. Kellerman in to show him that the infection had moved all the way up into my lower back, with the outside border of the affected tissue and time of the examination drawn on my skin with a permanent marker. "We are taking him in for a final debridement, but he is not going to live, It's like trying to stop a freight train with tissue paper," the surgeon confided. The affected area was simply too large, I had lost too much tissue and my major organs were no longer working.
Dr. Kellerman returned to the waiting area to join the others in prayer for what they believed to be the final surgical attempt to save my life. But, he knew now that only a miracle would save me. Someone closed the prayer with "thy will be done." Scott boldly countered, "not thy will, but my will Lord, save Bo's life and we will work out the details later." He was certain that the Lord had assured him He would spare my life and like Jacob, who wrestled the Angel of the Lord, Scott would not settle for anything less than my very life:
Jacob replied, "I will not let you go unless you bless me." Genesis 32:26 NIV
Two hours later the surgeon emerged from the elevator and sat down with everyone in the waiting area. "I've been a surgeon for many years," he softly said, shaking his head over and over. "I've never seen anything like this. We searched for hours and the infection is completely gone." Dr. Kellerman cast all sense of professional propriety aside and began leaping and shouting,"Praise the Lord!" Scott gathered everyone together for a prayer of thanksgiving and as he recorded in his journal, "We talked about how a miracle had been witnessed by us today and from this time forward, Bo's life and all our lives would be forever changed." Faith, finding expression in serious and unwavering prayer, had triumphed over one of the most virulent diseases known to man.
Faith triumphed and I began the hellish experience of day to day life in the ICU burn unit, weekly skin graft operations, sleepless nights and empty hours pondering how different my life would be from now on. I had been blind-sided by a disease I only knew existed in the headlines of supermarket tabloids and now my body and perhaps even my life was in ruin. I wondered, "what would sustain me through the unbearable pain? Could I walk again? Would I be able to return to work? How would I pay the mounting medical bills?" Dr. Blaisdell, my surgeon, told me that I would probably walk with a limp for the rest of my life. All of the flesh had been removed between my ankle and Achilles' tendon. He was direct in his assessment of the situation; "his tendon in hanging in the breeze." There would be a finger-size hole, which would have to be repaired by a plastic surgeon at a later date. Everything was in the Lord's hands at this point and my wellbeing was left to the physicians, nurses, and other caregivers.
Each patient in the burn unit is assigned their own nurse, 24 hours a day. One Saturday at 7AM, the day nurse came in and introduced herself as a "per diem nurse," filling a scheduling problem in the ICU. She had never worked in the burn unit before. At about 10 AM, she came in with a queasy look on her face. "Mr. Salisbury, I have to leave", she said, "I can't work here; everything we do hurts the patient." The horror of the burn unit was more than she could take and I understood completely.
The other nurses in the burn unit filled in. Just before noon, I had the sensation of wetness and thought I had an accident. But, it seemed to be a busy day and some time passed before any of the other nurses could get in to check me out. When they finally did, they discovered that my cast, which stretched from my toes to upper hip was "going bad" and fluid was draining out the top. The smell was rank and if it were allowed to go on, it could lead to infection, loss of successfully grafted skin or a serious enough infection to result in amputation.
Dr. Blaisdell was out of the country receiving an award and I was under the care of Dr. Katherine Mayer. Outside my room, I heard nurses arguing over what to do with me. The exchanges were heated, with yelling and swearing. The surgeons were five floors down, locked in their own drama and unavailable to come up and decide whether the cast should come off or not.
I have never felt so hopeless in my entire life as I did that morning. I was powerless to do anything and the professionals were arguing over what appeared to be a very critical situation. My nurses had "abandoned" me (not really, but there is a paranoia which comes with life in the burn unit). I prayed, "Lord, you alone can get me through this. No one knows what to do and I am completely helpless. You alone are my hope." But, it wasn't that I thought of the Lord as my only hope for healing, but that no matter which way this crisis turned out, my hope lay in Jesus and His promise of eternal life. As far as I was concerned, the success or failure of the last operation was a settled fact, nothing would change that. What I needed from the Lord was the assurance that, no matter which way it went I was in His hands. He gave me that assurance.
My deliverance came that morning and it appeared in the form of an unexpected Samaritan. Jo was a "drill sergeant" of a nurse, striking fear in the hearts of my children and other hapless visitors who arrived on her shift. She was often abrupt and tough. On this Saturday (and many other occasions), she was an angel. After my third nurse left before noon, she shifted her patient to another nurse and came into my room with a huge stack of towels and supplies to change my dressing and clean my newly grafted leg. "I'm gonna take care of you, honey," she said smiling. Then she shouted out the door, "Get those g-- d--- surgeons up here! I'm going to start unpacking his cast." She removed the spandex, which was stapled to my hip, covering the area between the top of the cast and the remaining six inches of open flesh. The gauze was putrid and soaking wet. Jo gingerly unpacked inch by inch, careful not to disturb the grafted skin. She went as far into the cast as possible before the arrival of Dr. Mayer.
Dr. Mayer saw and smelled the heap of medical waste and the decision was made to remove the cast right there in my room. Blaine, a technician, came in with the cast cutter. I was apprehensive about having my cast removed while I was conscious. This procedure was usually done under anesthesia, with the success or failure of the previous operation tactfully reported later. That day, I would be awake through this procedure and know immediately if the latest operation was successful or not. If it was not, it would mean more surgery, more time in the burn unit, more pain or something as extreme as the loss of bone or tissue.
Two other nurses got their patients settled and came in to assist Dr. Mayer, Dr. Morrison, Jo and Blaine. I was rolled onto my right side, hugging the rail of my bed, fixing my eyes on the floor and spiraling into the now familiar sensation of vertigo. The procedure would be very painful, so I was allowed as much morphine as I wanted; I just needed to say "when." I said "when" many times and I must say that I cannot remember the pain being very bad. The suspense, however, was more than I could bear placing my hope completely in God and nothing of this life.
Blaine finished the cut and my cast was cracked open. As the surgeons and nurses began removing the gauze, Xeroform and mesh, they all began gasping, with exclamations of "whoa!" "Look at that!" I wondered, "Is something really wrong? What's happening?" Then, I heard everyone very excitedly exclaiming, "it's beautiful!" "Look at the granulation at the ankle!" They were amazed, because in less than five days, the "hole" between my ankle and tendon had miraculously filled in with "granulation" or scar tissue and it was covering my Achilles tendon. For a second time, the Lord had answered prayer in a dramatic way, restoring flesh where there was once a hole.
Also, a very large graft on my thigh had taken beautifully, to the surprise of Dr. Mayer. She had performed the graft herself the previous Tuesday and when she and Dr. Benedetti moved me from the table to the gurney, they saw the entire graft and packing shift. They looked at each other through their face shields and shook their heads, thinking the graft had certainly sheared and all of their work was in vain. However, that graft continues to be one of the most durable and beautiful areas on my entire leg.
Mark, the physical therapist assigned to the burn unit, happened to walk by my room and saw the commotion. "Mr. Salisbury," he said, "would you like me to come in and work your knee while the cast is off? It could save you a lot of pain later." He donned a gown and gloves, came around the left side of my bed and began lifting my knee, flexing it with more force each time. He took my gooey, partially grafted leg by both hands and worked my hip. I was awed by his willingness to work on my terribly deformed leg, which was one long open wound. When he was finished, he came to my side to wish me well and he stood there, looking like a butcher with his bloody gown and gloves. My admiration for Mark increased about 1000% that day.
Everyone in the room seemed visibly relieved and I recall a lot of joking and upbeat chatter among the nurses and surgeons. My leg was thoroughly cleaned, dressed and bound up for my next surgery. Dr. Mayer went to the waiting area to tell my wife the good news, jumping up and down, giddy and bubbling over with the news of the miraculous ankle and the beautiful graft on my thigh.
That afternoon was a foretaste of my heavenly hope. The burn unit settled down from the morning chaos. Three nurses were able to care for me. I received the royal treatment as each one carefully pealed off the dried gauze and flaking skin from the donor sites, the areas where skin was shaved off to graft onto my leg. My entire chest, abdomen and right leg were cleaned up, revealing tender, pink skin which had covered the wounds. I drifted in and out of sleep, as they washed my entire body and rubbed oil all over. I felt as if I was visiting a plush spa.
I fell into the deepest sleep of the entire three months in the hospital, waking to the visit of a couple of friends in the early evening, standing by my bedside. My bed had been turned and I was looking straight out the window, into a golden sunset. The lights were down, there was a warm glow in the room and, for the first and only time during my stay, the burn unit was completely quiet. There were no emergencies and none of the usual hearty laughter of the nurses. It was as if the Lord was giving me a foretaste of the blessed hope, when Jesus will return, all tears will be wiped away and the Church will bask in the glow of the Savior's light:
And there shall no longer be any night; and they shall not have need of the light of a lamp nor the light of the sun, because the Lord God shall illumine them Revelation 22:5 (NIV)
The bacteria were eradicated, the skin grafts were successful and now the grueling work of healing and building strength began. But, it would be the love of others, expressed in actions, which would complete the triumph over the deadly flesh-eating bacteria and revive the ravaged body they left behind.
Denise was there nearly every day and we settled into a routine. She would arrive about 7AM and join me for breakfast. Then, she would fill up a basin of water, wash my hair and bathe me. I had received a positioning injury in my right shoulder, so my right arm and hand barely worked. I finished by shaving myself, resting the immobile arm on my chest and moving it a few inches at a time across my chest, so I could reach both sides of my face. Then, we settled in and watched two episodes of The Andy Griffith Show, between 8 and 9 AM. At night, we would read the Bible and pray together. She would help me brush my teeth, line up all the essentials on the table by my bed, so I could reach everything I needed through the night; Bible, tissues, water, call button and the urinal. In my 6'x 8' world, the proper positioning of those necessities became crucial to my ability to relax and perhaps, catch a few hour s of sleep. Then, with a kiss she was gone to stay with a friend nearby.
Between morning and evening, she was my messenger, my advocate, my best friend; she brought news from friends, cards and letters, reports about the wonderful things that God was doing through our trial. The nurses were so appreciative of her help, providing some well-deserved assistance they gave her the combination to the supply closet! When I was too depressed or exhausted to face my physical therapy sessions, she would encourage me with the progress I was making and speak to me in that gentle, yet firm motherly tone, "Bo, we have to go to therapy now. You did real well yesterday."
Denise spent nearly every day with me over the three months I remained in the hospital, leaving our home and family over fifty miles away. The Christian community, represented in a number of churches, took care of our household without missing a stride. Our youngest daughter, Emma, finished her homeschool year with one family and was welcomed from house to house throughout the summer. Our son, Sam, shared the household duties with Camille. Friends checked in on them, invited them to dinner and drove them to the hospital to visit me. One friend who is a landscaper, kept our lawn mowed on his way to jobs around town and his wife even dropped by one day to help him mulch and weed the rose garden. Others kept everyone around the country up to speed on my condition over the Internet and phone. One family even adopted our dog for the summer.
When it was time to go home, I was greeted by dozens of friends in our front yard and a large yellow ribbon girdled the liquid amber tree. I was cheered and hugged and kissed -- all very gingerly. The crowd parted and I was ushered into my home, where a brand new rocking recliner awaited; a gift from my friends and a local furniture store.
John, the "apostle of love" penned these words two thousand years ago:
This is how we know what love is: Jesus Christ laid down his life for us. And we ought to lay down our lives for our brothers. 1 John 3:16 (NIV)
Authentic love, the kind of love God imparts to His children, is not measured by the intensity of our emotions, but by the extent of our sacrifice for others. Many friends, family, physicians, nurses and therapists went beyond any reasonable expectation in helping my family and myself in this trial. There is no monument to their love here on earth, but the remembrance of those actions will endure for an eternity.
Love sealed the victory, which began in faith and was sustained by the hope of future redemption in God's kingdom. As time goes on, memories will fade, the medical records will be purged and this trial will be forgotten here on earth. Those who played a part will grow old and die. Photographs and stories may remind later generations, but they will never comprehend the intensity of the battle for my life, the emotional pain my family and friends endured in the waiting room or the downright hard work of hundreds of people who cared for my family and myself. But, the faith, hope and love of everyone involved in this drama will transcend this time-space existence and be transformed into praise and honor to the Lord Jesus for all eternity.
And now these three remain: faith, hope and love. But the greatest of these is love. 1 Corinthians 13:13a (NIV)
These are the truths I knew, but I could not fully comprehend under any other circumstances except, as C.S. Lewis wrote, "under torture." Only now can I comprehend how faith, hope and love, which are considered non-material attributes, are actually of greater value and more durable than anything we can possess on earth. I lost a beautiful leg and robust health through this trial, but what I gained was far greater. These trophies will remain and remind me of God's faithfulness through this life and long into eternity.