When I knelt down in a dusty Lake Tahoe campground one day last summer, something as infinitesimal as a speck of gravel punctured the skin on my kneecap, not painful enough for me to notice but just enough let in a virulent bug. (Sepsis and Bacterial Infections)
For the next two weeks, that insidious microorganism grew undetected into a rampant infection that damned near killed me.
By the time I finally showed up at the hospital, doctors told me, I had a day, maybe two, before septic shock would start shutting down my vital organs one by one until my heart stopped.
How did a seemingly innocuous pinprick become a life-threatening infection?
It was a warm August afternoon when my wife, Bonnie, and I arrived at Fallen Leaf Lake campground in South Lake Tahoe, California. We had booked a campsite for five days for a much-needed break from the coronavirus lockdown and the political turmoil. The mid-summer sun was blazing, the lake was sparkling, hiking trails awaited.
I was wearing shorts in the warm afternoon sun and while setting up camp, I knelt down to attach the propane connection to our portable grill. I must have brushed the dirt off my knee when I stood up, but otherwise didn’t give it another thought. We made a delicious steak dinner, shared a nice bottle of wine, enjoyed our campfire under the stars, and went to sleep.
When I awoke the next morning, my knee was pink, puffy, sore, and hot. And I had a fever.
My first thought: Coronavirus! I am healthy and physically active, but at seventy-three my advanced age alone is a key risk factor that increases my chances for a poor outcome with Covid-19. A gut-wrenching fear grabbed me.
I wasn’t taking any chances. We drove to a local hospital, where a nurse stuck a probe under my tongue and told me my temperature was 99.9 degrees—above normal but typically too low to indicate coronavirus. “You don’t have any other symptoms,” he said. “There’s really no cause to treat you or admit you.” He suggested I take some acetaminophen for the low-grade fever and take it easy.
“I don’t know,” I told Bonnie, “if I’m going to be sick, I would rather be sick at home.” We packed up our things and drove nearly two hundred miles back to our house in a leafy suburb thirty miles east of San Francisco.
Two days later, I met with my doctor by video. He ordered a blood test and prescribed an anti-inflammatory medicine and an antibiotic for my knee. I had the blood drawn that afternoon. The next day the doctor sent a note. “The good thing was the lab didn’t show infection,” he wrote, “so you do not need to take the antibiotic at this point.”
Okay, I thought, whatever this is, it will be over in a few days.
In fact, a dangerous bacterium was lurking inside my knee joint, not yet detectable but about to reproduce ferociously like some alien organism.
I went about my daily routine for the next week. The knee had greatly improved for a few days, but then it flared up again into a burning, softball-sized orb. I was crawling out of my skin with pain.
I went to see an orthopedic specialist, who performed an arthrocentesis, the medical term for “collecting synovial fluid from a joint capsule.
The next morning, I was in such excruciating pain that I couldn’t walk without the help of a crutch. I sat moaning in a recliner with an icepack on my knee. It had been exactly two weeks since it first flared up in Tahoe.
At that point, we were six months into the coronavirus pandemic stay-at-home policy where we live. Going to a hospital was dicey because of the potential exposure to infected patients or staff. Local health officials were advising residents to avoid non-emergency visits to reduce the risk.
For me, that gamble was finally one I had to take. “I can’t wait any longer,” I blurted to Bonnie after lunch. “I need to go to the ER.”
At the emergency entrance to San Ramon Regional Medical Center, two staff workers helped me into a wheelchair and prepared to roll me inside. Because of coronavirus restrictions on visitors, Bonnie wasn’t allowed in with me.
Before she drove off, I said I would text her when I knew more and when she could come back to pick me up. I figured I might be there a few hours, overnight at most.
I wouldn’t see her again for ten days.
The hospital summoned the orthopedic surgeon on call, Dr. Benjamin Busfield. While I waited on a gurney, I checked my phone. There was a test result from the orthopedist’s office. “Rare Staphylococcus aureus,” it said. I didn’t know what that meant, exactly, but it was in bold type and flagged with a capital A.
Staphylococcus aureus is the most dangerous of the many common Staphylococcus bacteria. What’s far more dangerous is that once a staph infection takes hold, the body initiates a powerful immune response against it that can lead to sepsis, a more perilous condition.
Dr. Busfield arrived at the hospital and after consulting with the ER staff about my X-rays and test results, he told me: “You have septic arthritis in your knee joint. We need to go in there and do a washout,” or, in medical terms, debridement.
“It’s an arthroscopic procedure,” he said. “I’ll make a small incision in your knee and go in with the scope to clean out the infection.”
Fortunately for me, he added, my infection was the MSSA variety—Methicillin-susceptible Staphylococcus aureus—meaning it is treatable with common antibiotics. The more deadly MRSA, or Methicillin-resistant strain, is a so-called “super bug.” He estimated the operation would take a couple of hours.
I called Bonnie with the update and said I would be in touch when I was awake. “I’ll be fine,” I assured her. I wasn’t all that convinced myself, but I didn’t want her to worry any more than I knew she already was.
Four hours after checking in at the ER, they wheeled me into the operating room and began to administer the anesthesia. My last conscious thought was, will I wake up?
I came to in the recovery room, groggy but relieved. Dr. Busfield stopped by my room later to check on me, said everything had gone smoothly, and that he would be back the next day.
The next several days were a blur of blood draws seemingly at all hours, intravenous antibiotic and pain medications, emptying the drainage sacs, intermittent sleep, navigating to the bathroom with the help of nurses and a walker, visits from doctors, phone calls and text messages with my wife, children and friends, and poking at the bland meals that arrived morning, noon, and night.
Five days after the surgery, just as I was expecting to be discharged, my temperature spiked to 101.3, and my blood tests again showed the presence of Staphylococcus aureus.
Dr. Busfield ordered a CT scan on my knee to see what was going on. What he saw both stunned and alarmed him. The scan revealed a large mass of fluid running all the way down my inner calf. The infection had migrated from my knee into my bloodstream, a condition known as bacteremia.
“This is highly unusual,” he told me. “I have never seen a case quite like this. We need to operate as soon as we can get everything ready. This is an emergency. It can’t wait.”
I called Bonnie with the news. She was as shocked as I was by this dire flareup, and I could sense a deepening anxiety in her voice. Again, I tried to reassure her based on Dr. Busfield’s assessment. “I’ll call when I can,” I said.
Later she told me that she spent the time on the phone with her daughter and two girlfriends, anxious and imagining what her life would be like as a widow.
After the operation, I spent the next three days in my room recovering while the doctors watched my blood for any sign of infection. Thankfully, this time there was no recurrence.
At last, Dr. Busfield removed all my drains and told me I could go home to continue my recovery. My five weeks of home care included thrice-daily self-injections of powerful antibiotics and regular visits by a nurse to draw blood and change dressings, followed by three months of outpatient physical therapy.
My infectious disease specialist tells me the likelihood of this happening to me again is up there with a lightning strike.
I still can’t help thinking how unlucky it would have been to avoid Covid-19 successfully for seven months only to fall prey to a different kind of overpowering bug.
The next time take a knee outdoors, I will be far more cautious and diligent about any little cut.