By Carolyn Campbell
David Cowles knew he was tired. But he had no idea he'd soon be nearly dead. The semester had just ended at BYU, where he taught English, and the bustle of Christmas vacation had begun. Besides being caught up in the hectic holidays, he and his family were packing to visit relatives in California and attend the funeral of his wife's grandmother. In all the stress and hurry, Cowles' suitcase turned out to be the source of a deadly invader.
A deadly suitcase? Like millions of people, many times in their lives, Cowles' suffered a scratch that broke the skin of his hand. The laceration wasn't even from the sharpest suitcase surface the hinge. It was only that the zipper scraped his skin. The scratch didn't look serious but opened him up to a mysterious assailant that was already beginning to streak venomously through his body.
On Christmas Eve, he first noticed his cut finger was slightly infected, and asked for a bandage. Later that night, pain ignited under his arm. He still didn't know that the trauma was related to the scratch on his hand. He stayed up, wrapped presents and assembled toys for his kids.
The next day, as the last child opened the last present, he started shaking. Then throwing up. Then walking around holding his hurt arm against his side.
He tried to distract himself from the pain by watching a hopelessly fuzzy TV set with few channels that his in-laws found for him. His wife, Delys, also a BYU English professor, told him he looked like a walking corpse.
When his family left for the funeral, and the distraction of their presence was gone, Cowles, who is LDS, prayed for the strength to endure and for an end to his pain. He says four words emerged in his brain, urgent and insistent. The thought that penetrated his mind was: "You need an ambulance. Now."
But he hesitated possibly from latent machismo, or just being too cheap to pay for the expensive emergency service.
Yet moments later, when he actually called 911, he wasn't strong enough to wait on the phone. As he hung it up, he could hear the 911 operator frantically trying to keep him talking. But he couldn't respond. As he began to lose consciousness, he literally crawled to the living room couch. Paramedics who arrived moments later couldn't find any blood pressure at all.
His next awareness was of being in the emergency room, where a doctor asked if he were a heavy smoker or drinker.
He said he followed the LDS Word of wisdom, which dictates no liquor or tobacco. But they asked him the same questions again and again anyway. Finally, after medical personnel asked if he was sure he hadn't been drinking he responded, "Of course, I'm sure. I may be in pain, but I'm not stupid."
For hours, his vital signs stayed low. He appeared to be showing indications of a heart attack, but other symptoms were inconsistent with that diagnosis. Eventually, someone asked him if he'd been kicked in the side, where there was now a mysterious, blackish-purple spot about four inches in diameter.
He noticed the doctors talking animatedly to his wife, Delys. The image of them sharing a conversation was his last conscious thought for six days. Cowles wasn't awake to hear doctors tell his wife he had a mere 5 percent chance of staying alive.
Delys instantly calculated that a 5 percent chance of living meant a 95 percent chance of dying. She understood that the next two hours would probably decide the fate of her husband's life, as he entered surgery where doctors would attempt to cut away the infected parts of his body in an effort to stem the raging infection.
Was she about to become a 37-year-old widow with five kids? She leaned over and whispered to her husband, "Choose life, David."
Yet at that crucial moment, it didn't appear that the 40-year-old professor had any kind of choice. Necrotizing fasciitis, the disease that struck Cowles, is a virulent and extremely aggressive bacterial infection that devours human tissue. Once it gets inside a host body, it begins chewing up tissue to get at the nutrients. In this nourishing environment, the bacteria multiply rapidly and eat their way through tissue at a rate that can destroy as much as an inch of human flesh in an hour. The bacteria and their toxins consume the skin and soft tissue, including the fascia, which is the membrane around the muscles. Eventually, the disease shuts down vital organs. Cowles was literally being eaten alive.
Is Cowles' experience as rare as it is devastating? How likely is the typical Utahn to suffer Cowles' fate? Ironically, Denver, Colo. was the site of 11 cases of necrotizing fasciitis last year, according to Donna Batdorff, a survivor of the disease who is also a co-founder of the National Necrotizing Fasciitis Foundation (NNFF). She contracted the illness from a cut she received while skiing.
Necrotizing fasciitis is also on the national Center For Disease Control's list of emerging infections for several reasons. One possible causal theory is the idea that antibiotics have been overused and misused to the extent that they are no longer as effective against certain infections. Batdorff says that estimates for the number of cases range from 1,000, which she believes is way too low, to 10,000 per year, with a mortality rate ranging from 30 to 70 percent. If not treated, death is certain, and treatment is often delayed because of misdiagnosis. In every case Batdorff is aware of, the disease was misdiagnosed in the beginning. Through the Internet, she has heard of 100 cases in the past year alone.
After Cowles was transferred to a second facility, doctors surgically opened him from his right wrist, up his arm and down his side to his hip. It looked like a shark bit him. As soon as they cut into his side, fluids poured out of his body, soaking the doctor's pants and socks.
The physicians told his wife they would attack the bacteria on three fronts antibiotic therapy, surgery to cut out all necrotized (dead) and infected tissue and third, a hyperbaric chamber.
Cowles recalls the hyperbaric chamber as something like a two-person submarine. Once he and his doctor were inside, atmospheric pressure was increased to force pure oxygen into his body's cells to speed healing. In addition to that treatment, Cowles underwent major life-saving surgery six times in six days. Each time the doctors sliced his body, they removed skin at least an inch deep, then left the wounds open and wrapped them with gauze.
Delys explains, "There was no reason to stitch him up, since they were going to operate again the next day. Besides, there was less and less skin to attach anything to."
Yet despite all the drastic measures, hope diminished. Although the family celebrated reaching the 24-hour mark, doctors told Delys they didn't have a good feeling about her husband's chances. She recalls, "His neck was so swollen they worried the bacteria had spread there. Much of the skin on his arm was gone, and the bacteria seemed to have spread down his side."
The surgeons wondered whether they should begin taking antibiotics to prevent themselves from contracting the disease. Along with its devastation, necrotizing fasciitis is frightening because it isn't too picky whom it attacks. Trying to avoid it is like trying to avoid being struck by lightning. It's just one of an array of illnesses that can be caused by a versatile family of more than 70 bacterial strains known as group A streptococcus.
Group A strep can cause skin rashes, ordinary sore throats and more serious strep throat, along with scarlet and rheumatic fevers and bubonic plague. In its most virulent forms, group A strep can also induce deadly infections, including a form of toxic shock syndrome which killed Muppets creator Jim Henson in 1990.
During each surgery, doctors removed blackened and dead tissue from Cowles' wounds. They followed the path of bacteria to find new areas of infection. After 48 hours, the infection covered his right arm, destroyed much of the flesh on his right side, crossed his abdomen and chest and destroyed much of his left side. The doctors didn't know where it would go next.
By the time he'd lived more than 48 hours, his prognosis for survival rose to 10 percent. His wife recalls that his condition was so desperate that doctors gave him five times the normal dosage of dopamine, a drug which pulls blood from all over the body to the heart so the blood pressure will be higher. Yet as a side effect of the dopamine, his toes turned purple from lack of blood.
"I just thought he had red and purple toe tips that would gradually fade into flesh color again," Delys recalls. "I didn't realize he was close to losing his toes because the tissue didn't have enough blood to keep it alive."
When Cowles returned to consciousness, he found himself in bed with a nurse holding his right arm up in the air to change the dressing. "I looked over at it and was horrified to see not my arm, but a shocking mess of blood, muscle, tissue indeed, everything but skin," he remembers.
Batdorff lost most of the tissue on one arm and her right ring finger, and like Cowles, knows of no other way the disease could enter her body except through a small scratch on her finger. She says that anything that weakens the wall of the skin, such as a bruise, can allow the bacteria to enter.
Necrotizing fasciitis first became infamous in 1993, after it attacked Canadian political leader Lucien Bouchard, causing him to lose his left leg. Seven months before Cowles fell victim, seven people in Gloucester, England, contracted the illness. Then, in Canada, three months before Cowles' experience, John Jeffs felt "pain and swelling start to move across my chest and up to my neck." Doctors diagnosed a severe group A streptococcus infection, and, at one point, considered amputating Jeffs' arm. Like Cowles, before too long he wound up on life support.
The Cowles family soon began to feel that another source of support was contributing to Cowles' survival along with the medical expertise. By the time 48 hours had passed, people from a variety of religious faiths were praying for him in both California and Utah. On a television news conference, Delys recounted all the support she had, from the hospital volunteers who helped her in-laws to members of the Cowles' Church who bought food and donated blood to thousands of people she never saw who prayed for her husband.
"Since the bacteria had affected all sides of my upper body, that was a long and tedious process. Though large areas of my body were numb from nerve damage, I could feel every move the therapists made to clean my wounds. It was by far the most excruciating pain I have ever experienced or imagined," he says.
By now, Cowles wife felt like he resembled an anatomy book illustration: "I could see all the muscles on his arm because there was no skin. As the therapists started working on his side, I could see right inside his body. I could see his ribs, his hip bones and down into his chest. His right side had no skin. His back flapped open from his shoulders to his hips 10 inches deep." Looking at her husband, Delys said, "I love you inside and out, David."
Other people, too, kept expressing their concern for Cowles. The hospital was getting so many phone calls that its public relations department consulted Joyce Baggerly of the BYU English Department for help. At 3 p.m. each day, the English Department express-mailed a large box or envelope with messages. There were faxes from across the United States; booklets with students' drawings; cartoon books, like Calvin and Hobbes; letters; and music tapes. A colleague of Cowles included a David Letterman-type list of the top 10 reasons for contracting his disease. One item suggesting that the hyperbaric chamber would give him new insight into high-pressure situations.
He's been told repeatedly that he has survived a more advanced case of necrotizing fasciitis than any other person. In three weeks of hospitalization, he eventually underwent 14 surgeries. Three times, doctors made the decision to amputate Cowles' arm to stop the infection, and predicted that he would have nerve damage whether or not they chose to cut off his arm. At one point, they held the nerve of his arm like a string and scraped off dead tissue.
When the issue of amputation arose, Delys kept reminding his doctors that he is a pianist, that music is his love if not his occupation. Later, he placed his hands on the top of the piano apprehensively, rationalizing that if he could play one piano chord, that would equal success. "I put my fingers on the keys, and it just came out; music, exactly what I was feeling, and we all just cried" he says. He now plays the piano daily, and is composing music for his own CD.
On the Christmas Eve following his illness, he played tennis against the doctor who once said he had a 5 percent chance to live. Cowles won the set, six-love.
But physically, he isn't as good as new. One third of the skin on his entire body has been eaten away. He has no muscle or connective tissue around his ribs, and his chest resembles a patchwork quilt. Yet he feels the most significant changes have been introspective reflections on the aspects of life he now values anew. "When you can't do much, you rejoice in small things," he says. He relished having his catheter removed, taking his first shower in six weeks and drinking a blackberry milkshake.
His father cried when he lifted his right arm, brought his hand close to his face, and touched his nose with shaking fingers. He says he's discovered that death is not frightening, and says the next world is a place he'd like to see someday.
While he had always felt the importance of family, after his recovery he found himself staring for hours at a family portrait his wife had left for him. He and his wife collaborated on a book titled, "Miracle Victory Over The Flesh Eating Bacteria," published by Gibbs Smith, in which they describe their experiences and express their opinion that he was healed by a miracle, along with thousands of prayers from around the world.
Perhaps most significantly, he hasn't lost his sense of humor and can now look back on his experience and laugh. He says there is a positive side to his new physique. Laughing softly, he confides, "If I want to be alone on a beach, all I have to do is take my shirt off and yell 'Shark!' I'll have instant privacy."
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