Wednesday, July 8, 2009

In Bill's words

Bill's Email address: william.obremskey@Vanderbilt.Edu

This will be the last entry into the Bill Obremskey/update/ blog as it is my thoughts and musings on the last 3 to 4 weeks of my life. It may also give others a clearer picture of what occurred. I feel a little as if this is like Jeopardy or starting a joke with the punch line as you all know the outcome of this saga. Anyway, I will try to fill in some of the details and give my early thoughts.

On Monday, June 8, I was “on call” after working on the weekend June 6 and 7. I received a call at approximately 7 a.m. after we had finished our morning rounds to assist Dr. May with an operation. I was a little concerned, as it is highly unusual to be asked to assist another surgeon and Dr. May is a personal friend as well as colleague and so I promptly went to see what help was needed.

Dr. May was attempting to save the life of a man who had developed what is commonly known in lay press as “flesh eating bacteria” and “toxic shock syndrome.” This gentleman had received a deep bruise to both thighs 3 days previously as he is a heavy construction work when a cinder block fell and as he was catching it hit his legs. Group A strep is a common bacteria in the environment on most people’s skin but it can occasionally become an active infection in people who have closed injuries. A common access point for the bacteria is through small cuts in feet such as with athlete’s feet or people with diabetes. This gentleman had diabetes, and his infection was unfortunately rampantly spreading through his left and his right leg. On attempting to remove all the deep tissue from his left leg it was noted that the entire leg was dead and Dr. May and I proceeded to remove his entire left leg. Unfortunately during the process I was stuck in the left long finger with a needle. I followed hospital policy and removed my gloves, cleaned the area and was able to scrub back in and complete the operation. The patient was checked for other diseases such as HIV and hepatitis C, as was I, and neither one of us had evidence of these common blood-borne diseases. These blood-borne diseases are routinely checked because they are very difficult to treat. The patient had Group A strep and necrotizing fasciitis and toxic shock syndrome. Unfortunately this man succumbed to his severe infection in the next week. The entire next week for me was fairly routine. My needle stick on my left hand appeared to be healing without significant incidence and had a regular operating room day on Monday, June 15. In retrospect, I think that during the operation on the patient with the severe leg infection that some of his blood spilled down onto my shoes and over the next week harbored and grew in my shoes. On Monday, June 15, due to a chronic 30-year history of athlete’s feet the infection probably spread to my right foot through blood-soaked shoes. Tuesday, June 16, I spent the afternoon on Percy Priest Lake with Allie and a group of teenagers in celebration of her upcoming 16th birthday. We water skied and knee-boarded and had a wonderful afternoon of fun. That evening I played tennis with a group at the country club. After that I felt incredibly tired and fatigued and went home and went immediately to bed. Jill was working that night but I checked on the kids and they were all doing well and they got themselves in bed. I woke up Wednesday feeling achy and sore like I had an early viral illness. I did not have very many operations to do and they were not to difficult and went and spent the day operating.

As I recently learned it was not such an easy day, as one of our nurse practitioners took several pictures of me in the surgeon’s lounge laid out sleeping between operations as I was beginning to be taxed by the infection invading my body. Again, I got home and went almost immediately to bed feeling I was just developing a summer cold and/or flu. Thursday morning I woke up after a restless night of sore back, achiness and feeling a little feverish and realized I was not well and immediately began to make phone calls to tell people at the hospital that I would need to be cancelling the clinic as I usually see patients in our office on Thursdays. By noon that day I really did not feel very well. I thought there was some redness in my foot and I noticed some new swelling on the right medial thigh. I called the surgeon’s office who did my right hip replacement as I was somewhat concerned about the possibility of development of a deep infection of my right hip and realized I needed to be very concerned about an infection there. I realized I was not feeling well at all and called the hospital. I asked one of our residents and one of my partners to see me. I arrived at Vanderbilt, had some blood work done, as well as x-rays of my right hip and an MRI of my right hip to see if there was any fluid around the right hip which would be an indication of infection in the right hip. Luckily there was no fluid in the right hip but there was inflammation in lymph nodes of my right groin and knee and the redness had progressed in my foot and thigh. After talking with my colleague and one of our infectious disease colleagues we had decided to admit me to the hospital and start IV antibiotics assuming this was an early cellulitis (infection of the skin) or lymphangitis (infection of the skin spreading up the leg in the lymph nodes).

Unfortunately, this was essentially the end of my conscious memory. By Friday morning, apparently I was somewhat confused and not feeling well but still not critically ill. Jill brought Analise by the hospital to tell me good-bye as she was leaving for camp that day. Jill also began a long series of good strong decisions by asking our good friend, Addison May, to come take a look at me as she was worried about how I was acting and how I felt. Addison saw me and immediately realized that I was not well as the infection was beginning to go through my body (sepsis)and I needed to be moved to a more closely monitored part of the hospital and as he is in charge of the surgical intensive care unit made arrangements for me to be transferred to the surgical intensive care unit (SICU). Friday and early Saturday were somewhat up and down events. As my body and the antibiotics were attempting to fight the infection and sometimes I seemed to be doing better and other times worse. By Saturday afternoon the overall trend seemed to be bad and Dr. May decided to take me to the operating room. When he did that he found that the infection was throughout my foot and traveled up the lymph nodes behind my knee into my medial groin. He felt the diagnosis at that time was “necrotizing fasciitis” and was developing “toxic shock syndrome.” Toxic shock syndrome is when the toxins released by the bacteria begin to affect other organ systems such as your kidneys, liver, lungs, heart. Dr. May attempted to clean out the infection in my leg on Saturday night and then again on Sunday morning and yet again on Monday. These 48 hours were the times when I was the most critically ill.



I asked Addison recently how ill I actually was. He told me he felt that if there had been a delay in moving me the SICU that it would have been too late to resuscitate (provide fluid, oxygen, medication) and if surgery had been delayed 2 to 3 more hours on Saturday that we might not be having this conversation. This is the time period when the family started to develop the blog to keep friends and family updated on my condition. This is also when Addison May started having twice daily family meetings and when Jill demonstrated incredible strength and intellect in leading the family meetings and approaching every issue in very factual and structured basis to try to make good decisions. During these 48 hours I at times was not doing well. One of my favorite quotes from another colleague, Dr. Patty Wright (an Infectious Disease specialist), who said “Bill, we were ready to try anything to make you better including spreading mayonnaise all over you.” Just for the record, they elected not to attempt mayonnaise but our Vanderbilt Chief of Staff, Dr. Allen Kaiser, approached Addison with a novel idea to consider a high dose steroid treatment (decadron) for 2 days to try to blunt the effect of the toxins effect on my kidneys, lungs, liver and heart, and to give my body and the antibiotics some space and time to begin to fight back. He had done some work with toxic shock syndrome patients 20 years previously and had felt it at times had been “a light switch” that allowed patients to begin improving. Addison May consulted with some colleagues about the idea and decided with Jill to use the steroids on Sunday. It is unclear but this seemed to be the timing that allowed me to begin to turn around. On Monday during surgery Dr. May felt the disease and infection had not progressed further and that we were beginning to make progress in staying ahead of the infection. By Tuesday I was improving. They attempted to remove the breathing tube but after a short period of it being out I was tiring out and it was reinserted. The breathing tube eventually was removed on Wednesday evening and this is when my conscious memories began to return.

Apparently a stream of family and friends came during these several days as well. I and my family were overwhelmed by the show of love and support from cards and letters and comments on the blog. I thank all for their kindness, thoughtfulness and empathy showed to myself and my family.

I remained in the surgical intensive care unit for the next 48 hours and this was some of the most challenging time for myself, as it is a time of partial consciousness, delusions, hallucinations which is a fascinating experience I care never to repeat again. The medication,, sleep deprivation altered sensorium for whatever reason and I went into a long series of hallucinations, delusions which I knew were hallucinations and delusions but I could not make them go away unless I intentionally did something, so I would frequently sit up and look around in the intensive care unit and this would make the cobwebs clear momentarily but then I would essentially slide back into partial consciousness attempting to fight the “demons of delusions.” My most vivid delusion was that Nick had returned in the middle of the night from my sister’s house in Jacksonville, Florida where he had gone to help entertain her 3 boys as well as remove him from the acuity of the situation. To this day I have a very distinct memory of him giving me an Ipod player to use and listen to in the intensive care unit and I gave him a credit card and told him to go catch a cab to home and wait until morning and then return to Jacksonville with his Aunt Kate.

The memory is so vivid that I could not find the Ipod player in my bedding as my bedding had been changed and I asked the nurses several times to go through the linen to find Nick’s Ipod which he had made such an effort to give me. Many of these experiences and understanding will help me to be a more empathetic and compassionate physician with patients in situations that have significantly altered their lives.

I left the surgical intensive care unit on Friday, June 26, and continued to improve daily until I was able to be discharged on Monday, June 29. Leaving Vanderbilt Hospital was a great experience and sense of freedom and relief.

In the 20 years I have been educated and practicing medicine, myself and a number of colleagues have taken care of several people with this Group A strep that then developed necrotizing fasciitis and toxic shock syndrome. The consensus of our experiences is that approximately 80% of patients do not survive this episode and those that do survive are missing parts of limbs. I left with several wounds on my foot from where the infection was drained as well as a wound that extends from the back of my knee to my medial thigh that is partially open with a drain constantly trying to shrink the area but overall my muscles, nerves and long-term leg function should be essentially normal. I lost approximately 10 pounds and I do not recommend this as a technique for weight loss but it certainly was effective. I have been home 5 days now and feel I have doubled my improvement essentially every day in terms of my stamina and ability to walk independently. I saw Dr. May in his followup clinic today. My wound is still open on my leg but we plan on closing it on July 6, Monday, and hopefully that will be my last operation and surgical episode with this illness.

From the moment I regained consciousness I had several thoughts or musings. It was incredibly clear to me that it is important to have a purpose and meaningful life. How each one of us decides to find that I think is our own personal decision. To pursue that meaningful life, I also felt that several other things were critically important to me for this encore part of my life.
#1 – Stay healthy, have a strong heart and stay alive. There is no doubt in my mind that my body would not have survived this without being in pretty good physical condition and having a strong heart. It is too easy to get out of shape and the long-term consequences of that can be deadly.
#2 – Hug your spouse, children and loved ones daily because you never know when you may not see them again. A friend of mine, John Shoenecker, suggested I should hug my dog as well. Being a dog lover I wholeheartedly agree with this. I also believe we should attempt to hug and love those around us as our dogs love us: unconditionally, constantly, at times frenetically. They also love us even when we forget to feed them or give them water and are never grumpy or cross with us. So, love your loved ones as your dog would love you.
#3 – Try to do a little good in the world everyday one person or patient at a time.
#4 – Try to look at life as half full as I have learned it can always get worse and while looking at it half full hopefully you take the time to enjoy some half full cups of red wine, enjoy a few sunsets and enjoy the journey of your meaningful life.

Monday, July 6, 2009

Doing well!

I apologize that it has been a few days since the last blog. Bill continues to do well. We spent the holiday weekend in Nashville with our family - 22 of us. Mom and Dad, Stasia, Dan and their family from CA, Kate and Tim and their boys from FL, Uncle Steve from CA, my girls and me. We tried to give Bill and Jill some "quiet time" during the day but spent the evenings at their home. They were wonderful hosts. Bill did great - when he got tired, he went to bed.

Bill went back to surgery this morning to close up his leg. The surgery went well but his leg still has alot of healing to do. He no longer has the wound vac or the antibiotic piic line - he was happy to see both of them go! Mom and dad left for home following the surgery. It was a wonderful birthday present for mom to be able to go home knowing Bill was doing well and would be "all right". Mom and Jill were and continue to be incredibly strong through this ordeal. I think Jill was actually sad to see her mother-in-law go!

Thank you for your continued prayers, love and support. We could not have come this far without you. Much Love, The Obremskey's

Wednesday, July 1, 2009

Settling In

Bill is settling into home and into a routine to aid his recovery process. Now that a sense of calm has returned to all our of lives, we are finding the time and energy to reflect on the past 2 weeks and how blessed and lucky we are to have Bill still with us. We have much to celebrate.

As I said a number of times while Bill was so sick; his health prior to becoming ill aided greatly in him surviving. He hope and pray in good time, Bill will return to his original ZEUS status!

I have asked Bill to write the next few blogs - so I am hoping he will do so soon.

We can NOT say it enough - your thoughts, prayers and support carried us through and will continue to do so. We look forward to spending the holiday weekend together as a family in Nashville. We will savor each and every moment - as life is so very fragile.

Wishing you all a safe and fun July 4th. Much Love, The Obremskey's

Monday, June 29, 2009

Home at last

Bill arrived home today - happy to be home but not as happy as his dog Buddy was to see him! The home routine will take some time to get used to, admisitering antibiotics, changing the wound vac, naps, etc. but I have no doubt the two doctors will figure it all out in no time.

Bill tires easily but looks great. He enjoyed a beer on his front porch today - nothing like home!

Keep your thought and prayers coming as it will be a long road to recovery.

Love, The Obremskey's

Sometime we forget the most important person....

JILL typed the blog addition for me tonight and I realized I was incredibly remiss in not thanking her. Easy for me as I was snoozing most of it -


"I had no idea how strong my wife has been these last 2 weeks. I can only try to enjoy a few more half -filled cups of good red wine, each others company, our children, and a few more sunsets"

Sunday, June 28, 2009

A post from Bill - Sunday Night, June 28


This is Bill and I read much of the blog and comments today. The support shown for our entire family was amazing and humbling. I want to thank all those who helped in any way and kept us in their thoughts and prayers. Tomorrow is the big day of returning home and begining a long rehabilitation process. I realize that this will not be a "quick bounce back". I had no idea how quickly I became sick. I want to thank the Vanderbilt SICU team, my orthopedic partners and especially our dear friend Addison May. Without his help I am sure that I wouldn't be here today. I never realized a big day would entail showering by myself, going to McDonalds for a coke and taking a 200 ft walk. I am not sure what I will do for an encore, but I think that I will start with the three goals that Jenny posted earlier. If you can see in the picture posted with this, the shirt says "half-full" - it is another good rule to live by. You never know when you will see another sun rise. Thank you and lots of love.
Bill

Coming home!

Bill will be released from the hospital tomorrow!! He will receive physical therapy and home health care at home. The wound vac and antibiotics will come home with him as well. He had a good day today as he ventured out of his room to the courtyard outside and visited with some friends for a couple of hours. The fresh air was a welcome change from the hospital room. He looks good and has accepted that the recovery will be long - he is ready for the challenge.

He sent me an email last night and asked me to post the following. I think we all know it is coming from his heart as he feel so very blessed with the care, love, prayers and support that he (and our family) has received.

Vanderbilt has asked me to write my three goals for the day but they could be for life
1.Have a strong heart and stay alive. For those of you that think you be able to beat me on tennis or skiing- good luck except doug dirschl. I make him look like federer
2 hug your spouse kids and loved ones everyday
3. Try to do a little good every day ,one patient/person at a time.

We are all looking forward to tomorrow and to having our Bill back with us!

Much Love, The Obremskey's

Saturday, June 27, 2009

A restful day and How we got here.....

I spent very little time at the hospital today but all reports are that Bill continues to improve beautifully. He seemed very good the short time I was with him, even a big improvement over yesterday. We hope he has a restful night and another good day tomorrow.

Many who have been following "The Blog" have asked how and when Bill got sick. I email out the following a week ago and may answer many of your questions.

We continue to feel your prayers of love and support - thank you. The Obremskey's

Sunday, June 21st

First and foremost, we want to thank you for your thoughts, prayers and support the past four days. Some of you may know most of the "story" and some are hearing it for the first time but I wanted to bring everyone up to date.

I will begin with tonight. Our entire family has arrived and we have just come from the hospital. Bill is stable - he is sedated and has a breathing tube. His vitals and labs continue to improve which is encouraging. The Drs. feel that they have the bacteria "under control" however, the concern now is the toxins, created by the bacteria, that remain in his body as well as the damage to his organs from the toxic shock. It will be a while before it is clear just what that damage, if any, will be. Recovery is still not mentioned but, God Willing, once it begins, it will be a long road.

In the morning, they will take Bill back to the OR to again examine the leg, which was opened last night, to drain the bacteria and administer antibiotics directly on the "source".

What got us to tonight? On Wednesday, June 17th, Bill began to feel "flu-like" symptoms. By Thursday morning, he knew there was an infection in his foot and it began to go up his leg, the leg with his artificial hip and he was concerned it may be infected. He went to the hospital Thursday afternoon for an MRI - his hip was clean but they knew he was sick so they admitted him and began IV antibiotics.

He was stable in the hospital on Thursday night, however, on Friday afternoon, he "crashed". Blood pressure dropped, kidneys failed - they immediately rushed him to the ICU. It was then that they realized he had a Strep A bacteria that was invading his body. This particular bacteria is rapidly moving and difficult to contain. In addition, it emits a toxin which is very harmful. Once they stabilized him, he was awake and alert, foot very red and swollen and his breathing was very labored. This state continued Friday night through Saturday evening.

On Saturday evening, he took a turn in the wrong direction. The bacteria had pooled in his right thigh and he was clearly not doing well. They took him immediately to the OR to drain the leg and determine the extent of damage to the tissue and surroundings. At that time, he was put on a ventilator to help him breath as it had become very difficult. This morning, they went in again to see if the bacteria had been contained and repack the area with antibiotics. The day was long but by this afternoon, the Drs felt as if they had contained the bacteria, it had not spread and his vitals continued to slowly improve. That brings us back to tonight.

The "source" of the infection is not known but we do know it entered his body through his right foot.

Bill and Jill's dear friend, Addison May, has led a team of doctors. We are very blessed he has been on the case as his expertise and care have been extraordinary, both professionally and personally with all of us.

Jill has been strong and by his side every minute with the support and love of many friends and family. Allie and Analise along with three of my four girls and Stasia's daughter, Grace all went to camp today in Indiana. Nick is home with Jill. The children know that Bill is sick but not the extent of his illness.

We are all coming to grips with the fact that this will be a "marathon". Your continued support and prayers will give us all strength, especially Bill, as he continues to fight.

All our love, Jill, Stasia, Bill, Jenny, Kate, Mom, Daddy and our entire family

Friday, June 26, 2009

A good day!

Bill was moved from the SICU today to a "regular" hospital room. He also showered and shaved. Many of the lines were removed from his arms and he looks more like "our Bill". The effects of his sickness continue but he can easily carry on a conversation and is completely aware of his surroundings. Fortunately, he remembers virtually nothing of his 7 days in the SICU.

He is exhausted as sleeping is very difficult. His Dr.'s would like him to get as much rest as possible this weekend to aid in his recovery. There will be lots and lots and lots and lots of time to spend with Bill as he recovers.

Daddy will go home to Lebanon tomorrow for the week and be back for the 4th bringing the girls from camp with him. We will miss his presence next week but know his leaving is a good sign that he is confident Bill will be okay.

We received a card today from a dear family friend that said "You gave us quite a scare, that's for sure! But I knew you would pull through because I had a dream that Jenny was crossing the street from the hospital, smoking a cigarette, holding a small baby that talked and she and the baby told me that you were going to be fine. I woke up feeling very positive.....how could a smoking mother holding her talking baby be wrong??"

We will take a positive sign ANYWHERE we can get it! All of your signs of love and support are so very appreciated and felt by all of us.

Love, The Obremskey's

Thursday, June 25, 2009

We all had the opportunity to visit with Bill today. His recovery remains steady. He is very, very tired but manages to have a conversation with everyone who comes in his room. He talked to both Allie and Nick on the phone today as well as Jeff Harelson and Flan. He realizes the love and concern he is receiving and is very moved by it all. Jill remains so very brave and is by his side constantly. She keeps a smile on her face as she comforts Bill and all of us.

Mike and Mary Esther Obremskey will leave tomorrow for home. Their being here has given us all comfort and strength, especially Halina.

We hope and pray each day is a little better then last for Bill. With your prayers, love and support, he continues to move in the "right" direction. Thank you.

Much love, The Obremskey's
Bill continues to move in a positive direction with his recovery. He had a difficult night as he is coping with the effects of being very sick. He communicates with us very well and is "tracking" well mentally.

Kate went back to FL yesterday with Nick and my Megan and Stasia left this morning for CA. The other children are at Gnaw Bone Camp in IN. We will all be back here next weekend for the Fourth of July.

Keep your prayers coming. Love, The Obremskey's

Wednesday, June 24, 2009

Have just come from the hospital. Bill is doing "well". He is aware of how sick he was and his road ahead. He told us not to be scared and he will be okay. Slow positive progress. We are felling very blessed and very tired - as is he. Good night
Great news! Bill was taken off the ventilator, he is awake, lucid and talking - wants to know why everyone is there. Jill and mom were with him. We will get to see him tonight between 8:30 and 10pm. Will write more then.

Your prayers continue to work - we are blessed.
Bill's news continues to be positive. His organ functions and vitals are improving steadily. In surgery this morning, his Dr's closed the wounds on his foot and were able to partially close the wound on his thigh. The next milestone is to remove the breathing tube and take him off the ventilator. The Dr's have asked us to limit our visits to him as he comes out of sedation because he easily recognizes us and tries too hard to communicate. We take this as a good sign!

Your love, support and prayers continue to heal Bill and are greatly appreciated.
Bill's surgery is at 7:30am. We will not meet with the Dr. until later this morning so my entry won't be until noonish. Many of you have requested our addresses. Mom and Dad are staying at Bill and Jill's.

Bill and Jill Obremskey
3609 Knollwood Drive
Nashville, TN 37215

Jenny Hannon
4422 Forsythe Place
Nashville, TN 37205

Tuesday, June 23, 2009

Tuesday night, June 23

Bill had a peaceful afternoon which he needed to rest for surgery in the morning. He was visited this morning by two of his dear "Duke friends", Greg Flanagan and Jeff Harelson. When he was told they were in the room, he gave them a thumbs up - we were all thrilled to hear it.

The report from his Dr. this afternoon was that his labs and vitals continue to be moving in the right direction and they remain optimistic about his progress. Keep the thoughts and prayers coming - they are working!

Tuesday, June 23, 2009

Dear Friends and Family,

We are establishing this blog today as an efficient way of keeping everyone updated on Bill's progress and ways to help the family. Please feel free to post comments for Bill and his family.

Today for Bill

Bill continues to make progress on his long journey of healing his body from this serious infection. He has regained some degree of consiousness and recognized a number of family and friends who visited him today. His doctors decided this morning to reinsert the breathing tube and initiate the ventilator to assist him with his breathing. While he was breathing on his own yesterday, it was with great effort and they felt that this step would allow him to rest and reserve his energy for healing. This was a good step for him, but a difficult step for us. This is an example of how this journey will unfold, three steps forward and one step back.

Tomorrow, he will return to the OR as planned to check the status of his thigh and foot wound. Depending on the doctors' observations, they will determine what the next course of action is for these areas. They are confident that the bacteria is no longer present in his blood or his tissues.

For those of you in Nashville who have offered to help, please contact Lacey Bulow by email at: bulowbunch@comcast.net. We would appreciate if you would direct your inquiries to her rather than to his medical team who is working overtime to get Bill healthy again.

We are grateful for your prayers, thoughts and offers of assistance. As the doctor's have told us, this will be a marathon not a sprint and we're just off the starting line. There will be many opportunities to support us along the way.

Much Love,

The Obremskey Family