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Astonishing Legends Network.

Disclaimer, this episode includes the usual amount of adult language and graphic discussions you've come to expect around here. But in the event it becomes an unusual amount, expect another call from me.

Welcome back to Scared All The Time. I'm Chris Cullari.

And I'm Ed Voccola.

And this week, we're diving into a topic that is sure to make your skin crawl right up until it begins to rot away. That's right, you hit play. You know what you're in for. We're talking flesh-eating bacteria this week. This is one of the gooeyest and gory-est topics you've ever covered. And let's just say you're lucky the podcasts are an audio medium because the imagery associated with this topic is unforgettable in the worst way. The audio probably is too, but we had trouble recording the sound of meat hitting the ground with a thick enough splat. So you'll be spared.

Also in this economy, we can't afford to toss meat away.

Well, flesh eating bacteria sounds like something out of a horror movie. It is very, very real and very, very gross, but how likely are you to catch it? If you do, can you be saved or are you doomed to suffer one of the worst deaths imaginable? Today, we separate fear from fiction and meat from the bone as we explore the world of flesh eating bacteria.

What are we?

Join us.

It's time for... Hey everybody, welcome back to the show. Just a little bit of housekeeping up top. I think first and foremost, we should mention that we have just launched our Patreon, which is in addition to our Supercast. So if you're already on Supercast, nothing changes, you're still a premium subscriber. Everything remains the same, but we have added to Patreon. We had a lot of people asking, they're already in the Patreon ecosystem. It's easier for them. So sign up on Patreon for our premium stuff. It'll be all the same tiers and rewards as you'll get on Supercast, just on a different platform. And if you sign up this month...

It doesn't matter how you sign up, because starting next month, those greedy sons of bitches at Apple are gonna be taking 30% from everybody if they sign up using the Apple iOS app store or like the app they use from the iOS app store. And that's gross and terrible. So if you just sign up any other way though, it's fine. But this month, it doesn't matter.

Yeah, so sign up this month if you're curious about us at all. And if you hate that shit, go ahead and cancel. But if you love it, you'll be in before those greedy sons of bitches at Apple start fucking with everyone's money. So we've got the Patreon going. We're very excited about it. And speaking of premium content...

It's a new month, so we have to read off. Producers in good standing. Through September of Year of Our Lord 2024. So, in alphabetical order with their last name hidden. unless they tell me otherwise, it just feels like it's safer for everyone. Our producers are Amanda M, Ambrosio L, Annemarie V, Ariel M, Audra M, Buttercup H, Cassandra O, Christopher F, Christopher M, Claire B, David V, Diana E, Donna B, Gabriel G, Ibis K, Isabella CB, Jeff Q, Jonathan B, Justin H, Justin R, Carly C, Catherine L, Kevin W, Kristen S, Kristen T, Lauren M, Lisa F, Lucas P, Madeleine MW, Marshall K, Matthew S, Melissa L, Royce D, Samantha C, Sean K, Tabby F, and our boy Timothy M. So that again is Producers in Good Standing as of September 2024. Thanks so much for being producers of this show. Without you, it just wouldn't exist.

Hell yeah, thanks so much, guys.

And no matter how you listen to the show, it's a pretty big month over here.

We've got all kinds of surprises out this October between now and the end of the month. We put a list of our episodes for the month up on our Facebook group and in our Instagram story. We'll be posting those again so that people can continue to check out what we've got coming up. But we've got a super secret crossover episode with another incredible podcast coming up. We've got our anniversary episode October 19th for our one year anniversary. We've got a couple other anniversary surprises throughout the month. Plus a ton of just great Scared All The Time content. So we are very excited for October. We're very excited for you guys to have a great Halloween season with us. But before we dive in, we wanted to read one very special five star review. You'll see why in a second. Five stars from Piggy Mom. This was posted September 22nd. Now this headline is funny and informative and the review says this. I discovered this podcast at the Italian Club in Milford, Connecticut. I've been listening ever since. It's funny, interesting and surprisingly informative. I look forward to every new episode to find out things I didn't know about that are sometimes, but not always, scary. So Ed, how on earth did somebody at the Italian Club in Milford, Connecticut find out about this show?

Well, when I'm home in Connecticut, I play darts with my friend Joe and now other new friends. Shout out all the dart players at the Italian American Club. I think technically west Haven maybe, but Milford west Haven line. Yeah, I'm as shocked as you are to see this review. So I don't know who Piggy Mom is. I don't know which one of you, but thanks so much for checking out the show and getting into it and writing a five-star review. That's pretty cool. Yeah, that's real boots on the ground marketing right there.

Yeah, that's a real fan to fan kind of word of mouth or ed to fan word of mouth apparently.

Yeah, those are some of the best people there though. I'm so happy that they're enjoying the show.

I love it.

It's always a blast when I'm there.

I think we're a great podcast for Italian clubs. If anybody else out there wants to spread the word in Italian club anywhere in America or anywhere in the world, you know, maybe it's just in our blood, but the Italians, they love us. So, but with that said, let's dive into this episode, which might be one of the best episodes we've ever done. We love doing this episode. It's really informative. It's really gross. Not in like a offensive way. It's just a lot of body horror kind of stuff.

But not so much to like stop listening now. I mean, there will be a couple of little, you know, warnings and let you know things are about to get gross in there, but it's really, I think it's all pretty listenable.

Yeah, yeah. So join us as we shudder in fear at the very idea of flesh-eating bacteria. Ed, have you ever wondered what it would be like to star in your own personal body horror film?

No, I'm not even like a Cronenberg guy, so this is gonna, I'm glad there's no visuals.

You don't ever think about your flesh melting or your meat leaking?

Now I'm never gonna stop thinking about the term meat leaking.

I don't know, sometimes I get-

Oh, here's Intrusive Thoughts Corner with Chris, let's go.

Yeah, I don't know, maybe they are Intrusive Thoughts. I get wrapped up sometimes thinking about how squishy and malleable all our skin and flesh and muscle is, and there's so much liquid rushing around inside of us, and we're so easily destructible.

Yeah, I think us and the planet Earth are a huge majority water.

Yeah, and so we're just like, I mean, we're really tomatoes.

Oh, god, tomatoes, the suicide bomber of sandwich toppings.

What?

Yeah, you ever put, like if I'm ever gonna eat a sandwich that I know I'm gonna eat later, I always ask that there's no tomatoes on it, because for some reason, like once you put them in the fridge, you come back and everything's just like red and wet. Like, I don't know what happened, but the tomato just explodes at some fucking point, and the sandwich is just sopping wet. So I always, yeah, I don't put tomatoes on anything I'm not gonna eat right away.

All right, I get it, that makes sense. I can't quarrel with that description. I can't imagine, you know, I know as our listeners know, we often start with personal experiences with the topic. I can't imagine you have much personal experience with flesh eating bacteria, do you?

No, I've had experience with bacteria in the sense of like, when I played sports, you'd get, things would get weird. You'd get like athlete's foot or jock itch or whatever, and I imagine that's bacteria based, I don't know. But luckily it wasn't like, I didn't come out and be like, well, my foot's gone. It's just bone.

Yeah. So it might get itchy or stinky.

Yeah.

But not rotty.

Yeah. But I know that the skin from that, it seems like the skin is, it's pretty ready to be.

Yeah.

It's ready to get fucked up.

Yeah. I mean, I've had infections. I've had like nothing that I've ever had to go to the doctor for, but I'll like get a hangnail that gets infected or like a toenail.

I had to go to a doctor for one of the things I just mentioned. It was just like, things were too itchy.

For your feet?

No. It was like for a jock itch situation. And I remember being like telling my older brother, I'm like, it's just everything is a nightmare down there. And he was like, oh, okay. So we'll go to the walk-in clinic. I don't know why I didn't just go to my mom with this. And then the doctor I got was like, now that I'm old, I'm like, the doctor was definitely like a 20 something year old girl. I remember being like so embarrassed when I went in.

Well, that's why you didn't go to your mom about it. No one wants to go to their mom about jock itch.

No, I may go to my mom about a lot, but.

I mean, I guess you go to your dad about it. I don't know what, I probably would have gone to a priest.

No, I mean, everything else always seemed to be like, all right, well, you shower and stuff and you're fine. For some reason this was, and they put me on like antibiotics and stuff.

Yeah, yeah, I mean, that happens. I think almost everyone's had some kind of a bacterial issue or an infection issue at some point, but boy, oh boy, after this episode, are we all going to learn to wash our hands and keep a close eye on infections because good God, can it go bad really quick? I have two things I wanted to bring up before we start. Neither of them are personal experiences with flesh-eating bacteria, but I wanted to talk about my introduction to this topic because I'm pretty sure the first time I ever thought about flesh-eating bacteria was after or when I saw Eli Roth's movie Cabin Fever.

I've never seen it because I know it's gross.

It is gross. And I don't love Eli's trajectory as a filmmaker, but Cabin Fever is still this very weird piece of horror detritus from the early 2000s that I have come back to more times than I ever thought I would.

I was working at Blockbuster when that came out. And well, like it was on the shelf at least. And I had to like, I remember people would rent it, like couples would rent it and then they'd come back and they were like, gross, bro.

And they'd break up.

I think they broke up, yeah.

I mean, Blockbuster, I remember made, part of the reason I think Cabin Fever has stuck in my memory and whatever is like between Blockbuster and Ain't It Cool News, Cabin Fever felt special. Like I don't remember why. I think because it was presented by Peter Jackson. It was one of those like Peter Jackson presents. And I think there was something about the fact that it was a, I'd watched enough horror at that point to be familiar with Cabin In The Woods as a genre. And I was struck by how odd it was. And it's not really that weird, but I don't know. To my freshman, sophomore and high school brain, it was weird to me that it was a Cabin In The Woods horror movie that wasn't about demons or monsters. It was about this flesh eating disease. If you haven't seen the movie, not too spoiler heavy here, but it is a Cabin In The Woods horror movie, but the threat is biological. A flesh eating virus gets into the water and anyone who drinks it gets really sick and is gonna have a real bad time. And of course, a bunch of college kids go out to this cabin in the woods and they all fall prey to it. And I think it appealed to me because it was gory and gooey and I was at that phase where I was trying to make homemade gore and stuff for my movies. So I was like, oh wow. And it didn't seem like a movie I could make because it seemed way too flashy and cool and well-produced for that. But I had the vibe of something that I could get close to. But it also stars Ryder Strong from Boy Meets World.

Which yeah, which we had to see his follow up to Boy Meets World.

And then he never really did anything else.

You know I do anything before or Cabin Fever either. It seems like Ryder Strong is Boys in the Hood. My God. Is, that would be a very different movie. Is Boy Meets World Cabin Fever than nothing?

Yeah, I did see him at Trader Joe's a couple of times. I think he used to live in my old neighborhood.

He should have. He could have added to his IMDB. His very bare, it sounds like IMDB at this point.

Maybe I could try to cast him in something.

You got to write a Ryder Strong vehicle.

Oh, I like this idea. Well, anyway, the movie Cabin Fever, it's no surprise that it didn't really launch Ryder Strong into the stratosphere of leading men. He's fine in it, but the movie is this weird combination of an actually pretty funny teen college comedy combined with this viciously mean horror movie, and it has some very weird, almost dreamlike elements, like this one kid who sits out on the porch of a general store and demands pancakes, and when he doesn't get them, he starts doing karate. To this day, I don't know if it's supposed to be funny, or if it's supposed to be unsettling, or maybe it's just, I know Eli Roth was David Lynch's assistant for a while, so maybe he learned about the, put elements from your subconscious into the movie or something, but Pancake Karate Kid feels a lot like possibly a Lynchian element. Anyway, one particular visual in the movie has stuck with me for a long time, I think it's maybe the best moment Eli Roth has ever pulled off in his filmography. As the college kids talk about what this flesh-eating virus can do to your body, the camera is just pushing in on one of them, who is slowly playing with like a string of honey that they put between their fingers, and they're kind of like smushing it and pulling it back out. And the dripping of the honey as they're talking about how fucked they all are is very effective as far as the visual goes.

It's also an effective way to get ants.

Yeah, there's also a moment that you would categorize as one of the reasons you probably haven't ever seen this movie, and this is a spoiler alert, I guess, if you haven't seen Cabin Fever, but I think is worth spoiling because it's very gross. I think it's one of the great, all-time great gross out moments. One of the cast members, she knows she's sick, so she kind of takes this bath that is very much, she never says it, but it's very much like the last bath she's ever gonna take, and she's soaping herself up, and she shaves her legs, and she covers her legs in shaving cream, and then as she starts shaving them, her skin comes off with each stroke of the razor.

With each stroke. First stroke, I'm done at that point.

yes, I mean, it's a movie moment. She's crying and shaving her legs, and she knows she's gonna die, and it's really stomach churning, and the sound of the skin coming off as she shaves is...

And you know, they had to hire some foley person who's like, all right, listen, Eli, I finally found it. It's like a piece of nail running over a cabbage. They do amazing work, those people.

God bless the foley artists.

Based on what you've said so far, I think I'm gonna stand steadfast in my commitment to never watch this movie. I've seen Outbreak, okay? I feel like I've seen a medical, fucked up, terrifying shit that, you know, I remember seeing that movie. I saw it at home, but there's that scene in Outbreak where they show that it's going into the movie theater. And I'm just like, being in the theater for that must have been so fucking unsettling. That said, I don't think I've ever seen a single Eli Roth movie other than the Death Wish remake, which is not a strong film.

Stinker. So Cabin Fever, I think, was my introduction to flesh-eating bacteria, but I was never really worried about it or had any kind of interaction with it until last year when my wife's cat got bit by a spider. I think we might have talked about this in the spider episode, but it's a story worth repeating because it's very relevant to this episode.

I would say the spider episode and Eatin Alive will definitely have things we're gonna circle back to from those episodes that have to do with like necro flesh shit.

Probably, yeah, I think so. But yeah, so last year, last, this would have been September-ish. We came back from a trip back east and found that Anna's cat, Nico, had this weird lump kind of growing around his jaw. And one of my friend's dogs, Ellie.

Alerted you to the issue, like Lassie?

No, no, no, no, no. Ellie, who is not listening to this episode probably because flesh eating bacteria is his greatest fear. And when I told him that I was doing this, he was like, I'm gonna skip that one. But Ellie's dog had just had like an infected whisker or something that had been like a lumpy jaw issue and it had gone away on its own. So I was like, well, let's just wait and see. And this was like on a Thursday. And we were kind of like, well, if it hasn't gone away by Monday, we'll call the vet. Sunday morning, Nico jumps up on the bed and there's photos of this in the show notes. Nico jumps up on the bed and there's blood all down his chest. Like it looked like he got hit with a squib or something or like a bullet wound almost.

We should probably mention now. I should just ask you on the listener's behalf.

yes.

This is a show notes to just not open, right? Even like that photo sounds horrible.

The Nico photos I cut, there's no gross photos in the show notes. Okay, great. There's no gross photos in the show notes.

Feel free to go to the show notes, people.

Except for the Nico photos. So we like panicked and took him to the vet right away. And Nico, to his credit, like didn't seem to think anything was wrong.

To his credit?

Yeah, well, he wasn't panicking or crying. He was just sort of like, you know, he didn't seem to be too phased by any of this. I still figured it was just like a really big cyst maybe, or like, you know, something infected that had burst. The vet comes out after they clean it up and she's like, you should, this is what's going on. And she shows us this photo that's in the show notes, a photo of the cleaned up wound. And this cat had a hole in its neck.

Wow.

Like a eaten away hole that you could like stick your finger in, in its neck. I don't know how he was alive, honestly, at this point. And I didn't think he was gonna live.

Now it's time for Nico's last bath.

Yeah, yeah, yeah, yeah. But Nico was a strong guy and it healed up really quickly. It healed up in a couple of weeks, couple of bandages and some antibacterial cream. And Nico was back on his feet. The vet told us that the wound was probably the result of a spider bite. They thought brown recluse, but as we discussed in the spider episode, there are no brown recluse spiders in California.

No, thank God, because I was watching something on the couch the other, literally like two nights ago. And I have already in weird pains and stuff, muscle issues. And everything got worse because there was a brown spider, but like a thick, fat, like crawling on my leg, going up from like my calf over onto my knee. And I like flipped to like get the fuck away, like slap that, you know? And then I was like, well, everything hurts more now because of that like instant flip. And then of course, like it escaped. Yeah.

Well, it wasn't a brown recluse.

No, I know. It's just, that just happened.

So I'm throwing that in.

Personal horrific moment.

But the point of the story is that the flesh in Nico's neck hole was necrotic.

That's a, you love those dark, what the hell is that metal core shit you're into? Like you talked about last episode, like that sounds like a song title or a lyric.

We're gonna hit a few more of those. There's one portion in particular where we'll highlight some band names.

Yeah, for real, jesus Christ.

Actually, necrosis is a death metal band for sure. I don't know if necrotic is, but necrosis definitely is.

Yeah, but is Nico's bloody neck hole or whatever?

No, no, no. The point is that some spider venoms are necrotizing and the vet thought that was the most likely culprit in this case, but it is possible that Nico was a victim of flesh-eating bacteria that entered through a bite or a scratch unrelated to a spider. The medical term for this is necrotizing fasciitis, also known as flesh-eating bacteria or flesh-eating disease, and it affects cats, dogs, humans, and any other mammals or probably reptiles, whatever, in much the same way. Necrotizing means it causes tissue death and fasciitis refers to the fascia inflammation, which is tissue under the skin.

Oh boy.

According to WebMD, the most accurate site on the internet.

At least the most anxiety-filling, right? Like people go to WebMD all the time and be like, what's wrong with my fucking leg?

Cancer, cancer. It's cancer.

It's tooth cancer.

According to WebMD, these life-threatening infections affect skin, muscles and soft tissue and cause patches of tissue to die. It spreads quickly and aggressively in an infected person, causes tissue death at the infection site and can be deadly if not treated right away. Every year, between 700 and 1,150 cases are diagnosed in the US and, concerningly, rates have been increasing.

Well, no.

This could be due to increasing awareness of the condition, which would lead to increased reporting. Like, there was a spike in 2019 of a couple of, you know, when I say unrelated, it's not like the flesh-eating bacteria is, like, you know, coming out of a pipe in the ground. It exists out there in the world, but there were a couple of unrelated cases in 2019 where there was this media frenzy of, like, oh no, the flesh-eating bacteria is out there.

Oh boy, it's just those orange tubes in New York City that, like, always have smoke coming out of the ground. Yeah, yeah, yeah. I mean, where is that? Do you think that's flesh-eating bacteria?

So this could be due to increasing awareness of the condition leading to increased reporting, or it could be increased bacterial resistance against antibiotics.

Oh wow, yeah, as you know, I'm very bad at taking pills.

Yep, so you have no antibiotics in your body.

I never take anything.

Yeah.

And so, I think I was, like, 30 before I got my first pill down without applesauce, and so, yeah, even when I got my wisdom teeth out, I gave away those Vicodin. Like, I'm not taking these giant pills, you know what I mean? Like, so, I just kind of grid and bear it for most stuff, but now I can kind of swallow pills. But yeah, so I wonder if I'm good, I guess, for a bit, if part of this is antibiotics.

It could be. One statistic, though, is concerningly consistent. Up to one in five cases of necrotizing fasciitis result in death.

One in five?

One in five.

So basically, when it gets going, it gets going. Yeah.

And there's two types of necrotizing fasciitis.

Fast and instant.

Yeah. Type one is polymicrobial, which is when more than one bacteria, usually a mix of aerobic and anaerobic bacteria or bacteria that thrives on oxygen and in oxygen-free environments, they can combine to cause an infection. Type two or monomicrobial is a form caused typically by one bacteria. Commonly in this case, it's a group A streptococcus or Staphylococcus auroris bacteria, which is the same type of bacteria that causes strep throat. But several types of bacteria, including group A streptococcus and Vibrio vulnificus, which is a bacteria that lives in water, have been linked to this disease. And an analysis of A streptococcus, the group A streptococcus genomes, revealed that a series of genetic changes began to occur in the early 1970s. The final changes that took place before the strain became a voracious flesh eater happened around 1983, when less virulent strains acquired the genes that are needed to produce the toxins in humans that kill the flesh. So at least with that one bacteria, something happened in the 80s, in the late 70s, early 80s, that turned it from just a strep throat causing bacteria into a, I'll eat your flesh and kill your family bacteria.

Wow. I mean, the 80s was a hell of a, you know, that was this excess, excess.

I'm gonna blame Reagan.

No, it's, wow, it just, it was, everything was bigger in the 80s. So it's just a bacteria in a business suit, like screaming on the stock exchange floor.

Yeah, yeah, yeah, yeah. And we should, I wanna pause to note that technically, even though these bacteria have been coined flesh eating bacteria, they don't really eat the flesh.

Not in the way sinkholes eat towns.

Not in the way that sinkholes eat towns. What happens is that when these particular types of bacteria get into deep tissue and reproduce, they release toxins that damage the tissues, which disrupt the blood supply and ultimately cause tissue death. So, your tissue, your flesh, your muscle will start to die at the site. And then as the bacteria multiply, the area of tissue death will gradually increase. The open wound develops, it grows in size, and it gives the appearance of the tissue being eaten, even though really what's happening is it's just dying.

It's just dying from the inside out.

Yeah, yeah, it's dying from the inside out.

It's the worst Pixar movie, dying from the inside out.

Yeah, yeah, yeah. It's about an anxious streptococcus bacteria.

Oh my god, dude. It's just the Inside Out 2 trailer where it's like, who are these guys instead of inside out?

Inside Out 3 is, the streptococcus comes in and eats what's Becky or whatever the girl's name is.

Shit, dude.

Concerningly, no one knows why certain strains of these bacteria have evolved to do this, but they have.

Life finds a way to kill.

Yeah, and even worse, necrotizing fasciitis is most commonly seen at the extremities, so hands and feet, but also very commonly, the perineum, which you and I might know is the taint.

Yeah, you taught me that. Yep. That's a taint area for sure.

The taint and genitals.

I might have shown mine to that 24 year old doctor when I was 17.

You might have. The taint and genitals often suffer from this disease. Only a few cases ever arise from the chest and abdomen, although we'll touch on one of those chest infections later. Some kind of trauma is usually the cause of the infection. So intravenous drug injection, insulin injections, animal and insect bites, catheter insertions over the skin, or a fistula connecting skin to the internal body organs.

The fuck's a fistula?

I don't know, I should have looked that up. I don't know what a fistula connecting skin.

It's gotta be inside our body.

Yeah. I mean, a fistula connecting skin to your internal organs sounds like a medical problem in and of itself.

Yeah, yeah, yeah. But yeah, a fistula might be, who cares? But I'm never gonna look it up. these are things I don't wanna google.

And later we will touch on, well, I think now's maybe a good time to bring up that like this is literally one of the reasons that if you have any kind of a cut, bite, scrape, infected, you know, it sounds gross, but like toenail, anything, yeah, soap, water, peroxide, because what's scary about flesh-eating bacteria is that the bacteria that cause this are everywhere, like literally everywhere. And they're rare, but they're like, they're rare.

They're rare, but they're everywhere. Listen to what you're saying.

What I mean is, you don't have to fall into like standing water or something, you know, like the bacteria itself is rare, but it could just be on a kitchen counter. It could be in a car. Like, so if you have an open wound, even if it's a small little cut or a scrape and you come into contact with it, it can go in that wound and then you're going to have problems.

I live for peroxide. I love it. Every time I get a cut, as a kid, I like that sizzle.

Yeah, and it doesn't sting.

It can. When you're a kid, I feel like it was really stung. Maybe we just had worse peroxide then. Maybe. It depends on what I'm putting it on. It'll definitely sting like crazy.

But not like rubbing alcohol.

No, but I just think we're adults who can handle it better than when we were kids.

I guess, yeah.

I like anything that shows activation. Like anything where I'm like, oh, look at the way it goes. I mean, it's doing something. And clearly it's doing something.

Yeah.

And I like that, the endorphin rush.

I've read, I forget what product it was. There's some home product, I want to say maybe like a laundry detergent or something that I read at some point, it doesn't really need to foam to activate.

It's probably like a bleach that you're spraying the tub or something.

Yeah, but they've changed them so that they foam, so that people go, oh, look, it's doing something.

That's what I'm saying. If I was in that focus group, I'd be like more foam things. I like the way it feels to see something activated. If you put not mentos and soda, but whatever, what are we to clean pennies as kids? To just put it in vinegar is lame. You want to see some baking soda in there or something.

Where were we here? Oh, yeah, the skin fistulas or whatever. Infections such as abscesses and ulcers can also complicate necrotizing fasciitis. For infections of the perineum and genitals, trauma, surgery, UTIs, urinary tract infections, stones and bartholene gland abscesses are the usual causes of necrotizing fasciitis in your balls.

Sure.

Now, when I read that bit about necrotizing fasciitis occurring at the site of drug injections, it immediately reminded me of stories I've heard about a drug called Trank. Have you heard of Trank?

I've never heard of Trank.

Okay, Trank is bad.

Yeah, about to say. I mean, you could just say, I mean, all needles are a problem.

yes. Well, Trank is a drug that has made news in Philly and I think all over the world for creating zombies out of users. They call them zombies. Now, this isn't like bath salts that like, Oh my God, remember bath salts? Bath salts.

That was all over the news.

Yeah. Maybe we'll do an episode on bath salts. I feel like that was kind of an overhyped thing, but that was like a methamphetamine that people would like freak out and then one guy like ate another guy's face in Florida.

That's the one that made the news.

Yeah. So this is different. This creates zombies in the sense of people who are wandering around, mumbling, staring off into space.

You're saying the entirety of La Brea right now are Trank users?

Well, and Kensington. There's a street in Philly called Kensington where there's been videos of dozens of people using this drug just who are out on the street. And it looks like a kind of a horde of zombies. And part of the reason it looks that way is not only are they mumbling and staring at the sky and everything, they're covered in open flesh eating wounds.

Oh, wow. Like every place that they've taken Trank turns into a... Well, yeah.

It can, yes. It can become infected in the muscle and skin and tissue gets eaten away.

My buddy's kid, Jordan, just moved to Philly. So if you're listening, Jordan, stay off the fucking track, bud.

Yeah, I don't know. I mean, I feel like Trank is one of those drugs where you end up trying it if you have a really like deep emotional wound that you're like, I'd rather be almost dead, you know?

Sure, I have an emotional wound that I would like to be more wounds all over my body.

Yeah, but so I thought that it must be necrotizing fasciitis infecting these wound sites. It turns out that this is actually a little different. these wounds are centered around the injection sites and the flesh is necrotic, but in this case, the wounds are not caused by bacteria. It's actually almost worse. I found an explanation from a woman named Barbara Schindler, MD, the Vice Dean of Merida and professor of Psychiatry and Pediatrics at Drexel University College of Medicine.

Oh my God, this is where Jordan went.

Oh, well Jordan.

He's at Drexel, dude. Don't get on Trank, and if you're even thinking about it, maybe stop by this lady's office. I'm sure she's got some horrific visuals to deter you from starting down that Trank path.

Barbara calls Trank worse than fentanyl and says it, quote, causes serious sedation, putting the brain to sleep, lowering blood pressure, and slowing the heart. It also causes skin lesions because it constricts blood vessels, and these lesions form not just at the injection site, but also on various areas of the body where the skin starts to decompose. And one of the scariest things is that it's not an opioid, so Narcan doesn't even begin to touch this. We have no antidote, so to speak.

But it's just as addictive?

I mean, I guess I shouldn't speak to its level of addiction, but I would say if people are continuing to inject it into open wounds, yeah, it's probably, it's probably fairly addictive.

It seems to have a hold on them at that point.

It's really horrific. We could probably do a whole episode on Trank. But this is flesh-eating bacteria, not constricted blood vessels causing flesh death. So let's go back under the microscope. I thought we'd touch on the history of flesh-eating diseases. Now, the history obviously, as with most things in the natural world, is they've been around a long time. Some strains have developed more recently, such as the strains in the 80s. But the first descriptions of this disease appeared thousands of years ago in the writings of the father of medicine himself, hippocrates.

He was prolific.

We've talked about the big guy on the show before. He's a total genius. He also believes in some weird shit, like what we've talked about before, I think, in the Homunculus episode. He might have been one of the guys who's-

We weren't even gonna do Homunculus, and it comes back all the fucking time. It's my proudest moment, is suggesting it.

One of the things I found in this run of research that hippocrates believed in was the wandering womb theory, which stated that a woman's womb was not stationary, but that it in fact moved around inside of her and caused various problems as it ping-ponged around her body.

So he's against the idea of these fascial hooks or whatever, like there is nothing keeping anything tied down.

The best description I found of wandering womb theory from the time was this, written in second century AD, although I think this was written not by hippocrates, but by Galen or one of Galen's.

Robert Frost wrote a poem called.

My womb found a fork in the road.

Yeah, it decided to just kind of cruise around a lady's body just all over.

The best description I found was this, written in second century AD, quote, in the middle of the flanks of women lies the womb, a female viscous, closely resembling an animal, for it is moved of itself hither and tither in the flanks, also upwards in a direct line to below the cartilage of the thorax, and also obliquely to the right or to the left, either to the liver or the spleen, and it likewise is subject to prolapsus downwards, and in a word, it is altogether erratic. It delights also in fragrant smells and advances towards them, and it has an aversion to fetid smells and fleas from them. And on the whole, the womb is like an animal within an animal.

Okay, first off, this just sounds like a person who failed every exam, and then they had to do the hands-on, show me you removing a womb, and it's like going to cut the wrong place. It's like, what are you doing? He's like, come on, you know the womb moves.

We don't know where it's at.

First off, we don't know what you're talking about, and then the student's like, what am I gonna need? I'm gonna need a couple of mint leaves, and I will draw the womb to where I'm cutting. I will draw it by these sweet smells, and you guys will see, I don't know. You're onto something there. Yeah, it's just so wacky. It just seems like a person who lied in their resume trying to make up for cutting into the wrong place by being like, these pesky wombs, dude.

They're on the move. They more were using the womb, and I didn't put too much into the show because again, I don't wanna get too sidetracked. We've got a lot of flesh eating left, but they really, they looked at the womb as a way to try to explain the differences between men and women, because they knew it was one of the big things that women had that men didn't.

What was the? Wait, wasn't, is hippocrates the same guy who had that other like ridiculous theory about women that's like, oh, they don't have tonsils or some shit?

Yeah, yeah, I forget, they don't have knees or.

They didn't have something that was very easy to check.

yes.

So this guy.

Oh, it was the teeth. It was.

Oh, they have less teeth.

They have less teeth, yeah.

So hippocrates, I gotta say, he was a shy guy or something. He definitely, he had some blind spots and they were all female related.

yes, I think many of the men of this time had similar blind spots, but it doesn't take away from the fact that hippocrates is one of the fathers of modern medicine. And in the fifth century BC, he described necrotizing soft tissue infection as a disease where those affected would have, quote, erysipelous, which is a kind of red blotchy skin all over the body. While the cause was only a trivial accident, meaning, you know, a scrape, a cut, whatever. bones, flesh and sinew would fall off from the body. And there were many deaths. That was what hippocrates knew about necrotizing fasciitis. The next notable mention of it was in 1764 by Bari Anne, who was, I guess, a doctor, who described a soft tissue infection in male genitalia. The first English description for necrotizing soft tissue infection was by British surgeon Leonard gillespie and British physicians Gilbert Blaine and Thomas Trotter in the 18th century. At that time, necrotizing soft tissue infections or fasciitis were known variously as a wide variety of things that, Ed, to your point earlier, all sound like grindcore bands.

Yeah.

We have fasciadanic ulcer, gangrenous fasciadana, gangrenous ulcer, malignant ulcer, putrid ulcer, fulminating gangrene, necrotizing erysipelous, gangrenous erysipelous, crepient cellulitis, gangrenous cellulitis, melanese cellulitis, necrotizing synergistic cellulitis, hemolytic streptococcal gangrene, progressive bacterial synergistic gangrene, or necrotizing abscess.

Wow. That is, I got lost in that for a minute. I thought I was being read Grindcore Dr. Seuss book.

Yeah.

Ooh, ba da ba da ba da ba da ba da, boh. I don't, for people listening at home, I wasn't expecting whatever that was.

It was an attempted Grindcore.

And now it's in your ears.

In 1871, the same disease was recorded by a man called Joseph jones, who was an army surgeon for the Confederate army. He called it hospital gangrene, and 46% of his patients died from it.

Oh, wow.

Or no, I'm sorry. 46% of his patients who suffered from the condition died from it. So still a lot of people died from hospital gangrene.

Civil War.

And then years later in 1883, or just a few years later in 1883, Jean Alfred Fournier delivered a lecture on perineal gangrene in a previously healthy young man, which I, it seems like a lot of guys had their taints rotting away. I tell you, this was a common thing.

I think it's a tough place to get to.

Wash your butt, boys.

Yeah, but you have to understand, like what, 18 something? You're probably sharing like a fucking weird metal tub with 30 other people. And it's like the water's only gonna stay hot for the first one of you. So, you know what I mean? I didn't have an excuse in 2003, 2002, but these guys definitely have excuses probably.

Yeah, true.

Well, anyway, everyone's wearing wool in the summer, especially the Civil War uniforms were just like hot ass wool.

Yeah. John Alfred Fournier ended up coining the term necrotizing fasciitis that appears on the male genitalia is now known as Fournier's gangrene, which is a hell of a way to be remembered.

Oh my God. So yeah, that was his name.

That was his name. He put his name to it and he's proud of it. I guess he helped people. He fixed them maybe.

Or someone else named it.

Cause it's just what the guy would never stop talking about. Oh, Fournier's gangrene. You know, he's always on about that gangrene. Yeah. I think it's cause he's cheap. And like, he'll be like, Oh, I'll buy dinner tonight. It's on me. And then he gets there and starts talking about gangrene. No one orders any things they don't want to eat. And so that's how we got out of big tavern bills.

Yeah.

At the time.

It's not a bad idea.

I'm starving. Oh, I just went to dinner. Yeah, you know.

I actually had a great idea. This, somebody, now, well, I can't say you're supposed, don't try this. Don't try this. And it probably wouldn't work. But I was thinking, what if, you know, so everything when they flip the screen around now for you to like, you order coffee or whatever, they flip the screen around, you got a sign.

I mean, I walk right away cause it might be a tip thing there.

What if you signed it void?

I don't think it matters.

Would you be able to challenge the charge?

I don't think so.

Okay, probably not.

Cause it says right above its signature.

Right.

It doesn't say thoughts on this transaction.

Anyway, it's just a thought I had while standing in line. In 1952, an American surgeon named literally just Wilson, as far as I could find.

Wow. I feel like every episode now, I get to bring up Dennis the Menace.

Yeah, Mr. Wilson. Or possibly I saw him also referred to as B. Wilson, but I couldn't find a name for this guy other than Wilson or B. Wilson. But he's the one who coined the term necrotizing fasciitis.

Oh, so he was smart. He's known for a disgusting term and took his name out of it.

Right, right, right. He wasn't like Wilson's balls infection.

Yeah, yeah. He wasn't like, and again, that's Brian Wilson at 740 Banana Street's ball infection.

Yeah, yeah, yeah.

Yeah, yeah. He's like, just go by Wilson. I'll just go by Wilson. Thank you.

Now, here's where we get to the good stuff. Here's where we get to what people really want to hear.

Oh, God.

Here's what happens if you're unlucky enough to come down with a case of the fash.

You're unlucky enough to get into this show and get to this episode.

Here's what you can expect. The early symptoms of an infection with flesh-eating bacteria usually appear within the first 24 hours of infection. Symptoms are similar to those of other conditions like the flu or a less serious skin infection. They're also similar to common post-surgical complaints, which really sucks because one of the ways people can become infected is through a poorly cleaned and treated surgery. So if you wake up from surgery with swollen, infected red skin, you get to play a fun game of, is this a common post-surgery symptom or am I infected with a flesh-eating bacteria? Oh wow. these symptoms can include serious pain, including areas other than the skin that looks swollen or red, inflammation, fever, nausea. There's also, if you have any of these symptoms, you should keep an eye out for increasing pain in the general area of a minor cut, abrasion, or other skin opening. Pain that is worse than would be expected from the appearance of the cut or abrasion. redness and warmth around the wound. Those symptoms can begin at other areas of the body. Flu-like symptoms such as diarrhea, nausea, fever, dizziness, weakness, and general malaise, and intense thirst due to dehydration.

You know what's crazy is you just sound like a fucking commercial for medicine right now. That's all I can think about hearing you list this stuff off. And I'm like, God, I definitely don't want a skin infection. But there are people who hear that and they're still like, give me Ozempic, it sounds great. People hear all that shit in the commercial and they're still fine with it.

Well, I mean, Ozempic, I guess, is a necessary...

Well, I just picked a thing.

I see.

I just picked a thing out of the air.

Some medicines, you deal with the symptoms because they're treating something much worse.

No, I get it. I'm just saying that you sounded like, again, an only country in the world basically that has ads for this ship.

Right, right, right, right.

But it is something we hear 25 times per football game I'm watching.

Well, you won't hear any of these, I don't think, during a medicine commercial. More advanced symptoms happen around the painful infection site within three to four days of infection. And these can include swelling, possibly with a purplish rash, large violet colored marks that turn into blisters filled with dark foul smelling fluid, discoloration, peeling and flakiness as tissue death begins, dizziness, fatigue or nausea.

Oh, if you're saying I'm gonna hit my goal weight, I'll take it.

And just wait till you pop those blisters filled with dark foul smelling fluid, you'll lose another four pounds of dark fluid.

That's true. And every womb in the area will run from you.

Yeah. I imagine at this point, most people will be concerned enough to see a doctor or go to the ER.

I hope so.

But if they don't, critical symptoms will develop within four to five days of infection, which, and these include a severe drop in blood pressure, toxic shock and unconsciousness. If you haven't received treatment at this point, the infection is going to tear through your body and it's highly likely that you will die. If you don't die, and again, only one in five does, although I would assume maybe that one in five is someone who waits to get it treated, you're in for a very, very bad time. So I turned to Quora to try to find some survivor stories. The first story I found was from an anonymous poster.

A real Wilson type.

A real Wilson type. Quote the anonymous, I got hit by necrotizing fasciitis three months ago.

A smooth criminal.

Yeah, the strep strain, which I believe is the most aggressive. It entered a small two to three millimeter cut on my elbow. What's it like to have a flesh eating disease? It was, of course, horrific. The pain wasn't so much in my arm, but my head, my legs and my insides. A repulsive, agonizing pain, which was the onset of toxic shock, I think. I had a bad fever and was hallucinating. Very low blood pressure. I went to A&E. I don't know what that is. Some department at the... Yeah, I went to A&E and said, do I have a reality show for you? It must be some intake at the hospital or something. Maybe, yeah. And signed a form to allow them to amputate my arm. Luckily, they didn't need to amputate. I had a great surgeon who made a call to cut my arm open from my wrist to my shoulder and started cutting away infected areas within two hours of arriving at hospital.

Wow. Oh, at hospital? No fucking article? This is England.

Oh yeah.

This is a commonwealth country, which is why he even went to begin with because it's like they have free health care.

Yeah.

So he didn't wait like we would.

Yeah. Over the next three weeks, my arm was kept open and every two days, I would get surgery to remove infected areas. It was incredibly painful! Exclamation point and a very long three weeks! Exclamation point. Anyway, I have nothing to complain about. I survived, kept my arm and have a cool scar to show for it. Hell yeah, brother.

Yeah, this guy's handling it a lot better. This person's handing it a lot better than that spider guy who was like, if I lose my fucking arm, just kill me.

Yeah. flesh-eating bacteria, he says, along with burning to death, were my two most feared ways to die. So this guy should listen to the show, I think.

Get him on, get him or her. It's anonymous. So get this person on the podcast.

I'm gonna reply to the Quora and maybe ask.

Also reply as anonymous, because there's no information. It just says, come on our podcast.

But listen, this guy's on our level. He says, what I found is that when you actually face your worst fear, you realize it's just an illusion and you can crush it. Anyway, life now tastes sweeter than it ever did and the experience reinforced what's important in life. Overall, it has had a positive impact on me, strangely enough. Which I think is maybe what the spider bite guy said too.

Well, he, the spider bite guy was just like, a day or two later, I came to my senses that like a life without an arm is better than not having a life. But I don't know if he came out of it as, this person seems very Pollyanna about the situation.

Yeah.

More I would say than the spider bite guy.

Well, the next person we're gonna talk about did not come out of the situation feeling quite so overwhelmed by a joy of life.

Also, they said millimeters, which also gives away that they're not a man.

Oh, yeah, yeah, true.

They said millimeters, they said hospital without an article.

Yeah. So A&E must be like the British version of like, yeah, appointments and emergencies or something.

Or like arms and epidermis.

What?

Well, epidermis, the skin. And then they had an arm issue.

Maybe, maybe, maybe.

Look, I worked.

I'll allow it.

That was lightning quick. It was an hour after the story was told.

So I wanted to try to find something more in depth about what it's like to survive necrotizing fasciitis because I think one of the things that's so scary about it is how you can go from thinking that you just have like an ingrown fingernail or something to possibly losing your limbs quickly.

I've been thinking about this the whole fucking time we've been recording because I can still feel, you know, my hematoma has a giant cut down the center of it.

Yeah.

And I can feel it. You know, we were talking about in an episode recently, something about how our brain ignores things. It ignores the feeling of your clothing on your skin, the sound of your breath, your nose. And this thing makes it impossible for me not to always constantly thinking about how my pants are rubbing against it. And so I've been thinking about that ever since we've done that episode. But now I'm thinking about like, you know what, I do have pain around where that actual cut is. Now I'm freaking out a little bit, but it's shit. This is what we do in the episode. This is why we do this.

It is. But I would also say that if you had necrotizing fasciitis in that wound, you would know for sure by now that wound's a couple of weeks old.

Yeah, but we manifest this shit though.

unless it just got in there. That's true.

We manifest it.

I'm gonna go home and Ed's like, oh, my knee's warm and radiating pain.

Yeah, you gotta like play Jumanji to get the effects of Jumanji. You gotta wear the mask in the mask.

What you're about to hear is a true story. It's maybe one of the lengthiest excerpts I've ever read on this show, but I feel like-

Buckle up, people.

The devil's in the details. The summary of this isn't as stomach churning as the actual experience. So this story is from a book called Complications, A Surgeon's notes on an Imperfect Science, which for everybody-

Is it an old book?

I don't think so. I don't know when it was published, but I'm pretty sure, just the way it's written, it's recent.

It's gotta be after you retire, right?

Yeah, I think so.

Nobody while still having a practice is like, let me tell you about all the mistakes I made.

Yeah, yeah, yeah. It's written by a man named Atul Gawande. And this story from the book is called The Case of the Red Leg, which even sounds like a good, scary story.

Why is it like a fucking Hardy Boys title?

So Gawande says, It was two o'clock on a tuesday afternoon in June. I was in the middle of a seven week stint as the senior surgical resident in the emergency room. I had just finished admitting someone with a gallbladder infection and was attempting to sneak out for a bite to eat when one of the emergency room physicians stopped me with yet another patient to see. A 23-year-old who, for the purposes of this story, he calls Eleanor Bratton. It's not a real name.

He had decided to still give a last name.

Yeah.

interesting.

Eleanor Bratton with a red and swollen leg. It's probably only a cellulitis, a simple skin infection, but it's a bad one, he said. He had started her on some intravenous antibiotics and admitted her to the medical service, but he wanted me to make sure there wasn't anything, quote, surgical going on, an abscess that needed draining or some such. Would you mind taking a look? Grown, no, of course not.

Yeah, if you're on your way out, you want to get some food, this is the worst possible time to be a patient to. Where it's like, hey, can I get the absolute least amount of your attention for a minute for this person's serious issue?

She was in the observation unit, a separate, quieter ward within the ER where she could get antibiotics pumped into her arm and wait for a bed upstairs. She looked fit, athletic, and almost teenage with blonde hair, tight in a ponytail, nails painted gold, and her eyes fixed on a television. There did not seem to be anything seriously ill about her. I glanced at her chart and saw that she had good vital signs, no fever, and no past medical problems. I walked up and introduced myself. Hi, I'm Dr. Gawande. I'm the senior surgical resident down here. How are you doing? You're from surgery, she said, with a look that was part puzzlement and part alarm. I tried to reassure her. Well, yeah, you never want to be in the ER and have a surgeon walk up to you and be like, hey, I'm from surgery. And you're like, I'm just here because my fingernail hurts.

Yeah, like what? I think you're talking to the wrong person.

Yeah, he tries to, he said, I tried to reassure her. The emergency physician was only being cautious, I said, and having me see her to make sure it was nothing more than a cellulitis. All I wanted to do was ask a few questions and look at her leg. Could she tell me what had been going on? For a moment, she said nothing, still trying to compute what to think about all this. And then she let out a sigh and told me the story. That weekend, she had gone back home. To Hartford, Connecticut to attend a wedding. She had moved to Boston with some girlfriends the year before after graduating from Ithaca College and landed work planning conferences.

Ithaca's got a lot of gorges.

I almost went to Ithaca because I loved it so much.

Because you love Carl Sagan.

I love the gorges.

People fall on the gorges every year, and the drunk ones usually end up okay, because they don't freak out. They just fall limp.

Yeah, Carl Sagan and Twilight Zone.

Rod Serling.

Rod Serling went to Ithaca.

Who also took the same train this girl probably did, because he wrote a lot of, I just found this out, he wrote a lot of Twilight Zone on the train from westport, Connecticut into the city.

Nice.

That's where he would work on episodes on the train.

Well, he almost could have written this story. Well, not really. There's no surprise twist, but anyway, she went to this wedding. The wedding had been grand, and she kicked off her shoes and danced the whole night. The morning after, however, she woke up with her left foot feeling sore. She had a week old blister on the top of her foot from some cruddy sandals she had worn, and now the skin surrounding the blister was red and puffy. She didn't think too much of it at first. When she showed her foot to her father, he said he thought it looked like a bee sting or maybe like she'd gotten stepped on dancing the night before. By late that afternoon, however, riding back to Boston with her boyfriend, my foot really began killing me, she said. The redness spread, and during the night, she got chills and sweats and a fever of 103 degrees. She took ibuprofen every few hours, which got her temperature down, but did nothing for the mounting pain. By morning, the redness reached halfway up her calf, and her foot had swelled to the point she could barely fit into a sneaker.

Wow.

So this is where my anxiety really starts to ratchet up, because this is how many times have we, I mean, we kind of said this a few times already, but this is where it's like, you start to feel that creeping feeling of something going from minor to possibly not minor, but you're like, no, it's probably, it's gotta be fine. It's just whatever.

I just, real fast, you told the story of getting hit in the eyeball with your shit, your fucking shit hanger, and Instagram fucking fed me in the algorithm, or served me. This video of people with a missing eye, but it was fine. It was just like people with fake eyes, kind of like fake eye awareness, I guess, and they were all just like, I'm gonna pass the phone over to someone who lost their eye, getting out of the tub. And it was all very, mostly very minor, dumb, stupid, little instances that just an accident happened and now they have a glass eye. So I just thought of that because it's like, something minor to something major so quickly. And then also, I don't know why, every mosquito bite I get, like fucking every mosquito bite. I mean, I'm not good about not scratching it, but they always end up becoming these week to two week long scabs, blister scabs on me. Now I'm thinking about that listening to you talk. Because every one of these are gonna be...

Yeah, wash them, don't scratch them. Yeah, band-aids on them. Anyway, Eleanor hobbled in on her roommate's shoulder to see her internist that afternoon and was diagnosed with cellulitis, which is, according to Gawande, your garden variety skin infection, the result of perfectly ordinary bacteria, the environment getting past the barrier of your skin through a cut, puncture, wound, blister, whatever, and proliferating within it. Your skin becomes red, hot, swollen and painful. You feel sick, fevers are common, and the infection can spread along your skin readily. Precisely, the findings Eleanor had. The doctor got an x-ray to make sure the bone underneath was not infected. Satisfied that it was not, she gave Eleanor a dose of intravenous antibiotics in the office, a tetanus shot, and a prescription for a week's worth of antibiotic pills. This was generally sufficient treatment for cellulitis, but not always, the doctor warned. Using an indelible black marker, she traced the border of the redness on Eleanor's calf. If the redness should extend beyond this line, the doctor instructed she should call. And regardless, she should return the next day for the infection to be checked.

Wow, that is crazy. I mean, I wouldn't be able to do anything. I'd be checking that black line every minute to be like, oh fuck, it's getting closer, it's getting closer.

Well, the next morning, Eleanor said, which was the morning that this story started with Dr. Gawande, she woke up with the rash beyond the black line and stretching to her thigh, and the pain was worse than ever.

So this is pre-Gawande showing up into the story. So someone else had already had the brilliant idea of drawing on this woman.

Yeah, yeah, yeah.

Gotcha.

So she phoned the doctor who told her to go to the emergency room. She'd need to be admitted to the hospital for a full course of intravenous antibiotic treatments, the doctor explained. I asked Eleanor if she had any pus or drainage from her leg. No. Any ulcers open up in her skin? No. A foul smell or blackening of her skin? No.

Where's your womb right now?

Would you say it's more up near your throat or down near your pelvis? Any more fevers? Not since two days ago. I let the data roll around in my head. Everything was going for cellulitis, but something was pricking at me, making me alert. I asked Eleanor if I could see the rash. She pulled back the sheet. The right leg looked fine. The left leg was red, a beefy, uniform, angry red. From her forefoot, across her ankle, up her calf, past the black ink line from the day before, to her knee, with a further tongue of crimson extending to the inside of her thigh. The border was sharp. The skin was hot and tender to the touch. The blister on the top of her foot was tiny. Around it, the skin was slightly bruised. Her toes were uninvolved, and she wiggled them for me without difficulty.

Uninvolved. toes were like, leave us out of this.

Whatever. She had a harder time moving the foot itself. It was thick with edema up through the ankle. She had normal sensation and pulses throughout her leg. She had no ulcers or pus. Objectively, the rash had the exact appearance of cellulitis, something antibiotics would take care of.

This is an episode of House MD now.

Kinda, yeah. This guy's a good writer too.

Yeah, I was thinking that.

That's part of why I'm quoting at length, because it's good.

We should have him on the show, because we're using enough of his book.

Yeah. Another possibility lodged in my mind now, one that scared the hell out of me. It was not for logical reasons though, and I knew this perfectly well. Decisions in medicine are supposed to rest on concrete observations and hard evidence. But just a few weeks before, I had taken care of a patient I could not erase from my mind. He was a healthy 58-year-old man who had three or four days of increasing pain in the left side of his chest, under his arm, where he had an abrasion from a fall. He went to a community hospital near his home to get it checked out. He was found to have a small and very ordinary skin rash on his chest, and was sent home with antibiotic pills for cellulitis. That night, the rash spread eight inches. The following morning, he spiked a fever of 102 degrees. By the time he returned to the emergency room, the skin involved had become numb and widely blistered. Shortly after, he went into shock. He was transferred to my hospital, and we quickly took him to the OR. He didn't have cellulitis, but instead, an extremely rare and horrendously lethal type of infection known as, say it with me now, necrotizing fasciitis.

Oh wow, here it comes, it's appeared.

The tabloids have called it a disease of flesh-eating bacteria, and the term is not an exaggeration.

The tabloids?

That's what he, yeah. Okay. Here begins a very gross part, so if you are a little queasy, maybe skip the next 15, 30 seconds.

It's actually more like a minute. You have been warned. Graphic story incoming in three, two, one.

Opening the skin, we found a massive infection, far worse than what appeared from the outside. All the muscles of the left side of his chest going around to his back, up to his shoulder and down to his abdomen had turned gray and soft and foul with invading bacteria and had to be removed. The first day in the OR, we had to take even the muscles between his ribs, a procedure called a birdcage thoracotomy. The next day, we had to remove his arm. For a while, we actually thought we'd saved him. His fevers went away and the plastic surgeons reconstructed his chest and abdominal wall with transfers of muscle and sheets of cortex. One by one, however, his kidney, lungs, liver and heart went into failure and then he died. It was among the most awful cases I have ever been involved in.

That wasn't so bad, was it? I can't hear what your answer is. I just wanted this to be long enough that you can more easily find the end of the story when skipping forward. But also, there are chapters you can use too.

Okay, gross part over. The old man died.

Yeah, wow. And also, as soon as you said the first day, I was like, yeah, that makes sense because they really didn't see any of that until they opened them up.

No.

And so you must get in there and go, fuck, we gotta make a checklist now of things to do.

It's like biting into an apple and finding out the whole insides rotted out. Yeah.

But I mean, God bless them. I throw the apples away. This guy tried to save the apple.

Yeah.

Well, you said the old man died. He was 58.

Well, sure.

RIP, God bless.

RIP, God bless to the young man. What we know about necrotizing fasciitis is this. It is highly aggressive and rapidly invasive. It kills up to 70% of the people who get it, which is different from R1 and 5 that we quoted earlier.

But also not that dissimilar from the Civil War numbers.

No. No known antibiotic will stop it. As with cellulitis, they are understood to enter through breaks in the skin. The break can be as large as a surgical incision or as slight as an abrasion. And this part got me. People have been documented to have gotten the disease from a rug burn, a bug bite, a friendly punch in the arm, a paper cut, a blood draw, a toothpick injury, and chicken pox lesions. In many cases, the entry point is never found at all. Unlike with cellulitis.

I don't like this.

No, dude, never found. So it can get in through a wound that you're not even aware that you have.

I mean, a bug bite, I mean, if it's not the kind that make you itchy, like you would just never even know, right?

I mean, I guess, but even then you'd think they'd go like, oh, here's where the skin seems to be falling off. Oh, look, it's centered around a bite or something.

That's a little bit of that hippocrates or I guess the Trank Boys or whatever. Moving wounds, not moving wounds, where it's like, yeah, the entry point is here, but then there's now lesions or whatever. Oh, yeah, right. But also this, the idea that you can be playing like punch buggy with someone in the car and now you're going to lose that arm.

I guess. But yeah, I don't know, man. Very scary.

So every mom out there, do they still kick kids with wooden spoons?

Well, don't do that. You'll give your kid necrotizing fasciitis.

That's what I'm saying, dude. That should be a PSA.

Yeah.

I know they're running you up the wall, but don't hit them with the wooden spoons no more because your kids are going to lose its ass.

Unlike with the cellulitis, the bacteria invade not only skin, but also deep underneath, advancing rapidly along the outer sheaths of muscle, the fascia, and consuming whatever soft tissue, fat, muscle, nerves, connective tissue they find. Survival is possible only with early and radical excisional surgery often requiring amputation. To succeed, however, it must be done early. By the time signs of deep invasion are obvious, such as shock, loss of sensation, widespread blistering of the skin, the person is usually unsalvageable.

So this guy is freaking out because he's like, I just lost this patient and now this girl's telling me that days ago she had fevers.

If there were a simple test to tell the two diagnoses apart, that would have been one thing, but there is none. The only way is to go to the operating room, open the skin and look, not something you want to propose arbitrarily. Yet here I was, I couldn't help it, I was thinking it.

And also, speaking of thinking, that guy they mentioned earlier, the anonymous writer earlier, who was like, and they said they might have to amputate me and so I signed the paper room. Like fucking, I'd be like, I need a few days to think about it. And they're like, you don't have a few days. And I'd be like, I need a few days to think about it. You're saying if we go in this room, I might lose my leg?

Yeah, that's sort of what happened next here. So I'm gonna fast forward a little. Dr. Gawande calls a colleague, this guy, Thaddeus Studdert, the stud of the hospital.

Oh shit, dude.

He's the general surgeon on call. And Gawande explains he thinks they could be looking at a case of necrotizing fasciitis. Studdert looks at Eleanor's leg and explains to her and her father, who had arrived to the hospital at this point, that it's most likely cellulitis, but it could be this other very rare, dangerous thing. And there's no way to know without performing a biopsy. If the fasciitis is found, they have to remove all of the infected tissue, which could mean performing an amputation. So father and daughter request a second opinion. They call a plastic surgeon with a degree from MIT, who concurs that it's very unlikely to be necrosis, but the biopsy should be performed. So Eleanor and her father agree to the surgery, but when it comes time to sign the papers, Eleanor freaks out and starts to cry, as one would.

Absolutely.

Because you have to not only agree to the biopsy, you have to agree to losing your arm, potentially, if the biopsy comes back positive, and there's no waking up between that. You just go to sleep thinking, well, they might just take a little skin, or I wake up without an arm.

Wow. Yeah, that's true. Fuck. So you're waking up and immediately looking down at whatever they just operated on, to be like, is it still there?

yes.

Holy shit.

Yeah.

Well, I know how this is.

Yeah.

Moving up the fear tier before we even get there.

So then they ask for time to see if antibiotics will help and the doctors are concerned because it's already been a few days and it can quickly go from barely presenting to killing you so they say no. You have to kind of decide now.

Sure.

And so they do. They agree to it. So now this is another gross part.

So it's probably no more gross than the last one, but this is like a five minute stretch. So it's probably easier to use the chapters than skipping ahead. You have been warned. Graphic story incoming in three, two, one.

Back to Gawande's writing. Quote, the anesthesiologist put Eleanor to sleep. A nurse then painted her leg with antiseptic from her toes up to her hip. With a small knife, stuttered cut out an inch long ellipse of skin and tissue from the top of her foot, where the blister was, down to her tendon. The specimen was plopped into a jar of sterile saline and rushed to the pathologist to look at. We then took a second specimen going deeper now down to the muscle from the center of the redness in her calf, and this was sent on as well. At first glance beneath her skin, there was nothing apparent to alarm us. The fat layer was yellow as it's supposed to be, and the muscle was a healthy glistening red and bled appropriately. Sure.

That's what you wanna see.

Yeah. When we probed the tip of a clamp inside the calf incision, however, it slid unnaturally easily along the muscle as if bacteria had paved a path.

Wow, that's just time and experience, right?

Yeah.

Like if I had done that on the second surgery of my life, I might have not noticed, but this guy's done a few, and he's like, that's not how it's supposed to feel.

This is not a definitive finding, but enough of one that stuttered, let out a sudden disbelieving, oh shit. He pulled off his gloves and gown to see what-

He said that out loud, do you think?

Yeah. I mean, that's what he says.

That's the beauty of having your patient knocked out.

Yeah, yeah, yeah, yeah. He pulled off his gloves and gown to go see what the pathologist had found, and I followed right behind him. To fast forward a bit again, the pathologist calls in a dermatopathologist or a skin pathologist, and after another really intense 40 minutes, they find deep tissue that has begun to die. No cellulitis could do that, so he gives the official diagnosis of necrotizing fasciitis. Stuttert says they need to move fast. He has no idea if they can save the girl's leg or her life.

Yeah, they also have just no idea how far in any direction this soft snow goes or whatever.

Yeah, well, especially because the last case Gawande did with that old guy, he had a pain under his arm. They opened him up and the whole side of his body, it seems like, was just rotted away.

It took days to find that too. I mean, if this was a movie, he's like, oh, please excuse me for a moment. And he collapses into the lockers, freaking out and sweating and seeing flashbacks of him having to talk to that guy's family about, it's just like, are you cool over there, bro? Are you good to do this? Because I'd be like, you're freaking out.

There is a whole scene, because this was so long, I left some stuff out. But there is a whole sequence in here where he does go to talk to the dad and explain, and the dad's got to call the mom.

Yeah, we don't need that on the show.

But it's crazy and very scary. So Dr. Gawande again, in the OR, they slit open Eleanor's leg from the base of her toes across her ankle to just below her knee to get a full view of what was going on inside. They pulled the opening wide with retractors. The disease was grossly visible now. In her foot and most of her calf, the outer fascial layer of her muscles was gray and dead. A brownish dishwater fluid was seeping out with a faint smell of decay. Tissue samples and bacterial cultures would later confirm that this was toxic group A streptococcus advancing.

Ah, group A showed up.

Group A is here.

Fuck, dude.

Group A boards first, baby.

And they lose all your luggage.

Yeah. I thought about a BKA, a below knee amputation, Stuttered says. Even an AKA, an above knee amputation. No one would have faulted him for doing either, but he found himself balking. She was such a young girl, he explains. It may seem harsh to say, but if it was a 60 year old man, I would have taken the leg without question. This was partly, I think, a purely emotional unwillingness to cut off the limb of a pretty 23 year old, the kind of sentimentalism that can get you in trouble.

Well, we have an episode coming out next week where it's the same rules with dolls.

Yeah, but it was also partly instinct again, an instinct that her youth and fundamentally good health might allow him to get by with just removing the most infested tissue, called a debridement, and washing out her foot and leg. Was this a good risk to take with one of the deadliest bacteria known to man and loosen her leg? Who knows, but take it he did.

I don't think when he wrote that, he did it in that who knows voice. He probably was like, yeah.

Who knows, but take it he did. For two hours, using scissors and electrocautery, Stuttered and this other doctor, Siegel, cut and stripped off the necrotic outer layers of her muscle, starting from the webbing of her toes, going up to the tendons of her calf. They took out tissue going three quarters of the way around, her skin hung from her leg like open coat flaps. Higher up, inside the thigh, they reached fascia that looked pink white and fresh, very much alive. They poured two liters of sterile saline to the leg, trying to wash out as much of the bacteria as possible. At the end, Eleanor seemed to be holding steady, her blood pressure remained normal, her temperature was 99 degrees, her oxygen levels were fine, and the worst looking tissue had been removed from her leg. But her heart rate was running a bit too fast, 120 beats a minute, a sign that the bacteria had provoked a systemic reaction.

Oh my God, I thought you were going to say a sign that she was in another episode of ours, waking up during surgery.

No, no, no.

I would like everyone on our show to just be in one episode at any given time.

Yeah, truly. No crossing of worlds here.

Yeah, please.

She was requiring large amounts of intravenous fluid, her foot looked dead, and her skin was still burning red with infection. The gross part for now is over.

You hear that? It's over. Chris says for now, but I don't think anything else comes up that requires Mr. Disclaimer or Trivia Bot.

Dr. Gawande then details the decision-making process to transport Eleanor to another hospital to place her in a hyperbaric chamber to increase the amount of oxygen available to cells, like immunity cells that could help them destroy the remaining bacteria.

So do you think they keep her asleep?

No, they woke her up in between.

For the transfer?

Yeah.

Oh, wow.

That's part of what I cut out. And she's like, she panics, she thinks she can't feel her leg, and then she can feel her leg, and it's a whole thing. But she eventually goes back under. The hyperbaric chamber that night was, as Eleanor described it, like a glass coffin. This whole section is scary in and of itself.

Yeah, this is like iron lung shit.

Yeah, she lay inside it on a narrow mattress with nowhere to put her arms, except straight down or folded across her chest. A panel of thick plexiglass, a foot from her face, and an overhead hatch sealed tight with turns of a heavy wheel. As the pressure increased, her ears kept popping, as if she were diving down into a deep ocean. Once the pressure reached a certain point, she would be stuck, the doctors had cautioned. Even if she should start throwing up, they could not get to her, for the pressure could only be released slowly, or it would give her the bends and kill her. One person had a seizure inside, she remembers them telling her. It took them 20 minutes to get him out. Lying there enclosed, more ill than she'd ever imagined she could be, she felt far away and almost totally alone. It's just me and the bacteria in here, she thought to herself.

My god, did she tell him that after?

I guess, yeah. The next morning, we took her back-

It's a poetic license.

Yeah. The next morning, we took her back to the operating room to see if the bacteria had spread, they had.

No.

The skin over most of her foot and front of her calf was gangrenous and black and had to be cut off. The edges of fascia we had left behind were dead and had to be excised as well.

Who's that guy, what was his name, who has gangrene named after him?

Fournier. But Fournier's gangrene is only in your perineum and genitals.

Okay. Well, it's the little wins.

Yeah. Here was the little win. Her muscle was still viable, including in her foot. The skin was dead, but the muscle wasn't. Oh, good. The bacteria had not killed anything up in her thigh. She had no further fevers, her heart rate had normalized. We repacked her wound with wet gauze and sent her back for more hyperbaric oxygen two hours twice a day. We ended up operating on her leg four times in four days. At each operation, we had to take a little more tissue, but each time it was less and less. At the third operation, we found the redness of her skin had finally begun to recede. At the fourth operation, the redness was gone and we could see the pink mossy beginnings of new tissue in the maw of her wound. Only then was stuttered convinced that not only had Eleanor survived, but her foot and leg had too.

That's a fucking, that got to be so pumped. I mean, she's got to be broken, a broken human being of like, this is the worst experience ever. But if on the surgery side, you have to be like pumping your fists in the air. They're like, fucking hell, yeah, we finally got to a manageable place.

Yeah. Well, there's a bit of an epilogue here that we'll talk about. Eleanor died a year later. No, she survived. But a lot of the stuff I cut out, but a lot of the stuff that's interesting is that-

Please call it a lot of the stuff that you surgically removed.

A lot of the stuff that I surgically removed from this story is about the doctor explaining this is how doctors make decisions. Because everyone always complains about, they went to the doctor and this doctor didn't think it was this, this doctor didn't think it was that, they should have given them pills for this. And this is an extreme case, but part of what he's talking about is it's tough. This is an imperfect science, we aren't wizards. We can only diagnose what we're looking at. And another doctor may not have, biopsy is a very serious thing, and another doctor might be like, there's a 1% chance that this is necrotizing fasciitis. Let's just give her some pills and send her home. Yeah.

And what's amazing is, because that is the response you would expect from a person on their way to lunch.

Yeah, yeah, yeah.

And so the fact that this guy was, he's so into his profession, and has like, I guess you would think, an inquisitive mind probably would let him into medicine to begin with. The hunger probably subsided and was like, I have a new problem to solve, and this is exciting.

And in a weird way, that guy that died kind of saved this girl's life, because Dr. Gawande wouldn't have been thinking about maybe it's necrotizing unless that guy had died.

Also, he's gotta be, fuck, it's just like two so close together, and it seems such a rare issue.

Oh yeah, that's true. Yeah, this is statistically running into it once is nuts.

It's in your career.

Twice in the span of a few weeks.

In the same city.

Yeah.

I'd be like, shut the fucking water down. Like something's happening. The happening is happening.

Yeah.

Wow, this is a, I'm gonna read this book maybe. It sounds gross, but this is really good.

Pretty good. So he says then, and this is the follow up that I think is worth covering, because it touches on some other fear things. It was a year before I saw Eleanor again. Passing through Hartford, I called in on her at her family's home, a roomy, spick and span, putty colored colonial with a glumfy dog and beds of flowers outside. Eleanor had moved back home to recover following her 12 days in the hospital, intending to stay only temporarily, but instead finding herself nestling in. Returning to a normal life, she said, was taking some getting used to. Her leg had taken time to heal, not surprisingly. In her final operation, done during her last days in the hospital, we had needed to use a 64-square-inch skin graft.

Oh, wow.

Taken from her thigh to close the wound. My little bum, she called the result. Although I think it might be Burn, but the photocopy on the text that I found was fuzzy. I think maybe my little Burn, she called it.

I don't think you should have a name for it at all.

Satan, the devil. She called the result, rolling up the leg of her sweatpants to show me. It wasn't anything you'd called pretty, but the wound looked remarkably good to my eye. In final form, it was about as broad as my hand and ran from beneath her knee to her toes. Inevitably, the skin color was slightly off and the wound edges were heaped up. The graft also made her foot and ankle seem wide and bulky, but the wound had no open areas, as there sometimes can be. And the grafted skin was soft and pliant, not at all tight or hard or contracted. Her thigh where the graft had been taken was a bright cherry red, but still fading gradually.

Was the, all this operation stuff, was it done in Boston or Connecticut? Like Boston or Hartford?

I think it was somewhere in Boston because that surgeon they call from MIT.

From MIT?

Yeah.

So that's what I was thinking. I mean, I gotta say, say what you want about fucking cities, whatever. Like Boston just has a ton of smart people from smart institutions in well-funded medical spaces. Like if you have to get your shit done anywhere, it seems like Boston's a great place to have to do the worst 12 days of your life.

Yeah. So she says, or Dr. Gawande says, recovering the full use of her leg had been a struggle for her. At first, coming home, she found she could not stand. Her muscles were so weak and sore. Her leg would collapse right under her. Then when she built the strength back, she found she could still not walk. Nerve damage had given her a severe foot drop. She saw a doctor stuttered and he cautioned her that this was something she might always have. With several months of intense physical therapy, however, she trained herself to walk heel-toe again. By the time of my visit, she was actually jogging. She had also started back working, taking a job as an assistant at one of the big insurance company headquarters in Hartford. There it is.

But also a little bit probably, this is the outcome that the doctor was initially like, let's not cut this. I mean, he made it about her looks, but I'm saying, let's not cut this young person's leg off because like a young person, maybe physical therapy and stuff can bounce back versus us.

A year on, Eleanor remained haunted by what happened to her. She still had no idea where the bacteria came from. Perhaps the foot soak and pedicure she had gotten at a small hair and nail shop the day before that wedding.

Yeah, maybe the day before.

Perhaps the grass outside the wedding reception hall that she danced barefoot through with a conga line. Perhaps somewhere in her own house. I'd say one of those first two is more likely than her own house, but anytime she got a cut or a fever, she was stricken with mortal fear.

Oh my god, the anxiety, she has PTSD 100% from this.

She would not go swimming, she would not immerse herself in a bath, she would not even let the water and the shower cover her feet.

I still haven't driven on the highway at night.

Yeah, well after this, you apparently won't shower or cover your feet.

Oh my god, yeah.

Her family was planning a vacation to Florida soon, but the idea of traveling so far from her doctors frightened her. The odds, the seeming randomness, were what disturbed her most. First, they say the odds of you getting this are nothing. One in 250,000, she said.

unless you're in Boston and two will show up in two months.

Yeah, but then I got it. Then they say the odds of my beating it are very low, and I beat those odds. Now, when she asked us doctors if she could get the flesh eating bacteria again, we told her once more, the odds are improbably low. One in 250,000, just like before. I have trouble when I hear something like that. That means nothing to me, she said.

Oh my god, that's true.

She was sitting on her living room sofa as we talked, her hands folded in her lap, the sun rippling through a bay window behind her. I don't trust that I won't get it again. I don't trust that I won't get anything else that's strange or we've never heard of or that anyone we know isn't going to get such a thing.

That is it. Wow. Psychologically, yeah, the fear is baked in and it's gotta be crippling, no pun intended, in a totally different way, but strong kid, I guess, and great doctors.

But that's why I wanted to read the whole thing because I guess I wanted to illustrate that the fear of a flesh-eating bacteria goes way deeper, no pun intended, than just the, oh no, look, it's gross on my arm. Like, there is such a process to, if you actually come down with this, and it affects you in so many different ways that I never even thought about when I started researching it. Yeah. And this was a really excellent example.

This is such a, this seems like a really fucking good book too.

Yeah, yeah. It's out there. I mean, I found an excerpt of it that I put in the show notes on, I think one of the colleges in Boston has it up as a PDF somewhere.

Sure. But we'll put a link in the show notes so people can buy it.

Maybe go buy it. Yeah, we read enough of it. I feel like we should put a link to buy it.

We'll absolutely buy it and put a picture of it in the show notes of us holding it.

So it scares the shit out of me. And the last thing I wanted to cover though, because no one has covered this in any of the stuff that I'd read yet, was how much flesh could necrotizing fasciitis eat before you die?

Probably depends on where it is. Well, if it starts around the heart, then maybe.

But if you didn't seek treatment, could the bacteria, if it started in your foot, how much of your legs would it eat before you died? Could you get turned into a zombie? Oh, I don't know.

Yeah, probably. I mean, every week we do these things, it seems like more and more things can turn you into a zombie than we ever thought before.

Just like, could you end up having all of your flesh eaten away if you didn't seek treatment? Well, it turns out, no.

Oh, well, what do I know?

While the disease is painful and horrific at the site of the infection, sepsis will kill you long before you're actually eaten away.

And describe sepsis to me?

That's what I'm about to do, because sepsis is also horrifying, and I feel like we've talked about it on the show before.

Is that what your blood gets bad for you, blood turns on you?

Not really.

Okay, well, I'm just asking.

I mean, there are blood infections that might cause sepsis.

That's probably next season.

So get this, so I think we've probably talked about sepsis on the show before, but we've never necessarily described it, which is nuts because it's a common way to die when dealing with all kinds of infections and diseases. estimates suggest that it contributes to one third to one half of all in hospital deaths.

Sure.

So basically sepsis occurs when the body's response to an infection goes into overdrive. It begins with an infection somewhere in the body, but instead of just fighting that specific problem, the immune system launches a massive body wide response. This causes widespread inflammation, which quickly affects blood vessels and makes them what is described as, quote, leaky. So aside from me imagining my body filling with little plumbers to fix my leaky ass blood, this leads to problems with blood flow to vital organs. At the same time, the body's clotting mechanism malfunctions, causing too many clots in some areas and not enough clots in others. Without proper blood flow and with all the inflammation, organs start to fail one by one. Blood pressure often drops dangerously low, making it even harder for the body to function properly. And the brain is also affected, leading to confusion and disorientation. In severe cases, a person may go into septic shock where the body can no longer maintain blood pressure or organ function, and what makes sepsis so dangerous is how rapidly it can progress and how it impacts the entire body simultaneously, turning a localized infection into a life-threatening emergency that requires immediate medical attention. So yes, you will be dead from sepsis long before your flesh rots off, and once you're dead, your flesh will rot off from being dead and not having bacteria eating it.

Same result.

Same result. Do you want to hear some stories from Quora of people who survived sepsis?

Right now?

Right now, I pulled up a few.

I mean, I feel like I might have it. I've had like I've had a leaky leaky leg.

Well, I think I think sepsis has other. I think you're good. I wouldn't worry about it.

I don't think so. It's funny.

I don't think the the leaky blood that sepsis causes is like leaky in the way that you can feel it. OK, gotcha, gotcha. Yeah. This is from Steve Conway on Quora. I had sepsis in 2015. I was in a coma for 12 days and in the hospital for 23 days. While in the coma, my doctors told my wife to be ready for the worst. It started with a small scrape on my arm that got infected. The infection quickly took over my whole body. My wife took me to the ER with flu-like symptoms. That's the last thing I remember until waking up 12 days later. Wow. Everything about it was slash is still painful. Every cell in my body hurt. They gave me morphine, which helped a bit. Being in a coma for 12 days, plus the sepsis itself, destroyed my body. I had to relearn how to walk. To this day, two and a half years later, I have no stamina. Walking to the mailbox wears me out. I literally could not run for my life if I needed to.

Wow.

I can't work anymore. After I got home, I had to continue heavy doses of intravenous antibiotics three times a day for a month. Sepsis sucks.

Sepsis sucks. But speaking real fast, the coma thing, I feel like Stephen King's The Dead Zone does a good job of that in the beginning, because the guy is in it for a long time. I feel like that's one of the few examples where I see where there were like muscles have atrophied, tendons have gotten tight, like all this crap, if you're not like being massaged and dealt with at the hospital. That like, and this guy was only 12 days. And so yeah, the coma, I have a friend who was in a medically induced coma for a while. And we can have, if we ever do coma stuff, we'll have her on.

Yeah, we'll do coma stuff at some point. Daniel Gray says, I got peritonitis and then sepsis after bowel surgery. I was in a coma for a month, so I missed most of the pain part, but the aftermath was horrible. Was on a respirator, and that was a major bitch learning to breathe on my own again. Felt like they were trying to suffocate you. It was hard work. The worst 10 minutes of my life are when I tried to sit up in a chair for the first time after waking from the coma. It was exhausting. I felt 100 years old. You never totally recover from sepsis. Two thirds of those with sepsis don't survive. So if you're here to talk about it, you're one of the lucky ones, even if a little broken. Wow. Then finally, this gem from a man named Timothy John on Quora. You may be unconscious if you're lucky, but you could be awake throughout the entire ordeal. My case of sepsis driven by massive inflammation felt like my body was on fire, burning from the inside out. Two rounds of morphine did nothing. Relief came when the antibiotics set in, ending about 10 hours of god-awful pain. I'm grateful that the ER nurses, lab techs and physicians identified the cause and proper treatment. But sepsis, like cancer, never really goes away. It hides. It tried to kill me once, and I think it would like to try again.

Jeez. Man, these are.

What an app.

This is a crazy, I mean, anytime we enter the medical space, it's really been eye-opening. And yeah, I'm ready for the fear tier if we're ready to go there.

Yeah, let's go to the fear tier.

Fear to your fucking, God, neck and neck with waking up during surgery. I think it's eeked out waking up during surgery.

Yeah.

What started as a flesh-eating bacteria, what is this episode called?

flesh-eating bacteria.

It's, that's the root cause of the fear, but I feel like the psychological aftermath of either this girl's story or the sepsis people is what makes it so scary. It's not that like this really scary thing happened for 12 days. Yeah. It's that I now live with the fear of this scary thing coming again, but then more importantly is I was just shook by that woman being like, the veil has been uncovered in my life of probability means nothing. Yeah. I've always said this, which is I don't think everything happens for a reason, but I think everything happens. Just her opening herself up to like everything can happen and might happen, and not like, I go to sleep with the blanket of comfort every night being like, well, one in a million, that's so for me that, wow, I think this is number one for me right now.

It is close to number one for me too, because it's so I literally, there aren't a lot of episodes of this show that change my behavior, but after this, I am never going to look at and open anything the same way again, like bug bites, ingrown nails, knee scrapes. I'm usually pretty good about washing them and band, whatever, but it's a whole new level now of making sure that I don't open a scab, like don't scrape them, don't scratch them. Just cover them up.

Remember how we all like idiots used to like wash down our groceries during quarantine?

Yeah.

That's got to be our bodies now.

Yeah.

But I think time will tell that like this won't be a fad. This is a good idea.

Yeah, this is a rough one. It's a mean one, but I enjoyed this episode, actually.

I think it's gross and I will put in, if you're hearing this and I didn't, then sorry. But I'm pretty sure I've got to put in the little warnings and I'll try and put very specific chapter marks for people of like, hey, if you want to avoid. But I didn't think anything was actually that gross because it's just medical. What are you going to do? You can't really get around it.

Yeah, it's all body stuff.

And we had the wonderful text from this writer who's a good writer. So fucking crazy that this was a good, I think this was a good episode and an eye opening episode, an episode we can learn from and the way that I feel like we learned a lot during sudden death with just stuff to think about with aneurysms and buries under your branches and stuff. It's just, if there's anything we've learned this season and partially last season is just a little bit of preventative stuff in your brain of like, maybe getting checked up maybe when you wouldn't have previously. You know, if you feel something, do something about it and also maybe like, get a physical every year, especially if it's already covered by your insurance or something.

Yeah, absolutely. All right. Well, guys, wash your hands and we'll-

Not of this show.

Not of this show. Wash your hands of this show.

No, no, no.

We will see you next week. Until then, this has been Scared All The Time. I'm Chris Cullari.

And I'm Ed Voccola.

See you next week. Bye bye.

Scared All The Time is co-produced by Chris Cullari and Ed Voccola.

Written by Chris Cullari.

Edited by Ed Voccola.

Additional support and keeper of sanity is tess Fiefel.

Our theme song is the track Scared by Perpetual Stew.

And Mr. Disclaimer is...

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Good night.

We are in this together.

Together.

Together.

===TRANSCRIPT END===