Bryson City Seasons — Flesh-Eating Bacteria (Part 2)

This is from the thirty-eighth chapter from my best-selling book, Bryson City Seasons, which is the sequel to Bryson City TalesI hope that you’ll enjoy going back to Bryson City with me each week and that if you do, you’ll be sure to invite your friends and family to join us.


Early recognition is the key. Reay and I both knew that successful management of necrotizing fasciitis was dependent first and foremost on early detection.

In Carl’s case, the appearance of the infection on his back actually helped me. In the 50 percent or so of the patients who develop necrotizing fasciitis without a defined portal of entry, theinfection begins deep below the skin, frequently at the site of a muscle strain or traumatic joint injury. In these folks, the disease can mimic deep vein thrombophlebitis or a mild cellulitis. 

However, the presence of fever, increasingly severe pain, an unexplained fast heartbeat, a marked elevation of the white blood cell count, and an elevated creatine phosphokinase level all suggest necrotizing fasciitis and should prompt surgical cleansing of the deep tissues.

In the OR, Kim had no problem getting Carl under anesthesia. However, before we could start surgery, his blood pressure began to drop quickly.

Kim yelled out to Ray and me, who were scrubbing in the hall, “Dopamine okay?” Dopamine was a medication that would increase his blood pressure.

“You bet!” cried Ray, who shouted out the dose he wanted Kim to start. He then turned to Louise. “Louise, let Betty know I’ll need some albumin and intravenous gamma globulin from the lab ASAP.”

“Yes sir!” Louise responded as she quickly left the surgical suite to go to the lab.

“Albumin and gamma globulin okay with you, Walt?” Ray asked.

I was a bit embarrassed because I hadn’t thought of these two medications—which were standard interventions for systemic infections that resulted in low blood pressure or shock. 

“Sounds good, Ray,” I mumbled.

After finishing our scrub, we entered the operating room and quickly gowned and gloved, while Kim and the OR staff placed Carl on his side and scrubbed his back with Betadine. We placed the sterile surgical drapes in place, then Ray made an initial large incision across Carl’s back. The skin was thickened from the infection, and it took a moment or two for us to slowly deepen the incision and control skin bleeders until we were finally able to enter the fat-filled space between the underside of the skin and the fascia, the thick leather like tissue overlying the back muscles.

What we found was astounding. Upon entering the space, the putrid smell nearly knocked us off our feet.

“Nice aroma, eh?” Ray kidded.

My surprise must have shown in my eyes.

“First case of necrotizing fasciitis?” he asked.

“Well, the first case I’ve accompanied to OR.”

“It’s not pretty. We’ve got lots of tissue to remove. Let’s go to work!”

As we extended the incision, pus poured from the wound.

We’d first irrigate out the pus and then break apart and remove any necrotic tissue and irrigate again and again.

The solution to pollution is dilution with solution,” Ray would mutter to no one in particular as he continued to cut out more and more gangrenous necrotic tissue. “Once we get all the necrotic tissue out, we’ll have to leave the wound open to drain. It won’t be pretty, and it’s going to take weeks to heal—if he even survives. But we’ll sure give it every shot we can.”



  1. Dead Man Standing (Part 1) (Part 2)(Part 3)
  2. Eyes Wide Open (Part 1)(Part 2)
  3. Auspicious Accidents (Part 1)(Part 2)
  4. Answered Prayers (Part 1), (Part 2), (Part 3), (Part 4)
  5. Rotary Luncheon
  6. Death by Emotion (Part 1)(Part 2)(Part 3)(Part 4)
  7. The Invitation (Part 1)(Part 2)
  8. Barbecue and Bacon (Part 1)(Part 2)
  9. A Touchy Subject
  10. Family Time (Part 1)(Part 2)
  11. Chicken Pops(Part 1)(Part 2)
  12. Swain County Football (Part 1)(Part 2)
  13. Hospital Politics (Part 1)(Part 2)(Part 3)
  14. The Bobcat Attacks (Part 1)(Part 2)
  15. Dungeons and Apples
  16. A Tale of Two Surgeons (Part 1)(Part 2)(Part 3)
  17. Tanned Feets (Part 1)(Part 2)(Part 3)
  18. Wise Counsel (Part 1)(Part 2)
  19. An Anniversary to Remember (Part 1)(Part 2)
  20. Mrs. Black Fox (Part 1)(Part 2)
  21. The Littlest Cherokee (Part 1)(Part 2)
  22. Christmas Firsts (Part 1)(Part 2)
  23. The Silver Torpedo
  24. Another New Year’s Catch
  25. Turned Tables
  26. Doctor Dad (Part 1)(Part 2)(Part 3)
  27. The Phone Tap (Part 1), (Part 2)
  28. Labor Pains (Part 1), (Part 2)
  29. Staph and Staff (Part 1), (Part 2)
  30. The Ribbon Cutting
  31. Mountain Breakfast
  32. Walkingstick (Part 1), (Part 2)
  33. One Big Fish
  34. Memorial Day (Part 1); (Part 2)
  35. The Parade of the Century (Part 1)
  36. Lost Boy (Part 1); (Part 2)
  37. Facing the Music
  38. Flesh-Eating Bacteria (Part 1); (Part 2)


  1. The Murder (Part 1)(Part 2)(Part 3)
  2. The Arrival (Part 1)(Part 2)
  3. The Hemlock Inn (Part 1)(Part 2)
  4. The Grand Tour (Part 1)(Part 2)
  5. The Interview (Part 1)(Part 2)(Part 3)
  6. Settling In (Part 1)(Part 2)
  7. First-Day Jitters (Part 1)(Part 2)
  8. Emergency (Part 1)(Part 2)
  9. The Delivery (Part 1)(Part 2)
  10. The “Expert” (Part 1)(Part 2)
  11. The Trial (Part 1)(Part 2)
  12. Shiitake Sam (Part 1)(Part 2)
  13. Wet Behind the Ears (Part 1)(Part 2)(Part 3)
  14. Lessons in Daily Practice (Part 1) — Anal Angina(Part 2)(Part 3)(Part 4)
  15. White Lies
  16. The Epiphany (Part 1)(Part 2)
  17. Becoming Part of the Team (Part 1)(Part 2)
  18. Monuments (Part 1)(Part 2)
  19. My First Home Victory (Part 1)(Part 2)
  20. Fisher of Men (Part 1)(Part 2)
  21. Fly-Fishing (Part 1); (Part 2)
  22. Something Fishy (Part 1)(Part 2)
  23. A Good Day at the Office
  24. An Evening to Remember
  25. Another New Doc Comes to Town
  26. ‘Twas the Night Before Christmas (Part 1)(Part 2)
  27. A Surprising Gift
  28. The New Year (Part 1)(Part 2)
  29. The Home Birth (Part1)(Part 2)(Part 3)
  30. The Showdown (Part1)(Part 2)(Part 3)
  31. The Initiation (Part 1)(Part 2)(Part 3)
  32. Hoe at Last (Part 1)(Part 2)(Part 3)  

© Copyright WLL, INC. 2019. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.

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