There’s another patient in the ICU, who arouses not just sympathy but fear in his caregivers.

He has necrotizing fasciitis from MRSA. It was eating into his abdominal wall, and elsewhere too. The surgeons cleaned it out, and what I can glimpse under the dressings doesn’t look too big or too bad now. But somehow he’s intubated, his lungs sound junky, and I’m guessing he’ll turn out to have either pneumonia or ARDS. From one little abscess on his stomach.

The nurses followed me out into the hallway this morning to ask: are they going to get necrotizing fasciitis from being around him?

This is supposed to be a rare disease, so rare that when we studied it two years ago in class, we were told it’s a once-in-a-lifetime diagnosis. I’ve seen three, during the last three months – in medical school. These same nurses took care of one of the other patients too, for a few days. He had an abscess on his back, and it ate his whole back . . . all the way down to the muscle. . . so that it looked like an anatomy specimen. . . he got trached. The third was luckier, it only ate part of his arm, and he didn’t need a ventilator.

All I could tell the nurses was: as healthcare workers we’re probably all colonized with MRSA (methicillin-resistant Staphylococcus aureus) by this time, as are our family members, and indeed a fair number of the general population. Sometimes something happens – but it’s usually preceded by immunocompromise of some kind: could be chemo or AIDS; these patients that we’ve seen have had morbid obesity and uncontrolled diabetes. So don’t worry about this patient – he can’t give you anything worse than what you’ve already got.

I asked the fellow, and she said nec. fasc. (we have a familiar name for it, now), is very rare, and she’s only seen two cases in her career. That doesn’t make me feel too much better. With one tenth her experience, I’ve seen it more than she has.

(Seriously, folks, no need to panic, just take a shower every few days, and try not to be morbidly obese, or let your diabetes get wildly out of control; and come see a doctor if you have an abscess, especially one that’s growing. Common sense.)

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