The Silver Wand 169
Positive Surprises
In December of 1976 a young man was sent to our clinic for a possible
amputation. John was a man of the north woods. Weathered and hard,
he faced the problem philosophically. "What's got to be has got to be,"
he said through tight lips. Three years before, he'd been in a snow-
mobile accident, breaking his right tibia (shinbone) in three places and
also fracturing the fibula, the smaller bone of the lower leg. He'd been
treated at a small local hospital, where the broken bones had become
infected. He'd undergone several operations to remove dead bone and
treat the infection, but the bacteria continued to spread. He came to us
with the fracture still not healed and with a long cavity on the front of
his shin in which one could see right into the dead and infected bone.
He was struggling to walk in a cast extending up to his hip. He was
married, with five young children, and his leg was obviously not the
only place he was having trouble making ends meet.
"What kind of work do you do?" I asked him.
"I trap muskrats, Doc."
"That's all?"
"That's all, Doc."
"How in hell do you manage with that cast on?"
"I put a rubber hip boot over the cast, Doc."
Muskrat trapping is hard work, a tough way to make a living even for
a man with two good legs. "John, if you have an amputation and wear
an artificial leg, you sure won't be able to do that. What will you do
then?"
"I dunno—welfare prob'ly. Prob'ly go nuts."
"You really like to work in the woods, don't you?"
"Wouldn't do anything else, Doc."
"Well, let's get you admitted to the hospital. Something has to be
done, and I have an idea that might let you keep your leg." For the first
time, John smiled.
In fighting the infection, the first step was to identify the enemy, the
microbes. John's wound was a veritable zoo. There were at least five
different types of bacteria living in it. Even with only one kind, os-
teomyelitis is notoriously hard to treat. Very little blood reaches the
bone cells,
so both antibiotics and
the body's own defense agents are
hampered in getting where they're needed. And even if we could get it
into the bone, no single antibiotic could fight all of John's germs. Even
a mixture would probably create a greater problem than it solved, for