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My Toughest CaseDiagnosing a Friend’s Mystery Illness

Neil Roth, Orthopedic Surgeon, Lenox Hill Hospital

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One Friday night at about 11:30, I was getting into bed when a friend called and said her husband wasn’t feeling well. She had taken him to the hospital with knee pain. As a sports-medicine specialist, I’m used to getting calls at home from weekend-warrior friends. But I thought, “This isn’t a guy who complains.” My gut said something was very wrong.

When I got to the hospital, my friend had a normal-looking knee, with some vague pain on the back side. But he could move the joint without pain and there were no signs of any injury. He had also had flulike symptoms for several days, but nothing serious. His X-rays were normal, but his lab work showed that he had some kind of infection going on, and it wasn’t clearing itself. He was an otherwise robust, healthy 41-year-old guy. I was baffled.

At that point, we admitted my friend to the hospital and started him on antibiotics. But he didn’t respond. In fact, he was deteriorating rapidly. His heartbeat was irregular and his blood pressure was dropping. We transferred him to the ICU. I consulted experts in infectious diseases, internal medicine, and critical care—all of whom were as perplexed as I was. I tried to reassure his wife that everything would be fine, but actually I wasn’t so sure. Then his kidneys started to fail, which is one of the first signs of system shutdown. Once a patient goes into septic shock, it’s really hard to get him back. My friend was circling the drain.

None of us was sure what to do next, but I decided to go in and open him up. I thought the problem had to be around the knee, and the only way to find out was to look inside. I wasn’t extraordinarily confident of my plan, but I didn’t see any other options. You never want to put a patient at risk without a clear diagnosis, but it had been twelve or thirteen hours since he’d come in, and we still didn’t know what was causing the problem. I didn’t think he had much longer to live, so I chose to go ahead with the surgery. I told his wife, “You can’t leave the hospital. He might not make it out.” This is a family I’m used to seeing around a Seder table—and now they’re all in the waiting room counting on me to save this man’s life. It was unreal.

As I was prepping the knee, one of the nurses said, “This is one of your closest friends. Are you sure you should be operating on him?” Doctors are supposed to avoid operating on friends, so their emotions don’t cloud their judgment. But I looked at the nurse and said, “Who can do a better job than me?” Still, the fact that this was someone I loved did make the situation more tense.

I opened up the back portion of the knee and found the problem right away. There was a pool of brownish fluid. A flesh-eating bacteria had started to eat at the area between the muscle and skin. In fact, it had invaded several areas of the knee, threatening nerves, arteries, and vital structures. The bacteria is actually common. My guess is it entered through a cut or scrape, and that his flu weakened his immune system and kept him from successfully fighting it off. Once I cleaned out the infected area, his blood pressure started to improve and his kidney function returned immediately. He was going to be okay.

Every time I see the family, I breathe a sigh of relief. It took him a little time to regain the strength in his knee, but we’re back playing golf. I still don’t give him any strokes.


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