Cut to pieces by a cruel disease

26/07/2010

Eighteen-year-old Sara Loo's legs and right arm were amputated. She had about 30 operations cutting away and grafting skin to try to beat the meningococcal disease that was killing her.

But after contracting the disease in May the Invercargill teenager succumbed at Middlemore Hospital on Monday.

It was a tough blow for the medical team that had tried desperately to save her by amputating limbs to try to stop the disease in its tracks.

"Sara was amazing as a patient," said Middlemore plastic surgeon Mr Richard Wong-She, who spoke to the Herald on Sunday with the permission of Sara's family.

"I was constantly humbled by how she coped with what life had given her. We wanted to make the quality of survival worth the pain of the treatment."

Wong-She worked with Mr Bruce Peat after Sara had left the care of Mr Patrick Lyall in Dunedin. She had both legs amputated in Dunedin.

She was taken to Middlemore's burns unit for skin grafts on areas that had been cut away after being ravaged by the disease.

Not long after she arrived in Auckland the decision was made to remove her right arm.

"The photos they [Dunedin Hospital] sent to me to plead her case were so graphic and horrific," Wong-She said. "There was no question that she needed to come to us.

"When she came to us she still had areas of dead tissue that needed to be removed. The largest cluster, the majority, was on her right upper limb. She had wounds on her legs, her left forearm and her fingers were basically mummified. I knew that at some stage we would need to shorten her fingers. She needed dialysis ... She had exposed fat and muscle in places and that needed to be protected so it didn't dry out and die - that was another challenge for us.

"We were basically removing as much of the dead tissue as we could and keeping the rest of what we could alive.'

Sara had a MenzB meningococcal vaccination, but she was not protected against the strain she contracted.

Wong-She said the decision to remove her right arm was "very tough".

"She also had raw open wounds and we had to decide what was the best way to close them. There were a number of options. We went through a round of putting on donated skin to close her wounds to make sure she was stable enough for skin grafts. We used artificial skin to try and build up and improve upon the end result. "

Trying to stop the infection was like "trying to hit a moving target", Wong-She said.

"It's not the kind of disease where you can treat one area and say 'I'm done with that' and move on to the next one."

Wong-She saw cases of meningococcal septicemia as severe as Sara's only about once a year. "When I was a young plastic surgeon training I would often have two or three of these cases every winter.

"Severe cases are rarer than they used to be. I probably get one a winter versus three or four a winter now. I've got another one in the hospital at the moment. A little girl who's a little bit healthier than Sara who's lost both her legs."

Wong-She estimated Sara had about 30 operations. "Whenever Sara needed to go to the operating room, she went. Whether it was the weekend or the middle of the night - she went."

It is not clear why Sara died. Wong-She said the team treating Sara was on top of the infection externally, but it may have irreparably damaged her liver.

"It is testament to her strength and courage that she got as far as she did. We are not always successful, despite our efforts. We took a terrible situation and tried to make the best out of it. We think we've failed. It's very tough."

When it became clear Sara would not wake up, staff went out of their way to make her and her family comfortable.

"When things are futile, then we cannot change the outcome, it is at that point your ability to care becomes the greatest. The guys in intensive care had a frank discussion and decided to move her across her bed to let her mother lie with her. It goes against every rule in the book - but that is called caring."

Wong-She said it was "terrible" when Sara died, but he could not let it affect him too much.

"Doctors are always accused of being dispassionate and impersonal. In many ways it is actually a defence. I do not get the luxury of mourning. Although Sara has passed away, I have at least another two patients in intensive care that I have to keep operating on otherwise they will die.

"We have our private moments of grief - we are human. We get closer to some patients than we do to others but ultimately we are professional. We keep going because we don't have a choice."