Standing in the doorway of their cramped mint-colored kitchen, Sharon Susie's husband Larry tells her to leave the dishes, but she quickly rebuffs him. She is capable of washing dishes with one arm.
Susie gently presses a dish rag with her left hand into a glass setting on a rubber mat in the stainless steel sink. Her cocker spaniel, Sambo, naps in a kennel near her feet which are clad in bright yellow socks and therapeutic shoes on this Tuesday afternoon.
"I'm having fun," the 63-year-old Sioux City woman says with a chuckle as she rinses a knife under the faucet.
Susie is learning to live again after a "flesh-eating" bacterium invaded her body last September, taking her right arm and nearly costing her her life.
The mother of two and grandmother of five endured eight surgeries at Mercy Medical Center to rid her body of necrotizing fasciitis, a serious bacterial infection commonly caused by Group A Streptococcus. The bacteria enter open wounds (some as small as a paper cut) and release toxins that rapidly destroy skin, fat and muscle tissue.
"People need to know that it's here," Susie says. "I got it."
Susie's infection is the worst case of necrotizing fasciitis that Bertha Ayi has seen in her career.
Ayi, medical director of Global Infectious Disease Services in Sioux City, encounters a patient with the "flesh-eating" infection about once every three months.
Several types of bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), Ayi says, can cause the same destruction as Group A Streptococcus when they enter an open wound.
A diagnosis of strep throat, Ayi says, doesn't mean that necrotizing fasciitis will follow. When bacteria get into the blood, muscle or the lungs, she says individuals are at risk for amputation and death if the infection isn't caught early.
"They just don't occur out of the blue," she explains. "Either someone cut themselves, a surgical site, or somebody got traumatized in a car accident and then bacteria can get in there and do that."
Intense pain at the site of the wound, purple discoloration and air bubbles underneath the skin are warning signs of necrotizing fasciitis, according to Ayi. Within 24 hours of infection, she says the toxins released by the bacteria are already destroying flesh.
"It's on your fingers one hour. The next hour it's up to the wrist. It goes that fast," Ayi says. "If something doesn't look right on your skin you should seek medical attention."
The bacteria can be passed from person to person by touching an infected wound, but Ayi says this is rare.
Diabetics, according to Ayi, are prone to developing necrotizing fasciitis because their immune systems are already compromised. She recalls a patient with diabetes who suffered a small paper cut on his finger in the morning. By the afternoon, she says the man had intense pain in his arm.
"The pain in the arm is way out of proportion to how the arm looks," she says. "It might not be looking bad, but that's because the destruction is going on at a deeper plane than the skin itself."
Susie doesn't have diabetes, but she believes a series of events made her susceptible to the infection.
She fell twice on the hardwood floor at her home in September, but didn't notice any open wounds or marks.
A short time after falling, Susie developed pink eye, an infection of the membrane lining the eyelids. A physician assistant at her family doctor's office examined her and prescribed an antibiotic to treat the eye infection. Four days later, she had her teeth cleaned.
On Sept. 28, Susie went to an urgent care clinic complaining of flu-like symptoms and severe pain in her right arm. A sample of her blood was drawn; and her arm was X-rayed. After the exam, Susie said she felt so ill that she couldn't drive herself home. When her husband came to pick her up, she said the doctor gave her a prescription for hydrocodone, a narcotic pain reliever. Later that night, Susie began vomiting.
Ayi says medical care shouldn't be delayed when symptoms of necrotizing fasciitis present themselves. Surgery, she says, is needed to remove dead tissue and to reduce the bacterial load in the body. Antibiotics alone, she cautions, won't stop the toxins from spreading.
The next morning, Susie went with her husband to a client's home to pet sit. While Larry Susie tended to two dogs and two cats, Susie sat at the kitchen table feeling faint. Larry Susie rushed his wife to Mercy Medical Center, where surgeons amputated her non-dominant arm just below the shoulder.
"When they opened it up, it was full of gangrene," Larry Susie recalls. "That's why (the amputation) is so high up on her shoulder."
Ayi says the infection entered Susie's bloodstream, causing her to go into septic shock. Her blood pressure plummeted, cutting off blood supply to her extremities. As a result, Susie developed gangrene in her toes. She lost the tips of four toes on each foot.
Larry Susie says he was "going with the flow" and trusting the doctors as his wife of 40 years was wheeled into surgery. Their sons John, of Taylors, S.C., and Brian, of Sioux City, rushed to the hospital along with Susie's sister Kathy Jones, of Springfield, Ill.
Susie, who was heavily medicated, says she doesn't recall anything about the ordeal until she woke up in the intensive care unit three and a half weeks later. She had no idea that her arm had been amputated.
For a while, Susie admits that she couldn't look at her stump and the pinkish red scars that mark her shoulder and her chest.
"What can I do about it? It's done. I've got to move forward," she says.
Moving forward hasn't been easy for Susie.
After being discharged from the hospital the second week of December, she went to a nursing home where she spent another month recovering. She was bedridden for so long that the hair on the back of her head thinned and she lost muscle tone in her legs. She had to learn to walk all over again.
Susie longs to be the active, energetic person that she used to be.
She can't go down to the basement to do laundry. She struggles getting dressed. Walking dogs and riding horses (her passion) are out of the question for the owner of Critter Sitters Pet Sitting. Opening a can of black olives with a manual can opener is impossible.
The can slides on the white countertop as Susie tries to turn the steel crank. She adjusts her grip, but ends up using an electric can opener her sister found in a magazine. Jones also gave her a set of rubber grip coasters to keep things in place and a special stand that holds her hair dryer.
"It's hard to (dry) this side," Susie says, patting the right side of her auburn hair. "A curling iron, that's impossible! But I'm working on it."
Susie is waiting patiently for a robotic arm. She hopes to receive a myoelectric prosthesis that functions with her muscle movements in the coming weeks and then eventually upgrade to a Modular Prosthetic Limb that she can control with her thoughts.
Leslie Hershkowitz, assistant professor of internal medicine at Nebraska Medical Center in Omaha and a friend of Susie's, contacted Albert Chi, a trauma surgeon who works with war veteran amputees, on Susie's behalf.
Susie traveled to Johns Hopkins Hospital in Baltimore, Md., in June, where she underwent Targeted Muscle Reinnervation (TMR) testing under Chi's direction. He determined that Susie won't need TMR, a surgical procedure to reassign the nerves that controlled her arm and hand. She'll be able to put on a robotic arm and, with training, control it.
"Your shoulder, your elbow, your wrist turn back and forth; and your fingers close, pinch and point," she says with a wide smile, as she mimics the motions with her left hand.
In the meantime, Susie is doing what she can. She vacuums and dusts around the house and goes to her acreage to brush and walk her beloved horses: an Arabian, two American Paint, and an American Quarter.
"I don't take for granted my breathing, my sadness, my happiness," she says. "When I go outside in the breeze, I'm thankful that I have another day."