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Rubbing Salt in the Wound

Steve's SSI Added Insult to Injury & Changed His Approach to Making Healthcare Decisions

Steve Benjamin, avid heli skier, whose experience with a painful SSI helped inspire and inform the development of CleanCision. Photo courtesy of Steve Benjamin.

Meet Steve Benjamin, a commercial real estate developer, married for more than 30 years, with two children and two grand daughters. An avid athlete that loves high adrenaline sports like heli-skiing, water skiing, cycling, and more, Steve is not one to shy away from a challenge or an adventure.

An engineer by training – Steve is a problem solver who looks at things from a systems point of view, evaluating facts, requirements, and data.

More than 15 years ago, when he was diagnosed with colorectal cancer and surgery was prescribed, he faced his diagnosis with an engineering mindset – learning everything he could about his upcoming surgery and preparing himself for it.

However, there was one thing he did not anticipate: developing a wound infection at the surgical site. That infection would cause serious complications that would change his life.

He graciously agreed to share his story with us to help the medical community understand the impact of surgical site infection on the patient experience.

Steve is one of several patients that inspired and informed the development of CleanCision.

In technical terms, surgeries are called successful if they succeed in their original purpose -- in your case a colon resection that removed cancer. However, you developed a surgical site infection (SSI) after your surgery. Did that change how you viewed the success of your surgery?

The best way I can say it, is that getting an infection after you’ve survived a difficult surgery, is adding insult to injury.

I had a bowel resection to treat my rectal cancer. And basically, if you’re operating on the human sewer system, there’s a good chance there’s going to be an infection. For the type of surgery I had, I know the rate of infection is much higher than with other types of surgery.

Will you share with us a little more about your personal experience?

Yes. I’d like to because I am hoping it will help make people who are getting surgery more aware of what risks face them, as well as how to choose a hospital that has really excellent programs for preventing infections.

My surgeon was deeply concerned for me when I did develop the infection. To him, it was like the surgery wasn’t a success, even though he did succeed in removing the cancer, saving my colon, and saving my life.

My family and I were very happy when we found out that I had made it through the surgery and that the cancer was gone. I would do chemotherapy just as an insurance policy. The surgical wound was closed with staples and I was recuperating pretty well in the hospital.

A few days after surgery while I was still in the hospital, my surgeon looked at the wound and said that things were not good and that I had developed an infection at the site of the incision.

What was your initial reaction?

Well, I had no experience or knowledge at the time of what this type of infection could do, so I wasn't really alarmed.

My surgeon told me he was going to have to take out some of the staples out and let it heal “from the bottom up.” I was in the hospital and they knew what to do to treat it. I had pain medication and was comfortable all things considered. I figured it would all be okay.

But, hey, what did I know...

So what happened as they began to treat the infection?

Well, my six-day hospital stay became a nine-day stay.

They had to remove the staples and stuff the wound with gauze – a lot of gauze. The gauze was changed twice daily. Things seem to proceed normally from there.

When it was time to be discharged, they told me that I would still need to take care of the would infection myself. "Okay," I said, "What does that entail?’ I don’t think I was fully prepared for the answer

They informed me that I would have to dress the wound twice a day. Dressing the wound didn’t mean putting on a bandage on it. It meant that every morning and evening, I would have to take the soiled gauze out of the wound and put clean gauze in to keep it from becoming infected again.

What was your reaction to that?

I remember saying to the nursing staff, "You mean I’ve got to pull all of this stuff out of a hole in my gut – twice a day?!"

They said, "Yep, that’s basically what you have to do. We can send a nurse over to help you."

Photo Credit: Savvapanf

I definitely did not want a nurse coming over twice a day to take out the gauze and dress the wound. I had young children at the time. It was bad enough they knew their dad had cancer and had been in the hospital. It would be more traumatic for them to see a nurse come to the house not once, but twice a day. It would send a message that I was still really, really sick.

If you’ve never had bowel surgery, then you can’t imagine how unpleasant it is to have an open wound to deal with at home. I didn’t want anyone in my family to have to deal with it, so I decided to change the gauze myself each day.

That does not sound like an easy job. What was it like for you?

What is hard about it is that mentally you confronted by the fact that you've got this deep, deep hole in your gut.

You have to reach in to pull out the old gauze. Clean the wound. Put in the new gauze and a little piece of tape over it. So every morning and every night, I took out the soaked gauze from my abdomen and replaced it.

Eventually, it was time to go back to my surgeon for follow up.

It doesn’t sound like the story ends there. What happened at the appointment?

I was able to drive to the appointment. I had been recovering fairly well. All in all things were going well. Or so I thought.

When I lay on the examination table and heard him say a pretty bad word that started with an “F.”

I told him, "When you use a word like that, it can’t be good."

He said it wasn’t good. And in fact the wound was infected, again!

He was very unhappy and upset and asked why I hadn’t told him about what was going on. I honestly didn’t even know it was infected. The wound didn’t have any bad smell. And, if I, as the person who was changing the gauze every day, hadn’t known, then who would have, other than a surgeon.

I’m sure that wasn’t what you expected. What was your state of mind after hearing that?

Well, I’m a very logical guy. I like to try and stick with the facts in front of me. I assumed there would be a pretty straightforward treatment for my infection, like more antibiotics.

But, what he said shocked me. "Sorry Steve but we’re going to have to open this up to clear out the infected areas and then let it re-heal."

I was pretty unhappy. I asked if that meant I would be going back to the hospital. He said, "Nope, I’m going to open it up right here. I’ll just cut along the dotted line."

After a few painful injections to numb the site, he began poking around to make sure I didn’t feel anything, then he got his scalpel and began to clean out the infection. Once that was done, he did the routine I had become all too familiar with – stuffed my wound with yards and yards of gauze. I would be back to changing that twice per week.

"Then, as he was working through the gauze process, I heard him swear for the second time. "Steve, I’m so sorry, but in addition to the infection, you now also have an incisional hernia that we’ll have to repair.""

So more insult to injury then?

Absolutely!

To start with I just couldn’t believe I was in for more wound treatment. When it was time to change the dressing that my surgeon had applied, I started pulling out the gauze and it just kept coming and coming!

Yards and yards of scarves like yards and yards of gauze. Jimmini the Magician. Photo by Isabelle Dubois

"You know that trick where magicians pull yards and yards of handkerchiefs out of their mouths or hats? Well imagine that being pulled out of my abdomen. It was unbelievable. I remember saying to myself, ‘Holy crap, I am going to have to do this for weeks and weeks until this heals."

Also, knowing that I had developed that hernia was as difficult as dealing with the infected wound. That hernia was not a minor inconvenience. It ended up being another serious complication of the infection and had a huge impact on my life. It added a lot more trauma to what was already a difficult diagnosis and a very difficult treatment process.

I’ll never forget how deflated I felt that evening as I drove home from the hospital. And I was driving a stick shift car. (Some of us still love stick shifts!)

It was a pretty brutal drive home. I had gotten through weeks of painstaking care of the wound on my own, only to be hit with more bad news.

Then I would still have to go through chemotherapy to treat the cancer, followed by another surgery to repair the abdominal hernia.

Did having an SSI influence your decision on the type of hernia surgery to have?

My experience with the first surgery and resulting infection definitely steered me toward a laparoscopic surgery. I went that route because I thought it would be less traumatic than the major surgery I had for colorectal cancer.

At the time, I didn’t realize that open repair would have been a better longer-term solution for me. Certainly, the open repair would have looked better! Today, I have a lumpy keg in my belly. I don’t actually care about the look, since at my age I’ve given up six-pack abs. But it drives my surgeon nuts. He and I became friends after my cancer surgery and when we’d go biking or swimming, he'd see the bulge in my abdomen and wanted to fix it for me. But there was no way I wanted another abdominal surgery!

Then, about four years ago I had to have surgery on my back for a disc problem. There was some concern that the disc problem was partially a result of weakness in my abdominal wall created by the hernia repair.

Do you make your healthcare decisions differently today because of having experienced an SSI and the resulting complications?

Definitely.

When I had subsequent surgeries for things like my disc problem and an ACL tear, I decided never to go to a hospital for surgery on those – even a well-known one, because the risk of infection is just higher at a hospital. I choose outpatient facilities that have very strict infection prevention protocols and no reports of infection.

When my wife needed some surgery, we chose the doctor, not only for his skill, but also because he operates at a facility that has its own HVAC system and has very rigorous infection prevention methods.

Whenever anyone I know comes to me for advice about this kind of thing, I tell them how important it is to look at infection rates and to choose a facility that is known for its ability to prevent them. It’s just not enough to have a good doctor.

Is there any additional insight about your experience that you feel could help surgeons and hospitals better understand the impact of an SSI?

Good surgeons really do focus on solving problems just like my surgeon did when he removed cancer. They should also not present a surgical site infection as a minor complication.

I understand that wound infections are viewed as unfortunate potential outcome of some surgeries. As you can see in my case, an infection is not a minor inconvenience, or an unfortunate outcome. An SSI can be a life changing event that adds considerable pain and trauma not just to the patient, but to a patient’s family.

"Whenever anyone I know comes to me for advice about this kind of thing, I tell them how important it is to look at infection rates and to choose a facility that is known for its ability to prevent them. It’s just not enough to have a good doctor."

I also want to say that treating my infection cost everyone an incredible amount of money. I don’t know exactly how much it cost the hospital, but things really add up when an infection develops, for example:

- My hospital stay was only supposed to be six days, but was extended to nine.

- I had a lot of follow up treatment visits and additional procedures as part of the infection treatment.

- I had another surgery to repair the damage caused by the SSI

I would encourage all hospitals and surgery teams to question if they are doing absolutely everything they can to keep patients safe from this kind of infection.

It would be helpful if hospitals, nurses, and surgeons could be incentivized when they reduce infection rates. It will encourage them to try different approaches and technologies that can better prevent these infections from occurring.

Did you know that your experience became one of the key reasons the CleanCision technology was developed?

I eventually came to know my surgeon as a friend and he told me that my experience was part of the reason that he wanted to come up with a better way to prevent surgical site infections. I was lucky to have someone who cared so much about my well-being. If he could have prevented my infection, I know he would have.

If sharing my experience is part of the reason that this technology is out there today to help others, then that is a really good outcome from what was a very difficult experience for me and my family.

I hope telling my story helps hospitals understand the trauma of surgical site infections on patients and their families. I hope it motivates them to keep seeking new ways of stopping these infections!