A free yacht and a lesson about how a trivial issue can become.........

[Sgeir]

Apologies if this has already been posted, but this is a remarkable story of injury and rescue in the Pacific. For those not on FaceBoook (https://www.facebook.com/bill.shaw/posts/10210418186833528), I have pasted it below.

While Bill Shaw has written that his sailing days are over and that the yacht is free for anyone who can recover her, many cruisers have responded with the hope that his yacht is salvaged and that Bill at least should be given the opportunity of resuming active ownership (http://www.cruisersforum.com/forums...l-32-free-for-taking-fiji-pacific-174101.html).

His story is a very good example of how a minor issue can have near catastrophic consequences. This is the story:

11 October at 10:13 ·
Start with the obvious: s/v Galena, Westsail 32 # 511, my home for the past decade or so, has been abandoned at sea. As far as I'm concerned, she's gone.
What happened, as near as I can recall at this point follows. Read if you like. I'm going to crawl into a bottle of rum for a bit. See you all on the other side.
I much anticipated my departure from Savusavu, Fiji. I'd been there far too long. The refits we're all finished. She was provisioned and ready. My plan was to leave on Monday the 3rd of October.
But on the 30th of September I foolishly dropped my aluminum dinghy on my foot.
It just hurt. No broken bones. No broken skin. Hell, didn't even leave a scrape on the skin. The foot was a bit swollen the next day. But still no discoloration, no indication of anything serious.
I decided this was a minor incident and didn't let it affect my departure plans; including my going away party on Saturday, which was a fantastic party.
Sunday, 2 October, just a little discoloration to go with the swelling. Still no big deal.
I departed Fiji as planned on 3 October. Foot sore but not really and impediment to sailing.
On the 4th day out, it starts to go bad. There are suddenly large blisters on the skin on top of my foot. They quickly pop and I soon have blood and fluids pouring out of me. The blisters keep forming and breaking and now they are bloody. I become concerned about infection. I apply OTC antibacterial ointments. I pour hydrogen peroxide over my foot.
The next morning, 7 Oct, after a night of excruciating pain, I am convinced I need help. I'm at the point where I ask to be evacuated or I lose my foot. At 1000 hrs local I activate my EPIRB. At the normal 0300Z Pacific Seafarer's Net call, I reported my status. I asked Peter, ZL1PWM, to see what response my EPIRB has generated.
The answer was a frustrating, "Not much." This was 5 hrs after activation. Rescue Coordination Center, Wellington, NZ, had immediately responded by notifying RCC, Suva, Fiji. I was in Fiji's area of responsibility. RCC Suva was "deciding" what to do.
I was expecting medivac. Nothing was happening. Peter had RCC, Wellington put some pressure on Suva. Suva responded by "asking Chinese fishing boat to stop by and "see what I needed. "
But now everyone knew what my problem was. I was in extreme pain, blood and plasma pouring out of me. A foot infection that had me worried about dying not just loosing my foot. I needed to be evacuated to a hospital. ASAP.
It's sunset on the 7th October. The only light is Peter. ( https://www.northlandradio.nz). All night I'm getting advice over the radio. Much was well intended but of little practical value. Peter even gets US search and rescue to put pressure on Suva.
By now I'm sailing back toward Fiji. Unable to properly sail Galena, I'm relying on a balky Aries wind vane. And for the most part it's holding course.
Evening of 7 October and Suva finally commits to sending a navy patrol boat. They promise it will depart Lautoka at dawn. At Dawn? Why not now? It has a max speed of 14 kts, I'm doing 4 towards them.
So another terrible night. I've declared distress on both satellite (EPIRB), HF, and VHF. New Zealand, Australia, the USCG, they all have my story.
Morning of the 8th. Suva says a fishing boat has agreed to come to my aid. Sure enough, a Chinese fishing boat comes up on VHF mid morning asking, "You got problem?" I asked they had doctor on board. "This fishing boat. No have doctor." I ask can they transport me to a hospital. "This fishing boat. We fishing."
And then I find out that suva has not released the Navy boat yet. I'm frustrated beyond measure. I'm crying; I'm screaming. I'm telling everyone on the radio to just go to hell.
Seas were from the east at 2.5m, winds 090 at 20-25. Galena had a full main and staysail up trying to hold 190. She was crashing along at 4.5 - 5 knots. To say it was a rough ride is an understatement. I'm barely able to hobble up the companion way ladder. I'm clearly unable to reef or change sail plan.
Peter gives me the radio frequency for RCC, Suva. Probably not a good idea. I "talk" with them. They now promise that the Navy boat will rendezvous with me at dawn, 9 Oct. One more night. USCG Fairbanks comes up and try to help by asking questions. They want to know if I'm wearing a PFD.
I'm now having hallucinations. That's a night I barely remember.
Before dawn I grab a backpack and start collecting person effects: passport, boat papers, a computer, a backup hard drive. A clean t-shirt. Then I think, what if they let me bring another bag? I'm looking around my little cabin. What do I want to see? Nothing seemed important to me. It was all just stuff. The most important things I couldn't take. Like that Icom 802. Best radio on the market. Or the Vesper Marine AIS.
What would I be doing for the next few years? I pulled up the V-berth cushion opening the forward most hatch. There was my Bear compound hunting bow. One neat package. Easy choice.
At dawn there was the navy patrol boat. They sent over an inflatable. I threw in my bags. And jumped in. I gave Galena a final salute.
The Navy doctor made me more comfortable and dressed my foot. The crew and Captain took excellent care of me for the 9 hour ride back to Lautoka hospital.
The hospital ER Doctors said I should have come in sooner. They started talking about possible amputation. I started to explain that I has put out the call for evacuation over 3 days ago. But what's the point.
My arrival on Sunday marked the start of excellent care. Pain meds, IV antibiotics, attentive staff.
Monday morning the doctors did the surgical debridement. I got a spinal block. I came away with my toes in place. The doctors said it should heal but may need grafts as most of the skin on the top of my foot is gone.
Tuesday, 11 Oct, was a day of rest, injections, bad food and flirting with nurses. And lots of sleep.
I booked a flight for Wednesday night to Las Vegas. There I'll settle into the care of my sisters and the peace of zero responsibility.
I always said the boat was tougher than I was. This week proved it.
Galena is adrift in the South Pacific Ocean. Galena's last known position was
15 34.6S, 177 33.1E
1900 hrs, 6 Oct UTC
Winds East at 20
Main and staysail up, sheets to the wind, Helm tied to leeward.

 

[Tammany]

He was lucky, blood poisoning can kill quickly and he was almost at that stage. On a similar note my mums friend was a volunteer at the local hospital wheeling around the library trolley. He stubbed his toe on the trolley one day and like this chap thought nothing of it. Too cut a long story short his leg was amputated within 2 months. Infection set in that eventually went gangrenous and bit by bit they took parts of his leg away.
The human body is so much more fragile than we think and we all take ourselves for granted. Has to be one of the big risks for lone voyagers, even younger ones.

 

[prv]

What's surprising to me as a non-medical person is that an infection like this can set in despite not breaking the skin. Assuming it's a bacterial infection, where do the bugs come from?

The story does highlight the potential importance of the heavy-duty ocean medical kit - if this guy had been able to self-administer serious antibiotics on the advice of a doctor as soon as he first called for help, the condition might never have got so bad. And if it did anyway, at least he'd have had some decent painkillers available.

Also emphasises the difference in response between European coastal waters and the Pacific islands, and the importance of having good long-range comms in that part of the world.

Pete

 

[RichardS]

What's surprising to me as a non-medical person is that an infection like this can set in despite not breaking the skin. Assuming it's a bacterial infection, where do the bugs come from?

Pete

I would also appreciate a medical response to that question. I am aware that microbes contained in the gut or intestines can create serious internal poisoning if they get into the blood stream but where do the bad bugs in the foot come from?

Richard

 

[Deleted member 36384]

I was packing boxes, new boxes supplied by the moving company and I was wearing my shorts. I leaned over a box stumbled a bit and hit my shin on the top edge of cardboard box. It hurt a bit, the way shin bone that has hardly any buffering of flesh can hurt. I cant quite remember if there was a scrape or not, recollection suggests there was an abrasion but I am not sure. Anyway, to cut a long story short about 2 week slater it had not healed and is slowly getting worse. I am using sensible stuff like 'Savlon' and sterile bandages, not painful but not healing either. It was just a sort of hole, not really spreading, trying to scab over but failing. At about week 3 it is now looking as if it has expanded. I mark the edge of the red area with a pen and go to work, by lunch time the red area has advanced beyond ink and I decide to go to the doctor. They cut bits out and then dose me with an anti biotic and it clears up, now got a big scar but apparently I was lucky as the infection did not get into the bone. The doctor advised that these things happen and people used to die of simple things like this.

 

[Tammany]

I would also appreciate a medical response to that question. I am aware that microbes contained in the gut or intestines can create serious internal poisoning if they get into the blood stream but where do the bad bugs in the foot come from?

Richard

Pulled from a medical website. It also mentions you are more prone to infected bruises if you suffer from diabetes or have an existing minor infection such as tonsillitis

The blood under the skin which causes the discoloration of bruising should be totally reabsorbed by the body in three weeks or less. But sometimes, there is formation of hematoma because of blood trapped in tissues. This blood may need to be drained lest some infection develops. Less commonly, it may develop calcium deposits at the injury site in a process called heterotopic ossification. This is more serious.

 

[AndrewL]

I asked my wife who, is a doctor, about this.

She went into more detail than I understood but the basics were. People occasionally have bacteria in the bloodstream, introduced through wounds, cleaning teeth and bleeding gums etc. It may cause no problem as it is soon detected and killed by white blood cells. But an injury, eg the dropped dinghy, can cause some internal bleeding and the blood +bacteria to collect. It is now outside the bloodstream so the bacteria is not detected and killed, it multiplies and soon you have a serious problem.

 

[prv]

people used to die of simple things like this.

Indeed - if I remember rightly, one of the first tests of penicillin was on a man who was seriously ill from an infection originally caused by pricking his finger on a rose bush! The penicillin helped dramatically and he started to recover, but this was before they had started proper production of it - the small test stock ran out, they weren't able to produce more quickly enough, and without it the patient relapsed and died.

The worry is that with indiscriminate use of antibiotics helping to breed resistant bacteria, we're at risk of returning to something like that world.

Pete

 

[Hydrozoan]

Indeed - if I remember rightly, one of the first tests of penicillin was on a man who was seriously ill from an infection originally caused by pricking his finger on a rose bush! The penicillin helped dramatically and he started to recover, but this was before they had started proper production of it - the small test stock ran out, they weren't able to produce more quickly enough, and without it the patient relapsed and died.

The worry is that with indiscriminate use of antibiotics helping to breed resistant bacteria, we're at risk of returning to something like that world.

Pete

He was Constable Albert Alexander; I posted about the 75th anniversary of his death earlier this year, with a link describing the events in some detail:

http://www.ybw.com/forums/showthrea...d-antibiotic-development&highlight=penicillin

 

[johnalison]

It is true that we all have occasional bacteria in the blood as described above, and this could have been the source, though any substantial contusion could also have broken the skin microscopically, which would be sufficient to give bacteria ingress. Although blood contains cells and compounds which kill or inhibit bacteria, blood itself is very nutritious, as those of us who enjoy black pudding will testify. Blood is added to some lab culture media in order to encourage bacterial growth, so any collection of blood outside the circulation can become a focus of infection, which is presumably what happened in the original case here. One remedy for a bruise is to drain it off, but this also raises the possibility of actually infecting the bruise.

 

[JumbleDuck]

The doctor advised that these things happen and people used to die of simple things like this.

Hence Susan Walker's obsession with iodine in the Swallows and Amazons series. It reads a bit oddly now, but we forget just how serious even small infections used to be. And will be again in due course, alas.

 

[tudorsailor]

Terrible story but with relatively happy ending. Of course we do not know all the facts. The most important fact is what bug caused the infection. Since there was no yellow pus/abscess it is unlikely to be a staphylococcal infection. Blood and fluid pouring out sounds more like strep. Yes, one can get bacteria in the bloodstream after cleaning your teeth but these are not the bugs that generally cause superficial infections.
The worst infection is a mixture of bugs. This causes necrotising fasciitis AKA flesh eating infection. This is excruciatingly painful and the sufferer is seriously ill. It can and does kill. One has to sometimes amputate to save life - I have done this.
I do not think one can self medicate with antibiotics without really knowing what is the likely infection.

The really worrying aspect of this story is the failure to get help having activated his EPIRB. I think Bill is lucky to be alive and have both legs

TudorSailor

 

[prv]

I do not think one can self medicate with antibiotics without really knowing what is the likely infection.

I wasn't suggesting that someone in this situation self-prescribe - but he had long-range comms and should have been able to get what the Ship Captain's Medical Guide refers to in red letters as Radio Medical Advice. One assumes that the doctors on call for that service are aware of what's in the MCA Category A medical stores and are able to advise on the correct treatment.

When I used to sail in Stavros, the medical store was a walk-in cupboard below the wardroom. The crew on board weren't qualified to prescribe much of what was in there, but they had a satphone and an arrangement with a specialist medical service in Switzerland who could. Same idea on a smaller scale for yachts - consultation and instructions can travel over the air, but the drugs and equipment need to be pre-positioned just in case.

The really worrying aspect of this story is the failure to get help having activated his EPIRB.

Sadly not unheard of on the empty side of the world. Or really anywhere that a poor or disorganised nation has ended up as the official rescue coordinator for an area. You hear stories of official government rescue or even naval craft unable to put to sea until a friend of the missing person arrives to buy them some diesel...

Pete

 

[Greenheart]

And so...

...where's the boat?