SPECIAL PRESENTATION of Scared All The Time: Flesh-Eating Bacteria

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People love Vital Proteins. In part, because it's so easy. Just mix it into your coffee, tea, or a smoothie, and you're good to go. And now, you can get 20% off the next order at VitalProteins.com by using promo code WIDEOPEN20 at checkout. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Astonishing Legends Network. Hey guys, Chris and Ed here for Scared All the Time. With Astonishing Legends' main episodes on hiatus until January, the star-studded talent of the Astonishing Legends Network is coming to the rescue to make sure you don't go too long without high-quality entertainment over here. So allow us to introduce ourselves for any of you who may have not found what many have called AL After Dark. Because, you know, in our episodes we swear and we drink and that's a totally different animal. But maybe people need that right now. Maybe people need that for the holidays. Scared All the Time is a monument to our intrusive thoughts. A way to laugh at all the things that keep us up at night. I am a horror writer who can't stop thinking about scary things. And Ed is a comedy writer who is scared of everything. So each episode, I present a new fear to him to learn and laugh about. So far, we've covered everything from plane crashes to clowns, spiders to elevator disasters, gang stalking to dolls, and mind control to horrible Christmas monsters. We polled thousands of fans on Instagram and Facebook, shout out to the squad, to see what episodes that they thought would be best to introduce more Astonishing Legends listeners to our special blend of Mystery Science Theater 3000 meets Unsolved Mysteries. Or Unsolved Mysteries 3000. And they were torn between our homunculus episode and our episode on flesh-eating bacteria. We were thrilled because both episodes are gross and weird, which is sort of our specialty. But which felt more astonishing legends? Flesh-eating bacteria for its fact-based infotainment? Or homunculus for its legend-based legendariness? Ultimately, we decided to go with flesh-eating bacteria because we figured at least most of you would know what that is. It's also shockingly more terrifying and less gross somehow than homunculus. And you know what? The story of those little creeps will still be there after you finish this one. So we hope that you enjoy all that the network has to offer over the holidays, and we'll be keeping your seat warm over at Scaredy Cat HQ for whenever you're ready for more humor with your history and funnies with your fears. Until then, enjoy Scared All The Time's special presentation of flesh-eating bacteria. Disclaimer. This episode includes the usual amount of adult language and graphic discussions you've come to expect around here. But in the event it becomes an unusual amount, expect another call from me. Welcome back to Scared All The Time. I'm Chris Kalari. And I'm Ed Vakola. And this week, we're diving into a topic that is sure to make your skin crawl right up until it begins to rot away. Ew. That's right. You hit play. You know what you're in for. We're talking flesh-eating bacteria this week. This is one of the gooeyest and goriest topics we've ever covered, and let's just say you're lucky that podcasts are an audio medium because the imagery associated with this topic is unforgettable in the worst way. The audio probably is too, but we had trouble recording the sound of meat hitting the ground with a thick enough splat, so you'll be spared. Also, in this economy, we can't afford to toss meat on the ground. While flesh-eating bacteria sounds like something out of a horror movie, it is very, very real and very, very gross. But how likely are you to catch it? If you do, can you be saved? Or are you doomed to suffer one of the worst deaths imaginable? Today, we separate fear from fiction and meat from the bone as we explore the world of flesh-eating bacteria. What are we? Scared. When are we? All the time. Join us. Join us. Join us. Now it is time for... Time for... Scared all the time. Ed. Yeah. Have you ever wondered what it would be like to star in your own personal body horror film? No. I'm not even like a Cronenberg guy, so this is gonna... I'm glad there's no visuals. You don't ever think about your flesh melting or your meat leaking? Now I'm never gonna stop thinking about the term meat leaking. I don't know. Sometimes I get... Oh, here's Intrusive Thoughts Corner with Chris. Let's go. Yeah, I don't know. Maybe they are intrusive thoughts. I get wrapped up sometimes thinking about how, like, squishy and malleable all our skin and flesh and muscle is, and there's, like, so much liquid rushing around inside of us, and we're so easily destructible. Yeah, I think us and the planet Earth are, like, a huge majority water. Yeah, and so we're just like... I mean, we're really tomatoes. Oh, God. Tomatoes. It's the suicide bomber of sandwich toppings. What? Yeah, you ever put, like... Like, if I'm ever gonna eat a sandwich that I know I'm gonna eat later, I always ask that there's no tomatoes on it, because for some reason, like, once you put them in the fridge, you come back and everything's just, like, red and wet. Like, I don't know what happened, but the tomato just explodes at some fucking point. Okay. And the sandwich is just sopping wet, so I always... Yeah, I don't put tomatoes on anything I'm not gonna eat right away. All right, I get it. That makes sense. I can't quarrel with that description. Um, I can't imagine, you know, I know, as our listeners know, we often start with personal experiences with the topic. I can't imagine you have much personal experience with flesh-eating bacteria, do you? No, I've had experience with bacteria in the sense of, like, when I played sports, you'd get... Things would get weird. You'd get, like, athlete's foot or jock itch or whatever, and I imagine that's bacteria-based. I don't know. Um, but luckily it wasn't, like, I didn't come out and be like, well, my foot's gone. Right. It's just bone. Yeah. So, luckily it was... It might get itchy or stinky. Yeah. But not rotty. Yeah, but I know that the skin, from that, it seems like the skin is... It's pretty... It's really ready to be... Yeah. It's ready to get fucked up. Yeah. I mean, I've had infections. I've had, like, nothing that I've ever had to go to the doctor for, but I'll, like, get a hangnail that gets infected or, like, a toenail. I had to go to a doctor for one of the things I just mentioned. It was just, like, things were too itchy. For your feet? No. It was, like, for a jock itch situation. Oh. And I remember being, like, telling my older brother, I'm like, it's just, everything is a nightmare down there. And he was like, oh, okay. So, we'll go to the walk-in clinic. I don't know why I didn't just go to my mom with this. And then the doctor I got was like... Now that I'm old, I'm like... The doctor was definitely, like, a 20-something-year-old girl. I just remember being, like, so embarrassed when I went in. Well, that's why you didn't go to your mom about it. No one wants to go to their mom about jock itch. No. I mean, I go to my mom about a lot, but... I mean, I guess you go to your dad about it. I don't know what... I probably would have gone to a priest. No. I mean, everything else always seemed to be like, all right, well, you shower and stuff and you're fine. For some reason, this was... And they put me on, like, antibiotics and stuff, but... Yeah. Yeah. I mean, that happens. I think almost everyone's had some kind of a bacterial issue or an infection issue at some point. But boy, oh boy, after this episode, are we all going to learn to wash our hands and keep a close eye on infections because, good God, can it go bad really quick? I have two things I wanted to bring up before we start. Neither of them are personal experiences with flesh-eating bacteria, but I wanted to talk about my introduction to this topic because I'm pretty sure the first time I ever thought about flesh-eating bacteria was after or when I saw Eli Roth's movie Cabin Fever. I've never seen it because I know it's gross. It is gross. And I don't love Eli's trajectory as a filmmaker, but Cabin Fever is still this very weird piece of horror detritus from the early 2000s that I have come back to more times than I ever thought I would. I was working at Blockbuster when that came out. And well, like, it was on the shelf at least. And I had to, like... I remember people would rent it. Like, couples would rent it. And then they'd come back and they were like, it's gross, bro. And they'd break up. I think they broke up, yeah. I mean, Blockbuster, I remember, made... Part of the reason I think Cabin Fever has stuck in my memory and whatever is, like, between Blockbuster and Ain't It Cool News, Cabin Fever felt special. Like, I don't remember why. I think because it was presented by Peter Jackson. It was one of those, like, Peter Jackson presents. And I think there was something about the fact that it was a... I'd watched enough horror at that point to be familiar with Cabin in the Woods as a genre. And I was struck by how odd it was. And it's not really that weird. But I don't know, to my freshman, sophomore, and high school brain, it was weird to me that it was a Cabin in the Woods horror movie that wasn't about demons or monsters. It was about this flesh-eating disease. If you haven't seen the movie, not too spoiler-heavy here, but it is a Cabin in the Woods horror movie. But the threat is biological. A flesh-eating virus gets into the water, and anyone who drinks it gets really sick and is going to have a real bad time. And, of course, a bunch of college kids go out to this Cabin in the Woods, and they all fall prey to it. And I think it appealed to me because it was gory and gooey, and I was at that phase where I was trying to make, like, homemade gore and stuff, you know, for my movies. So I was like, oh, wow. And it didn't seem like a movie I could make because it seemed way too flashy and cool and, like, well-produced for that. But, and I had the vibe of something that I could get close to. But it also stars Ryder Strong from Boy Meets World. Which, yeah, which we had to see his follow-up to Boy Meets World. And then he never really did anything else. He didn't really do anything before Cabin Fever either, it seems like. It seems like Ryder Strong is Boys in the Hood. My God. Is? That would be a very different movie. Is Boy Meets World, Cabin Fever, and then nothing. Yeah. I did see him at Trader Joe's a couple times. I think he used to live in my old neighborhood. Now I should have. You should have. You could have added to his IMDb. His very bare, it sounds like, IMDb at this point. Maybe, maybe I could try to cast him in something. You gotta write a Ryder Strong vehicle. Ooh. I like this idea. Well, anyway, the movie Cabin Fever, it's no surprise that it didn't really launch Ryder Strong into the stress sphere of leading men. He's fine in it, but the movie is this weird combination of, like, an actually pretty funny teen college comedy combined with this viciously mean horror movie, and it has some very weird, almost dreamlike elements, like this one kid who sits out on the porch of a general store and demands pancakes, and when he doesn't get them, he starts doing karate. To this day, I don't know if it's supposed to be, like, funny, or if it's supposed to be unsettling, or maybe it's just, I know Eli Roth was David Lynch's assistant for a while, so maybe he learned about the, like, you know, put elements from your subconscious into the movie or something. Oh, wow. Sure. But Pancake Karate Kid feels a lot like possibly a Lynchian element. Anyway, one particular visual in the movie has stuck with me for a long time. I think it's maybe the best moment Eli Roth has ever pulled off in his filmography. As the college kids talk about what this flesh-eating virus can do to your body, the camera is just pushing in on one of them, who is slowly playing with, like, a string of honey that they put between their fingers, and they're kind of, like, smushing it and pulling it back out. And the dripping of the honey as they're talking about how fucked they all are is very effective, as far as a visual goes. It's also an effective way to get ants. Yeah. There's also a moment that you would categorize as one of the reasons you probably haven't ever seen this movie, and this is a spoiler alert, I guess, if you haven't seen Cabin Fever, but I think is worth spoiling because it's very gross. There's, I think it's one of the great, all-time great gross-out moments. One of the cast members, she knows she's sick, so she kind of takes this bath that is very much, she never says it, but it's very much like the last bath she's ever going to take. And she's soaping herself up, and she shaves her legs, and she covers her legs in shaving cream. And then as she starts shaving them, her skin comes off with each stroke of the razor. What do you mean with each stroke? First stroke, I'm done at that point. Well, yes. I mean, it's a movie moment. She's crying and, you know, shaving her legs, and she knows she's going to die, and it's really stomach-churning. And the sound of the skin coming off as she shaves is... And, you know, they had to hire some Foley person who's like, all right, listen, Eli, I finally found it. It's like a piece of nail running over a cabbage. Like, they do amazing work, those people. God bless the Foley artists. I've never, based on what you've said so far, I think I'm going to stand steadfast in my commitment to never watch this movie. I've seen Outbreak, okay? I feel like I've seen... Yeah, Outbreak is pretty gross. ...a medical, fucked-up, terrifying shit that, you know, I remember seeing that movie. I saw it at home, but there's that scene in Outbreak where, like, they show that it's going into the movie theater. Yeah. And I'm just, like, being in the theater for that must have been so fucking unsettling. Yeah. That said, I don't think I've ever seen a single Eli Roth movie other than the Death Wish remake, which is not a strong film. Stinker. So, Cabin Fever, I think, was my introduction to flesh-eating bacteria, but I was never really worried about it or had any kind of interaction with it until last year when my wife's cat got bit by a spider. I think we might have talked about this in the spider episode, but it's a story worth repeating because it's very relevant to this episode. I would say the spider episode and Eatin' Alive will definitely have things we're going to circle back to from those episodes that have to do with, like, necro-flesh shit. Probably, yeah. I think so. But, yeah, so last year, last... This would have been September-ish, we came back from a trip back east and found that Anna's cat, Nico, had this weird lump kind of growing around his jaw, and one of my friend's dogs, Ellie... Alerted you to the issue, like Lassie? No, no, no, no, no. Oh. Ellie, who is not listening to this episode, probably because flesh-eating bacteria is his greatest fear, and when I told him that I was doing this, he was like, I'm going to skip that one. But Ellie's dog had just had, like, an infected whisker or something that had been, like, a lumpy jaw issue, and it had gone away on its own, so I was like, well, let's just wait and see, and this was, like, on a Thursday, and we were kind of like, well, if it hasn't gone away by Monday, we'll call the vet. Sunday morning, Nico jumps up on the bed, and there's photos of this in the show notes. Nico jumps up on the bed, and there's blood all down his chest. Like, it looked like he got hit with a squib or something, or, like, a bullet wound, almost. We should probably mention now, I should just ask you, on the listener's behalf, this is a show notes to just not open, right? Even, like, that photo sounds horrible. The Nico photos, I can't, there's no gross photos in the show notes. Okay, great. There's no gross photos in the show notes. Feel free to go to the show notes, people. Except for the Nico photos. So we, like, panicked and took him to the vet right away, and Nico, to his credit, like, didn't seem to think anything was wrong. To his credit? Yeah, well, he wasn't panicking or crying. Oh, sure. He was just sort of like, you know, he didn't seem to be too phased by any of this. I still figured it was just, like, a really big cyst, maybe, or, like, you know, something infected that had burst. The vet comes out after they clean it up, and she's like, you should, this is what's going on. And she shows us this photo that's in the show notes, a photo of the cleaned up wound. And this cat had a hole in its neck. Wow. Like, a eaten away hole that you could, like, stick your finger in, in its neck. I don't know how he was alive, honestly, at this point. And I didn't think he was gonna live. Now, it's time for Nico's last bath. Yeah, yeah, yeah, yeah. But Nico was a strong guy, and it healed up really quickly. It healed up in a couple of weeks, a couple of bandages, and some antibacterial cream, and Nico was back on his feet. The vet told us that the wound was probably the result of a spider bite. They thought brown recluse, but as we discussed in the spider episode, there are no brown recluse spiders in California. No, thank God, because I was watching something on the couch the other, literally, like, two nights ago, and I'm already in weird pains and stuff, and muscle issues. And I, everything got worse, because there was a brown spider, but, like, a thick, fat idiot, like, crawling on my leg, going up my, from, like, my calf over onto my knee, and I, like, flipped to, like, get the fuck away, like, ah, slapped at it, you know? And then I was like, well, everything hurts more now, because of that, like, instant flip. And then, of course, like, it escaped. Yeah. So, well, it wasn't a brown recluse. No, I know. I just, it's just, that just happened, so I'm bringing that in. Personal, horrific moment. But the point of the story is that the flesh in Nico's neck hole was necrotic. That's a, you love those dark, what the hell is that metalcore shit you're into, like, that you talked about last episode? Like, that sounds like a song title or a lyric. Oh, we're gonna hit a few more of those. There's one portion in particular where we'll highlight some band names. Yeah, for real. Jesus Christ. Actually, necrosis is a death metal band for sure. I don't know if necrotic is, but necrosis definitely is. Yeah, but is Nico's bloody neck hole or whatever? No, no, no. The point is that some spider venoms are necrotizing, and the vet thought that was the most likely culprit in this case, but it is possible that Nico was a victim of flesh-eating bacteria that entered through a bite or a scratch, unrelated to a spider. The medical term for this is necrotizing fasciitis, also known as flesh-eating bacteria or flesh-eating disease, and it affects cats, dogs, humans, and any other mammals, or probably reptiles, whatever, in much the same way. Necrotizing means it causes tissue death, and fasciitis refers to the fascia inflammation, which is tissue under the skin. Oh, boy. According to WebMD, the most accurate site on the internet. At least the most anxiety-filling, right? Like, people go to WebMD all the time, and they'll be like, what's wrong with my fucking leg? Cancer, cancer. It's cancer. It's tooth cancer. According to WebMD, these life-threatening infections affect skin, muscles, and soft tissue and cause patches of tissue to die. It spreads quickly and aggressively in an infected person, causes tissue death at the infection site, and can be deadly if not treated right away. Every year, between 700 and 1,150 cases are diagnosed in the U.S., and concerningly, rates have been increasing. Oh, no. This could be due to increasing awareness of the condition, which would lead to increased reporting. Like, there was a spike in 2019 of a couple, you know, when I say unrelated, it's not like the flesh-eating bacteria is, like, you know, coming out of a pipe in the ground. It exists out there in the world, but there were a couple of unrelated cases in 2019 where there was this media frenzy of, like, oh, no, the flesh-eating bacteria is out there. Oh, boy. It's just those orange tubes in New York City that, like, always have smoke coming out of the ground. Yeah, yeah, yeah. What is that? Do you think that's flesh-eating bacteria? So, this could be due to increasing awareness of the condition leading to increased reporting, or it could be increased bacterial resistance against antibiotics. Oh, wow. Yeah, as you know, I'm very bad at taking pills. Yeah. So, you have no antibiotics in your body. I never take anything. Yeah. And so, I think I was, like, 30 before I got my first pill down without applesauce. Mm-hmm. And so, yeah, even when I got my wisdom teeth out, I gave away those Vicodin. Like, I'm not taking these giant pills. You know what I mean? Like, so, I just kind of grin and bear it for most stuff. But now I can kind of swallow pills. But, yeah, so I wonder if I'm good, I guess, for a bit, if part of this is antibiotics. Maybe. It could be. One statistic, though, is concerningly consistent. Oh, good. Up to one in five cases of necrotizing fasciitis result in death. One in five? One in five. So, basically, when it gets going, it gets going. Yeah. Okay. And there's two types of necrotizing fasciitis. Fast and instant. Yeah. Yeah. Type one is polymicrobial, which is when more than one bacteria, usually a mix of aerobic and anaerobic bacteria or bacteria that thrives on oxygen and in oxygen-free environments, they can combine to cause an infection. Type two, or monomicrobial, is a form caused typically by one bacteria. Commonly, in this case, it's a Group A streptococcus or Staphylococcus aurorus bacteria, which is the same type of bacteria that causes strep throat. But several types of bacteria, including Group A streptococcus and Vibrio vulnificus, which is a bacteria that lives in water, have been linked to this disease. And an analysis of A streptococcus, the Group A streptococcus genomes, revealed that a series of genetic changes began to occur in the early 1970s. The final changes that took place before the strain became a voracious flesh eater happened around 1983, when less virulent strains acquired the genes that are needed to produce the toxins in humans that kill the flesh. So, at least with that one bacteria, something happened in the 80s, in the late 70s, early 80s, that turned it from just a strep throat causing bacteria into a I'll eat your flesh and kill your family bacteria. Wow. I mean, the 80s was a hell of a, you know, that was excess, excess. I'm going to blame Reagan. No, I'm not. It's, wow, it's just, it was, everything was bigger in the 80s. So, it's just a bacteria in a business suit, like screaming on the stock exchange floor. Yeah, yeah, yeah, yeah, yeah. And we should, I want to pause to note that technically, even though these bacteria have been coined flesh-eating bacteria, they don't really eat the flesh. Not in the way sinkholes eat towns. Not in the way that sinkholes eat towns. What happens is that when these particular types of bacteria get into deep tissue and reproduce, they release toxins that damage the tissues, which disrupt the blood supply and ultimately cause tissue death. So, your tissue, your flesh, your muscle will start to die at the site. And then as the bacteria multiply, the area of tissue death will gradually increase. The open wound develops, it grows in size, and it gives the appearance of the tissue being eaten, even though really what's happening is it's just dying. It's just dying from the inside out. Yeah. Yeah, it's dying from the inside out. It's the worst Pixar movie, dying from the inside out. Yeah, yeah, yeah. It's about an anxious streptococcus bacteria. Oh, my God, dude. It's just the inside out two trailer where it's like, who are these guys? And instead of anxiety. Yeah, inside out three is the streptococcus comes in and eats what's Becky or whatever the girl's name is. Shit, dude. Concerningly, no one knows why certain strains of these bacteria have evolved to do this, but they have. Life finds a way to kill. Yeah, and even worse, necrotizing fasciitis is most commonly seen at the extremities, so hands and feet, but also, very commonly, the perineum, which you and I might know is the taint. Yeah, you taught me that. Yep. That's a taint area for sure. The taint and genitals. I might have shown mine to that 24-year-old doctor when I was 17. You might have. The taint and genitals often suffer from this disease. Only a few cases ever arise from the chest and abdomen, although we'll touch on one of those chest infections later. Some kind of trauma is usually the cause of the infection, so intravenous drug injection, insulin injections, animal and insect bites, catheter insertions over the skin, or a fistula connecting skin to the internal body organs. What the fuck's a fistula? I don't know. I should have looked that up. I don't know what a fistula connecting skin... It's got to be inside our body. Yeah. I mean, a fistula connecting skin to your internal organs sounds like a medical problem in and of itself. Yeah, yeah, yeah. But yeah, a fistula might be... Who cares? But I'm never going to look it up. These are things I don't want to Google. And later we will touch on... Well, I think now is maybe a good time to bring up that this is literally one of the reasons that if you have any kind of a cut, bite, scrape, infected, you know, it sounds gross, but like toenail, anything. Yeah. Soap, water, peroxide. Because what's scary about flesh-eating bacteria is that the bacteria that cause this are everywhere. Like literally everywhere. Yeah. And they're rare, but they're... Like they're rare. Well, how is that? They're rare, but they're everywhere. Listen to what you're saying. What I mean is you don't have to fall into like standing water or something. Sure. Like the bacteria itself is rare, but it could just be on a kitchen counter. It could be in a car. Like, so if you have an open wound, even if it's a small little cut or a scrape and you come into contact with it, it can go in that wound and then you're going to have problems. I live for peroxide. I love it. Every time I get a cut... Yeah, a little sizzles a little. I like that sizzle. Yeah. And it doesn't sting. It can. I mean, when you're a kid, I feel like it was really stung. Maybe we just had worse peroxide then. Maybe. But I... Yeah, it depends on what I'm putting it on. It'll definitely sting like crazy. I mean, it's a little... But not like rubbing alcohol. No, but I just think we're adults who can handle it better than when we were kids. I guess, yeah. But it is... I like anything that shows activation. Yeah. Like anything where I'm like, oh, look at the way it goes. Look at... I mean, it's doing something. Clearly it's doing something. That's the endorphin rush. I've read... I forget what product it was. There's some home product. I want to say maybe like a laundry detergent or something that I read at some point. It doesn't really need to foam to activate. It's probably like a bleach that you spray in the tub or something. Yeah, but they've changed them so that they foam so that people go, oh, look, it's doing something. That's what I'm saying. If I was in that focus group, I'd be like more foam. Yeah, yeah, yeah. I like the way it feels to see something activated. Yeah. Like if you put not mentos in soda, but whatever, like what are we to clean pennies as kids? Like to just put it in vinegar is lame. Right. You want to sit there. You want to see some baking soda in there or something. So where were we here? Oh, yeah. The skin fistulas or whatever. Infections such as abscesses and ulcers can also complicate necrotizing fasciitis. And for infections of the perineum and genitals, trauma, surgery, UTIs, urinary tract infections, stones, and Bartholin gland abscesses are the usual causes. Sure. Of necrotizing fasciitis in your balls. Sure. Now, when I read that bit about necrotizing fasciitis occurring at the site of drug injections, it immediately reminded me of stories I've heard about a drug called Trank. Have you heard of Trank? I've never heard of Trank. Okay, Trank is bad. Yeah, I'm about to say. I mean, you could just say I mean, all needles are a problem. Yes, well, Trank is a drug that has made news in Philly and I think all over the world for creating zombies out of users. They call them zombies. Now, this isn't like bath salts that like, you know. Oh, my God. Remember bath salts? That was all over the news. Yeah, maybe we'll do an episode on bath salts. I feel like that was kind of an overhyped thing, but that was like a methamphetamine that people would like freak out and then one guy like ate another guy's face in Florida. That's the one that made the news. Yeah, so this is different. This creates zombies in the sense of people who, you know, are like wandering around, mumbling, staring off into space. You're saying the entirety of La Brea right now are Trank users? Well, and Kensington. There's a street in Philly called Kensington where there's been videos of dozens of people using this drug just who are out on the street and it looks like kind of a horde of zombies and part of the reason it looks that way is not only are they mumbling and staring at the sky and everything, they're covered in open flesh-eating wounds. Oh, wow. Like every place that they've taken Trank turns into a... Well, yeah. Like where they even... It can, yes, yes. It can become infected in the muscle and skin and tissue gets eaten away. My buddy's kid Jordan just moved to Philly, so if you're listening, Jordan, stay off the fucking Trank, bud. Yeah, I don't know. I mean, I feel like Trank's one of those drugs where you end up trying it if you have a really like deep emotional wound that you're like, I'd rather be almost dead, you know? Sure. I have an emotional wound that I would like to be more wounds all over my body. Yeah. But so I thought that it must be necrotizing fasciitis infecting these wound sites. It turns out that this is actually a little different. These wounds are centered around the injection sites and the flesh is necrotic, but in this case, the wounds are not caused by bacteria. It's actually almost worse. I found an explanation from a woman named Barbara Schindler, MD, the Vice Dean Emerita and Professor of Psychiatry and Pediatrics at Drexel University College of Medicine. Oh my God, this is where Jordan went. Oh, well, Jordan. He's at Drexel. Don't get on Trank. If you're even thinking about it, maybe stop by this lady's office. I'm sure she's got some horrific visuals to deter you from starting down that Trank path. Barbara calls Trank worse than fentanyl and says it, quote, causes serious sedation, putting the brain to sleep, lowering blood pressure and slowing the heart. It also causes skin lesions because it constricts blood vessels and these lesions form not just at the injection site, but also on various areas of the body where the skin starts to decompose. And one of the scariest things is that it's not an opioid. So Narcan doesn't even begin to touch this. We have no antidote, so to speak. But it's just as addictive? I mean, I guess I shouldn't, I shouldn't speak to its level of addiction, but I would say if people are continuing to inject it into open wounds. Yeah, it's probably fairly addictive. It seems to have a hold on them at that point. Yeah, it's really horrific. We could probably do a whole episode on Trank. 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But this is flesh-eating bacteria, not constricted blood vessels causing flesh death. So let's go back under the microscope. I thought we'd touch on the history of flesh-eating diseases. Now, the history, obviously, as with most things in the natural world, is they've been around in a long time. Some strains have developed more recently, such as the strains in the 80s. But the first descriptions of this disease appeared thousands of years ago in the writings of the father of medicine himself, Hippocrates. He was prolific. We've talked about the big guy on the show before. He's a total genius. He also believes in some weird shit, like what we've talked about before, I think, in the Homunculus episode. He might have been one of the guys who's... We weren't even going to do Homunculus, and it comes back all the fucking time. It's my proudest moment is suggesting it. One of the things I found in this run of research that Hippocrates believed in was the wandering womb theory, which stated that a woman's womb was not stationary, but that it, in fact, moved around inside of her and caused various problems as it ping-ponged around inside her body. So he's against the idea of these fascial hooks or whatever. Like, there's nothing keeping anything... No, nothing's locked down. Tied down, sure. The best description I found of wandering womb theory from the time was this, written in 2nd century A.D., although I think this was written not by Hippocrates, but by Galen or one of Galen's... Robert Frost wrote a poem called... My womb found a fork in the woods. In the road, yeah, and it decided to just kind of cruise around a lady's body just all over. The best description I found was this, written in 2nd century A.D. Quote, In the middle of the flanks of women lies the womb. A female viscous, closely resembling an animal, for it is moved of itself hither and tither in the flanks, also upwards in a direct line to below the cartilage of the thorax, and also obliquely to the right or to the left, either to the liver or the spleen, and it likewise is subject to prolapsus downwards, and in a word, it is altogether erratic. It delights also in fragrant smells and advances towards them, and it has an aversion to fetid smells and fleas from them, and on the whole, the womb is like an animal within an animal. Okay. First off, this sounds like a person who failed every exam, and then they had to do the hands-on show me you removing a womb, and it's like going to cut the wrong place. It's like, what are you doing? He's like, come on, you know the womb moves. We don't know where it's at. First off, we don't know what you're talking about, and then the student's like, what am I going to need? I'm going to need a couple of mint leaves, and I will draw the womb to where I'm cutting. I will draw it by these sweet smells, and you guys will see. You're onto something there. Yeah, it's just so wacky. It's just like, it just seems like a person who lied in their resume trying to make up for cutting into the wrong place by being like, oh, these pesky wombs, dude. They're on the move. They more were using the womb, and I didn't put too much into the show because, again, I didn't want to get too sidetracked. We've got a lot, we've got a lot of flesh-eating left, but they really, they looked at the womb as a way to try to explain the differences between men and women because they knew it was one of the big things that women had that men didn't. What was the, so. Wait, wasn't, is Hippocrates the same guy who had that other, like, ridiculous theory about women that's like, oh, they don't have tonsils or some shit? Yeah, yeah, I forget, they don't have knees or, they didn't have something that was very easy to check. Yes. So this guy, oh, it was the teeth, it was, oh, they have less teeth. They have less teeth. So Hippocrates, I gotta say, he, I was a shy guy or something, he definitely, he had some blind spots and they were all female related. Yes, I think many of the men of this time had similar blind spots, but it doesn't take away from the fact that Hippocrates is one of the fathers of modern medicine and in the 5th century BC, he described necrotizing soft tissue infection as a disease where those affected would have quote, erysipelas, which is a kind of red blotchy skin all over the body while the cause was only a trivial accident, meaning, you know, a scrape, a cut, whatever. Bones, flesh, and sinew would fall off from the body and there were many deaths. Okay. That was what Hippocrates knew about necrotizing fasciitis. The next notable mention of it was in 1764 by Baryan, who was, I guess, a doctor who described a soft tissue infection in male genitalia. The first English description for necrotizing soft tissue infection was by British surgeon Leonard Gillespie and British physicians Gilbert Blaine and Thomas Trotter in the 18th century. At that time, necrotizing soft tissue infections or fasciitis were known variously as a wide variety of things that, Ed, to your point earlier, all sound like grindcore bands. Yeah. We have phagodainic ulcer, gangrenous phagodaina, gangrenous ulcer, malignant ulcer, putrid ulcer, fulminating gangrene, necrotizing erysipelas, gangrenous erysipelas, crepient cellulitis, gangrenous cellulitis, melaninous cellulitis, necrotizing synergistic cellulitis, hemolytic streptococcal gangrene, progressive bacterial synergistic gangrene, or necrotizing abscess. Wow. That is, I got lost in that for a minute. I thought I was, I thought I was being read a grindcore Dr. Seuss book. Yeah. Oh. Ba-da-ba-da-ba-da-ba-da-ba-da-ba. I don't, for people listening at home, I wasn't expecting whatever that was. It was an attempted grindcore. And now it's in your ears. In 1871, the same disease was recorded by a man called Joseph Jones, who was an army surgeon for the Confederate army. He called it hospital gangrene and 46% of his patients died from it. Oh, wow. Or no, I'm sorry. 46% of his patients who suffered from the condition died from it. So, still, a lot of people died from hospital gangrene. The Civil War. And then years later in 1883, or just a few years later in 1883, Jean-Alfred Fournier delivered a lecture on peroneal gangrene in a previously healthy young man, which, it seems like a lot of guys had their taints rotting away in the 1890s. This was a common thing. I think it's a tough place to get to. Wash your butt, boys. Yeah, but you have to understand, like, what, 18-something? You're probably sharing, like, a fucking weird metal tub with 30 other people, and it's like, the water's only gonna stay hot for the first one of you. Yeah, yeah, yeah. So, you know what I mean? I didn't have an excuse in 2003, 2002. But these guys definitely have excuses, probably. Yeah, true. Well, anyway. Everyone's wearing wool in the summer, especially the Civil War uniforms were just, like, hot-ass wool. Yeah. Jean-Alfred Fournier ended up coining the term necrotizing fasciitis that appears on the male genitalia is now known as Fournier's gangrene, which is a hell of a way to be remembered. Oh, my God. So, yeah, that was his name? That was his name. He put his name to it, and he's proud of it. I guess he helped people. He fixed them, maybe. Or someone else named it. Because it's just what the guy would never stop talking about. Oh, Fournier's gangrene. You know, he's always on about that gangrene. Yeah. I think it's because he's cheap. And, like, he'll be like, oh, I'll buy dinner tonight. It's on me. And then he gets there and starts talking about gangrene. No one orders anything because they don't want to eat. And so that's how he got out of big tavern bills at the time. It's not a bad idea. I'm starving. I thought you just went to dinner. Yeah, you know. She had a great idea. This, somebody, no, well, I can't say you're supposed to. Don't try this. Don't try this. Don't try anything we say. And it probably wouldn't work. But I was thinking, what if, you know, so everything when they flip the screen around now for you to, like, you order coffee or whatever, they flip the screen around, you got to sign? I mean, I walk right away because it might be a tip thing there. What if you signed it void? I don't think it matters. Would you be able to challenge the charge? I don't think so. Okay, probably not. Because it says right above its signature. Right. It doesn't say thoughts on this transaction. Anyway, it's just a thought I had while standing in line. In 1952, an American surgeon named literally just Wilson as far as I could find. Wow. I feel like every episode now I get to bring up Dennis the Menace. Yeah, Mr. Wilson. Or possibly I saw him also referred to as B. Wilson. But I couldn't find a name for this guy other than Wilson or B. Wilson. But he's the one who coined the term necrotizing fasciitis. Oh, so he was smart. He's known for a disgusting term and took his name out of it. Right, right, right. He wasn't like Wilson's balls infection. Yeah, yeah. He wasn't like and again, that's Brian Wilson at 740 Banana Street. Yeah. It's a ball infection. Yeah, yeah, yeah. Yeah, yeah. He's like, just go by Wilson. I'll just go by Wilson. Thank you. Now, here's where we get to the good stuff. Here's where we get to what people really want to hear. Oh, God. Here's what happens if you're unlucky enough to come down with a case of the fash. If you're unlucky enough to get into this show and get to this episode. Here's what you can expect. The early symptoms of an infection with flesh-eating bacteria usually appear within the first 24 hours of infection. Symptoms are similar to those of other conditions like the flu or a less serious skin infection. They're also similar to common post-surgical complaints, which really sucks because one of the ways people can become infected is through a poorly cleaned and treated surgery. Yeah. So, if you wake up from surgery with swollen, infected red skin, you get to play a fun game of is this a common post-surgery symptom or am I infected with a flesh-eating bacteria? Oh, wow. So, these symptoms can include serious pain including areas other than the skin that looks swollen or red, inflammation, fever, nausea. There's also, if you have any of these symptoms, you should keep an eye out for increasing pain in the general area of a minor cut, abrasion, or other skin opening. Pain that is worse than would be expected from the appearance of the cut or abrasion. Redness and warmth around the wound, though symptoms can begin at other areas of the body. Flu-like symptoms such as diarrhea, nausea, fever, dizziness, weakness, and general malaise. And intense thirst due to dehydration. You know what's crazy is you just sound like a fucking commercial for medicine right now. Yeah. That's all I can think about hearing you list this stuff off and I'm like, God, I definitely don't want a skin infection. Right. But there are people who hear that and they're still like, give me Ozempic. It sounds great. Like, people hear all that shit in the commercial and they're still fine with it, so. Well, I mean, Ozempic, I guess, is a, you know, a necessary. Well, I just picked a thing. I see. I just picked a thing out of the air. But some medicines, like, you deal with the symptoms because they're treating something much worse. No, I get it. I'm just saying that you sounded like, again, only country in the world, basically, that has ads for this shit. Right, right, right, right, right. But it is something we hear 25 times per football game I'm watching. Well, you won't hear any of these, I don't think, during a medicine commercial. More advanced symptoms happen around the painful infection site within three to four days of infection. And these can include swelling, possibly with a purplish rash, large violet-colored marks that turn into blisters filled with dark, foul-smelling fluid, discoloration, peeling, and flakiness as tissue death begins, dizziness, fatigue, or nausea. Oh, if you're saying I'm going to hit my goal weight, I'll take it. And just wait until you pop those blisters filled with dark, foul-smelling fluid. You'll lose another four pounds of dark fluid. That's true. And every womb in the area will run from you. Yeah. I imagine at this point most people will be concerned enough to see a doctor or go to the ER. I hope so. But if they don't, critical symptoms will develop within four to five days of infection, which, and these include a severe drop in blood pressure, toxic shock, and unconsciousness. If you haven't received treatment at this point, the infection is going to tear through your body and it's highly likely that you will die. If you don't die, and again, only one in five does, although I'd assume maybe that one in five is someone who waits to get it treated, you're in for a very, very bad time. So I turned to Quora to try to find some survivor stories. Okay. The first story I found was from an anonymous poster. A real Wilson type. A real Wilson type. Yeah. Quoth the anonymous, I got hit by necrotizing fasciitis three months ago. A smooth criminal. Yeah. The strep strain, which I believe is the most aggressive. It entered a small two to three millimeter cut on my elbow. What's it like to have a flesh eating disease? It was, of course, horrific. The pain wasn't so much in my arm, but my head, my legs, and my insides. A repulsive, agonizing pain, which was the onset of toxic shock, I think. I had a bad fever and was hallucinating. Very low blood pressure. I went to A&E. I don't know what that is. I don't know. Some department at the, yeah, I went to A&E and said, do I have a reality show for you? It must be some intake at the hospital or something. Maybe, yeah. And signed a form to allow them to amputate my arm. Luckily, they didn't need to amputate. I had a great surgeon who made a call to cut my arm open from my wrist to my shoulder and started cutting away infected areas within two hours of arriving at hospital. Wow. Oh, at hospital? No fucking article? This is England. Oh, yeah. This is a commonwealth country, which is why he even went to begin with because it's like they have free healthcare. Yeah. So he didn't wait like we would. Yeah. Over the next three weeks, my arm was kept open and every two days I would get surgery to remove infected areas. It was incredibly painful, exclamation point, and a very long three weeks, exclamation point. Anyway, I have nothing to complain about. I survived, kept my arm, and have a cool scar to show for it. Hell yeah, brother. Yeah, this guy's handling it a lot better. This person's handling it a lot better than that spider guy who was like, if I lose my fucking arm, just kill me. Yeah. Flesh-eating bacteria, he says, along with burning to death were my two most feared ways to die. So this guy should listen to the show, I think. Get him on. Get him or her. It's anonymous. So get this person on the podcast. I'm going to reply to the Quora and maybe ask. Also reply as anonymous given no information. It just says, come on our podcast. But listen, this guy's on our level. He says, what I found is that when you actually face your worst fear, you realize it's just an illusion and you can crush it. Anyway, life now tastes sweeter than it ever did and the experience reinforced what's important in life. Overall, it has had a positive impact on me, strangely enough. Which I think is maybe what the spider bite guy said too. Well, he, the spider bite guy was just like, a day or two later I came to my senses that like a life without an arm is better than not having a life. But I don't know if he came out of it as this person seems very Pollyanna about the situation. Yeah. More, I would say, than the spider bite guy. Well, the next person we're going to talk about did not come out of the situation feeling quite so overwhelmed by a joy of life. Also, they said millimeters, which also gives away that they're not a matter of. Oh, yeah, yeah, true. They said millimeters, they said hospital without an article. Yeah, so A&E must be like the British version of like appointments and emergencies or something. Or like arms and epidermis. What? Well, epidermis, the skin, and then they had an arm issue. Maybe, maybe, maybe. Look, I worked, that was lightning quick. It was an hour after the story was told. So, I wanted to try to find something more in depth about what it's like to survive necrotizing fasciitis because I think one of the things that's so scary about it is how you can go from thinking that you just have like an ingrown fingernail or something to possibly losing your limbs quickly. I've been thinking about this the whole fucking time we've been recording because I can still feel, you know, my hematoma has a giant cut down the center of it. Yeah. And I can feel it. You know, we were talking about in an episode recently something about how our brain ignores things. It ignores the feeling of your clothing on your skin, the sound of your breath, your nose, and this thing makes it impossible for me not to always constantly thinking about how my pants are rubbing against it. And so I've been thinking about that ever since we've done that episode. But now I'm thinking about like, you know what, I do have pain around where that actual cut is and now I'm freaking out a little bit, but it's shit. This is what we do in the episode. This is why we do the show. It is, but I would also say that if you had necrotizing fasciitis in that wound, you would know for sure by now that wound's a couple weeks old. Yeah, but we manifest this shit though. So it just got in there. That's true. We manifest it. So I'm going to go home and Ed's like, oh, my knees warm and radiating pain. Yeah, you got to like play Jumanji to get the effects of Jumanji. You got to wear the mask in the mask. what you're about to hear is a true story. It's maybe one of the lengthiest excerpts I've ever read on this show, but I feel like buckle up people the devil's in the details like the summary of this isn't as stomach churning as the actual experience. So this story is from a book called Complications, A Surgeon's Notes on an Imperfect Science, which for everybody Is it an old book? I don't think so. I think I don't know when it was published, but I'm pretty sure I mean, just the way it's written, it's recent. It's got to be after you retire, right? Yeah, I think so. Nobody while still having a practice is like, let me tell you about all the mistakes I made. Yeah, yeah, yeah. It's written by a man named Atul Gawande. And this story from the book is called The Case of the Red Leg, which even sounds like a good scary story. Yeah, like why is it like a fucking Hardy Boys title? So Gawande says, it was two o'clock on a Tuesday afternoon in June. I was in the middle of a seven week stint as the senior surgical resident in the emergency room. I had just finished admitting someone with a gallbladder infection and was attempting to sneak out for a bite to eat when one of the emergency room physicians stopped me with yet another patient to see. A 23 year old who for the purposes of this story, he calls Eleanor Bratton. It's not a real name. He had decided to still give a last name. Yeah. Interesting. Eleanor Bratton with a red and swollen leg. It's probably only a cellulitis, a simple skin infection, but it's a bad one. He said he had started her on some intravenous antibiotics and admitted her to the medical service, but he wanted me to make sure there wasn't anything quote surgical going on, an abscess that needed draining or some such. Would you mind taking a look? Groan. No, of course not. Yeah. You're on your way out. You want to get some food. Yeah. This is the worst possible time to be a patient too. Yeah. Hey, can I get the absolute least amount of your attention for a minute? For this person's serious issue? She was in the observation unit, a separate quieter ward within the ER where she could get antibiotics pumped into her arm and wait for a bed upstairs. She looked fit, athletic, and almost teenage with blonde hair tight in a ponytail, nails painted gold, and her eyes fixed on a television. There did not seem to be anything seriously ill about her. I glanced at her chart and saw that she had good vital signs, no fever, and no past medical problems. I walked up and introduced myself. Hi, I'm Dr. Gawande. I'm the senior surgical resident down here. How are you doing? You're from surgery, she said, with a look that was part puzzlement and part alarm. I tried to reassure her. Well, yeah, you never want to be in the ER and have a surgeon walk up to you and be like, hey, I'm from surgery. And you're like, I'm just here because my fingernail hurts. Yeah, I think you're talking to the wrong person. Yeah. He said, I tried to reassure her. The emergency physician was only being cautious, I said, and having me see her to make sure it was nothing more than a cellulitis. All I wanted to do was ask a few questions and look at her leg. Could she tell me what had been going on? For a moment, she said nothing, still trying to compute what to think about all this, and then she let out a sigh and told me the story. That weekend, she had gone back home to Hartford, Connecticut to attend a Connecticut. The insurance capital of the world. Yeah. At the time. That actually, I think is going to come back. Oh, wow. Home to Hartford, Connecticut to attend a wedding. She'd moved to Boston with some girlfriends the year before after graduating from Ithaca College and landed work planning conferences. Ithaca's got a lot of gorges. Luckily, she didn't fall in. I went to Ithaca because I loved it so much. Because you love Carl Sagan? I love the gorges. I love... People fall in the gorges every year, and the drunk ones usually end up okay because they don't freak out. They just fall limp. Yeah. Carl Sagan and Twilight Zone. Rod Serling. Rod Serling went to Ithaca. Who also, took the same train this girl probably did because he wrote a lot of... I just found this out. He wrote a lot of Twilight Zone on the train from Westport, Connecticut into the city. Nice. That's where he would work on episodes on the train. Well, he almost could have written this story. Well, not really. There's no surprise twist, but... Anyway, she went to this wedding. The wedding had been grand and she kicked off her shoes and danced the whole night. The morning after, however, she woke up with her left foot feeling sore. She had a week-old blister on the top of her foot from some cruddy sandals she had worn and now the skin surrounding the blister was red and puffy. She didn't think too much of it at first. When she showed her foot to her father, he said he thought it looked like a bee sting or maybe like she'd gotten stepped on dancing the night before. By late that afternoon, however, riding back to Boston with her boyfriend, my foot really began killing me, she said. The redness spread and during the night she got chills and sweats and a fever of 103 degrees. She took ibuprofen every few hours which got her temperature down but did nothing for the mounting pain. By morning, the redness reached halfway up her calf and her foot had swelled to the point she could barely fit into a sneaker. Wow. So this is where my anxiety really starts to ratchet up because this is, how many times have we, I mean, we kind of said this a few times already but this is where it's like you start to feel that creeping feeling of something going from minor to possibly not minor but you're like, no, it's probably, it's gotta be fine, it's just whatever. I just, real fast, you know, you told the story of getting hit in the eyeball with your shit, your fucking shit hanger and I just, Instagram fucking fed me in the algorithm or served me this like video of people with a missing eye but it was fine, it was just like people with fake eyes kind of like fake eye awareness I guess and they were all just like, I'm gonna pass the phone over to someone who lost their eye getting out of the tub, I'm gonna, and it was all very like, mostly very minor, dumb, stupid little instances that just an accident happened and now they have a glass eye so I just thought of that because it's like, you know, something minor or something major so quickly and also, I don't know why, like every mosquito bite I get, like fucking every mosquito bite, I mean, I'm not good about not scratching it but like they always end up becoming these like week to two week long like scabs, blister scabs on me, same, now I'm thinking about that listening to you talk and like, is every one of these are gonna be wash them, don't scratch them, yeah, band-aids on them, anyway, Eleanor hobbled in on her roommate's shoulder to see her internist that afternoon and was diagnosed with cellulitis which is, according to Gawande, your garden variety skin infection, the result of perfectly ordinary bacteria, the environment getting past the barrier of your skin through a cut, puncture wound, blister, whatever, and proliferating within it. Your skin becomes red, hot, swollen, and painful, you feel sick, fevers are common, and the infection can spread along your skin readily, precisely the findings Eleanor had. The doctor got an x-ray to make sure the bone underneath was not infected. Satisfied that it was not, she gave Eleanor a dose of intravenous antibiotics in the office, a tetanus shot, and a prescription for a week's worth of antibiotic pills. This was generally sufficient treatment for cellulitis, but not always, the doctor warned. Using an indelible black marker, she traced the border of the redness on Eleanor's calf. If the redness should extend beyond this line, the doctor instructed, she should call, and regardless, she should return the next day for the infection to be checked. Wow, that is crazy. I mean, I wouldn't be able to do anything. I'd be checking that black line every minute to be like, oh fuck, it's getting closer, it's getting closer. Well, the next morning, Eleanor said, which was the morning that this story started with Dr. Gawande, she woke up with the rash beyond the black line. Oh no. And stretching to her thigh and the pain was worse than ever. So this is pre-Gawande showing up into the story. So someone else had already had the brilliant idea of drawing on this woman. Yeah, yeah, yeah. Gotcha. So she phoned the doctor who told her to go to the emergency room. She'd need to be admitted to the hospital for a full course of intravenous antibiotic treatments, the doctor explained. I asked Eleanor if she had any pus or drainage from her leg. No. Any ulcers open up in her skin? No. A foul smell or blackening of her skin? No. Where's your womb right now? Would you say it's more up near your throat or down near your pelvis? Any more fevers? Not since two days ago. I let the data roll around in my head. Everything was going for cellulitis but something was pricking at me, making me alert. I asked Eleanor if I could see the rash. She pulled back the sheet. The right leg looked fine. The left leg was red, a beefy, uniform, angry red from her forefoot across her ankle up her calf past the black ink line from the day before to her knee with a further tongue of crimson extending to the inside of her thigh. The border was sharp. The skin was hot and tender to the touch. The blister on the top of her foot was tiny. Around it, the skin was slightly bruised. Her toes were uninvolved and she wiggled them for me without difficulty. Uninvolved. Yeah, yeah. Toes are like, leave us out of this. Whatever. She had a harder time moving the foot itself. It was thick with edema, up through the ankle. She had normal sensation and pulses throughout her leg. She had no ulcers or pus. Objectively, the rash had the exact appearance of cellulitis, something antibiotics would take care of. This is an episode of House MD now. Kinda, yeah. This guy's a good writer too. Yeah, I was thinking that. That's part of why I'm quoting it at length because it's good. We should have him on the show because we're using enough of his body. Yeah. Another possibility lodged in my mind now, one that scared the hell out of me. It was not for logical reasons though and I knew this perfectly well. Decisions in medicine are supposed to rest on concrete observations and hard evidence but just a few weeks before I had taken care of a patient I could not erase from my mind. He was a healthy 58 year old man who had three or four days of increasing pain in the left side of his chest under his arm where he had an abrasion from a fall. He went to a community hospital near his home to get it checked out. He was found to have a small and very ordinary skin rash on his chest and was sent home with antibiotic pills for cellulitis. That night the rash spread 8 inches. The following morning he spiked a fever of 102 degrees. By the time he returned to the emergency room the skin involved had become numb and widely blistered. Shortly after he went into shock. He was transferred to my hospital and we quickly took him to the OR. He didn't have cellulitis but instead an extremely rare and horrendously lethal type of infection known as say it with me now necrotizing fasciitis. Oh wow here it comes it's appeared. The tabloids have called it a disease of flesh-eating bacteria and the term is not an exaggeration. Now The tabloids? That's what he the uh Okay. Here begins a very gross part so if you are a little queasy maybe skip the next 15-30 seconds. It's actually more like a minute. You have been warned. Graphic story incoming in 3, 2, 1. Opening the skin we found a massive infection far worse than what appeared from the outside. All the muscles of the left side of his chest going around to his back up to his shoulder and down to his abdomen had turned gray and soft and foul with invading bacteria and had to be removed. The first day in the OR we had to take even the muscles between his ribs a procedure called a birdcage thoracotomy. The next day we had to remove his arm. For a while we actually thought we'd saved him. His fevers went away and the plastic surgeons reconstructed his chest and abdominal wall with transfers of muscle and sheets of cortex. One by one however his kidney, lungs, liver and heart went into failure and then he died. It was among the most awful cases I have ever been involved in. That wasn't so bad was it? I can't hear what your answer is. I just wanted this to be long enough that you can more easily find the end of the story when skipping forward. But also there are chapters you can use too. Okay gross part over. The old man died. Yeah wow. And also as soon as you said the first day I was like yeah that makes sense because they really didn't see any of that until they opened him up. No. So you must get in there and go fuck we gotta make a checklist now of things to do. It's like biting into an apple and finding out the whole insides rotted out. Yeah. You know like But I mean God bless him I throw the apples away this guy tried to save the apple. Yeah. But you said the old man he's 58. Well sure. R.I.P. God bless. R.I.P. God bless. To the young man. What we know about necrotizing fasciitis is this it is highly aggressive and rapidly invasive. It kills up to 70% of the people who get it which is different from our 1 in 5 that we quoted earlier. But also not that dissimilar from the Civil War numbers. No. No known antibiotic will stop it. As with cellulitis they are understood to enter through breaks in the skin. The break can be as large as a surgical incision or as slight as an abrasion. This part got me. People have been documented to have gotten the disease from a rug burn a bug bite a friendly punch in the arm a paper cut a blood draw a toothpick injury and chicken pox lesions. In many cases the entry point is never found at all. Unlike with cellulitis. I don't like this. No dude. Never found. So it's a it can get in through a wound that you're not even aware that you have. I mean a bug bite. I mean if it's not the kind to make you itchy like you would just never even know right? I mean I guess but even then you'd think they'd go like oh here's where the skin seems to be falling off oh look it's centered around a bite or something. Well that's a little bit of that Hippocrates or I guess the Trank boys or whatever moving wounds not moving wounds where it's like yeah the entry point is here but then there's now lesions or whatever opening other places but also this the idea that you can be playing like punch buggy with someone in the car and now you're gonna lose that arm. I guess but yeah I don't know man very scary. Every mom out there do they still kids with wooden spoons? Well don't do that you'll give your kid necrotizing fasciitis. That's what I'm saying dude that should be a PSA. Yeah. I know they're running you up the wall but don't hit them with the wooden spoons no more because your kid's gonna lose its ass. Unlike with the cellulitis the bacteria invade not only skin but also deep underneath advancing rapidly along the outer sheaths of muscle the fascia and consuming whatever soft tissue fat muscle nerves connective tissue they find. Survival is possible only with early and radical excisional surgery often requiring amputation. To succeed however it must be done early. By the time signs of deep invasion are obvious such as shock loss of sensation widespread blistering of the skin the person is usually unsalvageable. So this guy's freaking out because he's like I just lost this patient and now this girl's telling me that days ago she had she had fevers. If there were a simple test to tell the two diagnoses apart that would have been one thing but there is none the only way is to go to the operating room open the skin and look not something you want to propose arbitrarily yet here I was I couldn't help it I was thinking it. And also speaking of thinking that guy they mentioned earlier the anonymous writer earlier who was like and they said they might have to amputate me and so I signed the paper room like fucking I'd be like I need a few days to think about it and they're like you don't have a few days and I'd be like I need a few days to think about it you're saying if we go in this room I might lose my leg? Yeah that's sort of what happened next here so I'm going to fast forward a little Dr. Gawande calls a colleague this guy Thaddeus Stuttart the stud of the hospital Oh shit dude he's the general surgeon on call and Gawande explains he thinks they could be looking at a case of necrotizing fasciitis Stuttart looks at Eleanor's leg and explains to her and her father who'd arrived at the hospital at this point that it's most likely cellulitis but it could be this other very rare dangerous thing and there's no way to know without performing a biopsy if the fasciitis is found they have to remove all of the infected tissue which could mean performing an amputation so father and daughter request a second opinion they call a plastic surgeon with a degree from MIT who concurs that it's very unlikely to be necrosis but the biopsy should be performed so Eleanor and her father agree to the surgery but when it comes time to sign the papers Eleanor freaks out and starts to cry as one would absolutely because you have to not only agree to the biopsy you have to agree to losing your arm potentially if the biopsy comes back positive and there's no waking up between that you just go to sleep thinking well they might just take a little skin or I wake up without an arm wow yeah that's true fuck so you're like you're waking up and immediately looking down at whatever they just operated on to be like is it still there yes holy shit yeah well I know how we're this is moving up the fear tier before we even get there so then they ask for time to see if antibiotics will help and the doctors are concerned because it's already been a few days and it can quickly go from barely presenting to killing you so they say no you have to kind of decide now sure and so they do they agree to it so now this is another gross part so it's probably no more gross than the last one but this is like a five minute stretch so it's probably easier to use the chapters than skipping ahead you have been warned graphic story incoming in three two one back to Gawande's writing quote the anesthesiologist put Eleanor to sleep a nurse then painted her leg with antiseptic from her toes up to her hip with a small knife stuttered cut out an inch long ellipsis of skin and tissue from the top of her foot where the blister was down to her tendon the specimen was plopped into a jar of sterile saline and rushed to the pathologist to look at we then took a second specimen going deeper now down into the muscle from the center of the redness in her calf and this was sent on as well at first glance beneath her skin there was nothing apparent to alarm us the fat layer was yellow as it's supposed to be and the muscle was a healthy glistening red and bled appropriately sure that's what you want to see yeah when we probed the tip of a clamp inside the calf incision however it slid unnaturally easily along the muscle as if bacteria had paved a path wow that's just time and experience right yeah like if I had done that on the second surgery of my life I might have not noticed but this guy's done a few and he's like that's not how it's supposed to feel this is not a definitive finding but enough of one that stuttered let out a sudden disbelieving oh shit he pulled off his gloves and gown to see he said that out loud you think yeah that's I mean that's what he said that's the beauty of having your patient knocked out yeah he pulled off his gloves and gown to go see what the pathologist had found and I followed right behind him to fast forward a bit again the pathologist calls in a dermatopathologist or a skin pathologist and after another really intense 40 minutes they find deep tissue that has begun to die no cellulitis could do that so he gives the official diagnosis of necrotizing fasciitis stuttered says they need to move fast he has no idea if they can save the girl's leg or her life they also have just no idea like how far in any direction right this soft snow goes or whatever yeah well especially because the last case Gawande did with that old guy he had like a pain under his arm they opened him up and the whole like side of his body it seems like yeah rotted away took days to find that too I mean this is if this was a movie you know he's like oh please excuse me for a moment and he like collapses into lockers yeah you know freaking out and sweating and like seeing like flashbacks of him having to talk to that guy's family about yeah you know it's just like are you cool over there bro are you good to do this because I'd be like you're freaking out there is a whole scene because this was so long I left some stuff out but there is a whole sequence in here where he he does go to talk to the dad and explain and the dad's got yeah we don't need that on the show I mean we're but it's crazy and very scary so Dr. Gawande again in the OR they slit open Eleanor's leg from the base of her toes across her ankle to just below her knee to get a full view of what was going on inside they pulled the opening wide with retractors the disease was grossly visible now in her foot and most of her calf the outer fascial layer of her muscles was gray and dead a brownish dishwater fluid was seeping out with a faint smell of decay tissue samples and bacterial cultures would later confirm that this was toxic group A streptococcus uh group A showed up group A is here fuck dude group A boards first baby uh I thought and they lose all your luggage yeah yeah yeah I thought about a BKA a below knee amputation Studdard says even an AKA an above knee amputation no one would have faulted him for doing either but he found himself balking she was such a young girl he explains it may seem harsh to say but if it was a 60 year old man I would have taken the leg without question this was partly I think a purely emotional unwillingness to cut off the limb of a pretty 23 year old the kind of sentimentalism that can get you in trouble well well we have an episode coming out next week where it's the same rules with dolls yeah uh but it was also partly instinct again an instinct that her youth and fundamentally good health might allow him to get by with just removing the most infested tissue called a debridement and washing out her foot and leg was this a good risk to take with one of the deadliest bacteria known to man loose in her leg who knows but take it he did I don't think when he wrote that he did it in that in that who knows voice he probably was like who knows but take it he did for two hours using scissors and electroconnery stuttered and this other doctor seagull cut and stripped off the necrotic outer layers of her muscles starting from the webbing of her toes going up to the tendons of her calf they took out tissue going three quarters of the way around her skin hung from her leg like open coat flaps higher up inside the thigh they reached fascia that looked pink white and fresh very much alive they poured two liters of sterile saline to the leg trying to wash out as much of the bacteria as possible at the end Eleanor seemed to be holding steady her blood pressure remained normal her temperature was 99 degrees her oxygen levels were fine and the worst looking tissue had been removed from her leg but her heart rate was running a bit too fast 120 beats a minute a sign that the bacteria had provoked a systemic reaction oh my god I thought you were going to say a sign that she was in another episode of ours waking up during surgery no no no I would like everyone on our show to just be in one episode at any given time yeah yeah truly no crossing of worlds here yeah please she was requiring large amounts of intravenous fluid her foot looked dead and her skin was still burning red with infection the gross part for now is over you hear that it's over Chris says for now but I don't think anything else comes up that requires Mr. Disclaimer or Trivia Bot Dr. Gawande then details the decision making process to transport Eleanor to another hospital to place her in a hyperbaric chamber to increase the amount of oxygen available to cells like immunity cells that could help them destroy the remaining bacteria so do you think they keep her asleep no they woke her up in between for the transfer yeah oh wow that's part of what I cut out and she's like she panics she thinks she can't feel her leg and then she can feel her leg and it's a whole thing yeah yeah yeah she eventually goes back under the hyperbaric chamber that night was as Eleanor described it like a glass coffin this whole section is scary in and of itself yeah this is like iron lung shit yeah she lay inside it on a narrow mattress with nowhere to put her arms except straight down or folded across her chest a panel of thick plexiglass a foot from her face and an overhead hatch sealed tight with turns of a heavy wheel as the pressure increased her ears kept popping as if she were diving down into a deep ocean once the pressure reached a certain point she would be stuck the doctors had cautioned even if she should start throwing up they could not get to her for the pressure could only be released slowly or it would give her the bends and kill her one person had a seizure inside she remembers them telling her it took them 20 minutes to get him out lying there enclosed more ill than she'd ever imagined she could be she felt far away and almost totally alone it's just me and the bacteria in here she thought to herself oh my god did she tell him that after i guess yeah the next morning we took her poetic license yeah the next morning we took her back to the operating room to see if the bacteria had spread they had no the skin over most of her foot in front of her calf was gangrenous and black and had to be cut off the edges of fascia we had left behind were dead and had to be excised as well who's that guy what was his name who has gangrene named after him uh fournier but fournier's gangrene is only in your perineum and genitals okay well it's the little it's the it's the little wins yeah but well this was and here was the little win her muscle was still viable including in her foot so the skin was dead but the muscle wasn't oh good and the bacteria had not killed anything up in her thigh she had no further fevers her heart rate had normalized we repacked her wound with wet gauze and sent her back for more hyperbaric oxygen two hours twice a day we ended up operating on her leg four times in four days at each operation we had to take a little more tissue but each time it was less and less at the third operation we found the redness of her skin had finally begun to recede at the fourth operation the redness was gone and we could see the pink mossy beginnings of new tissue in the maw of her wound only then was stuttered convinced that not only had Eleanor survived but her foot and leg had too astonishing legends is brought to you by progressive insurance fiscally responsible financial geniuses monetary magicians these are things that people say about 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be shared there was a guy who bought a 2020 Porsche Cayman GT4 on eBay it was well loved there are plenty of Caymans in great condition on eBay but this one needed some work that's just the start of the story so after this guy gets a great deal on his dream car he rebuilds the whole thing with all these parts he found on eBay performance brakes suspension body panels the works guaranteed to fit next thing you know this nearly scrapped Cayman was out there on the track as a full-blown race car you're ready to go daily driver your next restamod hello Lotus Alon and the parts to finish it eBay has thousands of cars and is the largest online selection of vehicle parts and accessories eBay things people love that's a fucking that gotta be so pumped I mean she's gotta be broken a broken human being of like this is the worst experience ever but if on the surgery side you have to be like pumping your fists in the air they're like fucking hell yeah we finally got to a manageable place yeah well it's there's a bit of an epilogue here that we'll talk about Eleanor died a year later no she's survived but a lot of the stuff I cut out but a lot of the stuff that's interesting is that please call it a lot of the stuff that you surgically removed a lot of the stuff that I surgically removed from this story is about the doctor explaining like this is how doctors make decisions because everyone always complains you know about like they went to the doctor and this doctor didn't think it was this this doctor didn't think it was that they should have given him pills for this and this is an extreme case but part of what he's talking about is like you know it's tough like this is an imperfect science we aren't wizards we can only diagnose what we're looking at and you know another doctor may not have you know a biopsy is a very serious thing and another doctor might be like there's a one percent chance that this is necrotizing fasciitis let's just give her some pills and send her home yeah you know and what's amazing is because that is the response you would expect from a person on their way to lunch yeah and so the fact that this guy was he's so into his profession yeah and has like I guess you would think an inquisitive mind probably what led him into medicine to begin with yeah the hunger probably subsided and was like I have a new problem to solve and this is exciting and in a weird way that guy that died kind of saved this girl's life because Dr. Gawande wouldn't have been thinking about maybe it's necrotizing unless that guy had died so also he's gotta be fuck it's just like two so close together and it seems such a rare issue oh yeah that's true yeah this is statistically running into it once is nuts running into it twice yeah in the span of a few weeks in the same city yeah I'd be like shut the fucking water down like something's happening the happening is happening yeah wow this is a I'm gonna read this book maybe it sounds gross but this is really good pretty good so he says then and this is the follow-up that I think is worth covering because it's touches on some other fear things it was a year before I saw Eleanor again passing through Hartford I called in on her at her family's home a roomy spick and span putty colored colonial with a galumpy dog and beds of flowers outside Eleanor had moved back home to recover following her 12 days in the hospital intending to stay only temporarily but instead finding herself nestling in returning to a normal life she said was taking some getting used to her leg had taken time to heal not surprisingly in her final operation done during her last days in the hospital we had needed to use a 64 square inch skin graft taken from her thigh to close the wound my little bum she called the result although I think it might be burn but the photocopy on the text that I found was fuzzy I think maybe my little burn I don't think you should have a name for it at all Satan the devil she called the result rolling up the leg of her sweatpants to show me it wasn't anything you'd called pretty but the wound looked remarkably good to my eye in final form it was about as broad as my hand and ran from beneath her knee to her toes inevitably the skin color was slightly off and the wound edges were heaped up the graft also made her foot and ankle seem wide and bulky but the wound had no open areas as there sometimes can be and the grafted skin was soft and pliant not at all tight or hard or contracted her thigh where the graft had been taken was a bright cherry red but still fading gradually was the all this operation stuff was it done in Boston or Connecticut like Boston or Hartford I think it was somewhere in Boston because that surgeon they call from MIT yeah that's what I was thinking I mean I gotta say say what you want about fucking cities and whatever like Boston just has a ton of smart people yeah from smart institutions in well-funded medical spaces like if you have to get your shit done anywhere it seems like Boston's a great place to have to do the worst 12 days of your life yeah so she says or Dr. Gawande says recovering the full use of her leg had been a struggle for her at first coming home she found she could not stand her muscles were so weak and sore her leg would collapse right under her then when she built the strength back she found she could still not walk nerve damage had given her a severe foot drop she saw Dr. stuttered and he cautioned her that this was something she might always have with several months of intense physical therapy however she trained herself to walk heel-toe again by the time of my visit she was actually jogging she'd also started back working taking a job as an assistant at one of the big insurance company headquarters in Hartford there it is there it is but also a little bit probably this is the outcome that the doctor was initially like let's not cut this I mean he made it about her looks but I'm saying let's not cut this young person's leg off because like a young person maybe physical therapy and stuff like can bounce back versus us a year on Eleanor remained haunted by what happened to her she still had no idea where the bacteria came from perhaps the foot soak and pedicure she had gotten at a small hair and nail shop the day before that wedding yeah maybe the day before perhaps the grass outside the wedding reception hall that she danced barefoot through with a conga line perhaps somewhere in her own house I'd say one of those first two is more likely than her own house but anytime she got a cut or a fever she was stricken with mortal fear oh my god the enzyme she has PTSD 100% from this she would not go swimming she would not immerse herself in a bath she would not even let the water in the shower cover her feet I still haven't driven on the highway at night yeah well after this you apparently won't shower or cover your feet oh my god yeah her family was planning a vacation to Florida soon but the idea of traveling so far from her doctors frightened her the odds the seeming randomness were what disturbed her most first they say the odds of you getting this are nothing one in 250,000 she said unless you're in Boston and two will show up in two months yeah but then I got it then they say the odds of my beating it are very low and I beat those odds now when she asked us doctors if she could get the flesh-eating bacteria again we told her once more the odds are improbably low one in 250,000 just like before I have trouble when I hear something like that that means nothing to me she said oh my god that's true she was sitting on her living room sofa as we talked her hands folded in her lap the sun rippling through a bay window behind her I don't trust that I won't get it again I don't trust that I won't get anything else that's strange or we've never heard of or that anyone we know isn't going to get such a thing that is it wow so that's psychologically yeah yeah the fear is baked in and it's it's got to be crippling no pun intended yeah in a totally different way but strong kid I guess yeah and great doctors but that's why I wanted to read the whole thing because the I guess I wanted to illustrate that the fear of a flesh eating bacteria goes way deeper no pun intended than just the oh no look it's gross on my arm like there is such a process to if you actually come down with this and it affects you in so many different ways that I never even thought about when I started researching it yeah and this was a really excellent example this is such a this seems like a really fucking good book too yeah yeah it's out there I mean I found an excerpt of it that I put in the show notes on like I think a Boston like one of the colleges in Boston like has it up as a PDF somewhere sure but we'll put like a link in the show notes if people can buy it and maybe go buy it yeah we read enough of it I feel like we should we will buy it we'll absolutely buy it and put a picture of it in the show notes of us holding it so it scares the shit out of me and the last thing I wanted to cover though because no one has covered this in the in any of the stuff that I'd read yet was how much flesh could necrotizing fasciitis eat before you die probably depends on where it is well like if it like starts around the heart if you but if you didn't seek treatment could the bacteria like if it started in your foot like how much of your legs would it eat before you died like could you get turned into a zombie oh you know I don't know yeah probably I mean it sounds every week we do these things it seems like more and more things can turn you into a zombie well than we ever thought before just like could it you know could you end up having all of your flesh eaten away if you didn't seek treatment and maybe well it turns out no oh well what do I know well the disease is painful and horrific at the site of the infection sepsis will kill you long before you're actually eaten away and describe sepsis to me that's what I'm about to do because sepsis is also horrifying and I feel like we've talked about it on the show before is that like your blood gets bad bad for you blood turns on you not really okay well I'm just asking uh I mean there are blood infections that might cause sepsis that's probably next season so get this so we've I think we've probably talked about sepsis on the show before but we've never necessarily described it which is nuts because it's a common way to die when dealing with all kinds of infections and diseases estimates suggest that it contributes to one third to one half of all in hospital deaths sure so basically sepsis occurs when the body's response to an infection goes into overdrive it begins with an infection somewhere in the body but instead of just fighting that specific problem the immune system launches a massive body-wide response this causes widespread inflammation which quickly affects blood vessels and makes them what is described as quote leaky so aside from me imagining my body filling with little plumbers to fix my leaky ass blood this leads to problems with blood flow to vital organs at the same time the body's clotting mechanism malfunctions causing too many clots in some areas and not enough clots in others without proper blood flow and with all the inflammation organs start to fail one by one blood pressure often drops dangerously low making it even harder for the body to function properly and the brain is also affected leading to confusion and disorientation in severe cases a person may go into septic shock where the body can no longer maintain blood pressure or organ function and what makes sepsis so dangerous is how rapidly it can progress and how it impacts the entire body simultaneously turning a localized infection into a life-threatening emergency that requires immediate medical attention so yes you will be dead from sepsis long before your flesh rots off and once you're dead your flesh will rot off from being dead and not having bacteria eating it so same result same result do you want to hear some stories from Quora of people who survive sepsis right now right now I pulled up a few I mean I feel like I might have it I've had like I've had a leaky leaky leg well I think I think sepsis has other I think you're good I wouldn't worry about I don't think I don't I don't think the the leaky blood that sepsis causes is like leaky in the way that you can feel it okay gotcha gotcha yeah um this is from Steve Conway on Quora I had sepsis in 2015 I was in a coma for 12 days and in the hospital for 23 days while in the coma my doctors told my wife to be ready for the worst it started with a small scrape on my arm that got infected the infection quickly took over my whole body my wife took me to the ER with flu-like symptoms that's the last thing I remember until waking up 12 days later wow everything about it was slash is still painful every cell in my body hurt they gave me morphine which helped a bit being in a coma for 12 days plus the sepsis itself destroyed my body I had to relearn how to walk to this day two and a half years later I have no stamina walking to the mailbox wears me out I literally could not run for my life if I needed to wow I can't work anymore after I got home I had to continue heavy doses of intravenous antibiotics three times a day for a month sepsis sucks sepsis sucks I'm speaking real fast via a coma thing yeah I feel like Stephen King's the dead zone does a good job of that in the beginning because the guy's in it for a long time I feel like that's one of the few examples where I see where they were like muscles have atrophied tendons have gotten tight yeah like all this crap if you're not like being massaged and dealt with at the hospital yeah that like in this guy was only 12 days yeah and so yeah the coma I have a friend who was in a medically induced coma for a while and I want we can have if we ever do coma stuff I'll have her on yeah we'll do coma stuff at some point Daniel Gray says I got peritonitis and then sepsis after bowel surgery I was in a coma for a month so I missed most of the pain part but the aftermath was horrible was on a respirator and that was a major bitch learning to breathe on my own again felt like they were trying to suffocate you it was hard work the worst 10 minutes of my life or when I tried to sit up in a chair for the first time after waking from the coma it was exhausting I felt a hundred years old you never totally recover from sepsis two-thirds of those with sepsis don't survive so if you're here to talk about it you're one of the lucky ones even if a little broken wow and then finally this gem from a man named Timothy John on Quora you may be unconscious if you're lucky but you could be awake throughout the entire ordeal my case of sepsis driven by massive inflammation felt like my body was on fire burning from the inside out two rounds of morphine did nothing relief came when the antibiotics set in ending about 10 hours of god-awful pain I'm grateful that the ER nurses lab techs and physicians identified the cause and proper treatment but sepsis like cancer never really goes away it hides it tried to kill me once and I think it would like to try again geez man these are what an app this is a crazy I mean anytime we enter the medical space it's really been eye-opening and uh yeah I'm I'm ready for the fear tier if we're ready to go there yeah let's go to the fear tier fear tier fucking god neck and neck with waking up during surgery I think it's eked out waking up during surgery yeah what started as a flesh-eating bacteria what is this episode called flesh-eating bacteria it's uh that's the root cause of the fear but I feel like the psychological aftermath of either this girl's story or the sepsis people is what makes it so scary it's not that like this really scary thing happened for 12 days yeah it's that I now live with the fear of this scary thing coming again but then more importantly is I was just kind of shook by that woman being like the veil has been uncovered in my life of probability means nothing yeah you know and I've always said this you know which is I don't think everything happens for a reason but I think everything happens and so just her opening herself up to like everything can happen and might happen and not like I go to sleep with the blanket of comfort every night being like well one in a million yeah that's so for me that wow that I think this is number one for me right now it is close to number one for me too because it's so I literally there aren't a lot of episodes of this show that change my behavior but after this I am never going to look at and open anything the same way again like bug bites you know ingrown nails knee scrapes like I'm usually pretty good about washing them and band whatever but I'm it's a whole new level now yeah making sure that I don't you know open a scab you know like don't scrape them don't scratch them just cover them up cover them up remember how we all like idiots used to like wash down our groceries during quarantine yeah that's got to be our bodies now yeah yeah but I think time will tell that like this is this won't be a fad this is a good idea yeah this is this is a this is a rough one it's a mean one but I enjoyed this episode actually I think it's gross and I will put in you know if you're hearing this and I didn't then sorry but I'm pretty sure I've got to put in you know the little warnings and I'll try and put very specific chapter marks for people of like hey if you want to avoid but I didn't think anything was actually that that gross because it's just medical what are you going to do you can't really get around it yeah it's all body stuff and we had the wonderful text from this writer who's a good writer so fucking crazy that this was a good I think this was a good episode and an eye-opening episode an episode we can learn from in the way that I feel like we learned a lot during sudden death with yeah just stuff to think about with aneurysms and berries under your branches and stuff it's just if there's anything we've learned this season and partially last season is just a little bit of preventative stuff in your brain of like maybe getting checked up maybe when you wouldn't have previously yeah you know if you feel something do something about it and also maybe like get a physical every year especially if it's already covered by your insurance or something yeah absolutely all right well guys wash your hands and not of this show not of this show we love having you here we will see you next week until then this has been scared all the time i'm chris kallari and i'm ed vicola see you next week bye bye scared all the time is co-produced by chris kallari and ed vicola written by chris kallari edited by ed vicola additional support and keeper of sanity is tess feifel our theme song is the track scared by perpetual stew and mr disclaimer is and just a reminder you can now support the podcast with sap premium and get all kinds of cool shit in return depending on the tier you choose we'll be offering everything from ad-free episodes producer credits exclusive access and inclusive merch so go and sign up at scared all the time podcast.com don't worry all scaredy cats welcome no part of the show can be reproduced anywhere without permission copyright astonishing legends production tonight we are in this together together together astonishing legends is brought to you by progressive insurance fiscally responsible financial geniuses monetary magicians these are things that people say about drivers who switch their car insurance to progressive and save hundreds because progressive offers discounts for paying in full owning a home and more plus you can count on their great customer service to help you when you need it so your dollar goes a long way visit progressive.com to see if you could save on car insurance progressive casualty insurance company and affiliates potential savings will vary not available in all states or situations hello hello i'm malcolm glabwell host of smart talks with ibm i recently spoke with ibm's new director of research jay gambetta we discussed his vision for the future of quantum computing at ibm research what we always do is answer what is the future of computing whether it's coming up with new algorithms coming up with better ai coming up with quantum or coming up with just how do different accelerators go together it's our dna to answer the question of what is the future isn't it a perfect problem for ibm because you kind of need to have a legacy of building stuff yes building actual physical machines yeah it's why i came to ibm i wanted the experience the culture of building hard things that others have not done before where do you imagine we are in the timeline of this technology there will come a point when it will mature right yeah my cell phone is a mature technology at this point how far are we from that point with quantum by 2029 we'll build the first fault tolerant quantum computer that is one that can run a very very large large problem to learn how ibm is building the future of computing visit ibm.com slash quantum all right quick quiz for the hiring managers out there what's worse being understaffed or being poorly staffed well that's a trick question because both are recipes for chaos either way just say to yourself this is a job for indeed sponsored jobs you'll get matched with candidates that meet the skills certifications and everything else you're looking for or go a different way and get no traction seriously sponsored jobs posted directly on indeed are 95% more likely to report a higher than non-sponsored jobs it really is a no-brainer spend less time searching and more time actually interviewing candidates who check all your boxes less stress less time more results when you need the right person to cut through the chaos this is a job for indeed sponsored jobs and listeners of this show will get a $75 sponsored job credit to help your job get the premium status it deserves at indeed.com slash podcast just go to indeed.com slash podcast right now indeed.com slash podcast terms and conditions apply need to hire this is a job for indeed sponsored jobs ever notice that feeling your worst also seems to happen at the worst time in the worst places like sudden nausea at 9pm when you're out of town really now fortunately with Hartford HealthCare's HHC 247 app you can get answers diagnosis prescriptions even speak live with clinicians anytime anywhere so maybe there's never a good time to be sick but at least the best care is always there download the app at your app store or HHC 247 dot org lately car buying has become a pretty dull experience but on ebay behind every car in part is a story waiting to be shared there was a guy who bought a 2020 Porsche Cayman GT4 on ebay it was well loved there are plenty of Caymans in great condition on ebay but this one needed some work that's just the start of the story so after this guy gets a great deal on his dream car he rebuilds the whole thing with all these parts he found on ebay performance brakes suspension body panels the works guaranteed to fit next thing you know this nearly scrapped Cayman was out there on the track as a full-blown race car you're ready to go daily driver your next restamod hello Lotus Alon and the parts to finish it ebay has thousands of cars and is the largest online selection of vehicle parts and accessories ebay things people love astonishing legends is brought to you by progressive insurance fiscally responsible financial geniuses monetary magicians these are things that people say about drivers who switch their car insurance to progressive and save hundreds because progressive offers discounts for paying in full owning a home and more plus you can count on their great customer service to help you when you need it so your dollar goes a long way visit progressive.com to see if you could save on car insurance progressive casualty insurance company and affiliates potential savings will vary not available in all states or situations hello hello I'm Malcolm Gladwell host of Smart Talks with IBM I recently spoke with IBM's new director of research Jake Gambetta we discussed his vision for the future of quantum computing at IBM research what we always do is answer what is the future of computing whether it's coming up with new algorithms coming up with better AI coming up with quantum or coming up with just how do different accelerators go together it's our DNA to answer the question of what is the future isn't it a perfect problem for IBM because you kind of need to have a legacy of building stuff yes building actual physical machines yeah it's why I came to IBM I wanted the experience the culture of building hard things that others have not done before where do you imagine we are in the timeline of this technology there will come a point when it will mature right my cell phone is a mature technology at this point how far are we from that point with quantum by 2029 we'll build the first fault tolerant quantum computer that is one that can run a very very large large problem to learn how IBM is building the future of computing visit ibm.com slash quantum all right quick quiz for the hiring managers out there what's worse being understaffed or being poorly staffed well that's a trick question because both are recipes for chaos either way just say to yourself this is a job for indeed sponsored jobs you'll get matched with candidates that meet the skills certifications and everything else you're looking for or go a different way and get no traction seriously sponsored jobs posted directly on indeed are 95% more likely to report a hire than non-sponsored jobs it really is a no-brainer spend less time searching and more time actually interviewing candidates who check all your boxes less stress less time more results when you need the right person to cut through the chaos this is a job for indeed sponsored jobs and listeners of this show will get a $75 sponsored job credit to help your job get the premium status it deserves at indeed.com slash podcast just go to indeed.com slash podcast right now indeed.com slash podcast terms and conditions apply need to hire this is a job for indeed sponsored jobs ever noticed that feeling your worst also seems to happen at the worst time in the worst places like sudden nausea at 9pm when you're out of town really now fortunately with Hartford Health Care's HHC 24 7 app you can get answers diagnosis prescriptions even speak live with clinicians anytime anywhere so maybe there's never a good time to be sick but at least the best care's always there download the app at your app store or HHC 24 7 dot org lately car buying has become a pretty dull experience but on eBay behind every car in part is a story waiting to be shared there was a guy who bought a 2020 Porsche Cayman GT4 on eBay it was well loved there are plenty of Caymans in great condition on eBay but this one needed some work that's just the start of the story so after this guy gets a great deal on his dream car he rebuilds the whole thing with all these parts he found on eBay performance brakes suspension body panels the works guaranteed to fit next thing you know this nearly scrapped Cayman was out there on the track as a full blown race car you're ready to go daily driver your next restamod hello Lotus Alon and the parts to finish it eBay has thousands of cars and is the largest online selection of vehicle parts and accessories eBay things people love ever notice that feeling your worst also seems to happen at the worst time in the worst places like sudden nausea at 9pm when you're out of town really now fortunately with Hartford HealthCare's HHC 24 7 app you can get answers diagnosis prescriptions even speak live with clinicians anytime anywhere so maybe there's never a good time to be sick but at least the best care is always there download the app at your app store or HHC 247.org I'm US Transportation Secretary Sean Duffy we all get distracted when we drive whether it's from our phones or kids in the backseat bickering but how we handle these distractions can be a matter of life or death before you get on the road for your next road trip please put your phones on silent and take a mental note to focus on driving paid for by NHTSA for delicious meals you could go out to eat or spend hours in the kitchen or you could just make a Marie Callender's meal yeah you heard me Marie Callender's classic chicken parmigiana bowl is delicious with scratch made marinara sauce creamy mozzarella cheese and no preservatives it's high in protein with 30 grams per serving Marie Callender's what having it all tastes like