Doctors take tough decision

Tartu Ülikooli kliinikumi kirurgiakliiniku külalisprofessor Peep Talving vastamas eile õhtupoolikul Maarjamõisa polikliinikus ajakirjanike küsimustele. Tema sõnul oli arstliku konsiiliumi otsus ühine: amputeerida Edgar Savisaare jalg ülaltpoolt põlve.

PHOTO: Kristjan Teedema

At 10 o’clock yesterday morning, six physicians convened to Tartu University Hospital intensive care unit to discuss action regarding Centre Party chairman and mayor of Tallinn Edgar Savisaar under constant anaesthesia since early Thursday morning last week, his right leg under attack by flesh-eating bacteria.

The team of doctors led by the hospital’s anaesthetics and intensive care clinic chief Professor Joel Starkopf, inspected Mr Savisaar and arrived at a decision to take him into the operating theatre as infection in the soft tissue of the led begged surgery.

Up to then – yesterday – media had basically distributed the version of Mr Savisaar sick with a hard case of pneumonia. As admitted by Mr Starkopf at the press conference held at the hospital yesterday where Mr Savisaar arrived Wednesday afternoon last week complaining weakness, tiredness and feeling bad, he also thought this was pneumonia. «All symptoms pointed towards that,» he added.

However, said Mr Starkopf, it soon surfaced that what Mr Savisaar actually suffered from was an infection due to leg injury. On the lower right leg, he had a skin scratch about a centimetre in length, the cause and origin of which is not known. From there, described the professor, streptococcus infection spread rapidly causing blood poisoning and taking Mr Savisaar into a critical condition, causing a toxic shock syndrome.

Via media, last week, the initial days of scarce information had led to assumptions that the severe health failure of Mr Savisaar may have been triggered by his recent trip to Thailand. About that Mr Starkopf would not speculate, only saying that the «microbe carries no label from whence it came from. This [flesh-eating bacteria] is a simple disease agent, found all around us, both in Thailand and Estonia.»

The professor explained that from a skin damage the bacteria moves on to tissue under the skin, initiates a source of infection and from there proceeds to spread increasingly; as circumstances converge, it may result in blood poisoning affecting the entire body.

Prof Starkopf said that as early as on Thursday, the doctors faced the question of how to save Mr Savisaar’s life.

Radical treatment

Operating on Mr Savisaar on Thursday, the surgeon Marko Murruste made cuts into the right leg. New surgeries, to fight the infection in the leg, had to follow on Friday and Saturday.

«The fight was victorious,» assessed the surgeon. «As far as we can tell, we were able to reach the stage where the spread of the infection was stopped.»

At yesterday’s press conference, held as agreed by those closest to Mr Savisaar to bring clarity into the contradictory and often speculative information spreading in the media, Mr Murruste added that according to current inspections and findings, the doctors have the impression that the infection has not spread into the body of Mr Savisaar.

Even so, it was clear to the doctors that the infection was continually damaging the tissues of the leg – tissue necrosis in the leg was still underway. The leg looked progressively worse.

At the meeting yesterday morning, the doctors unanimously concluded that radical surgical treatment was needed. In other words: surgery had to continue and, during it, they had to decode by assessing vitality in muscles and tissues what to do with the leg after all.   

As put by Mr Murruste, the options were if it would «suffice to remove the necrotic tissues or an action even more radical was needed.»

Mr Starkopf said they contacted the patient’s family before the surgery yesterday, telling them of the options and securing agreement regarding amputation of the leg if necessary. Nothing could be asked from Mr Savisaar personally, the man under narcosis for fifth day running – not in artificial coma as some publications had announced –, as this way, said the professor, it was easier for him to endure the breathing apparatus and repeated surgeries.

Asking for agreement by loved ones is, in such situations, the usual procedure. «Amputation of a leg renders an individual handicapped, we do not do this lightly,» said Mr Starkopf.

Only one way out

Yesterday morning, the team of doctors was joined by visiting professor of extraordinary surgery Peep Talving, up until last fall for six years employed at trauma team of Los Angeles County and University of Southern California, USA. 

«We entered the operating room to do [the surgery] step by step, to see of the limb could be preserved or not,» he described. «We begun with the tissues damaged worst. We realised these tissues had been damaged beyond recovery. We moved on.»

Moving on with the operation, the doctors arrived at a unanimous decision, thus summarised by Mr Talving: «This limb cannot be preserved, as the decay of the limb and muscle is in essence supporting multiple organ failure.»

Thus, the doctors had only one option left to save Mr Savisaar’s life: to do away with the infection and the outbreak at decaying tissue, the leg had to be amputated above the knee. 

At the press conference yesterday, Mr Talving expressed hopes that the dangerous source of infection was successfully removed. Even so, added the surgeon, Mr Savisaar will have to be wheeled into the operating rooms in the days to follow, if at all allowed by his condition.

«We will do this [surgery] every day,» promised Mr Talving, «Till we see that all sources of infection have disappeared.»

Meanwhile, the talk about Mr Savisaar having pneumonia is not altogether unfounded, as Mr Starkopf said they have detected some infectious findings in his lungs, but these are secondary in the present situation. 

«The main sickness is infection of soft tissue in the leg,» he confirmed. «This is an infectious disease that can hit any of us and is extremely severe.»

As admitted by Mr Starkopf, the information spread by media regarding possible kidney damage to Mr Savisaar is true. «Resulting from blood poisoning, he has several organs substantially damaged, including the kidneys, which need supportive treatment,» he said.

As to other organs damaged, the professor desired not to provide more specific information.

As assessed by the doctors treating Mr Savisaar, the patient’s condition continues to be very severe and critical, necessitating help by special apparatuses.

According to Mr Talving, Mr Savisaar’s condition was not substantially better even after yesterday’s surgery by the afternoon. «But let us hope the condition will improve,» he said.

«Each six hours gained have been a victory,» noted Mr Starkopf.