Tanya Gludau’s face reflects her serenity and confidence after a morning bike ride near the shore of Lake Tahoe last November. Jonah M. Kessel / Tahoe Daily Tribune
In a South Shore grocery store or coffee shop, or out shopping for shoes, Tanya Gludau goes about her business as anyone would. Like many harried shoppers, the South Lake Tahoe woman has a mission, gets what she wants and leaves. To those around her, Gludau perceives herself as out of sight and out of mind. But she knows she's really not: In her periphery, she notes the eyes of other shoppers. They're either curiously transfixed - especially if they are the eyes of children - or they look, shift and dart away.
"I've gotten used to the stares," the 34-year-old woman said. "At first, they were annoying, but anymore I just don't think about it."
And so it goes for Gludau: March 22 marked an agonizing one-year anniversary. On that day a year ago, she lost half of her right upper body to a strange infection called necrotizing fasciitis.
This flesh-eating bacteria, considered fatal within 72 hours, incubated from a form of Strep A that all humans have in their bodies; the bacteria formed a perfect storm in her bloodstream. For Gludau, it was identified 70 hours after it had begun to seize her arm, killing the flesh in her fingertips first, then moving to her hand, arm, chest and shoulder.
Eight Salt Lake City surgeons spent nearly 12 hours to stop the bacteria from moving to its deadly destination: her brain.
They stopped it, but in the process had to sever Gludau's entire arm above her collarbone. Doctors also had to make deep cuts down through the right side of her neck and chest, removing her right breast.
What is necrotizing fasciitis?
The name “flesh-eating bacteria” is a little sensational, but essentially, this is what the bacteria appears to do. It gets into the body, quickly reproduces and gives off toxins and enzymes that destroy the soft tissue and fascia, which quickly becomes gangrenous (dead). This gangrenous tissue must be surgically removed to save the life of the patient. The bacteria also stealthily hides itself from the body’s innate immune system, allowing it to spread rapidly along tissue planes. Necrotizing fasciitis causes excruciating pain, dangerously low blood pressure, confusion, high fever and severe dehydration due to the toxins poisoning the body. Unfortunately, necrotizing fasciitis sometimes occurs beneath the skin with few symptoms to explain the victim’s condition. This results in a great many cases of misdiagnosis.
Source: National Necrotizing Fasciitis Foundation, www.nnff.org
A deep cavity in the right side of Tanya Gludau’s body replaces what was her arm and breast. The life-altering scar is the result of an invasive Strep A infection that led to necrotizing fasciitis, also known as flesh-eating bacteria, and forced doctors to perform an amputation to save Gludau’s life. Jonah M. Kessel / Tahoe Daily Tribune
The almost-surreal encounter with the bacteria has sensitized Gludau to her physical appearance and how it draws visceral reactions. Before March 2007, she explains, she, too, was curious when she encountered people with physical disabilities. She would find herself looking at a person, well up with empathy and then turn her eyes away.
"I think it's human to look," she said. "When you see somebody who's disfigured, you're seeing something that's out of the ordinary. So your eyes go there.
"I think people want to know what happened to me, but I don't think a lot of people have it in them to come up and ask," she said. "If they did, I would tell them. I would tell them about necrotizing fasciitis."
Tanya Gludau and her fiancé, Neil Peerens, snowshoe through the forest at Kirkwood Mountain Resort’s Cross-Country Center in January. After having her right arm and breast amputated, Gludau’s balance was thrown askew. With Peerens’ support, she has regained her balance and the confidence to live a normal life. Jonah M. Kessel / Tahoe Daily Tribune
A journey turned tragic A professionally trained and schooled chef, Gludau learned early on that her chosen line of work coincides with her passion for the outdoors. Raised in New York and Florida, she was drawn to the West for its vast outdoor canvas.
A hiker, skier and cyclist, she found the clean mountain air cleansed her soul. The West had become a natural fit for her in a spiritual journey as well. It was a world with which she had dabbled while hiking alone in the mountains of Montana, and one that would become clarified when she met Neil Peerens of South Lake Tahoe.
The two met in 2005, as do many who are worlds apart: on the Internet.
She had been working as a chef in Montana near Yellowstone. He was in his last year at Idaho State University. Before transferring, he had taken classes at Lake Tahoe Community College.
Peerens is a hulk of a man who at first glance looks intimidating - like a football player or bar bouncer, which he once was in his 20s on the South Shore. He doesn't concern himself with unimportant things: He digs deep to find meaning. His undergraduate degree is in philosophy and, like Gludau, finds the outdoors the best place to come face-to-face with his maker.
"Our first date was cross-country skiing at Yellowstone," Gludau recalled. "There was something in him that you don't get with e-mail. He has this thing in him about pushing forward and pushing yourself."
With Gludau working as a pastry chef near Yellowstone and Peerens working on his degree at Idaho State University in Pocatello, the two decided to take their relationship to the next level. Gludau moved to Idaho, and in with Peerens.
How do you get necrotizing fasciitis?
Most often, the bacteria enters the body through an opening in the skin, quite often a very minor opening that can be as small as a paper cut, a staple puncture or a pin prick. It also can enter through weakened skin such as a bruise, blister or abrasion. It also can happen after a major trauma or surgery, and in some cases, there appears to be no identifiable point of entry.
Source: National Necrotizing Fasciitis Foundation, www.nnff.org
A cut, a strain and incubation March 19, 2007, began like any other day, but for Gludau, it would end with a disease she wouldn't even know she had contracted.
Gludau had landed a cooking job at a catering company that prepared food for employees at a semiconductor company in Pocatello.
She was a routine sous chef and liked working her 6 a.m. Monday-through-Friday shifts, leaving her weekends to enjoy the outdoors.
She had been on the job for three weeks. She prepped first thing in the morning, beginning with celery using her personal 10-inch, straight-edged chef knife. As she began to chop, the knife plunged into her middle right finger.
"It looked like a deep paper cut. It bled a little bit. I told everyone in the kitchen that I cut my finger," she said, explaining that announcing a cut is proper practice in a kitchen.
Gludau threw out the celery, ran the knife and cutting board through a dishwasher, sanitized the work station with bleach and went to the kitchen's first-aid kit to dress the wound. She eventually found a bandage to fit her cut, rewashed the wound, dried it, applied the bandage and put on a pair of gloves so she could continue working.
Four hours passed without a thought about the cut - though unbeknownst to Gludau, she was experiencing the wound's peripheral effects. As she lifted 60-pound pots of potatoes off a stove, she felt the muscle in her right shoulder pull.
The pain shot down her arm, she said. "I told my supervisor that I had pulled a muscle, but that I wanted to continue working and that it wasn't that serious," she recalled.
The pain continued to get worse after she arrived home that night, now accompanied by chills that turned to sweats. She thought she had the flu.
The day after the work incident, Gludau told Peerens that she wanted to go to the hospital. She called her supervisor and told her she had deep shoulder pain and flu symptoms.
She arrived at work, and her supervisor took her to the hospital, where Gludau filled out workplace injury forms. She said she wanted blood work done, but the doctors declined, saying she didn't need it, Gludau said.
Doctors gave her 800 mg of ibuprofen, put her arm in a sling and advised her not to work for the next few days. The doctor also told her that she would "feel worse before getting better."
Two days after the work incident, Gludau lay in bed, more fits of chills and sweats racking her body.
"I was in excruciating pain from my neck into my shoulder," she said.
She developed chest pains and returned to the hospital. Once again, Gludau said, she asked for blood tests. And once again, staff told her that a blood test wasn't necessary. "The medical staff gave me Tylenol and told me to stay in bed," she said.
At about 2 a.m. on the third day of her travail, Gludau woke up dazed and thirsty, and went into the kitchen for water. When she turned on the light, she saw that all five of the fingertips on her right hand were black, and that her palm was purple with dots.
"And then I looked up my arm. My hand and arm were bubbling, like there was something growing inside the skin like you'd see on the SciFi Channel. I asked myself, 'Am I dreaming?' "
She woke up Peerens, who reminded her that the doctor said it would get worse before it got better.
"No, something is wrong," she told him, showing him her hand.
"We've got to get you to the hospital," Peerens told her.
What are the symptoms?
EARLY SYMPTOMS (in 24 hours): 1. Usually a minor trauma or other skin opening is evident (the wound does not necessarily appear infected). 2. Some pain in the area of the injury is present. It’s not necessarily at the site of the injury, but in the same region or limb of the body. 3. The pain usually is disproportionate to the injury and may feel like a muscle pull, but it becomes more and more painful. 4. Flulike symptoms begin to occur: diarrhea, nausea, fever, confusion, dizziness, weakness and malaise. 5. Intense thirst occurs as the body becomes dehydrated. 6. In general, sufferers probably will feel worse than they’ve ever felt and not understand why.
ADVANCED SYMPTOMS (in three to four days): 1. The limb or area of body experiencing pain begins to swell and may show a purple rash. 2. The limb may begin to show large, dark marks that will become blisters filled with blackish fluid. 3. The wound may begin to appear necrotic: bluish, white or dark, mottled and flaky.
CRITICAL SYMPTOMS (in four to five days): 1. Blood pressure will severely drop. 2. The body begins to go into toxic shock from the bacteria. 3. Unconsciousness will occur as the body becomes too weak to fight off the infection.
Source: National Necrotizing Fasciitis Foundation, www.nnff.org
'We cannot help her here' Lying on a hospital gurney and barely conscious, Gludau remembers hearing the word "blood clot." A blood test had revealed the worst, and the rest of that morning she never will forget.
Nor the words that started it.
"It came from the doctor. He was shouting. He said, 'I know what it is. Get her on a LifeFlight to Utah. We cannot help her here.' "
On the helicopter, a nurse told Peerens that he'd better say goodbye to her, because he may never see her again, he recalled.
"I had a good idea when they put her on the helicopter what was happening," he recalled. "I tried hard not to show her panic. I wanted my last contact with her to be something with love."
'What's wrong with my arm?' For six weeks, Gludau was in an induced coma. It was 2 a.m. May 4 when she "came to" - a planned awakening so her parents could be by her side. But she woke up early. "I looked around and knew that I was in a hospital," she said. "I knew something was wrong, because I reached for the nurse button, and it was on my right side. I couldn't reach it."
She began to scream for help. A nurse came in. Gludau asked her what was wrong and why she was in a hospital. The nurse told Gludau that she needed to talk to a doctor. Gludau asked for her cell phone sitting on her bedside table. She called Peerens.
"We started talking, and I told him something isn't right. I told him my arm was missing. I asked, 'What's wrong with my arm?' Neil said to reach over and touch my shoulder. I did."
He explained to her what had happened, and then they broke down.
Tanya Gludau looks through the rearview mirror of her converted tricycle in the Bijou neighborhood of South Lake Tahoe last November. The tricycle has been custom-designed so that Gludau can operate it with just one hand. Jonah M. Kessel / Tahoe Daily Tribune
Recovery and relearning routines For nine weeks, Gludau was in the burn center ward of the University of Utah. She had six skin grafts, with the skin for one graft harvested from a cadaver and five pieces of skin sliced from her right upper thigh. She consumed a liquid diet to quickly replenish her nutrients, but she didn't care much for the choices. She wanted her favorite drink, a Starbucks Frappuccino. The doctors OK'd the unusual request.
"Each one has 1,500 calories," she said. "It's what I wanted and needed."
Once out of the burn unit, Gludau underwent aggressive therapy to regain her sense of balance. She bicycled and lifted weights, 25 reps at a time. She had to relearn and retool her basic physical life skills: She had to learn how to dress herself (particularly challenging was putting on socks, and she now wears a lot of pullovers) and how to eat with her left hand.
"It was exhausting, but there was no choice," she said. "It took me a year, but I finally learned how to do buttons. I told Neil, 'One giant leap for Tanya, one small leap for mankind.'
"It's one of those things, where you realize, 'OK, how do I do this?' But then after a while, it becomes routine."
Cooking has become somewhat of a challenge. Over time, Gludau has learned how to open jars by putting them between her knees. Stirring is easy; cutting is not. She has dozens of kitchen gadgets designed to make it easier, but she says they go unused.
"I like the challenge," she said.
Complacency is not an option Having finished his college degree while Gludau was in the coma, Peerens asked her where she wanted to go after the hospital. She told him, "I want to go to Lake Tahoe with you."
An avid cyclist before the accident, Gludau can be seen pedaling around town on an adult tricycle. She hikes, snowshoes and skis with Peerens. She also spent a week whitewater rafting in September, a turning point in her recovery, she says, because it was the most physically demanding thing she's done.
"Complacency isn't one of my options," she said. "I'm not going to sit around and watch Oprah and do nothing. My life - life in general - is too short. There is the possibility that I could get it again and die."
And her doctors at UC Davis agree with her outlook.
"It appears she's doing great. She is far ahead in her recovery. Most people wouldn't be in the state of mind she's in (during) this period of the disability," UC Davis surgeon Kelly Nagasawa said during a routine examination Feb. 5.
When Gludau got the go-ahead for downhill skiing, David Greenhalgh, chief of the UC Davis Department of Burn Surgery, jokingly but seriously advised her "not do any flips or fly off of 15-foot cliffs. Otherwise, I say go and have some fun."
Later, Greenhalgh said Gludau's strength lies in keeping a positive attitude.
"She wants to do those things that are preinjury, and she has the enthusiasm to do that. She's well ahead in her recovery," he said.
On March 18, Gludau began her second gig working for Starbucks as a barista. She admitted being nervous that first morning - thinking she wouldn't be able to do what she had done before - but the challenges soon vanished. She made five drinks in the first several hours of retraining.
"It's second nature," she said. "The only thing I can't do at the moment is tie the garbage ties."
Gludau's medical bill is $2.5 million and growing. She faces more surgery, in which skin from her stomach will be stretched to cover the transparency of the grafts. The skin also will be used to reconstruct the breast area.
She is suing to force Idaho workman's compensation to pay for the care, since she had not secured health insurance at the job. She had only been employed at the catering company for three weeks.
Gludau owes much of her will to Peerens, she said. She inspires him, Peerens said. They now are engaged and plan to marry someday.
"There is the mind and body connection to this, and we talk about it a lot," he said. "We continue to talk about it. She is the perfect example of someone who lives it. She walks the walk. The success that she's managed really blows my mind.
"She has this incredible will to live. While others are out there not understanding or reaching their higher consciousness, she has made it her mission. She sees what many don't: That she has a reason and a purpose. She has the will to live every day and make the most of every day."
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