“It spread quickly, sending my body into acute septic shock”: How flesh-eating disease nearly killed a Toronto tech CEO
I had no idea there was a deadly bacteria quietly and rapidly growing in my body. It was just over a year ago, and I was staying at the Mandarin Oriental Hotel in midtown Manhattan. At the time, I was the CEO of PathFactory, a leading AI-powered marketing technology company based in Toronto that helps businesses like IBM, Adobe and Oracle market their products. I was in town to speak to a gathering of the top private-equity firms in North America.
The day after my talk, I awoke with a fever of 102. I had five meetings in five hours, and I needed to catch a plane home that night, so I slammed down four Tylenols and three cups of coffee and tried to shake it off. By 2 p.m., I was in meeting number three and my left leg, just an inch or so below the kneecap, was killing me. I chalked up the pain to skiing: a few days earlier, I’d tried to shave two seconds off my time on an icy run in Caledon and wiped out at the bottom. I figured this was my comeuppance. My business partner, Nick, had taken over the talking at our meetings. I was just trying to make it through the day. Meanwhile, a snowstorm had rolled into New York City; there was no way I was going home that night.
The next day my fever had spiked to 104.5 and my leg was still screaming in pain. When I tried getting out of bed in my hotel room, I collapsed on the floor, losing consciousness. Some time later, I came to. I couldn’t muster the strength to move my arms or legs. I’m in trouble, I thought. My iPhone was across the room. “Hey Siri!,” I tried. “Text Nick.” Nothing. I tried several more times without success. It was then that I realized how weak my voice was. I took a deep breath and summoned every ounce of strength I had. “Hey Siri!” I shouted. “Text Nick.” “What would you like to say?” I only had a few words left, so I just said it: “Help, I’ve fallen and I can’t get up!”
Nick burst into my room a few minutes later, followed by a hotel doctor, then EMTs. Nick was adamant: I was going to the hospital. Mount Sinai West was three blocks away. I assumed I had the flu. But Nick made a big deal out of the fact that my leg was hurting, and I credit his stubbornness with saving my life. The EMTs whisked me past emergency and straight to a trauma room.
The attending physician was concerned about the leg pain combined with acute fever. He wanted to do an exploratory surgery, but first he would need a CT scan, and that meant someone had to call my insurance company to get approval for a $17,000 test. That duty fell to Nick. He got it done. When the scans and my blood panels returned, the trauma room suddenly exploded with action. They’d found something—something terrible—and they were rushing me to surgery. I was fading.
The bacteria that was killing me is called Streptococcus pyogenes. It’s surprisingly ubiquitous: up to 15 per cent of the population carries it with no symptoms whatsoever. In others, it might lead to treatable conditions like strep throat, tonsillitis or respiratory illness, or skin conditions like impetigo. However, in random and rare cases—fewer than 200 in Canada annually—the bacteria might become something terrible. I was one of those random and rare cases. The bacteria had bloomed into necrotizing fasciitis, more commonly known as flesh-eating disease. It was spreading rapidly from my left knee up and down my leg, destroying the skin and muscle tissue. The disease had also caused my body to spiral into acute septic shock, which manifested in dangerously low blood pressure and cascading organ failure. It was going to kill me fast.
To save me, surgeons would have to stop the disease from progressing further by cutting it out. At first, they tried to remove only a 12-inch portion of the skin and fat from my lower leg. Hours later, when that failed to stabilize me, I was back in the table for a more aggressive tissue removal.
My wife, Danielle, was at our home in Toronto’s west end. Our kids—10-year-old Racquel and seven-year-old Max—had just gone to bed when the phone rang. The attending doctor told Danielle I was very sick and that she needed to come to New York right away. I was going into surgery and I might not survive. As the surgeons prepped me, they handed me the phone. I apologized to Danielle for wrecking her evening; I tried to stay upbeat. The room fell silent as I spoke. I said goodbye to her, and that was the last thing I remembered for a long time.
By the time Danielle landed in New York, I was in a coma and on life support. They guided her into my room, where my body lay, surrounded by machines. My surgeon spoke to Danielle in a grim, measured tone. They had removed significant amounts of tissue from my leg, saving as much muscle as they could. They hoped they’d stopped the disease from spreading further, and I was on powerful antibiotics. At the moment, their biggest concern was that I was in acute septic shock. I was on an aggressive course of vasopressors and inotropes, designed to bring my blood pressure up and prevent my organs and brain from dying. The trade-off was that the vasopressors worked by constricting the blood flow to my extremities. My limbs were starved of blood, and my hands and feet were turning black.
After four intense days, the staff started to see improvements in my condition and worked to wean me off the vasopressors. But the bacteria was proving hard to kill. Despite everything, it was still hiding in my leg. It bloomed again, and, for the second time in a week, I spiralled into septic shock. According to the prevailing research, going into septic shock twice in one week put my chances of surviving at roughly five per cent. Suddenly, even though I was still in a coma, I was a medical celebrity: I had a kidney team, a cardiac team, a surgical team, an infectious disease team and a host of other experts running tests and keeping tabs on me. I was in one of the top hospitals in the biggest city in the U.S., yet they had only encountered two other cases like mine in the past two years.
Danielle had a ton of support: my sister flew down from Toronto, along with some family friends. Our parents worked shifts at home taking care of the kids and trying to keep life normal for them. Despite all this, Danielle felt completely alone. This was the most serious event in our lives, and the person she would normally turn to for support was unconscious. All the doctors would say is, “He is very, very sick.” That’s how she knew it was very, very bad: despite all the work being done, no one seemed to be planning for my survival. Every night, she was the last to leave, retreating to an empty hotel room. Every morning, she returned early, hoping I had made it through the night.
“Open your eyes, Mark. Open your eyes…” I did. It was bright. I couldn’t feel anything, and I couldn’t move. I didn’t know it at the time, but I was recovering from a three-week coma. When I’d gone into the hospital, it was the third week of February. By the time I woke up, it was mid-March. It took me three days to fully come out of my coma, but to me, it felt like three years. I was still me, but the me-part was compressed into a small ball of consciousness, a ball that had been tossed into a deep black ocean. I vaguely recalled being married, having kids, having a life. But I wasn’t sure what was real. I would float to a level of lucidity, just enough to open my eyes and process my surroundings, and then, without warning, I would sink down again, away from my body. The cycle would not stop.
After three days, I suddenly snapped back, and this time, I stayed. I was told I was extremely sick, but I was having a hard time comprehending exactly what I was sick with. An army of medical staff were perpetually circulating through my room. They all smiled the same smile: a combination of disbelief and relief. I tried as hard I could to smile back at them. I was too weak to move, I had a feeding tube, seven or eight IVs, and I could barely speak. I could not see my body or move the covers, but I could see my arms. They were swollen to the point of being unrecognizable. I’d absorbed about 40 litres of intravenously fed saline that was now stuck in my tissue. It felt like I was encased in cement.
My blood pressure remained at dangerously low levels, and my organs had been starved of nutrients. My kidneys were not working and I was on full-time dialysis. My liver had been severely compromised. My heart had taken a merciless beating and doctors were concerned it might also be permanently damaged. I couldn’t breathe properly due to a collapsed lung, and I heard whispers that I might have brain damage. My hands and feet were still black like stone from the vasopressors, and I knew I might lose them, but that was the least of my problems. The expression on my doctors’ faces gave it away: I could still die.
And yet I still didn’t fully comprehend my situation, despite the fact that I was hooked up to a feeding tube, dialysis machine, infusion pumps, catheters and a vital sign monitor that was constantly telling everyone how messed up I was. I figured I could go home soon and just walk it off. I’ve always seen myself as a strong person. I was going to be 50 that year. I was a tech CEO for 20 years, so I thought I understood what stress was. I was a boxer, so I thought I understood mental endurance. I thought it would be a day or two before my boundless energy and vitality would return.
That idea was largely dispelled the first time I saw what remained of my leg. Four days after I woke from my coma, two surgical residents silently removed the elaborate layers of dressings that spanned the top of my leg to the top of my foot to reveal…well, mostly stuff you don’t ever expect to see. “That’s bone, right?” I croaked. The skin on my lower leg was gone, along with much of the muscle. I could clearly see almost the full length of my tibia. The back of my thigh was also gutted, leaving only exposed muscles and tendons. It looked like something from a horror movie. I had a hard time imagining how I was supposed to heal from this.
No one was saying anything so I pushed out a few words, the kind of words you actually hear in movies but never expect to say yourself: “Am I going to walk again?” The room was silent. Danielle leaned into my field of vision and spoke to me in her most confident voice. “Yes, you will walk, but it’s going to take some time and we will get there together.” I realized I needed to modify my expectations.
I spent three more weeks in the ICU, regaining some organ function while doctors pumped me with massive courses of antibiotics. The infectious disease team would show up periodically to draw fluid from under my kneecap, employing a comically large syringe that needed two people to operate. My leg was still completely gutted, and bones and muscles would be exposed for weeks still. The dressings needed to be peeled off and changed every day—an 8 a.m. horror show that required four surgical residents and 30 minutes to accomplish. I was given some oral pain medication but I still nearly passed out from the agony each time. I was also on dialysis, which made me throw up most of what they were feeding me through the tube in my nose.
Fortunately, my organs improved quickly. First my heart bounced back, and the cardiac doctors had a little celebratory party in the hallway. My liver suddenly seemed okay, too. But my kidneys were only working at about 15-per-cent capacity. They would take the longest to heal. The hardest thing was not being able to move. I was in constant pain from my huge open leg wounds, as well as from the pressure points on my spine and the back of my head. I needed to be washed regularly, and even that was excruciating.
About six weeks into my hospital stay, I was stable enough to be moved. I’d need extensive reconstructive surgery on my leg, but I had to go back to Canada to get it. My surgeon, Reid Ravin, reached out to a colleague in Toronto, and I was referred to the burn centre at Sunnybrook Hospital, a self-contained, quarantined facility with a dedicated group of specially trained nurses and doctors, its own surgical suite, as well as pain management, skin bank and critical care proficiencies. They had seen nec-fasc cases before and had a bed ready for me. I had been the subject of hundreds of test and procedures and numerous consultations by experts from multiple fields. The cost of saving my life in New York had amounted to a whopping $1.4 million. The insurance company was pleased I was returning to Canada.
Danielle figured out how to get an international medevac from Manhattan to Toronto. A day later, two smiling nurses from Montreal appeared in my room, sporting Canadian flags on their uniforms and ushering everyone out of the way. “We’re here to take you home,” they said. An hour later, I was loaded onto a Learjet. A few more hours, some ham sandwiches and Diet Cokes later, they pushed my gurney through the large double doors of the burn unit on the seventh floor of D-wing at Sunnybrook. Almost immediately, I was injected with a cocktail of painkillers, and for the first time since I came out of the coma, I was in zero pain.
Marc Jeschke, the centre’s medical director, came out to speak to Danielle. Despite all the progress I’d made, he said, I was still extremely sick. My kidneys were compromised, my blood pressure was all over the map, and I was in danger from my wounds, blot clots and respiratory complications. The bacteria was likely long gone, but they were not going to take any chances and planned to keep me on antibiotics till the lab cleared me. I had dry gangrene in my hands and feet that would need to be dealt with, and it was unclear if my leg was salvageable. Jeschke mentioned amputation, and Danielle gasped. She’d suspected it was a possibility, but no one at Mount Sinai West had ever talked about it.
As it turned out, I did need amputations. My left foot needed to be removed, as well as the toes on my right foot and the index and middle fingers on my left hand. Losing pieces of my body was a small price to pay to be alive. Besides, there was lots to celebrate: over the course of six operations, the surgeons at Sunnybrook saved a good portion of my leg. With an aggressive set of muscle and skin grafts, they even preserved my my knee function. Miraculously, my hands healed for the most part. And best of all, my kidneys came back online, I finally started to process some of the fluid that was trapped in my body.
By the end of March, once I was back in Toronto and stable, I was finally able to see my kids. It had been more than seven weeks, and I knew they were scared; I was scared too. My young son only wanted to know if all the bad things were over. I told him they were, and that was good enough for him. My 10-year-old daughter was shocked when she saw me. “Dad, your muscles are gone!” she blurted out. She was right: skin was hanging from my arms, and I looked 20 years older. “I’ll get them back,” I told her. She wanted to know everything and see everything. She was so grown up—it was the one time I cried.
After my surgeries were done, I was transferred to St. John’s Rehab, where I would to learn to walk again. I had been immobile for eight weeks and lost 40 pounds. They say you lose one per cent of your muscle mass every day of immobility, and they’re right. I spent hours trying to do the simplest things, like lift an arm or move a leg. In the short term, I would need special shoes to make up for my missing foot and lost toes. Ultimately, I would get a silicon prosthetic.
Rehab is a lot like it looks on TV—but far more painful. It took every ounce of my willpower to stand or take a step, and my reward was vomiting and passing out. I decided to treat it like a full-time job: my whole world became working out and eating as much protein as I could hold down to regain strength and put on weight. Once I could get up, I took to waking up in the middle of the night and doing slow, tedious laps around the nurse’s station with my walker. I also finally got a proper look at myself in a mirror. It was shocking, I had grown an epic beard, but the rest of me was frail and thin. The pressure wound on my head was healing, but it was doubtful that any hair would grow there. Fantastic, I thought. I’ll have to tattoo something back there instead. I suggested one of those head-ports from The Matrix. Danielle said no.
I’m not known for my patience. I was obsessed with getting strong enough to leave rehab as soon as humanly possible. And two weeks after they rolled me into St. John’s on a gurney, I walked out with just the help of a cane. It was the end of April, and I stood outside alone with the rain falling my face. It was incredible. I felt human for the first time in months.
I returned to work in May, after nearly four months away. I was thrilled to be back with my team. Even after everything that happened to me, I was still in love with the company I ran, addicted to the metrics, the culture, the pace. I couldn’t wait to see us step it up to the next level. Although my heart and mind were committed, the rest of my body would not cooperate. After three weeks, I realized I’d returned to work too early. The surgeries had left me in near-constant pain. I was taking hydromorphone and pregabalin, and those helped a little, but they also made me feel sick to my stomach. I was accustomed to having boundless energy, the kind that helps me manage details, listen carefully and make hard decisions. Suddenly it was harder to reach for that energy.
A zero-sum choice was forming fast. I could do a good job of running the company or I could do a good job of healing, but not both. There was only one choice: I stepped down as CEO, though I would stay on the board of directors. It was a tough decision. Given the therapy and equipment I would need, I knew our expenses would increase. At the same time, I was sure it would be a matter of months before I’d be back at 100 per cent. It was the right risk to take.
I spent the summer getting stronger. I did weights, balance exercises, stretching, cardio and more weights. My leg, however, was a constant problem. I no longer had a foot on which to distribute my weight while standing. Instead, all the pressure was concentrated on a small group of bones surrounded by scar tissue. The flesh in the area kept breaking down into messy, open wounds. The pain was severe, relentless and hard to control.
Over the last few months, I’d learned a great deal about pain. The takeaway was simple but profound: in time, inevitably, pain will change you. It will change how you move, how you act, and even how you think. I loved Danielle and the kids, and I loved who I was when I was with them. I didn’t want the pain to change me. I approached the problem like I’d approached hard decisions in the past: research, logic and a truckload of analysis. I asked my doctors a thousand focused questions and scrutinized their answers until I understood all the factors. I learned about state-of-the-art prosthetics and tracked down others who had been through a similar set of complications. Ultimately, I realized that my leg would only get worse as I aged, and the technology to replace it would only get better. And so, a few short months after brilliant surgeons had worked so hard to save most of my left leg, I made the decision to amputate it.
Eventually, I got Danielle and my doctors to agree with me. The only thing standing in my way was OR time: my surgeons at Sunnybrook were swamped with considerable backlogs of patients who needed work done as badly as I did. While I waited, I did things that would minimize my post-surgical recovery time. I learned how the procedure would be done, what muscles and nerves would be involved. I knew I would be stuck in a bed with limited mobility, and that would make me weaker again. It would be weeks before the wounds would close, so I’d have to be strong enough to move my own weight around with just one leg. I shifted my workouts to focus on pushing exercises with my good leg and pull-ups with my upper body. I also dropped some of the weight I previously worked to put on. Then, suddenly, in October 2019, I got the call to come in.
Much to my surprise, I got the choice of either a general anesthetic or an epidural and sciatic nerve block. I chose the second option: I wouldn’t feel anything below the waist, and I could be be somewhat awake. The idea of being partially awake was intriguing: you only cut your leg off once, I thought, and I wanted to be as aware as possible for it.
The operation took two and a half hours. You’d think there would be a faster way to take off a leg, but the procedure requires a lot of careful cutting and sewing to create a good stump. Toward the end, I asked the surgeon if I could see my leg. He told me it was already in the morgue.
After surgery, they rolled me back to my room. I sat alone in my bed looking at where my leg used to be. The phantom pain hit me me hard: despite the fact my leg was gone below the knee, I could feel everything from my toes right to the wound site. My brain was interpreting the loss of nerve signals as pure pain. I had an infuser pumping anesthetic into what was left of my leg, and I was allowed to give myself 0.2 milligrams of hydromorphone every five minutes by pressing a button. The infuser made a happy little chime every time I pressed it, but as far as I could tell, that was all it did. By midnight the pain was increasing faster than I could take pain medication; picture a breakwater steadily being overwhelmed by the crashing waves of a tsunami. It was a very long night.
The next morning, doctors added Lyrica and ketamine to my painkiller cocktail; that did the trick. The wound was wrapped in a clear plastic dressing with a suction pump attached to it, which drew fluid from the wound site and promoted healing. Before the procedure, my leg was a mess of reconstructed tissue, so it was cool to see what the surgeon had done. I was ready to go home after 10 days, but first, I had to prove I could hop around adequately on crutches without killing myself. This was harder than I expected. Crutches are a lot less scary when you have two legs, even if one is damaged. Now I was functioning as some sort of tripod, and the floor seemed a long way to fall.
In the weeks that followed, I learned how much you take for granted when you have two legs—even going to the bathroom in the middle of the night becomes a big problem. Falling down needs to be avoided at all costs: when you’re missing a limb, you can’t collapse safely as you fall, the way every toddler learns to do. If you go down, you go down hard. And if you break an arm or a hip, you’re screwed. But I adjusted—and more importantly, the pain was gone. I had made the right decision.
This past January, four months after my amputation, I met with my prosthetist, Wilson Cisneros, at Sunnybrook Centre for Independent Living. He presented me with my new leg, comprised of a socket, suspension and foot and ankle system. The custom socket is designed to spread to the weight of my body over specific tissues, like the patellar tendon below the knee and calf muscles at the back. These tissues can withstand weight better than the bottom of my stump. Between the socket and my skin is a precision-moulded liner made of a highly specialized urethane compound. The material is the exact density and texture of human skin, and it’s designed to prevent my own skin from shearing off as I walk. The socket is attached to a suspension system that is in turn attached to a high-tech ankle and foot mechanism. Wilson had put one of my running shoes on the new leg and showed me how to put the whole thing on. Then, I stood up, and took a few steps. They weren’t great: I felt like my leg was asleep. However, seeing two shoes with two feet in them flooded my brain with reassuring signals. I quickly adjusted and everything started to make sense. I smiled the entire time. This is going to work, I said to myself.
With some additional therapy, I can now see myself returning to things like boxing, skiing and running. I also want to get back to work. I miss PathFactory, the company I co-founded with Nick and ran for six years. But they did just fine without me, and I’m proud. I’ll stay on the board of directors, and I’m currently exploring some exciting options for my next CEO job. I look forward to building more businesses and contributing to the tech community in Toronto. Danielle and the kids are also doing great. After a long and scary interruption, our lives are starting to feel normal again. We’re back to making plans, laughing and spending time talking about anything other than me. For that, I am truly grateful.
Mark Attila Opauszky has been a tech CEO in Toronto for 20 years. He runs ACEO, a blog for tech leaders.