Thirty-six hours before the Vibrio vulnificus pulled him into a coma, Kenny Watts was boiling crabs.
It was a Saturday in August, and the summer of 2017 had been full of weekends like this one: Watts’ friend, a commercial crabber in Virginia, would make regular trips to Maryland to sell the smallest of his catches at a discount. Watts has a shellfish allergy, but loved cooking for company.
It was around 5 p.m. that the 53-year-old Greenwood resident felt one of the blue No. 2s pinch him and penetrate the skin on his left hand. He didn’t know at the time that he had been infected at that moment by Vibrio vulnificus, a fast-acting, sometimes fatal bacteria found in brackish water.
Watts would be one of thousands of people in the U.S. that year who contracted some kind of Vibrio, according to official estimates. The type he contracted releases enzymes that can rot flesh and shut down internal organs, thus is often erroneously described as "flesh-eating."
Some of the most severe cases of the disease can result in amputation or death, such as a man who died from the bacteria four days after cleaning crab pots at his Ocean City condominium in 2016. Experts say the risk of the bacterial infection has increased as coastal waters, including those around Delmarva, get warmer.
The wound, barely visible on his palm at the base of his thumb, would be the start of a year of fighting a bacterial infection that would forever change his life.
But Watts grew up crabbing and had been pinched plenty of times before. So he thought little of it as he went to the medicine cabinet to pour rubbing alcohol over the two near-invisible pinpricks. The night went on: Cars slipped in and out of his driveway between lingering conversations and sips of Stella Artois. He kept cooking until early morning, when the last of his friends went home, then fell asleep at 6 a.m.
At 10:30 p.m., his rottweiler’s barking woke him up. Watts came to the door to find his co-worker, who came to check on him on behalf of worried friends. He wasn't answering his phone, his co-worker said. She suspected that Watts, who didn’t typically sleep for 16 and a half hours at a time, was having an allergic reaction to the crab that pinched him.
His co-worker went home, but not without calling Watts' girlfriend of 17 years, Tricia Sulecki, to tell her, "Kenny's not acting right."
Sulecki called shortly afterward, but Watts insisted that there was no reason for her to have to come over. He went back to bed.
At 7:30 a.m., Sulecki called again. It was Monday and, this time, Watts didn't feel well.
"I can’t wake up," he told her. "And I’ve got this big blister on my hand."
The wound, which had been microscopic not two days ago, was now half the size of a tennis ball.
Sulecki sped over. When she arrived, he was unconscious in his bed again. She woke him up and insisted she would drive him to the Beebe Medical Center in Lewes. He struggled to get dressed and had unusual trouble bending over to tie on his shoes.
The longer Sulecki looked at her boyfriend, the more she noticed something was wrong: Not only did his wound look like a giant blood blister, with purple offshoots visibly creeping up his wrist, but his legs were swollen and red. He was too weak to walk. He couldn’t focus. He wasn’t himself, Sulecki thought.
When Watts was hoisted into the passenger seat of Sulecki's Toyota Camry, he noticed the seat-belt wouldn’t fit over his body — something he never had trouble with in the past. Sulecki started the ignition and Watts passed out again. When he came to, they had arrived to the hospital.
A nurse asked Watts if he could get into a wheelchair. He said, "I don't think so." That's the last he remembers before slipping into a coma.
Editor's note: The next section of the article contains an image that some readers may find graphic.
"Every crab ... guaranteed"
Watts would become one of Delaware's 12 reported cases of Vibrio in 2017. The Centers for Disease Control estimates that there are 80,000 illnesses and 100 deaths nationwide per year from the bacteria.
Those familiar with Vibrio will assure that the disease, especially the kind that infected Watts, is rare. But those same experts also say it is a hard time finding a crab or oyster in Delmarva's brackish waters that doesn’t have some kind of Vibrio during summer months, since the bacteria prefers water that is at least 64 degrees Fahrenheit with salinity between 15 to 25 parts per thousand.
"It’s well known. Every crab in the Chesapeake Bay, in August, guaranteed," said Dr. Scott Olewiler, the infectious disease specialist who treated Watts at Beebe.
Jeff Shields, a professor at the Virginia Institute of Marine Science, said studies show that 50 to 90 percent of blue crabs contain Vibrio in their blood.
"Probably all of them have it on their shell," he said.
But that isn’t a reason to be alarmed, experts say. Shields said that even though vulnificus leads to more severe symptoms than other Vibrio species, it’s "very rare" to get vulnificus from eating raw oysters, and even rarer to get it from a wound like Watts did. This is why, Shields said, vulnificus has not been "well studied" in blue crabs, especially since the crustaceans are served cooked.
"You should never store cooked crabs in the same refrigerated case with raw crabs," Shields said.
A spokesperson for the Delaware Department of Natural Resources and Environmental Control said the state has never had a known Vibrio case from shellfish, such as clams, mussels and oysters, harvested from its waters.
The Department of Public Health said there have been zero cases of Vibrio vulnificus in 2018. Health officials did not track the type of Vibrio of each reported case, which could vary in severity and origin, before this year.
Many people who swim in bay water can get exposed to Vibrio either through brush burn or swallowing a small amount of germs, experts say. But it usually isn’t enough to be infected.
In his opinion, Olewiler said those who "are really in trouble" with the disease are those who contract it from eating raw oysters, which he called "a really bad mistake."
"Locally, everybody loves that and thinks it’s the greatest thing in the world," Olewiler said. "They just eat the raw oysters and one day later they’re in the intensive care unit in shock. … A large number of them will die. Probably all of them die if they are truly in shock."
"It was a nightmare"
After four days comatose, Watts woke up in a hospital bed in the intensive care unit. His hand was suspended and the size of a catcher’s mitt under bandages. Sulecki was at his bedside.
She told him what happened: He contracted Vibrio vulnificus from the crab pinch. He had arrived to the hospital on the fringe of shock. He was on life support for two days with a 5 percent chance of survival. Had his blood pressure been lower, his chance of living would have been next to none.
"Within an hour (of being at the hospital), they told me to call his family," Sulecki said. "It was a nightmare. … They really didn’t give him that much hope."
Sulecki didn't leave the hospital for the first two days. Watts’ brother, Michael, drove in from South Carolina. Others paid visits during the nights and early mornings.
"I’ve never seen so many grown men in my life standing by a person’s bedside, crying," Sulecki said.
Olewiler said Watts survived because of how soon he got to treated.
"The ER doctors called me right away," Olewiler said. "I was able to get there and, really with one look, ordered the antibiotics."
Doctors who practice near the Chesapeake and Delaware Inlet bays get used to spotting the disease, and Watts had all the telltale signs when he arrived: He was groggy and drowsy. He had a fever and a purplish, jigsaw-puzzle-like mottling on his skin. His blood pressure was low. Most importantly, it was August, and he had recently been pinched by a crab.
"You’d have a hard time thinking of anything else," Olewiler said.
Whether the bacteria was in his bloodstream could take days to confirm from a blood culture, and Olewiler had a hunch that they wouldn't have time to wait for the results.
"He may have been an hour — checking in, etcetera — before the right antibiotics were going into him," Olewiler said. "He got treatment very, very quickly."
Even though he survived, the bacteria was still eating away at his hand. Surgeons had to perform a series of surgeries to try to keep the infection at bay, Watts was told, but few if any expected him to regain full function ever again. That is, if he was able to keep the hand at all.
Watts had two surgeries before he was handed over to a specialized team of surgeons at the MedStar Union Memorial Hospital Curtis National Hand Center in Baltimore, where he underwent three more surgeries. With each one, doctors became more confident that he would keep his hand.
But he then got more bad news: His tissue and nerves looked damaged beyond repair, and he might never be able to make a complete fist or point his index finger. For the next year, Watts worked to prove them wrong.
"An incredibly unusual germ"
Data from the Delaware Department of Public Health show a slight increase in reported cases of Vibrio in recent years, which is in line with a national trend. But experts still dispute over whether the bacteria is becoming more common.
"This is an incredibly unusual germ," said Olewiler, who has specialized in infectious diseases in the Lewes area for 23 years. "There's no reason for me to think it's more common. In my experience, it's not. But I'm just one guy."
Dr. Rick Hong, an interim medical director for the Delaware Division of Public Health, guesses that the "small trend" of increased reported cases may be because people have become more aware about the disease, which may lead to more testing or proper diagnosis.
Some scientists argue that rising water temperatures due to climate change lead to higher risk of being infected by the bacteria. Some say that correlation is also why the bacteria is more common in the Gulf Coast than in waters further north.
"I suspect it's climate change, but I don't have data to indicate that," Shields said.
Olewiler thinks that the fearful public perception of Vibrio comes from which cases get reported.
"For a lot of diseases, the seriousness gets way overestimated because you only diagnose the worst of the worst," Olewiler said. "I have no doubt that there’s lots of Vibrio that probably does not get diagnosed."
But there aren’t many antibiotics that would work for Vibrio, Olewiler said, and the common ones for skin infections would have "no activity against this germ." Most Vibrio wound infections also bring on dark, blood-filled blisters that would tip off the doctor that it’s not a run-of-the-mill infection.
Still, most who contract the bacteria through a wound end up walking out of the hospital with all of their limbs and extremities intact, Olewiler said. He said he only sees one or two patients per year who contract Vibrio through a wound infection, which they get from aquatic activities such as fishing or playing at the beach.
"You can keep them in the hospital one day, two days," Olewiler said. "They go out on an oral antibiotic and they do well."
He added that Watts’ case was "particularly severe."
"He was a lot more ill than most people with wound infections," Olewiler said. "There’s some people who have this infection and just get better on their own immune system."
Watts is diabetic, which the CDC says might increase risk of infection. Specialists say that people with high levels of iron, either from certain liver diseases or an affinity for over-the-counter vitamins (“which you really shouldn’t do without a doctor’s advice,” Olewiler said), can be more prone to the disease.
A generally poor immune system doesn’t help, either. But healthy people are not immune.
“I’m sure that more than half of the people who get these infections really do not have a predisposing condition," Olewiler said.
Recovery and treatment lasted nine months
The unit let Watts go home soon after his last surgery in September 2017, but he still had to make weekly visits back to the Baltimore hospital. He moved in with Sulecki, who helped Watts wash and re-bandage his hand three times a day.
It was hard at the start. The first time the couple took the bandages off, underneath was a wound that cut down to the bone. Tendons and ligaments shone through a cavity where muscle and skin used to be.
"I could see how emotional he was getting when we saw (it)," Sulecki said. "I knew if I lost it he was going to lose it."
When she was not at work in Rehoboth Beach, Sulecki was at her home in Millsboro taking care of her boyfriend. Watts owns a cleaning service and, in the beginning, could do little work beyond managing invoices one-handed from his home computer. She spent mornings, lunch breaks and evenings tying his shoes, pulling his pants up and cutting his steak.
"He would get angry sometimes because he couldn’t do things for himself," Sulecki said. "There were times I would have to walk away and just say to myself, 'Patience, patience, patience.' It’s tough on a couple."
But his hand was healing. Those weekly visits to Baltimore eventually turned into every other week, which eventually turned into every month. Once November rolled around, Watts began occupational therapy at Beebe, where it became clear that he had to retrain the muscles in his entire arm, including those in his forearm and shoulder.
"The whole arm was affected," said Katie Merk, his occupational therapist.
It took nearly nine months of treatment, with methods ranging from ultrasound and electrical stimulation to squeezing balls of clay to stretch and restrengthen his muscles. He moved back to his Greenwood home by Christmas and finished therapy in mid-July.
Now, his hand and thumb has regained feeling. It still feels stiff, but he can play pool again — one of his favorite pastimes. There's still progress to be made, he admits, but he can mop floors again for his cleaning service. He can hold the clutch of his motorcycle. He can point his index finger and make a fist.
"Nobody will ever change my mind that it was the power of prayer that got this man through," Sulecki said. "And willpower."
Olewiler credits Watts' recovery to occupational therapy and his own efforts at home. But there were things that Watts could have done to stave off the bacterial infection, he later learned. For example, nurses told him that he should have squeezed the blood out of the fresh wound, instead of pouring rubbing alcohol, in order to push the bacteria out.
Doctors encouraged Watts to keep crabbing and fishing, because cases like his are still rare. But these days, he's more wary when going into the water, and he isn't regularly hosting crab boils at his house. He has heard of few Vibrio cases as extreme as his, but he wonders if people aren’t talking about it enough.
"This isn’t as uncommon as what they want to make you believe it is," Watts said. "You just don’t hear about it. … That would drive away a lot of people from coming to the beach."
But if you ask health officials, it's still much less common than other health concerns.
"That money ought to be spent giving vaccines to children and doing mammograms for women, not spending money on a lot of education for Vibrio that’s really only needed for people that live at the beach like us," Olewiler said. "Quite simply, it’s your job to know what’s prevalent."
Contributing: Maddy Lauria, The (Wilmington, Del.) News Journal
Follow Sarah Gamard on Twitter: @SarahGamard