Eighteen-year-old Sara Loo's legs and right arm were amputated.
She had about 30 operations cutting away and grafting skin to try
to beat the meningococcal disease that was killing her.
But after contracting the disease in May the Invercargill
teenager succumbed at Middlemore Hospital on Monday.
It was a tough blow for the medical team that had tried
desperately to save her by amputating limbs to try to stop the
disease in its tracks.
"Sara was amazing as a patient," said Middlemore plastic surgeon
Mr Richard Wong-She, who spoke to the Herald on Sunday with the
permission of Sara's family.
"I was constantly humbled by how she coped with what life had
given her. We wanted to make the quality of survival worth the pain
of the treatment."
Wong-She worked with Mr Bruce Peat after Sara had left the care
of Mr Patrick Lyall in Dunedin. She had both legs amputated in
She was taken to Middlemore's burns unit for skin grafts on
areas that had been cut away after being ravaged by the
Not long after she arrived in Auckland the decision was made to
remove her right arm.
"The photos they [Dunedin Hospital] sent to me to plead her case
were so graphic and horrific," Wong-She said. "There was no
question that she needed to come to us.
"When she came to us she still had areas of dead tissue that
needed to be removed. The largest cluster, the majority, was on her
right upper limb. She had wounds on her legs, her left forearm and
her fingers were basically mummified. I knew that at some stage we
would need to shorten her fingers. She needed dialysis .. She had
exposed fat and muscle in places and that needed to be protected so
it didn't dry out and die - that was another challenge for us.
"We were basically removing as much of the dead tissue as we
could and keeping the rest of what we could alive.'
Sara had a MenzB meningococcal vaccination, but she was not
protected against the strain she contracted.
Wong-She said the decision to remove her right arm was "very
"She also had raw open wounds and we had to decide what was the
best way to close them. There were a number of options. We went
through a round of putting on donated skin to close her wounds to
make sure she was stable enough for skin grafts. We used artificial
skin to try and build up and improve upon the end result. "
Trying to stop the infection was like "trying to hit a moving
target", Wong-She said.
"It's not the kind of disease where you can treat one area and
say 'I'm done with that' and move on to the next one."
Wong-She saw cases of meningococcal septicemia as severe as
Sara's only about once a year. "When I was a young plastic surgeon
training I would often have two or three of these cases every
"Severe cases are rarer than they used to be. I probably get one
a winter versus three or four a winter now. I've got another one in
the hospital at the moment. A little girl who's a little bit
healthier than Sara who's lost both her legs."
Wong-She estimated Sara had about 30 operations. "Whenever Sara
needed to go to the operating room, she went. Whether it was the
weekend or the middle of the night - she went."
It is not clear why Sara died. Wong-She said the team treating
Sara was on top of the infection externally, but it may have
irreparably damaged her liver.
"It is testament to her strength and courage that she got as far
as she did. We are not always successful, despite our efforts. We
took a terrible situation and tried to make the best out of it. We
think we've failed. It's very tough."
When it became clear Sara would not wake up, staff went out of
their way to make her and her family comfortable.
"When things are futile, then we cannot change the outcome, it
is at that point your ability to care becomes the greatest. The
guys in intensive care had a frank discussion and decided to move
her across her bed to let her mother lie with her. It goes against
every rule in the book - but that is called caring."
Wong-She said it was "terrible" when Sara died, but he could not
let it affect him too much.
"Doctors are always accused of being dispassionate and
impersonal. In many ways it is actually a defence. I do not get the
luxury of mourning. Although Sara has passed away, I have at least
another two patients in intensive care that I have to keep
operating on otherwise they will die.
"We have our private moments of grief - we are human. We get
closer to some patients than we do to others but ultimately we are
professional. We keep going because we don't have a choice."