A German tourist celebrating his 50thbirthday in Costa Rica last year says hewent to a hospital complaining of pain inhis right foot and woke up in the airportwith his leg amputated.However, the surgeon responsible andother medical officials who attended hiscase dispute aspects of his story, and suggestthe possibility he suffered a kind ofdementia and memory loss set off by hiscondition – a particularly vicious strain ofgangrene.A bizarre amputation story had circulatedon Web-based news sites for the pastseveral weeks and appeared more likeurban legend than fact, but The Tico Timesrecently verified the operation.RONALD Jurisch, a high-schoolmathematics teacher from Dessau, a townin east Germany, arrived in Costa Ricaalone in February 2004, he told The TicoTimes in a phone interview in Englishfrom Germany.In the second week of his vacation, hisfoot began to swell slightly and hurt, but hecould still walk, he said. It worried himbecause he has diabetes, but neverthelesshe decided to have it checked when hearrived back in Germany.When he tried to board his returnflight, however, officials at JuanSantamaría International Airport inAlajuela, west of San José, barred his entryand told him to go to the hospital becausehe looked quite ill.Jurisch, who doesn’t speak Spanish,said he doesn’t remember the name of thehospital he checked into, but The TicoTimes saw documents from his operationat the state Hospital San Rafael deAlajuela, in Alajuela.“THEN he (the doctor) said it is necessaryto amputate it,” Jurisch said. “And Isaid no, I will go to Germany. Then, I don’tknow. The next thing I know is I wake upat the airport, the next day, I think, in theafternoon. I think after a half hour, I sawthat I was amputated. I was shocked. Thensome people come to me and some younggirls are speaking English and they helpme to a private clinic.”He said he never signed a consent formfor the amputation. The Tico Times, however,later saw a consent form bearing hisname, a signature and passport number.The operating surgeon, Dr. AntonioTorres, said Jurisch signed the form after itwas read to him in English. The form, aswell as the diagnosis and list of medicalprocedures performed, is in Spanish andon file with the Social Security System(Caja). The diagnosis listed is gas gangrenein the right foot.“I don’t know if he’s unthankful ormaybe confused, but he doesn’t know whatwe did for him,” Torres told The TicoTimes. “We thought he was going to die.Imagine – the airline wouldn’t let himboard because of the odor from his foot. Itgives us chills to know there are people insuch bad condition walking around, withouteven knowing what they have.”Jurisch said an ambulance took himfrom the airport to the private HospitalCima San José, but both Torres and CimaMedical Director Dr. Hugo Villegas toldThe Tico Times Jurisch arrived directlyfrom the Alajuela hospital and never setfoot in the airport.They both explained the discrepancy,and other aspects of Jurisch’s statements,as evidence of his disorientation and confusion,symptoms of his condition.It is not the policy of state hospitals tomove patients to private hospitals unlessthe patient requests it. Nobody The TicoTimes questioned knew who requested thetransfer, but Torres and Villegas guessedJurisch himself asked to move.JURISCH spent four weeks at CimaHospital, during which time he contactedthe German Embassy and met two officials,one of whom he remembered isnamed Stefani Glass.Glass, the German consul to CostaRica at the time, is now working at theGerman Embassy in Tashkent, Uzbekistan,one of the former Soviet bloc countries.She told The Tico Times via e-mail sheremembered Jurisch but could not commenton the case.The German Embassy in San Joséissued a statement from Consul UweKöhler that said the embassy helpedJurisch with paperwork from his medicalinsurance company in Germany and locallegal procedures with translations toSpanish.“The embassy cannot make a medicaljudgment on the issue,” Köhler said.GAS gangrene is a rare bacterial infectionthat spreads rapidly and kills surroundingtissue, according to the U.S.National Library of Medicine. It is mostoften an infection of an open wound, but itoccurs spontaneously in one-third ofpatients, most of whom have previous conditionssuch as diabetes.Amputation is recommended to controlthe spread of the infection.“The practical effect is that it rots thefoot,” Villegas said. “He came to Cima witha severe infection that involved practicallyall his organs and affected his brain. It can beexpected that he could remember things in away that is slightly different,” he said.At Cima he went into “septic shock,”Villegas said, which the U.S. Library ofMedicine defines as a life-threatening conditioncaused by an “overwhelming infection”that affects vital organs, including thebrain. “Septic shock has a high death rate,exceeding 50%,” the library states.“THE recovery phase was so complex,it took four weeks to get him stable enoughto air evacuate him to Germany,” Villegassaid.Jurisch flew to Germany on a medicalplane under medical supervision.Two weeks into his month at Cima,Jurisch said he opened his wallet andfound a receipt for a $250 amputation billfrom the first hospital, and that amount ofmoney was missing.He moved three weeks ago and lost thereceipt, he said.Villegas never saw such a receipt, hesaid. Torres said the true cost of the operation,including all the drugs used to fightthe infection, was closer to $2,000. TheTico Times was unable to obtain a copy ofthe bill.AFTER he arrived in Germany,Jurisch was hospitalized for three monthswhile doctors performed 23 operations onhis leg.“Doctors said the amputation was nogood,” he said. The amputation was notdone well and the leg had infected, he said.He doesn’t plan to press charges, however.“People from the embassy in CostaRica say they think I have no chance. I saidin the hospital I don’t want an amputation,but they (the embassy) say it is not necessarythat I say yes.”Doctors can’t legally perform proceduresthat “imply grave risk to physicalintegrity, health, or life, without previousconsent,” either from the patient or someonelegally authorized, states Article 22 ofGeneral Health Law 5395. However,“urgent interventions” are an exception.“IT could be that the doctors in thehospital saved my life, but I don’t know,”Jurisch said. “And the doctors in Germanysay they don’t know if it’s possible or not.”He has had to learn how to walk anddrive with a prosthetic leg.“It was a new beginning of some kind,”he said.