By Brianna Patti, MD
We must amputate.
As orthopedic surgeons, we all remember the first time we had to utter those four words to a patient. Whatever the circumstances: infection, trauma, congenital deformity, tumor, or vascular compromise, the conversation is never easy. It is a discussion that, even decades into practice, does not get any easier. Almost universally, amputation is the one surgical option that no one wants to consider.
“There has to be something else you can do.”
Sometimes as surgeons, we get lucky and we have the luxury of time. We can counsel our patients, help them consider the option of amputation with the help of patient education and the many outreach programs available to us. Sometimes, however, we are not as lucky, and our hand is forced. In true ‘life or limb’ situations, the preservation of life comes first.
Unfortunately, even today, amputation continues to carry a stigma. Despite the Pinterest posts, the Facebook blogs, Twitter feeds, and the empowering stories from across the globe, the thought of permanently losing part or all a limb comes with a black cloud. It is ‘different’, and it is permanent. The hand, the foot, the finger, the toe, the leg, the arm…
To this day, I have one patient whose story has stayed with me. I was a senior resident at the time, on call at our regional children’s hospital. I woke up from a dead sleep after midnight to the sound of my pager going off, a 9-1-1 page from my junior resident who was manning the ER. The junior resident was a 6’5” former college linebacker. He did not show fear, ever, but more than 5 years later I can still hear the shake in his voice when he picked up the phone.
“You need to get down here. Now! I…I need help.”
A six-year-old boy had gotten his arm caught in an auger on his parent’s farm. I remember walking into the trauma bay to see him. His parents were huddled around the top of his hospital gurney, trying to keep him from looking at the blood-soaked bandages dripping onto the linoleum. I had been rehearsing what to say while walking down the hallway. None of the words seemed appropriate once I walked into the room.
“We’ll do all we can…it might not survive…we might have to amputate…”
For two weeks, we worked to save his arm. We rounded on him constantly. But after two weeks, there was only one thing to do: amputate, above the elbow. His parents were devastated. Our entire orthopedic team was shattered. Was there something else that we could have done?
I remember going in to round on him that first morning after the amputation, dreading the walk down that cartoon-covered lime green hallway. What was I supposed to say? To him? To his parents?
To my surprise, when I opened the door, the little boy was already awake, a massive smile on his face.
“Look, look!” he whispered, careful to not wake his parents. “Look what they did!”
He lifted what remained of his right arm up off the bed, bandages, and all, like there was nothing wrong. I stood there, dumbfounded.
“What did they do?” I finally asked.
“It’s gone,” he replied. “I can play again, and it doesn’t hurt. Isn’t that cool?”
I think about those words to this day. A six-year-old boy put the gruesome and frequently traumatic reality of amputation into perspective for me. Take away pain. Maximize function. Move on with life. Smile.
Those are the goals.
I continue to think about that in my practice today. For some, amputation is the answer to making those goals a reality. Our surgical techniques have improved over the last several decades. So have the rehabilitation programs and prosthetics. Prosthetics are now lighter, custom-made; some even have microprocessors. Patients are running marathons, skiing, painting, surfing, and living full and complete lives.
For any patients and their families who are facing an amputation, or who have already gone through the operation, there is an entire network to offer support, not only locally in northern Arizona but across the country and throughout the rest of the world. Know that you are not alone with your journey, and neither is your family.
Resources for patients and their families: