Take another little piece of my heart…or foot…or hand
During surgery, we take out a lot of things: tumors, gallbladders, ovaries, etc. All of these pieces are careful dissected out and handed off in little sterile cups to be sliced up and examined under a microscope in the pathology lab, a world away from their original owners. Most patients don’t mourn the loss of these parts and (after recovery) won’t notice their departure. However, when we perform an amputation, it is a whole different story for patients and those involved in the case.
My first amputation was a BKA (below-the-knee amputation). At the time I was still a newbie to OR life and I was excited to scrub the case. After the patient was brought in and induced, the circulating nurse pulled back the blanket in order to prep the leg. It looked completely normal! When I’d read the diagnosis citing inadequate blood flow, I was expecting to see a white, lifeless, basically gross looking limb that we would happily chop off and magically fix the patient. I was not expecting it to look normal. This surprise knocked the wind out of me and I realized that this case was going to be both technically and emotionally demanding.
The surgeon arrived and we got to work. Unlike cardiac surgery, orthopedics is a messy business. (My standard is that if you don’t leave a big ortho case covered in blood, you obviously didn’t accomplish anything. Just a joke kids. Hemostasis is important.) Ortho takes a lot of skill and precision, but you’re also sawing, hammering and dislocating joints. This case was no exception and we were quickly through the patient’s tissue and down to the bone. We took an oscillating saw to the tibia and fibula about 3 inches below the knee then the surgeon thrust the leg into my arms. “Here, take this!” he said, like he’d just handed me a sack of groceries and not half of a human leg.
My brain detached from the action at the field as I stared at the limb. There was a moment of confusion where I couldn’t comprehend that this was A LEG and it was no longer attached to the person on the table. Even worse, we weren’t putting it back on the person on the table…like EVER. I’d never experienced this. In the past, when we opened a part of someone, we always closed it back up. The patients left the room looking the same as when they came in (plus or minus a few incisions). Diseased or not, it felt oddly wrong that we were taking away a substantial piece of this patient.
I snapped back into focus to my preceptor saying, “We need you over here. Drop the leg.” She motioned with her head at something behind me and I turned to see what looked like a trashcan lined with a fire-engine red, biohazard bag. I stepped over to the bag and looked back at my preceptor for confirmation. “I’m really just supposed to throw away a human leg??” “Drop it!” she repeated, forcefully. And I did…both hands simultaneously released at the sound of her command and I dropped the leg from six inches above the bag. What I did NOT know was that the bag was NOT set inside of a trashcan. It was pulled over a steel cart with a four-inch lip around the edge. The leg hit with a resounding THUD of bone meeting metal and the impact sent blood spattering EVERYWHERE: on me, my preceptor, my surgeon, the walls… Everyone stopped and my preceptor quietly mumbled, “I didn’t know you were going to take me literally. Probably should have been more specific.” Yeah, you think? It was an incredibly mortifying moment, but the spontaneity of it granted a temporary reprieve of the emotions that the case had inspired.
After the case, I thought a lot about amputations and their effect on surgical personnel. As a tech, I admit I am fascinated with the technical aspect of removing a limb. It’s kind of amazing that we can remove such a large piece of someone and have him or her recover to live a full life. As a person, I feel a sense of loss after performing amputations. My empathy goes into overdrive and I can’t help but think of the implications the procedure will have on their daily life. Since I’m not a part of these patients’ care pre or post-operatively, it is sometimes difficult for me to find a means of catharsis for the loss these patients experience. Within my little realm of intra-operative care, I’ve found the best I can do is to show empathy for my patient pre and post-induction, receive each amputated limbs with a healthy dose of respect for the years of service it has given, and to give each limb a silent farewell in honor of its owner before it is sent off to the lab.
