So I've been slacking a bit with these posts, who would've thought that I'd manage to get some sort of a life, whilst being stuck in this God forsaken small town, but here am I...behind on my posts. I feel like I should continue this more serious roll, I have going on at the moment, so this post will also feature a story about a patient, just like the previous one...
It was a regular day and as always a tad slow in the morning, that was until my man, which is one of my many male patients got the news about him going down the OR (or as the lovely Brits say, theatre) in order to have a LBKA. I imagine your synapses are a bit crowded, as your neurons fire at an accelerated speed in order to solve this rather fancy abbreviation, let me put you out of your misery. LBKA is a left below knee amputation. This is an operation that I haven't seen before, so this was a once in a life time opportunity. My man, aka. P is such a lovely elderly man in his prime at the age of 73. He has a wonderful sense of humor and it's a pleasure to speak with him. He always smiles and sometimes waves at me, if he sees me coming down the hallway. However, due to his serious problem with his leg that causes him tremendous pain, he's often confused, because of the dosage of the pain relieving medication. The doctors made the decision about the amputation a couple of days ago, they even had to fly in specialists from London to see P.
My man, I think it can be interpreted as wrong, if I keep refering to him as my man, but it just feels right and it's really a bad habbit that has followed me throughout the past three years, when I first enrolled to do this gig.
So back on track...P is the only one, who makes my heart "flutter", when he shouts "love", "darling" and "dear" after me. He's one of those patients that stick with you...
The reason as to why he's having a LBKA, is him being on a drug called, Warfarin (this one you ought to look up, I won't give it all away!) Apparently this drug leaves some sort of crystals or it crystalizes in the arteries, which ever really, and when the crystals start to clot, then it becomes dangerous. This has caused that an area of P's leg has had limited blood flow with oxygen and the vital nutritions, this has caused ireversable tissue damage, so the leg is no longer viable. P has also got a history of Diabetes, and this doesn't exactly help his situation! So his leg is an ischemic one, that's almost neucrotic and the malleolus is exposed.
He's brought to the OR at around 4pm and an hour later it's all over. Imagine, an amputation sounds like major surgery, and to me it is, but in fact a bowel surgery takes longer. Shocker!
The surgeon begins with the laser, which enables him to cut through all the layers of the dermis. It smells, you can even spot a few "smoke bubbles", it's impossible to decribe what it smells like and even more so to compare it with something else. But it's manageable. The surgeon needn't worry about accidentally cutting something "important", seeing that there's no flow what-so-ever. He continues using the laser for about ½ an hour, even though it felt like longer. Some places he's forced to use the scalpel, which ensures that the laser has done its job. The skin is now loose and the tibia is completely exposed and "raw". It's time for the saw. I imagined it lookind differently than it did, I suppose I pictured it to be more "saw-y" (that's definitely not a word!) It was steel blade that moved in a "saw-y" way. You could see small saw dust particles, as if it had been a log, he'd cut into.
This was a humbling experience (not sure if that's the right word to use, to describe what I felt at that instance!), because it wasn't some random log, the surgeon was in the process of taking a man's ability to walk away from him. After a while the leg is no longer attached to the rest of the body, and the leg is removed by the sterile nurse and layed on a table next to P. Just one hour had passed since the first incision and the leg was now a seperate thing. The surgeon spends a lot of time to sow the skin laps together, and then attaches a drain and a vaccum-pump to relieve the pressure and excess the extra fluid. The stump is dressed with dressing pads and tegaderm. And then I leave him and don't see him until the next day...
The following day P is in pain. A lot of pain! And it's not only because I like him as much as I do, but it hurts me to see him like that. And because of the very heavy dosage of pain relieving medication, he's so confused that he's refusing to take any stronger tablets.
Of course because I'm fond of him, it affects me a bit more than had it been a who-ever. I put my hand on his shoulder and tried to take his mind of his pain, easier said than done! He's hurting in a place that's no longer there.
"I know it hurts right now, but it won't hurt forever! I promise it will get better and I know that it doesn't seem like that, but it will!" those were the only comforting words I could muster, I was absolutely no help whatsoever! I just sat with him and tried to keep the tears at bay, almost easier said than done...
-xoxo-
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