Cutting a foot off.

11/16/2009 at 5:46 AM Leave a comment

One of my dear patients just had her foot cut off. It was the culmination of a tragic and torturous 8 years. She had a spill of her motorcycle which crushed her foot/ankle. Right at that point the lower part of her leg ceased to be a foot. It may have looked like one but it did not function as one. She suffered untold amounts of physical and emotional pain trying to get it to be a foot. No amount of medicine would make the pain totally go away. She could hardly walk. She became horribly depressed. I saw an energetic, vibrant person change into the merest shell of herself.

She underwent untold number of tests, many major surgeries. With each succeeding surgeon promising he could fix it. (more on surgeon’s attitudes another day). Finally a few months ago she came to me desperate. She was now ready to hear what had become obvious soon after the accident. The foot needed to come off. “What the f.! ” she said. I told her she could continue the way she was for the rest of her life, in constant unending pain, unable to do even the smallest amount of housework or she could take a chance. The orthotics are wonderful. She is a driven person so she would learn to use one quickly. The phantom pain would still be there but it would be a constant, not flare up when she put presure on it.

We spent some time talking about it and to her credit she talked to a surgeon who agreed that was all that was left. (and surgeons are loath to cut things off ). We then had to work hard at overcoming the emotional attachment to her foot. I had her write down everything in her life that the foot had destroyed and everytime it came in the way of a normal life. She did that and  she set the date for the surgery. I gave her a week’s worth of a mild sedative to get over the severe anxiety.

I gave her a 50/50 chance of going through with it.  I just found out that she did it. I am just as torn as she was. Most of me is now hopeful for the first time in 8 years, but a small primitive part is going “They took her bloody foot off!” She hasn’t made it back to my office yet, but I can’t wait to see her.

I remember a wise old (hell he was probably my current age) surgeon telling us that in situations like this it is immediately obvious that amputation is the best way to go, that the joint is damaged beyond recognition, that any attempt to rebuild it will simply fill it with more scarring and arthritis, but emotionaly the patients need to go through the ordeal of trying to save it. And that it is right for them to do that so that there are no second thoughts later.

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Entry filed under: How things work, true story. Tags: .

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