Something interesting I learnt in the operating room…an amputation that saved the life.

It was just another routine day in the Casualty, when I was informed by the on duty CMO that there was a patient with a very bad left leg. The patient was taken immediately to the Trauma ward and I began evaluating him. What caught my attention was probably the worst ignored, cellulitic limb I had ever seen. The leg was filled with maggots below the knee and was extremely foul smelling.  The patient had a very feeble pulse and his blood pressure was as good as not recordable suggesting he had severe sepsis.

I informed my seniors and we decided to intubate the patient and stabilize him. I immediately rushed and intubated him and he was given inotropic support and transferred to the Surgical ICU. We kept the decision concerning amputation of the limb on hold and decided to closely monitor the patient until he was stabilized. To my surprise, when we had almost lost all hope, the patient extubated himself and was generally stable. This was something I had never seen; his inotropic support was also gradually tapered.

We decided to go for a below knee guillotine amputation. The patient was taken to the operating room and when I was least expecting it, my seniors told me that this was going to be my first independent amputation and that they would assist me. I began with the incision, cauterizing the vessels and cutting/ cauterizing the soft tissue underneath. With the sound of the Gigli saw cutting the last bone fragment, I was relieved. We dressed the wound and moved the patient to the Surgical ICU.

The patient tolerated the procedure and was transferred to the general ward the very next day. In the due course, after a series of 7-8 dressings we decided to discharge him. I informed him the day before about his discharge so that he could make all the logistic arrangements. The next day almost all his relatives turned up in huge number outside the ward. At first, I thought that they were probably here to argue about something, but to my amusement they were all there to congratulate me and thank me for saving his life.

That day. I ended up realizing one thing – we just don’t always cure patients; we may, however, bring happiness and hope for them and their dear ones. We may be just doing our job but it may have a profound impact on the life of the patient.

This is why I chose surgery and the life of a surgeon. Darkness is not the absence of light, it is the lack of hope that light will ever exist.