27 November 2023
The day I decided surgery was for me…a new arm.
25 October 2022
‘I never thought I would be able to earn a living again. You saved my life, my career, and my family’
Although these words seem like common talk received by doctors from patients, something about the tone of this voice felt deep and true. The patient pushed over a bottle of wine to the plastic surgeon in the clinic, almost causing the paperwork on the table to fall. His right arm appeared discoloured around a well-defined border yet was smooth with contiguous edges. He wore a huge smile on his face, grinning from ear to ear, and he could not hide his excitement.
Six months earlier, while on my emergency rotations, a patient was brought in by ambulance. His right forearm appeared charred beyond recognition, and he was bleeding profusely from multiple points. I watched the surgical registrars systematically stabilise him with the ATLS protocol. After a few hours, the bleeding was arrested, he had had the necessary scans and was waiting for a verdict from the most senior on-site registrar. The letters N.E.P.A were boldly written on his now-torn blue uniform, initials used for workers who fix high-tension wires that connect homes to the national electric grid in Nigeria.
‘I’m sorry, we may need to amputate your arm’
The patient appeared positive while the senior registrar spoke to him, but after learning the possible fate of his right arm, I watched his smile fade into sheer terror. For a NEPA official, losing your arms means no work and no means of livelihood. He burst into tears and remained sobbing for a good while, until the consultant plastic surgeon decided on a different plan. He described a most unusual procedure. He was going to raise a flap in the abdomen and attach it to the debrided surface of the injured arm, which would remain buried in this abdominal wall for many weeks. I watched the surgery in total disbelief as the arm, was attached to his abdomen and sewn tight. ‘A pedicled abdominal flap,’ he described.
Six months later: ‘The arm has healed nicely, and you can go back to work now’
As I reflected on these events, my mind couldn’t process how he had gone from almost losing an arm, to having a near-fully-functional hand, such that he could now resume work, just 6 months after. This was my ‘Eureka’ moment. Surgery saved a patient from a life without work or earnings. How many more patients have been saved by surgery? and how many more will be able to benefit? This was the day, a day like any other, in a dusty old clinic with four medical students and 5 doctors in attendance, that I decided on a career in surgery.
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