I had counseled my patient before his surgery; he may need an amputation of his right foot. He accepted the risk. A few cuts into my diabetic foot debridement, it was clear. His foot needed to come off. His infection was bad, life-threatening. The gangrene was worse than I expected. Slicing into the necrotic skin over his foot, the air in the tissue escaped and seemed to be happy to be free and dancing its tentacles of stench through my surgical mask and deep into my nostrils. The nasty juice under the skin spilled onto the floor. I palpated up into his lower leg and could tell the infection traveled a significant distance.
I wasn’t sterile yet, so I took off my gloves and grabbed some yummy-smelling hand sanitizer a previous volunteer had left. I break it out on special occasions such as this. I squirted a tiny bit of it in each of our masks to cover up the putrid smell of dead flesh (but not enough to get drunk!). Now we were good to go!
Mark was providing anesthesia care, and the patient had significant hypotension following his spinal. Mark was treating it perfectly. The patient was still lucid.
I hadn’t talked to the family about the amputation (I had only talked to the patient on rounds), so I decided to bring his wife in to show her how badly he needed an amputation. Yes, into the operating room. He was my last case of the day, and it was Friday afternoon.
The wife looked at his wound and started to panic. I escorted her out and talked to the men. They started to get upset. I would do an amputation?!?!?! So I brought two men in to show them the wound too. They did not want an amputation.
I wasn’t sure at what point the patient himself decided he also did not want an amputation, but he then started saying he did not want an amputation.
Wait, what? No, you already told me you were okay if you needed an amputation. We had discussed that I would try to save your foot, but if the infection was too bad, I would have to take it off. You had agreed.
“I would rather die, than have my foot cut off!”
Okay, bring a proper translator, get the family on my side, etc, etc.
“Ok, well sir, you are actually dying, and I need to take off your infected foot.”
His blood pressure was dipping into the 50’s systolic. Maybe I can claim he doesn’t know what he’s talking about.
Mark had repeated a few doses of epinephrine, and we were pouring fluids into him. We also started a blood transfusion.
I had some questions translated into Arabic. “What year is it?”
“2019, no it’s 2020”.
Okay, well he still knew what he was talking about. Sort of.
I exchanged family members. I explained the gravity of the situation to the new family members, and finally they all agreed with me. Two of them came in and tried to talk some sense into my patient, who was laying on the table, ready to have his leg amputated or ready to die. One of which was going to happen that same day.
My patient still absolutely refused amputation.
I was using his early-20’s grandson as a translator, at this point in tears, unable to get it into his grandpa’s head; this needs to happen!
No way. “I’ve been injured several times in the military. I was always fine. God took care of me. He will this time too. If it’s my time to go, then I accept.” He went on to explain his past injuries.
At this point, Mark, Philippe, Andrew and I were just standing back in the OR while different family members came in to plead with the patient to accept. They told me to just cut it off and don’t listen to him.
I explained to them I had to respect his wishes. I would not simply lop off the leg of an unwilling patient. He had to tell me to.
Mean while it had been about 30 minutes of begging and pleading with this man, who would clearly die without an amputation, and maybe would die with an amputation.
It was sad. I tried my best to explain things to him. I was worried he would get too hypotensive and not be able to talk to us anymore.
God gives us choices to make. We should respect those choices in others too. Even if they are making the wrong one.
There was one moment from this night I will never forget. I was allowing different family members to come in, trying to talk some sense into this man.
I saw two scenes unfold before me. Andrew, turning calmly, quietly, non-intrusively away from the action, hands folded in prayer. And the grandson explaining to me, the patient accepts. They come simultaneously. A life saved.
I couldn’t believe my ears! It actually brought tears to my eyes (which doesn’t happen very often anymore). What a struggle. What a relief. We can now help this man. What an answer to my prayer, Andrew is the right surgeon for Bere. He may not feel completely ready to do the gamut of cases that exist here, but he is ready to be used by God. And God is clearly using him.
We invited the other 6-7 men into the room. Yes, into the operating room! The head of the family lifted his face toward the sky and led them in prayer, all with palms facing up, better positioned to receive Allah’s blessings from heaven. It certainly was a sight to see, especially if you are not used to family members in an operating room!
They soon left. We continued our case. We cut off his leg and I sliced up the sides of his leg and removed all of the dead tissue I could. We packed his wounds open.
Two days later, I had to cut his leg off even higher. He made no remarks about not wanting it. He said, do whatever I felt best.
After a few days of redressing his wound from his infected amputation, he told me through translation that he had a present for me.
What!? A present?
The next day on rounds, I heard something moving in a box under his bed. I suspected it might be an animal because all of the nurses know I love animals. He told me, open the box. I opened it and there were two teenage bunnies inside! My patient raises bunnies for a living and wanted to give me something special.
I love our new bunnies. The kids are already playing with them daily.