I got a call to go to the emergency room: A construction worker had been hit with falling rebar—the wiring used to make mesh for walls. Apparently they were hoisting it and it fell from seven stories. This guy pushed other workers out of the way, but a long piece of metal came down like a whip and virtually cut through his leg.
He was the closest thing to Paul Bunyan I’d ever seen: red-haired and six foot nine and 340 pounds, maybe 30 years old. His leg was hanging on by just some soft tissue. The bone was broken.
He begged me to save his leg. There is a fine line between an extremity that is salvageable and one that isn’t. It has to do with the soft-tissue injury as much as the bone, but the first step is to stabilize the bone. We put on an external device, which held it aligned. Next you create a blood supply. Even if you can get arteries to work, you have to get the veins to work. Without blood flow, the extremity can become gangrenous.
I was naïve. I thought that if I could fix certain parameters, then other things would heal. I remember watching the vascular surgeons work, and thinking, But the bone looks great! You get tunnel vision. If you have a hammer, then everything you look at is a nail.
But this wasn’t just a bone injury. It was an arterial injury, a vein injury, a nerve injury. The surgery took hours before we realized that there was too much damage. The leg became gangrenous before our eyes: gray, then ice cold. It literally looks dead.
We did the amputation in two stages. First, we did a guillotine amputation, which means you amputate where the injury is so the patient doesn’t get infections. Later we converted it to a higher amputation so the leg could be closed into a stump for a prosthetic fitting.
This guy lost his leg right above the knee. That’s a bad amputation to have. A below-knee amputation is very efficient because the patient is just compensating for his foot and ankle. But here you have to create a knee too. It takes a lot more energy for a person to walk. And he’s a huge man.
I kept wondering: Did we do everything that we could have? And then I felt guilty that I never told the patient before the surgery, “You could lose your leg.” He knew it was a possibility. I knew it was a possibility. But I kept saying, “We’re gonna do everything to save your leg.”
When he woke up, I had to deliver the news. It chokes you up. Of all the things you can sugarcoat in the world, the loss of a limb is not one of them.
He went through a period where he was very angry. He didn’t say anything like “You guys stink!” He was just volatile: “The food’s no good!” And he’d throw a tray on the ground. They had to call security at one point. The interesting thing was I was the only person he would listen to. I realized that he didn’t look at me as the person who didn’t succeed. He looked at me as the person who had tried to help.
Ten days later, he had the second surgery. You have psychiatrists then, you have a prosthetist, you have multiple specialists helping to educate a person that his life is going to be viable. Different, but viable.
I knew him for a few years, and he continued to have periods of volatility. Of course he couldn’t do what he used to do for a living. And I think he got divorced, which, sadly, is common with these injuries. But I think he came to terms with what had happened. When I saw him last, he was happier.
The hardest part for me was to understand that in medicine you can fail—sometimes before you even get started. But I also learned that for the most part, when you do the right thing, the patients, deep down inside, no matter what the outcome is, know. And they ultimately bond with you for that.