There's something definitely wrong about removing a limb. My whole
orthopedic life I have purposely avoided major arteries and nerves to
prevent loss of function. Removing a member of the body so precious as
an arm seems aggregious but there are times I suppose as tonight there
was no choice.
A nineteen year old man was involved in a pedestrian versus car
injury yesterday. Apparently clipped from behind by a fast moving car.
The high velocity injury dislocated his elbow and hit his arm with
such force that the blow tore the skin from the front of the shoulder
under the axilla, underarm and to the back of the arm. The promimal
humerus was broken almost at the shoulder and the muscles and nerves
of the arm were stretched away from their normal attachments.
Apparently he was seen relatively quickly and the large avulsed area
was washed and sewn together by a medical professional and the patient
was referred for open repair of his humerus and concommitent elbow
dislocation. Unfortunately what was not realized was that the arm was
pulseless. The forceful blow had also stretched the brachial artery,
the only source of blood flow to the entire arm.
36 hours later the young gentleman arrived at Kijabe hospital with
a cold, dark, pulseless arm. After 6 hours of no blood supply the limb
will die. There was no function to the muscles and the skin, blistered
from the trauma and swelling was already beginning to peel off of the
arm. As Tobias, the chief orthopedic surgeon, discussed the
grim prognosis it seemed the patient had already resigned himself to
the fact that he would lose the arm.
Shortly thereafter I was in the operating room with the patient.
After preparing the arm and draping for surgery, the stitches placed
the day before were removed and the skin pulled back from the wound.
Immediately the definition between living and dead flesh could easily
be discerned. Escaping from the newly opened wound was a sweet,
pungent odor I thought God had only created for dead bowel cases in
general surgery. My mind briefly was taken back to my time as an
intern and medical school student by the smell and its associations
like the smell of peppermint and fir trees remind me of Christmas.
It was Sunday night and an outdoor church service could easily be
heard through the hospital widow as they sang "Were you there when
they crucified my Lord" on an outdoor loud speaker over a loud
electric guitar.
Muscles, bone, nerves, damaged skin, and the artery were trimmed.
Tissues were nonanatomically sewn together over bone to protect the
stump. The shoulder was preserved to allow the patient to carry things
like a backpack on that side in the future.
I felt guilty for removing the arm. As if I had broken some sacred
trust between doctor and patient to always protect the loss of the
structures. I wondered if maybe if we could have helped him yesterday
if the outcome would have been different or was the damage too great.
The church service in the background was over but I couldn't help
from thinking how I have seen members of the body of Christ damaged by
life or influences. In my busy world I either didn't notice the
problem or like the priest in the parable of the good Samaritan just
walked to the other side of the road. I never "checked their pulse" to
see if there was anything I could do to have the life flow of
fellowship in the spirit return to them.
Soon they were amputated from the body. It may not be as dramatically
as my recent experience but just as important spiritually they are
gone.
I pray that I would be more careful to watch for signs of spiritual
or physical problems in my brothers and sisters in Christ and help
early so that " the Body" could be kept whole and functional as God
would want.
Rhett
orthopedic life I have purposely avoided major arteries and nerves to
prevent loss of function. Removing a member of the body so precious as
an arm seems aggregious but there are times I suppose as tonight there
was no choice.
A nineteen year old man was involved in a pedestrian versus car
injury yesterday. Apparently clipped from behind by a fast moving car.
The high velocity injury dislocated his elbow and hit his arm with
such force that the blow tore the skin from the front of the shoulder
under the axilla, underarm and to the back of the arm. The promimal
humerus was broken almost at the shoulder and the muscles and nerves
of the arm were stretched away from their normal attachments.
Apparently he was seen relatively quickly and the large avulsed area
was washed and sewn together by a medical professional and the patient
was referred for open repair of his humerus and concommitent elbow
dislocation. Unfortunately what was not realized was that the arm was
pulseless. The forceful blow had also stretched the brachial artery,
the only source of blood flow to the entire arm.
36 hours later the young gentleman arrived at Kijabe hospital with
a cold, dark, pulseless arm. After 6 hours of no blood supply the limb
will die. There was no function to the muscles and the skin, blistered
from the trauma and swelling was already beginning to peel off of the
arm. As Tobias, the chief orthopedic surgeon, discussed the
grim prognosis it seemed the patient had already resigned himself to
the fact that he would lose the arm.
Shortly thereafter I was in the operating room with the patient.
After preparing the arm and draping for surgery, the stitches placed
the day before were removed and the skin pulled back from the wound.
Immediately the definition between living and dead flesh could easily
be discerned. Escaping from the newly opened wound was a sweet,
pungent odor I thought God had only created for dead bowel cases in
general surgery. My mind briefly was taken back to my time as an
intern and medical school student by the smell and its associations
like the smell of peppermint and fir trees remind me of Christmas.
It was Sunday night and an outdoor church service could easily be
heard through the hospital widow as they sang "Were you there when
they crucified my Lord" on an outdoor loud speaker over a loud
electric guitar.
Muscles, bone, nerves, damaged skin, and the artery were trimmed.
Tissues were nonanatomically sewn together over bone to protect the
stump. The shoulder was preserved to allow the patient to carry things
like a backpack on that side in the future.
I felt guilty for removing the arm. As if I had broken some sacred
trust between doctor and patient to always protect the loss of the
structures. I wondered if maybe if we could have helped him yesterday
if the outcome would have been different or was the damage too great.
The church service in the background was over but I couldn't help
from thinking how I have seen members of the body of Christ damaged by
life or influences. In my busy world I either didn't notice the
problem or like the priest in the parable of the good Samaritan just
walked to the other side of the road. I never "checked their pulse" to
see if there was anything I could do to have the life flow of
fellowship in the spirit return to them.
Soon they were amputated from the body. It may not be as dramatically
as my recent experience but just as important spiritually they are
gone.
I pray that I would be more careful to watch for signs of spiritual
or physical problems in my brothers and sisters in Christ and help
early so that " the Body" could be kept whole and functional as God
would want.
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