I took our 9 o’clock case by the hand, careful to avoid the fresh bandage over his renal shunt, and guide him from the gurney to the OR bed. As the Anesthetist put him under I quietly count the needles and sponges with the scrub tech. Since we weren’t going into the belly we skip the instruments but one catches my eye, the long sleek amputation knife. If you appreciate cutlery, it’s a morbid piece of elegant stainless steel. I connect the pneumatic hose to the bone saw as the surgeon enters, freshly washed hands held in front. As the scrub tech gowns and gloves him we confirmed the patient, the diagnosis, the limb, and the procedure.
The doc’s eyes are shielded by a splash guard and his voice is dulled by the surgical mask. “BKA.”
I write, Below Knee Amputation, on the chart and note the start time of the operation.
I’m on the general surgery team because I’m fresh out of out of nursing school. But amputations are already routine. Diabetes is the leprosy of our day. As those afflicted lose circulation in their limbs and their toes turn black with rot, we cut off their legs. With modern techniques and equipment severing a limb is a breeze. But we hate to do it. The OR is about repair and cutting a patient apart is the last straw, a defeat. No one says so, but we blame the patient. Objectively, each member of the team knows diabetes is progressive, that it kills more than breast cancer and Aids combined, but we like to think it is always manageable and if a leg has to come off, it’s the patient’s fault. He didn’t take good enough care of himself. Besides, none of us want to think such a calamity is visited upon the innocent. Amputation is too scary to think that God is capricious.
I crinkle my nose against the burnt hair smell of the electro-cautery and consider touching a drop of Wintergreen to my mask. The charged blade sizzles as it cuts through skin, muscle, and seals small bleeders. Larger vessels are tied off or crimped shut with metal clips. The buzz of the reciprocating saw is high pitched and industrial. It stops abruptly as the lower leg drops into the scrub tech’s waiting hands. I’m ready with a pair of red biohazard bags, doubled against seepage. The scrub tech catches and passes the leg to me in a single motion. The surgical team is eager to pass the accursed limb off. I secure the bags blood-tight but that isn’t enough. No one bats an eye at globs of flesh like ovaries or a gall bladder, but specimens that look as human a leg give the whole OR the heebee-jeebees. I slide the boot-shaped form into a used carboard box and escort it out of the room immediately. I lay it to rest in the incinerator trash bin; a nondescript box among sacks of bloody drapes and gory sponges. I offer no benediction, just turn on my heel and begin thinking about the 10 o’clock case.
My wife and I didn’t exchange Christmas presents anymore. We had been together enough years that we had what we needed and had made a pact to put our money towards a nice vacation. Celebrating the holiday with family had been enough. I was looking forward to a leftover piece of my sister-in-laws homemade pumpkin pie when the phone rang.
I answered it with, “Merry Christmas,” even though it was the day after.
It was my doctor’s nurse with the lab results from my physical. “The doctor wants you to come in right away to discuss diabetes.”