Bedside Lessons – 8. Forequarter Amputation

Photo by Fausto Marqués on Unsplash

He was found on the floor after having fallen down while walking back from his bathroom. A human arm should not have been able to bend at the odd angle that his arm was in. He was in terrible agony and an ambulance was called to take him to hospital.

I met him the next morning on the post-acute ward round. Overnight he had his fractured arm operated on, and screws and plates had been installed in order to fix the broken limb. He needed help with toileting and needed help with feeding. His other limb had been affected by cancer some years ago and had been removed along with his shoulder in an operation called forequarter amputation. It was terrible luck that his remaining arm had been badly injured.

Over the next weeks I got to know him better, getting to know the man that he was. He really missed the nursing home that had been his home for the previous six years. He didn’t have any family of his own and the home caregivers were the closest thing to kin for him. Staying in the public hospital might’ve been good for his physical health but it was badly affecting his emotional health. He really wanted to go back home, but his physical condition became worse, meaning more time in hospital.

He lost his appetite and became less interested in the limited world around him. I was worried about him and ordered investigations to find out what was going on. The results were non-specific and indicated general unwellness. My seniors were bone surgeons and were really good at human carpentry but they lacked the softer skills to handle this case. I had only been a doctor for six months but felt that my patient was fading away. Day by day he seemed to lose just a bit more of himself. At times his skin appeared translucent, and the spark had gone from his eyes.

I had seen this look before a number of times. He had the signs of dying; decreasing consciousness levels, problems with swallowing, increasing confusion, decreased activity levels, talking less, generally more detached from the world.

I called his nursing home to update them on his condition and talked to the nurse manager. The staff had missed him over the past weeks and were shocked to hear that he was rapidly deteriorating. They were keen to bring him back home and to provide end of life care for him.

I made arrangements for him to go home, he was happy to be heading back to his friends and only family. I contacted the local hospice service to organise palliative care follow-up for him in the nursing home. I said goodbye to him and shook his hand, knowing that I would never see him again. As we exchanged sad smiles he said, “Thank you for your help doctor.”

Lesson learnt:

It’s important to be able to step back and look at the big picture of our patient’s situations, of what is really happening. The fracture had been fixed well, but the rest of the patient’s body was falling apart.

Doctors can become super-specialised to the point of becoming insensate to the parts of the body they don’t concentrate on. “I am an eye specialist, who only operates on cataracts…of the right eye.” A joint is replaced but the doctors treat the hardware as if it is a person, and the rest of the body as if it is the prosthesis.

What’s required is whole person care – care for a whole person.

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