Estoy moviendo mis extremidades.

The human being typically is found to have four extremities.  Two arms. Two legs. It is through the movement of these extremities that the individual is able to move and work through time and space. I said 'typically' because there are times in which for one reason or another, the human being does not have the aforementioned four extremities. What could cause this? Congenital anomaly. Trauma. Sickness, illness, and disease. In the event of one or multiple of these, resulting in the absence/loss of one or more limbs, the human being (in it's amazingness) is able to adapt and often with the help of prosthesis is able to continue to move and work through time and space with minimal difficulty.


To paraphrase one of my Vascular attendings, "I don't understand why some people are so attached to their appendages!"

In my short time with Vascular Surgery I have already seen both extremes when it comes to patients and their emotional attachment to their appendages.  Well, perhaps emotional and then the-lack-thereof attachments.

For example, The Lack Thereof:
"Hello my friend, it's time to change the dressing on this foot."
"Ok"
{remove dressing}
"Ok my friend, do you see this part here?
"Yes"
"This is unhealthy skin, this wound will not heal with this black area.  We need to remove the bad part.  And you see how this toe is discolored, it is not healing either.  We may need to remove it as well."
"Ok"
"Do you understand what I'm saying my friend?"
"Yes"
"Can you tell me what is going to happen?"
"You're going to take my toes."
"Are you ok with that?"
"Yup"
"Do you have any questions?"
"Nope"

And then on the other hand, The Emotional:
"Good morning my friend, how are you doing today?"
"Good."
"How is the pain in your leg today?"
"Oh it's getting better, see what do you think?  Is the foot getting better?"
"My friend, I'm glad your pain is better today, but your foot still does not look good."
"Oh really?  I thought it was looking better."
"Do you remember what the Attending told you? About the angiogram?  You have no blood flow to your foot.  They weren't able to open the blood vessels during the angiogram."
"Oh yes I know, but I still thought it would get better."
"My friend, your foot is purple.  You can't move it and it is causing you pain.  Should we let it stay like this there is a high risk it will get infected and make you very very sick.  You could die from it."
"Oh really!? Well, I just don't know. Maybe it will get better."
(this exact same conversation was held with the patient multiple times a day for almost a week.)

In the end The Emotional patient was discharged to rehab as they had to that point refused any treatment other than pain control for their dead foot.  Discharged with instructions to return when the pain became unbearable and they had changed their mind. Hopeful that would happen before it was too late.  And they did, we got a page from the ED last Thursday.  This patient was back.  The foot which was purple and dark was now black and blistered.  Amputation is scheduled for Monday, we'll see if it happens.

And as for The Lack Thereof patient, amputation is scheduled for Tuesday.  I have no doubt it will happen.  I just perhaps question if the patient needs something more than just wound care for their all around well-being.

Much Love.