Learning to Walk Softly

All names and identifying information in this article have been changed to ensure patient confidentiality and privacy. *

I’d be lying to you if I said I wasn’t buzzing with excitement after being told I was about to witness my first ever above-the-knee amputation. That surge of unsolicited anticipation truthfully irked me. Deep inside it stirred the kind of feelings that, until then, I was proud of never having. Someone was about to lose a part of themselves, but it was my prerogative to glean some fragment of medical wisdom from their misfortune. However unfair this all seemed, I had to accept that it was real.

All I knew about Graham Vernon was that he had peripheral artery disease and advanced dementia, much like the rest of our geriatric patients. I approached the pre-operative holding area where his family gathered closely around his hospital bed. He lay there in fetal position, muscles fully contracted, and pretended to eat from of an invisible soup bowl. His three adult children laughed nervously at his silly antics, even though they knew he was not joking. In that moment, we somberly acknowledged that Graham was living in complete oblivion over his immediate future.

After providing them occasional words of comfort, I walked over to the looming double doors where a stop sign read, “Authorized Personnel Only Beyond This Point.” After swiping my badge for access, I scrubbed, gowned, and gloved appropriately. This time entering the OR, I casually learned that some surgeons prefer working under the knife to the tune of their own soundtrack. The vascular specialist today had an uncanny resemblance to my dad, and somehow that put me oddly at ease; until I suddenly realized he was a brazen fan of Justin Bieber. Playing for us in the background was his collaborative Latin-pop single, “Despacito”—the one that inevitably gets stuck in your head every time you hear it.

Well, that’s a little strange, I thought. There was no way of ever predicting I would be listening to Daddy Yankee’s romantically-charged innuendos echoing over a Sony boom-box while he virtually serenaded an operating room full of seasoned surgeons. I smiled (just a little) and recalled how regularly we are reminded as students that medicine is both an art and a science. I suppose it sort of clicked- how each of us has the liberty to choose which artistic medium makes our doctor minds tick. If being a “Belieber” helped my attending reach razor sharp focus and execute fine motor tasks with swift manual dexterity to the best of his ability, then who is anyone to judge?

Looking down at Graham, it became obvious he was no longer conscious. Lying flat on the surgical table, his left leg was splashed with antiseptic iodine and securely hanging from a bandaged sling. Angled up high, I saw his starkly necrotic foot—his ischemic toes withered solid like bits of black charcoal. After making the first incision, our attending grabbed his Bovie electrode in hand like a dip pen and cauterized layers of skin and subcutaneous tissue. He made sure the popliteal vessels and sciatic nerve were isolated, silk suture ligated, and carefully transected. He maneuvered his arms in every direction, skillfully cutting here and sewing there, while I gracefully stood holding a tube that suctioned away hazardous fumes released from the electrosurgical tools. So far not too bad, I told myself.

The chief resident then pulled out a Gigli saw, a flexible metal wire with dragonfly-shaped handles on both ends. She held one end and gave the other to her colleague who was standing on the opposite side of Graham’s body. Without hesitation, they began to slice through his thigh bone. They pulled the serrated rope back and forth like a game of tug-of-war, except with intense finesse, almost as if they were playing a stringed instrument with synchronized precision. As they continued to saw, sprinkles of collagen and osseous salts showered my blue surgical gown.

On a steel table against the back wall, Graham’s amputated leg was wrapped in a bag with his thigh portion still exposed. There they were for us to see: sartorius, gracilis, tensor fasciae latae. All encircling his femur like a taut pinwheel, and none of which I could accurately identify with confidence during first semester of gross anatomy. As we approached the final phase of our procedure, my eyes kept watching but my mind flew elsewhere. Is it true that severed human limbs are disposed like city trash? Of course not, they can’t be. I immediately wondered if all the PPE on my face was enough to hide my expression of total unease. For whatever reason, it was hard for me to understand what just happened—that at 9:53 AM Graham had both his legs, and at 9:59 AM he only had one.

Later that night on my walk home, flurries of snow came tumbling down and melted instantly once they touched the ground. Before I left the wards, Graham was soundlessly half asleep from residual effects of his anesthesia. I struggled with the thought of where his dwindling mind would run the minute he woke up. His breathtaking panic, his utter confusion, his assumption of personal blame. During Graham’s 86 trips around the sun, I imagined all the places his working legs let him go.

That evening, my Maltese pup jumped uncontrollably at my ankle the second I set foot inside my tiny studio apartment. I settled onto the bed and looked at my lanky legs; I poked the plum-colored bruise on my patella, smirked at the unattractive sight of my unshaven calves, and finally stopped caring about the mushroom-shaped patch of vitiligo on my thigh. It’s been half a year since then, and I still can’t explain the fleeting sense of aliveness that overtook me as I sat there wiggling my toes.

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