I guess that anyone with expertise in a certain area unconsciously, or maybe consciously, wonders how they would have handled what they’re looking at or what they would have said when they are listening to a talk on a subject about which they know a fair bit. the other day, I as a lay preacher, was talking to two ministers who had been in the audience where I had just preached. One of them said that he had wondered how he would have handled the topic. And he may well have done it better but was too gracious to say so!
I was a specialist surgeon and the GP before whom I was sitting was one of my interns years ago. I wonder how he felt! When I see him, before speaking he often asks what I think, not because he’s not in charge but in deference to our past. And obviously he knows that as hard as I try not to self diagnose I have already thought about what is going on. And I know that he doesn’t want to take our conversation to all the possibilities as to what the diagnosis may be, or to where investigations and treatment may lead us. I felt sorry for him as he (we) worked on a plan as where we would go to sort things out.
I wondered what I would have said and what he was going to say, as I knew that he and I were thinking parallel thoughts. So, and I think he handled it well, he said ‘you know that is usually a significant symptom.’ Still there are exceptions!
Now to await the specialist visits and the test results!
It may be almost illegal these days to say that about a husband-wife relationship! Particularly if you are the male speaking! There I go, being provocative again. But I’m not talking about a person but about a load of work.
Some years ago I self published a book – a sort of autobiography come medical journey of mine. It sold out and is 10 years out of date at any rate. Then a few years ago I wrote a book, probably better called a booklet, for my students as they began their clinical surgical courses. It was relevant to their situation with lack of facilities and language difficulties. Their ability to read thick tomes was limited, so I tried to put the very relevant stuff in a compressed form. As I meet a new era of Western students sold on investigations, before physical examinations, I’m convinced that it may be of use to them also.
I’m pretty dumb, computer wise, but my eldest son, who lives on our farm and runs it and who runs me is a wizard. He wants to reproduce them and also shortly after them another pictorial cum anecdotal short book of our lives. So at the moment the thumb of pressure to get it done on time is hard on me! Publication date for the first two is set for November 27. Between now and then we have a granddaughter’s wedding to attend about 1,500Km away, and a sheep shed to get built, so the pressure is on, the thumb is pressing down.
My first book was called ‘Have Scalpel – Will Travel’, and the new edition will have the same name but with ‘Revised and Updated’ added. The other will be ‘Medical Diagnosis – a Surgical Approach.’ I’m slowly labouring through the third one – as yet unnamed.
The introduction to the first book was and will remain as follows: –
They cut off the tip of his ear. Yes he was a thief and this was the custom. He was naked and caught stealing clothes left out by the river to dry. He could see no-one but they saw him! He was tightly bound with his hands behind his back and taken to court. Eventually he was brought to the hospital. One arm was already gangrenous. It had to be amputated. The other – the nerve supply had been cut off by the pressure of the binding and the arm was paralysed, probably forever.
How did he feed himself? How? He had his food put on the cupboard by the bed – but there was no one to feed him. He had to feed himself. So he got up like a dog on his knees and elbows. He ate like a dog. My heart was touched and so each day I stayed back at lunch time and fed him myself. What became of him? I don’t know. But to God he is a person – to the others he was just a thief.
One night I sat in the common room of Addis Ababa HQ of SIM – the mission with which I was associated. I had just come up from Soddo on business and had left behind this one who deeply disturbed me. People were singing that beautiful old hymn ‘Peace, perfect peace when all around….’ Yet I was not totally at peace. Sitting in that common room I was not totally at peace. Was I doing all that could and should be done in these circumstances? Certainly the future my young thief saw ahead had no pension, no physiotherapy, and no social support.
Some relationships don’t last. Cut them off. Certainly some bumps and lumps need to be cut off. Cancer is often cured by its removal. So much money is spent on face lifts and tummy tucks that it is almost unbelievable.
But, as I’ve mentioned in other posts, I’m going through slides and memories. I’ve been thinking, as I’ve looked at slides, about the reasons for which I have amputated kids’ limbs. I’ll tell you a few!
Personally I have not been involved in amputating a child’s limb in Australia. In Ethiopia I have done a lot – too many to count! I just want to mention the reasons. These are not listed in a time sequence, except the first.
The first one, and that soon after I arrived as a young surgeon (28) in the country, was because a kid, playing in the paddock came across an old unexploded Italian bomb. He succeeded in making it explode amd lost an arm, an eye and had a piece of bomb lodged in his heart. Three operations on the same boy at the same time. He did well and left – one armed, one eyed but with a normal working heart.
2. Another because he was run over by a train. He lost 3 limbs, both legs above knee and one arm below his elbow. I was not the first to operate on him but had later to revise a poor job. As he told me the story later, I wished that I had been the first surgeon, because if he told me the truth (and I have no reason to doubt him) we could have preserved more limb length than was saved. I had to reoperate soon after I first met him because there were spikes of bone sticking into his skin making every movement there excruciating.
3. One because of an electrical burn. He lost both his right arm at the shoulder and his left leg below the knee. He had other extensive burns and suffered tetanus infection before his eventual survival.
4. The majority because of no doubt well intentioned but faulty local healer treatment. Of these over many years we had almost one a week. The splints applied were too tight and post splinting principles of normal follow up were not practiced. That is you must release the splinting if there is any sign that it is too tight.
5. Certainly I had to amputate in lepers because of uncontrolled infection, but the only child with infection as the primary cause of amputation was a girl with extensive gas gangrene.
Often in these children there was so much severe infection that they needed quick early surgery to remove the mess and then reconstruction later. One I remember had 3 cardiac arrests on the table. Others were brought so late that they died , sometimes within hours of arrival, because of septic shock.
6. Several for limb cancers. The pictures, if I showed them, are revolting as they came so late. The smell often was nauseating, but you just had to hold it in, and get on with the job at hand!
There are some nice photos of happy customers below the line – no blood, few bandages.
I remember hearing a famous speaker talking about the above subject and coming down on the side of character but also saying but noone wants to sit down at the breakfast table every morning looking at a nightmare! Some of us have the problem with even looking in a mirror!
According to my policy I warn you that there are two pictures under the line – with no sores nor any blood – but seeing them is essential to reading my thoughts for today.