Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The horror and beauty of performing an amputation

Sid Schwab, MD
Physician
September 22, 2013
57 Shares
Share
Tweet
Share

There’s something irresistibly horrifying about doing an amputation. I did several during training, and a few in practice, before eventually turning such cases over to people who did it more. In a way, it’s a microcosm of the perversity and beauty of surgery; of the screaming contradiction that one must somehow accept to be a surgeon. Removing a limb is so many things: failure, tragedy, cataclysm, life-saver, life-ruiner. Gratifying.

Stark and sudden, an above-knee amputation done in the “guillotine” fashion for infection is shocking. But, if you’re a surgeon, you can — maybe you must — find pleasure in it; and I don’t mean some poetic sense of helping one’s fellow man. I mean in the actual act of doing it. Which is why I say it’s a microcosm. Some things we do are terrible. And yet, within walled-off portions of the mind, divorced from the suffering of the patient, there’s a place to go wherein satisfaction comes from the the work itself; the physicality, the artistry, even the transgressive brutality.

The foot, dying, has been wrapped in towels and covered in a sterile plastic bag. The leg, painted in iodine, protruding through a paper drape with a rubberized hole in it, is all you can see of the patient. With the knee bent, you place the covered foot on the table, and it holds itself in place. Holding in your hand the rough handle of a huge amputation knife, you reach as far as you can under the thigh and bend your arm back over the top toward yourself, curling the knife blade around and under the thigh as much as possible.

Can you see what’s going to happen? You’re going to uncurl your hand and arm, drawing the knife, as deeply as you can, completely around the thigh; slashing — if it works — in a single circular motion all the way down to and around the femur. If there were normal circulation, you probably wouldn’t be doing this; so there’s often not much bleeding. Still, you need to be aware of the femoral artery and be ready to clamp it quickly. Maybe you’ve placed a tourniquet of some sort above; or maybe you have a strong and big-gripped assistant who’s squeezing the leg between both hands. In any case, once the bone is visible around its entire circumference, you reach for the gigly saw.

And, while someone holds the leg down, you place the wire under the femur, grab the handles between the middle and ring fingers of each hand, and stretch the saw nearly straight. Back and forth, fast as you can, making the toothed snake rise through the bone, which it does with surprising ease. It’s a whirring sound, more than grinding — high-pitched, err err err err. White until you get to the marrow, the fragments coming off are like gruel. And then the wire springs up with a flap and a splatter as it rises out the top. Start to finish, it’s been only a couple of minutes. (Somewhere I read of the fastest such amputation, done in a few seconds, including the removing of a couple of the assistant’s fingers.)

It’s awkward lifting the leg off the table and handing it away. The balance point is hard to find. There’s an awareness of mutual discomfort in this act — in the giving and the receiving. (A gallbladder plops into a pan, free of emotion. Handing one person the leg of another: that’s an exchange for which there are no words.) It’s a relief to return gaze to the stump: concentric and clean. White bone, red muscle, brown skin. The anatomy is there, on end: hamstrings, quadriceps, neurovascular bundles. It’s not a commonly seen slice.

Before the operation, there’s been pain — physical and emotional. There’ve been sad talks, bargaining. Nothing to feel good about, for anyone. After, there’s the stark realization, the encouraging words that ring hollow. The relief — mine — of turning much of it over to rehab specialists, prosthetists. But there, for that few moments in the operating room, there’s a separate, private, and possibly unspeakable pleasure. (And I must say the same can be said about other amputations I did throughout my career, hundreds and hundreds of times, as a breast cancer surgeon.) The dissociative and dramatic doing.

The fact that, for an instant, I can remove from my consciousness the horror and find enjoyment in my craft, can see beauty even here — that’s something almost too terrible to admit, even now.

Sid Schwab is a retired surgeon and author of Cutting Remarks: Insights and Recollections of a Surgeon.

Prev

We need health care instead of disease management

September 22, 2013 Kevin 46
…
Next

Who will pressure physicians to join the 21st century?

September 22, 2013 Kevin 16
…

Tagged as: Surgery

Post navigation

< Previous Post
We need health care instead of disease management
Next Post >
Who will pressure physicians to join the 21st century?

More by Sid Schwab, MD

  • Navigating the gray area: a doctor’s perspective on treating a colleague

    Sid Schwab, MD
  • Big Joe: living proof of a surgeon’s fallibility

    Sid Schwab, MD
  • I didn’t know her name until it was over

    Sid Schwab, MD

More in Physician

  • A mentor’s legacy in medicine, leadership, and embracing evidence-based care

    Arthur Lazarus, MD, MBA
  • Breaking free from restrictive covenants to combat burnout

    Raya E. Kheirbek, MD
  • From medical student to intern: Discovering a deeper connection with patients

    Johnathan Yao, MD, MPH
  • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

    Jennifer Lycette, MD
  • Decoding name displays in health care: Privacy, identification, and compliance unveiled

    Deepak Gupta, MD
  • Master time management with 7 productivity strategies for optimal results

    Farzana Hoque, MD
  • Most Popular

  • Past Week

    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
  • Recent Posts

    • Overcoming the lies of depression: Senator John Fetterman’s struggle with mental health

      Harvey Max Chochinov, MD, PhD | Conditions
    • Master the ABIM Certification exam with effective strategies: insider tips for success

      Farzana Hoque, MD | Education
    • A mentor’s legacy in medicine, leadership, and embracing evidence-based care

      Arthur Lazarus, MD, MBA | Physician
    • Breaking free from restrictive covenants to combat burnout

      Raya E. Kheirbek, MD | Physician
    • Fixing the system and prioritizing patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • From medical student to intern: Discovering a deeper connection with patients

      Johnathan Yao, MD, MPH | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Sickle Cell Disease Poses Major Risk for Pregnant Black Patients
  • CAR-T Tops Standard Care in Heavily Pretreated Lenalidomide-Refractory Myeloma
  • Artificial Intelligence Could Improve Medical Practice -- But Only if Done Right
  • Huntington's Disease Chorea Improved With Valbenazine
  • T-DXd Proves Mettle in Multiple Solid Tumors

Meeting Coverage

  • CAR-T Tops Standard Care in Heavily Pretreated Lenalidomide-Refractory Myeloma
  • T-DXd Proves Mettle in Multiple Solid Tumors
  • Preoperative Ocular Surface Disease Algorithm Re-Introduced
  • Omitting RT Safe in Many Locally Advanced Rectal Cancers
  • Novel IDH1/2 Inhibitor Shows 'Dramatic Effect' in Low-Grade Glioma
  • Most Popular

  • Past Week

    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
  • Recent Posts

    • Overcoming the lies of depression: Senator John Fetterman’s struggle with mental health

      Harvey Max Chochinov, MD, PhD | Conditions
    • Master the ABIM Certification exam with effective strategies: insider tips for success

      Farzana Hoque, MD | Education
    • A mentor’s legacy in medicine, leadership, and embracing evidence-based care

      Arthur Lazarus, MD, MBA | Physician
    • Breaking free from restrictive covenants to combat burnout

      Raya E. Kheirbek, MD | Physician
    • Fixing the system and prioritizing patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • From medical student to intern: Discovering a deeper connection with patients

      Johnathan Yao, MD, MPH | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The horror and beauty of performing an amputation
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...