Wednesday, March 16, 2011

Fem pop .....

Fem-pop, fem-flop, fem-chop. The anaesthetists version of the vascular anthem.
Those gangrenous shrivelled up arterially challenged limbs (and their nicotine-drenched owners), present, and the sing-song starts.
First the angiograms, then the never-ending fem-pop-bypass. When I say never-ending, I literally mean it. A couple of days, and the nicely demarcated limb is neatly chopped off. All done, fem-pop, fem-flop, fem-chop. I'm sure it irritates the vascular surgeons, considering the heroically back-breaking efforts they make to save these limbs, but I suspect that deep down they sing the same little tune.
All except the unique vascular specimen I've become a slave to in the last 2 years.
This guy just doesn't give up! Ever. He is difficult (no surprise there) , and he can be painfully stubborn, but yes, I like him.
Early on in our synergy, he asked about the fem-pops I'd been exposed to back home. I nonchalantly sang him the anthem fem-pop, fem-flop, fem-chop, and giggled - just a little bit mind you. It soon became apparent that he didn't share my humour. The daggers in his eyes could've stabbed me in the chest across the blood-brain-barrier and all! Needless to say, the next topic was amputations. When I explained that the local threshold for amputations in the teaching hospitals was quite low, the horrified look on his face was, well, horrific. I explained about how patients presented really late, that most couldn't afford the tediously expensive route of fem-pops and weren't prepared to give up smoking, which ruled them out as surgical candidates. Also that the patient load was so huge they simply couldn't get to everyone, and that ultimately with the festering, non-circulating limbs (sepsis just waiting to happen) out of the way, the patients generally did a lot better, a lot quicker.
He didn't hear a word, just said he didn't operate that way. I soon saw what he meant.
I've already said he never gives up. Drives the entire team to drink, from matron right down to runner. But in his defence, I realised after our most recent fem-pop, that we haven't done a single amputation since I've been here!
All the candidates start with an angiogram. Unfortunately there is no angio suite yet, so the whole affair takes place in a standard theatre using a C-arm for screening with a non-moving bed. I must say I feel a tinge of pity for the poor bloke. These procedures are difficult enough without having the technical stuff against you too. He actually does extremely well under the circumstances.
This particular grandpa's leg looked like death warmed up. The rest of him didn't look too great either, but since when has that bothered a surgeon? The anaesthetist is mos also a magician, we wave our wands and we fix!
I took one look at him (holistically) and thought - amputation for sure. There was just no point in doing anything else. I told the surgeon. He ignored me. We did the initial angiogram. A few days later we spent, oh, just about 12 hours doing our heroic fem-pop bypass. Our vein graft only clotted up about three times intra-op, so to top it all off, a couple of embolectomies and some thrombolysis were thrown into the mix. I was a teeny weeny bit peeved at the end of this procedure. A total waste of time, money and effort. I was even more peeved when he brought the patient back two days later for a repeat angiogram, and spent another 6 hours fiddling with the blessed graft. I actually gave up trying to figure out what he was doing and really felt like sulking.
Then a few more days and gramps came for the amputation! I was revving up for the I-told-you-so speech when I saw it was only a big toe amputation. The big toe was the only clearly demarcated bit! The rest of the leg was pink, warm and pulsing!! What an absolute miracle!! I told the surgeon. He just looked at me with shining eyes. Don't think I've ever seen him so animated.
I watched the patient walk out of the hospital a couple of weeks later. It was an awesome sight, really. I congratulated my colleague on his perseverance and a job well done. His motto it seems, is to always try ... always. Like he says, if you give up, you will never know if it might've worked. And when it does, it just makes it all so worthwhile. He is so right. And here, I would've bagged that leg without a second thought. Just goes to show.

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