A Tale of Two Knees IV

Ministerial Meandering

A tale of two knees - Part 4

These two young hopefuls sat in front of me - actually, that’s a lie, now I come to think of it.  He was lying in a ward bed, and his fiancée was sitting on the end of it, holding his hand, and I had just finished examining him.  I was also sitting down on a chair by his bed, and had just looked - yet again - at his x-rays and all his medical and service notes, that made a mountain in my lap. 

It was very quiet and expectant.  They had been seen by all the other specialists, and somehow ended up with me.  They were exhausted with frustration and fatigue - and having hopes dashed so many times.

I thought back to my trauma training, and an old adage that I used to trot out to my students; ‘Treat first what kills first.’  This is a good plan, because it is very easy to be distracted by the arm that is hanging off, when the real problem is that your patient has vomit stuck in his throat and can’t breathe.

Neither pertained to my patient, but this was like a trauma case in slow motion.  What threatened to kill my patient was a large pulmonary embolus that might block his pulmonary artery and all the blood going to his lungs, and - ‘Good-night, Irene.’

So, working backwards from the pulmonary embolus - which was only being prevented at present by the IVC filter that had to be cleared of clot by dangerous thrombolytics from time to time - we had the cause of the clots bunging up the filter to consider next.  That wasn’t too hard to work out; his bad leg was full of blood clots in his deep veins, and further emboli were only being prevented by his continued use of anti-coagulants.

All fine and dandy - but that was giving blood in his sperm, which for some idiosyncratic reason was rendering him infertile.  Not good for family planning, though not insurmountable with IVF and all the other modern possibilities you might think, but not a cheap or guaranteed option.

However, that didn’t allow for the fact that he was a young man and wanted a career, and to be able to support a wife and family; and that career didn’t look like it was going to be in the RAF.  And all because of a knee that he couldn’t walk on safely, and couldn’t be repaired.

I put the mountain on the floor by my feet, took the bull by the horns, and said to them, ‘What about I take your leg off?’

Expecting both barrels from the two of them, I braced myself mentally for the emotional onslaught - and was totally surprised when they both breathed a sigh of relief, and said, ‘At last - someone who knows what to do!’

All of our man’s problems would be solved by an above-knee amputation - (bar the question of employment post-operatively.)  The source of clots would be removed along with his leg - into the bucket; the IVC filter could go, as it was now redundant, and his risk of pulmonary embolus dropped to as near zero as any other person - and he could stop all his anti-coagulants - and practise baby-making with no blood to get in the way of his fertility.

There are few patients (in my experience) who look forward to losing a limb, even when it is necessary - because it has been near-enough blown off already, or is stinking with gangrene; but this young man couldn’t wait to get to surgery.

He made a rapid recovery, and learned to use his prosthetic leg well.  He and his fiancée had already decided what he would do for a living.  As it was his left leg that had to go, he had had decided to become a high-end chauffeur.  The couple got a loan to buy a really smart limousine, and he had it adapted to a left-hand drive, so he could get in and out easily, and had automatic transmission installed - uncommon in Britain at that time.

He left the RAF on a Medical Discharge and a modest pension - but happy as a clam, that he now had all he wanted to make a life for his soon-to-be wife and family to come.

If you haven’t worked it out by now, the moral of this tale of two knees is all about attitude.  Both our men had sustained sporting injuries, and, in some respects, you might say both were ‘self-inflicted’.  Certainly, our RSM had no-one to blame but himself - but he looked for everyone else to vent his anger and bitterness on, as did his family.

Our man from the RAF had a completely different attitude, despite being similarly let down by military orthopaedic specialists, who had failed on multiple occasions to fix his wonky knee.

It was he who was  grateful, although he lost his leg.  I never heard either he or his fiancée complain once about his treatment.  Later, they sent me a photo of their wedding, and then another one of him and his limousine looking very smart indeed.  He made a real success with his business and never looked back.

The last I heard of our RSM, he was still fighting the MOD (Ministry of Defence) for more compensation.

How we approach life makes such a difference to how we experience it.  Which ‘knee’ will you be? 

Philip+