I Amputated A Child's Leg And Then Went Back To Work

I remember that case for two reasons. One, because it was bloody awful and two, because afterwards, I cracked on because I had other sick people to take care of
Stuart Kinlough

The Case I Can’t Forget is a weekly series that hears from the people working at the coalface of public service about the cases they have carried with them throughout their careers.

This time, surgeon Simon Fleming reflects on the case of a baby girl who suffered complications from an infection, causing her legs to turn black.

As told to Lucy Pasha-Robinson. If you have a story you’d like to tell, email lucy.pasha-robinson@huffpost.com

case i can't forget

I started medical school in 2001 and qualified in 2006 and, since then, have worked around the country and the world, so I have a pretty good mental archive of cases, tragic or joyous, funny or heart-breaking. Plus, I love telling a story, so have a repertoire of “old faithfuls”.

The reason I chose this case, rather than the multitude of others, is that it’s topical, but not for the reasons you might think.

More and more we are hearing about how those of us in healthcare who are not happy with the status quo need to be more resilient. That if we want to combat burnout, morale issues or mental health problems, deal with bullying and the rest, we just need to work on our “bounce back-ability”.

With that in mind, this is my case that I can’t forget.

I found myself working at a hospital that deals with some of the toughest cases out there and one such case came across my path: a young child, on holiday in the UK. She was here with her folks, who, for their own reasons, did not have health insurance. While visiting family, the little girl got sick. Snuffly-sick, not 999-sick. But a few days later, she got 999-sick. So they sensibly popped to the local A&E who confirmed that yes, she was pretty unwell and needed a little hospital stay.

But she didn’t get better.

In fact she got worse, and quickly. So much worse in fact that she was transferred to another, bigger, shinier hospital, to have stronger meds and more machines and more expert doctors and nurses and the like, so she could get better and go home… Job done. End of story.

Except she didn’t get better. In fact the team at the shinier hospital called for help. And so it was that this one-year-old girl found herself in my hospital under the care of the team I was working with. She had had all the medicines and we looked to be winning.

But the illness she had – some kind of infection – combined with all the medicines and machines had done something to her circulation.

I was called because her legs had gone black. So had her fingers. And it quickly became apparent that one of the legs was really not OK.

There were issues with the family around their understanding of what was going on. I won’t dare try to trivialise what they must have been going through. When I think about it, I think about the “issues” in terms of cultural and social and religious and financial and psychological. But what it comes down to was that we were suggesting amputation of their baby’s leg. I don’t really know the first thing about what they must have been going through. Not really.

One morning, after a long process of lots of conversations and meetings, and forms and team work, we did what this young girl needed and, under the supervision of my trainer, I amputated the leg of a one-year-old girl, who will never have the same life again. She will go back to her home country and begin a life that nobody planned for her.

I came back to the ward after that case to find one of the nurses crying. I comforted her as best I could. Then, I took a deep breath, had a coffee and I went to the Outpatient Clinic and did my job. I smiled and laughed and built rapport because that’s what my job is and that’s what my patients needed and deserved. But also because, though that was a rough case, it wasn’t and isn’t uncommon.

In medicine, death and loss and awful things are standard.

Yet, a lot of the data out there says medics are actually less resilient than the general population. A lot of the metrics, and courses and training, for how well you deal with something terrible are based on normal people with normal jobs.

But what happens when your normal job is, by its very nature, traumatic?

If I pick someone in the street and tell them “Learn how to run a 10K” they will. Then, with some special courses and training and motivation, I bet they could knock two minutes off their best time.

But turn around to Mo Farah and tell him to knock two minutes off his time and he’ll laugh. If he can knock two seconds off his time, he will be overjoyed. So, in a way, he has less to give. He is already performing at peak and you are asking him to give a little more; and he might not have any more to give. And if he does, you wouldn’t train him the same way you train a park runner.

I remember that case for two reasons; one because it was bloody awful and two, because afterwards, I cracked on because I had other sick people to take care of and nobody asked me how I was or offered me a cup of tea or a sit down. So please, don’t tell me we lack resilience. Instead, help us care for ourselves better, so we can care for you better.

Simon Fleming is a Trauma and Orthopaedic registrar on the Pott rotation in London.

The Case I Can’t Forget is a new series from HuffPost UK that hears from those on the frontline of public service about the cases they have carried with them throughout their careers. If you have a story you’d like to tell, email lucy.pasha-robinson@huffpost.com.


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