The Amputator

The  Amputator

It was 1991. I was a newly minted doctor and was starting my residency in Trauma and Orthopedic Surgery in our local Teaching Hospital in the town of Zaria in Northern Nigeria.

I was one of two new residents who would share call. Accidents on the roads in Nigeria are common and many injured would be brought into our Emergency Room. I learnt to deal with many types of fractures and was also learning how to do Orthopedic Surgery.

It must have been my second time on call that I was called to see a young man. He had fallen off his bicycle and broken his leg. His family took him to the local bone setter, who splinted the leg with a splint made of wooden sticks. Unfortunately, these were tied on too tight, and the leg became gangrenous.

They went back to the bone setter, and he told them that they had displeased the gods and that is why his leg was rotting away. The desperate family then brought him to our hospital.

Even before I got to him, I could smell the strong sickly smell of rotting flesh. As I unwrapped the splints, I could see his leg had become gangrenous and would have to be amputated.

I broke the news to the patient and his family, and they were naturally upset. The patient then asked me to do what needed to be done. I called the operating room and the anesthetist. I had assisted in several amputations before, but this was the first I would do on my own.

He was wheeled into the operating room and the anesthetist put him to sleep. I was assisted by one of our surgical technicians. I prepared his leg with antiseptic solution, then draped the leg and began the amputation.

It is easy to do an amputation, but making sure that the patient has a good stump that will make using a prosthesis easy is however quite technical. I marked out the flaps and started cutting. I found the large blood vessels and tied them to prevent bleeding. A saw was used to cut the bone. Finally, the flaps were sutured closed.

The patient did well, and eventually he got a prosthesis that enabled him to ambulate well. I ended up getting these types of patients frequently and did regular amputations. I was so frequently in the operating room with an amputation, that one of the General Surgery residents (a close friend) decided to call me “The Amputator”. This was a play on the title of the 1984 Arnold Shwarznegger movie “The Terminator”. The name stuck, and from then on, many of my friends used this as my nickname.

One day, a three-year-old girl was brought in with gangrene of her leg. She had developed rickets, a disease caused by a dietary deficiency of vitamin D that is common in children in West Africa. This had led to bowing of her legs. She was an only child and her parents had waited many years before being able to have her. Her mother wanted her legs to be perfect and straight and decided to take her to a local bone setter.

He broke her legs and tied them straight with the wooden sticks. Unfortunately, one leg was tied too tightly and caused gangrene. The little girl was quiet and stoic when I examined her. However, when I broke the news to her mother that the leg would have to be amputated, she started wailing loudly as her husband tried to comfort her.

I proceeded to amputate the little girl’s leg. It was a very traumatic experience for me. That little girl’s quiet bravery affected me deeply. Amongst the many patients I often wonder about is this brave three-year-old, who should be a grown woman now. I hope she is doing well.

                                                Traditional Bone Setter Splint