Rage against the dying of the limb: Grieving for the leg (while it is still attached)

I just read this excellent article in Army times:

http://www.armytimes.com/news/2009/02/ap_mo_soldier_leg_021509/

It suggested that most soldiers requiring amputation of their limb delay this by many months or longer. 

It made me immediately think of Dylan Thomas’ entreaty to not “go gently into that good night. Rage, rage against the dying of the light”. 

I would suggest that we may regularly encounter this phenomenon– both in patients and (perhaps more subtlety) in the clinicians that care for them. I call it (for lack of a better term) “grieving for the limb” while it is still part of the person. Some of us (doctors and patients) require time to realize that a high-level amputation might be best for that person in some select circumstances. While I firmly believe that this is the minority of patients for whom we care (most wounds can be healed and most limbs with even horrendous problems do not require amputation), I do believe this is something to consider the next time we consider embarking upon (or prolonging) heroic measures in “limb salvage”.  

David G. Armstrong

Dedicated to amputation prevention, wound healing, diabetic foot, biotechnology and the intersection between medical devices and consumer electronics.

One comment

  • I have a little different view on this. These are patient driven decisions. In emergency trauma case in young patients, we almost always try to save the limb and many patients are grateful for these efforts. Over time, a small number (only 57 from the Iraq experience) have dysfunctional legs or chronic pain syndromes and eventually elect amputation after consultation with their surgeons. This approach gives the patient a choice in the matter, and many limbs that would have otherwise been lost are salvaged and patients remain functional. Such a careful approach salvages the highest number of functional limbs and avoids unnecessary amputations,

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