…and I’m still thinking about it.
The patient had been struck on his dominant index finger with a big pipe, twice. The force of at least one of the impacts blew out a big chunk of the bone of the finger, and the arteries (and apparently nerves along with them), but left the skin behind. By ‘blew-out’ I mean there was a big laceration on both sides of the finger, but it looked like a (pale, dusky, insensate) finger.
A conversation with the hand surgeon confirmed what I already knew: this finger was no more, and a ‘completion of amputation’ was in order. What I didn’t know: that was my job. (He was nice about it, and would follow the patient up in the office, but had to get to the OR).
Now, I’m not green anymore, and have completed a lot of digit amputations before but they were, frankly, utterly cosmetically deranged fingers. They looked a lot less like fingers than ground chuck, and it’s not hard to rationalize removing devitalized tissues and closing the wound. I do it pretty well, thanks.
This was different, at least superficially. It looked very much like a finger, and while intellectually I knew it was never to be a finger again, there’s a deeply ingrained taboo that prohibits me from causing permanent damage. Only after telling myself several times that this was actually no longer a finger was I able to take the sharp implement and cut off most of a finger. An index finger, a pointer, the one used for dialing a phone, scratching an itch, beconing, exploring a nostril, and a million and one other uses.
Into the basin went the limp digit (no bony support), and the closure was as good as I could do. The patient was amazingly calm about the whole amputation-thing, and actually said when I first saw him “…I know you’re gonna have to cut it off…” and showed me another amputated digit from a prior experience.
I don’t want to do that again, though.