I cut off a finger the other day

…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.


Comments

  1. So sorry Grunt Doc. I would have done it for you had I been the one you called.

  2. Weird. I have a hard time even visualizing the injury.

    Though if you’ve gotta lose a digit, the index finger is the one to lose…

  3. John S. Wilkins says:

    Yeah, that’s what the plastic surgeon said when he amputated my (cancerous, don’t ask) left index finger. And it’s bullshit. I have lost all coordination in most of my manipulation-skills, particularly typing.

  4. GD,

    Just remember all of the times you’ve seen gangrene, and be glad it wasn’t at that stage–not any better in some respects.

    But, also treat yourself to a good cuppa joe and a nice bottle of champagne for the Ooo-rah to get it done. You’re a good doc.

    -SSG J

  5. Wow. Glad he took it so well. Glad you were there to do what needed to be done.

  6. I’m just glad it wasn’t what I first read the headline to be ;)

  7. new one on me doc. understand your heebie-jeebies.

  8. Jim in Texas says:

    “…and showed me another amputated digit from a prior experience.”

    What the heck kinda job does he have? I assume it was a work related unless he owes his bookie a lot of money.

    Whatever he does, he’s 20% down on digits (moreso if you don’t condsider the pinkies to be productive) If it were me, I would start to consider a new career move.

  9. I work in an area where there are a lot of farming accidents. During harvest season it is not unusual to see guys who got their hand into a corn auger or something similar,and present with a hand that looks like hamburger. Usually the dominant hand, too. They tell me, “Hey Doc, clean it up, cut off what you have to, but do it fast. I have to get back out in the field. There’s two hours of daylight left.”

    I actually saw one patient who told me he was a farmer, and I didn’t quite belive him. He had all of his digits.

  10. Sounds like he works in the oil patch. Drill pipe and chain does a pretty good job of getting fingers.

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  1. [...] cutting things off, Gruntdoc, an ER doc hailing from Texas with some surgical grounding, “cut off a finger the other day“. It wasn’t pleasant doing it, as he concluded, “I don’t want to do that again, [...]