Amputation: Crippling Help
Norman L. Higinbotham, M.D. *
A few statistics from Memorial Hospital demonstrate the magnitude of the amputation problem. In the last 35 years, 1,116 patients in the bone service have been subjected to some form of amputation, from the removal of a digit to hemicorporectomy. This is a good deal of mutilating surgery. It calls for a lot of rehabilitation.
Amputation for cancer poses a quite different problem from amputation for trauma or infection. Most are major, or high, amputations. The cancer patient is usually fully aware of his diagnosis. He lives in constant fear. His hope must be bolstered. He must be kept occupied.
It is an unfortunate custom for many surgeons to operate and then rest on their laurels—ensured of the gratitude of patient and family for a lifesaving procedure. They usually are little aware of, or interested in, rehabilitation. This apathy must be combatted.
Surgeons should be encouraged to refer patients to rehabilitation services. In cooperation with these services, surgeons must practice diligent and conscientious follow-up tactics.
The amputation patient's first question is, "Can I get an artificial limb?" Then, "Can I get instruction in its use? Where?" We must be in a position to provide tangible answers.
Let us not lose sight of the cancer patient who has a poor chance, percentagewise. Given our medical inexactitude, the "low percenter" may outlive the "high percenter" and do a better job of living and working. A prosthesis should be provided as though a cure were expected.
All too often, amputees are referred to the few existing large rehabilitation centers. These are likely to be beyond a patient's means. But most large hospitals provide occupational therapy. Most have physiotherapy units. Many have both. These units can constitute a nucleus for a hospital's development of a completely integrated rehabilitation service.
Our goal must be easy availability of rehabilitative services at all stages of disease. We must eliminate red tape and useless forms that stand between the patient and rehabilitation. No case is final until the patient is dead.
Reprinted by permission of the publisher and author from Medical World News, December 31, 1965.