Thursday, January 05, 2012


BKA aka below knee amputation, is a surgery which cut off your leg at a measured level below knee.

This is the operation I saw during my second orthopaedic oncall during last Monday night. The patient was the one I clerked before for case report last month. He was actually admitted once last month due to diabetic foot. Ray’s amputation was done before he was discharged. And I thought that he would be okay after that. However, after another 10 days , he revisited our ward again due to the spreading of gangrene again in his left foot.

He said when he was in clinic, the doctor cut through his foot and found a lot of pus inside his foot. It’s a sad thing when you thought that you are already recovered after removing part of your foot, and now the doctor tells you that you have to remove another bigger piece of your leg. His wife once told me before that they were actually having some financial restraints. Even with the help from government’s welfare, it was just enough to drive through their routines. All his children but the eldest one are still schooling. He can no longer work as he feel tired most of the time. ( fatigue is one of presentation for diabetic patients, not that they are lazy. ) His wife can only earn a few hundred bucks by working in a school canteen.

During morning round, our doctor told him that BKA needed to be done on him as the foot was already not viable and also to prevent the colonization of microorganism there. He agreed without thinking too much. He understood. Just that I could not understand why he could be so calm when someone told him that his foot needed to be removed? I guess if I am him, I am gonna cry a whole day long.

Sometimes, it might be just an ordinary operation for us as medical students or doctors, but it plays a huge part for patient’s life. It might be vital for survival but it does affect a lot on patient. I just feel like the psychosocial part is a important part also in managing patient. They are human being, their hearts are still pumping, they still have their feelings which we can never ignore it. Don’t blame them if they are reluctant to accept your decision of management, especially the more invasive one, but try to understand why they feel that way. It does not always appear to be the good choice. It might treat the disease but not necessarily the patient himself.

Appreciate your patients as they are helping you in becoming a doctor. Without them, you can never be a doctor. That’s what I feel and learn from him.

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