Amputation Expectation

A gentleman in his mid 60’s was admitted to hospital to have a number of toes amputated due to Peripheral Arterial Disease that had progressed to gangrene. After returning from surgery the patient was informed that due to the gangrene his forefoot had been amputated. The doctors informed the patient there was a possibility of more surgery depending on further investigations. Consequently the patient was taken back to surgery the following day and a below knee amputation was performed.

I saw the Mr A the afternoon after his first surgery to explain my role, get a history and develop a plan with the patient towards his discharge. The patient informed me that he is the primary carer for his wife who requires assistance with most tasks including feeding, bathing and transfers. Mr A was quite concerned about what level he would be able to return to and how long he would take to recover, particularly as his wife was currently in temporary care. Mr A felt that the doctors had not made it clear that they would do more than amputate his toes, however after our discussion he felt that he would be able to return to a sufficient functional level with the forefoot amputation.

When I went to see Mr A after his below knee amputation surgery it was like I was confronted with a different person. He was very emotional about his situation, ranging from anger at his situation and the doctors for taking off his leg, to despair that he would no longer be able to function to look after himself, let alone continue to be the carer of his wife. I had intended to see the patient to attempt some basic exercises and education but instead I spent time talking with the patient and trying to help him understand his situation.

I found this situation quite hard to manage due to the fact that I had told the patient what he could expect with a forefoot amputation and built up expectation that he would be able to function at a certain level, only to have these expectations then shattered by the further surgery. I felt like I had contributed to this patient’s problems by building up plans that were largely not achievable.

Looking back at the situation I could have gathered more information about the likelihood of further surgery from the senior nurses and medical team, which potentially would have changed my approach for future planning and education with the patient. However until the investigations are done and a decision to have more surgery is made, the patient needs to be treated for their current condition.