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Adjusting to Amputation - The Diary of an Amputee

Paul, a 34 year-old man married with two young children, was asked to record his thoughts and feelings during his stay in hospital.  In 1970 Paul suffered a broken left ankle, which initially healed well. In 1976, the X-rays showed slight osteoarthritic changes, which was not unusual.

However, by 1988 the pain was so severe it interfered with all his normal activities; he found it difficult to concentrate at work and became impatient at home.  The cause of the severe pain was never diagnosed, but it was felt that the only option, after strong narcotic analgesia and other pain therapies had failed, was a below-knee amputation.  Paul came into hospital knowing that the forthcoming procedure was not guaranteed to cure his pain, as phantom limb pain can sometimes be as severe as the original pain, but there seemed to be no other option, so he was prepared to take the risks.

The following extracts are taken from his account over the next six weeks:

Days 1 and 2

“I have spent the first two days in hospital, being seen by doctors and nurses and having various tests. The physio taught me my pre and post-op exercises.  I found plenty of time to sit and think about the forthcoming operation during these first few days.  After two days, I am already quite bored and have finished my first book.

Day 3

I saw the consultant this afternoon and signed the consent form.  It gave me a strange feeling – I felt depressed afterwards.  My wife and daughter came in the evening and I cheered up.  I seem to be in two minds.  I want it to happen as quickly as possible, but I hope it takes a long time for Friday to come.  I know if it works I can lead a normal life and I’ve set a goal that I will be walking normally by Christmas and no-one will know I have an artificial limb.

Day 4

This morning I had a brief chat with the Registrar, who was reassuring.  I thought a lot in the afternoon and although I had plenty of visitors again which took my mind off the operation, I am getting worried.  Will it work?  Everyone keeps telling me it will and I will be all right, but it’s not the same.  It’s not their foot!

Day 5

The day of the operation has arrived and I’m first on the list, which is fortunate as it leaves me no time to think about it.  I spent most of the day in a haze.  When I returned to the ward I was surprised how I felt…the agony from my foot has finally gone, therefore no regrets about losing the foot.  I am quite relieved, but it is strange to look down and see the stump.  The reaction from my wife is the same as mine, but perhaps slight sadness for me that this was the only cure.  All the staff keep asking me how I feel.  I know I will get depressed at some stage, or perhaps not, but I don’t want to now.  The only time I dwell on it is when I’m alone.  Fortunately I’m only alone at night.

Days 7 and 8

Two days after the op and I sat up in a chair for breakfast and stayed mobile all day.  I feel much better than I thought I would.  The stump is still painful, but its pain I can control rather than the other way around.  My little girl has shown no reaction to the stump at all – all she wanted to know was “is Daddy’s leg better”.  She was happy when she was told “yes”.  I see my boy tomorrow, after his return from holiday, and wonder what his reaction will be.

Days 9 and 10

Starting physio is very painful, but I’m up on crutches quicker than I thought, therefore good progress.  The only time I think about the stump is at “lights out”.  I have too much to do during the day so it takes my mind off it.  My boy was a bit quiet, but cheered up when I told him I would be able to play football again.  I had too many visitors during the day, which may sound ungracious, but it is tiring.

One of the patients seems very upset and won’t talk to anyone, which puts a dampener on the whole ward.  Life has settled into a pattern.  The clock rules everything: meals, tea, lights on / lights off and the arrival of newspapers.  It would be nice to have a bit of variety.  Damn painful when the plaster came off.  Although I only saw the stump for about five minutes before it was re-bandaged, it suddenly became personal rather than impersonal and for a few moments, I felt dreadful, but it soon passed.  My little boy was quite outgoing today, he’d made me three get well cards.

Day 11

Seven days post op and I was alright until lunchtime.  When at physio the bandage was removed, I felt sick, and on return to the ward I did not want to talk to anyone or do anything.  I felt really low and depressed, but also empty and extremely angry with myself as I had always said I wouldn’t get like this.  I didn’t say much to my family in the afternoon; my wife recognised my mood and just held my hand.  I didn’t sleep at all during the night.  I shouldn’t feel sorry for myself – just look at the children in the ward next door.

Day 12

Yesterday’s mood stayed with me till lunchtime, when the nurses stripped the bandage down, which helped me to talk about the stump while looking at it.  My wife recognised the change in the afternoon and told me off when I apologised for yesterday.

Day 13

When I saw the stump today, I had no reaction.  It’s funny how the mind reacts sometimes and not others, perhaps it’s linked to the fact that I slept well last night.  On the first day of using the airbag, I had a curious sensation, as if walking without touching the ground.  It gave me a feeling of being one more step down the road though. ,(Bad pun)

Day 16

A couple more days have gone by and I’m fitter than I have been for the last few years, and not smoking as much.  I will definitely try to give up when I’m discharged.

Day 17

Today, half the staples came out.  I’m going home on weekend leave.  My prosthesis should be ready next week, so I’ll be able to walk out on two legs when I’m discharged.

Day 18

Pins and needles in my toes are getting worse.  It seems stupid that the brain can be told the foot isn’t there while the nerves still feel the toes.  Only disappointment today was that my leg couldn’t be cast as the stump is still inflamed. I must learn to be patient.

Day 21

After returning from weekend leave, I tried to put on a happy face, but I felt slightly empty inside when my wife and children left.  The phantom pain and pins & needles in my toes seemed worse.  The sight of the other amputees in the Limb Fitting Centre encouraged me though – in many cases you wouldn’t even know they had false limbs.

Day 23

It’s the middle of the week and I feel much more cheerful – probably because I’m going home tomorrow for a week and a half.  I went swimming, which was tiring, but gave me a great sense of achievement.  My stump gets a strange sensation in the pool.  I think the turbulence around it creates a funny feeling.

Day 39

While on leave, I was in two minds about returning to the ward; not happy at leaving my family, but looking forward to getting the prosthesis.  I am determined to walk out of here with no sticks, but it is taking longer than I expected.  Today, however, I walked back from physio with the leg on.  I had a feeling of elation and a real sense of achievement and I can’t wait to see what my wife and children think.

Day 44

The week started badly after a good weekend.  The socket wouldn’t fit and my stump was sore.  The socket was adjusted on Tuesday and I started to walk well.  My outlook on life has changed and I keep the prosthesis on nearly all day.  The consultant seemed very pleased and set my discharge for Friday.  I felt an entirely different person and I’m glad everything has turned out so well.  I did not expect it to be so quick and I now hope to be playing golf by November”.

One year after the amputation, Paul has no pain at all.  He is now looking forward to playing squash again, which he has been unable to do since 1976, and he also enjoys playing football with his children again.

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