Merriam-Webster's Unabridged Dictionary defines “miracle” as “an extraordinary event taken to manifest the supernatural power of God fulfilling his purposes,” “an event or effect in the physical world deviating from the laws of nature,” and “an accomplishment or occurrence so outstanding or unusual as to seem beyond human capability or endeavor.” Some might add that faith is also involved.
This is the story of a 93-year-old mother and her devoted daughter. The mother was lying in her hospital bed. The daughter was holding her mother's hand and looking at me with imploring eyes; she had just been told that her mother's left leg had to be amputated above the knee.
The mother had been able to walk until a few weeks before admission. She had scratched her itching leg, and gangrene developed. A 7-centimeter band encircled her left leg above the ankle, and her left foot was cold and cyanotic. She was in constant pain.
Angiograms had shown the complete absence of the left external iliac, femoral, and popliteal vessels, so a bypass procedure was not an option. When I explained this, the daughter gazed at me with doubt, determination, and serenity. I mistakenly thought that she was resigned to the loss of her mother's leg and perhaps her life. The daughter said that she would talk with me again in a few days about whether her mother and she would consent to the amputation.
A medical specialist soon called me for permission to examine the patient. He, too, favored amputation. Without surgery, he said, death would certainly come soon from the complications of gangrene.
Christmas was approaching rapidly, and the holiday spirit was strong inside and outside the hospital. The daughter remained at her mother's bedside day and night, comforting her, caring for her, turning her from side to side, giving her back rubs, feeding her, and talking to her in Italian. The mother responded mainly with grunts.
I dropped by after several days to evaluate whether there had been any changes in the patient's condition. I shook my head sadly to convey that amputation was inevitable. The mother was silent; the daughter appeared to be unperturbed. She offered me fruit from a basket, but she made no mention of their decision.
A few days later, I asked, “Shall we remove that leg?”
As naturally as if she were saying good morning, the daughter looked me in the eye and said, “Doctor, I want you to operate. You are going to find an artery in her leg to do the bypass.”
I responded, “Our X-ray doctors are experts at reading angiograms. Besides, your mother's age would make it risky to explore her leg for an artery that the angiogram missed. And if we do find a vessel for a bypass, she will need plastic surgery later.”
“Doctor,” she said, “You will find an artery, and you will save my mother's leg. I have been praying every night, and I am certain that you will not have to amputate it. I know that you can do it.”
I went to the nearest telephone and scheduled a bypass for the next Monday morning. Somberly, I told the operating room clerk the patient's age. The daughter followed me to the nurses' desk. Turning to her, I said, “If I can't find a vessel, I will amputate the leg.”
“No, doctor;” she responded, “you will save my mother's leg.” That was a final statement if I have ever heard one.
During surgery, to my surprise, I discovered a patent superficial femoral artery, 44 centimeters long. I used it to perform a left iliofemoral Dacron bypass. The next morning, the mother's left foot was warm. A few days later, my plastic surgery colleague débrided the full-thickness gangrene and applied split-thickness skin grafts on the patient's left leg. These procedures were completely successful.
The Christmas holiday was over, and the new year had arrived. In early January, I saw the patient taking a few steps, with the support of two physical therapists. Not long after that, she was discharged and went home.
I don't really know whether to call my patient's outcome an outright miracle, but if not for her daughter's faith and persistence, she most likely would have lost her leg and probably her life. Certainly, this was an outstanding occurrence—a wonderful event beyond our comprehension.
Submissions for Peabody's Corner should 1) focus on the interpersonal aspects of a specific patient-doctor experience; 2) be written in storybook fashion; 3) contain no references; and 4) not exceed 5 double-spaced typescript pages.
From: Department of Surgery, Christ Hospital, Jersey City, New Jersey 07094