시골의사 2 - 미니스커트

MINISKIRT

Hope vs. desperation. What would make a difference between the two?

What makes the difference between people who make tons of money but are very unhappy and commit suicide and those who have to rely on a wheelchair but keep smiling?

Several years ago, there was a car accident on the Gyung-Bu Highway.  A young woman driver was hit head-on by a freight truck which had crossed the middle line.  When she (Injoo) arrived at the ER, OMG, her body was torn apart so badly that I wished I didn't have to see her. The right leg was badly smashed by the heavy truck, and her intestines were punctured at several spots.  At first sight I thought that she was not going to make it.

When we see a victim of a car accident, we have a certain order of treatments to save his or her life.  First thing we do is to ensure that the patient breathes OK.  Next we make every effort to stop bleeding and maintain blood pressures at normal levels.

If surgery is inevitable, priorities are given in the order of chest-head-abdomen-arm-leg.  The limbs are the last concern, because they do not immediately threaten the life.  However, Injoo's case was beyond textbook instruction. Because one of her legs was so severely damaged, we were unable to stop bleeding.  The only option we had was to amputate the leg.

The surgery had to be done as soon as possible.  If the bleeding continued, injuries in other organs could cause serious complications and threaten her life.  However, it is illegal to carry out the operation without the consent from her immediate family, caregivers, or Injoo herself, otherwise we might get in serious trouble.  Because of the total destruction of the car, there was quite a bit of delay in finding her identity, thus we were unable to contact anyone who is related to the victim.  And she was still unconscious. 

OMG!  So what do we have to do?  What can we do?  Injoo's life is a matter of seconds! After an intense discussion with other staff, we finally decided to go ahead with the surgery.  But who wants to hang a bell to the cat's neck? 

As a precaution, we made a petition that explained why we had to take actions without the consent from the patient's side.  That means, if by any chance a legal action is taken, then we swear to share the full responsibility for our action.  As supporting evidence for our decision, we took as many pictures as possible of her injuries.  And then nurses and doctors added written description about the state of the patient on arrival and documented the reasons why we did not have any other options except for the immediate surgery.  At the end of the documents, everybody signed.  Doing such a thing was not easy, considering the risks we have to take.

In the end, Injoo entered the surgery room.  During my career as a surgeon, I have done so many kinds of surgery.  However, amputation is a type of surgery I dislike most, especially when the patient is a young woman or child.  I bet this kind of feeling would be the same for all other surgeons in the world. 

I waited until the amputation team finishes their job, so that I can continue another surgery to fix the internal organs.  Although I didn't have to be in the surgery room during the amputation, I felt like I had to watch the whole procedure, as she will be my patient after all. 

Soon the room was full of goose-bumping noises coming from the electric saw cutting the bone.  In only 30 minutes, a once beautiful woman's leg was separated from the rest of the body.  As a last touch, the amputation team sealed the cut with the extra skin, and left the room with two words, 'your turn'.  When surgery like this is ongoing, no one wants to talk much.  We just wished to finish the operation ASAP, and forget about it.

Abdominal surgery went well.  Several ruptures were found in the small intestine; fortunately, Mesentery was not damaged seriously, and the large intestine was largely in good shape.  We cut off the damaged part of the small intestine and reconnected it.  While the surgery was ongoing, the vital indicators got better.  Bleeding stopped, and a fair amount of transfusion helped the recovery of other organs.

As soon as the surgery was over, the amputation team came to me and asked nervously.

"Will it be OK?" 

They were so anxious about the misconduct we did without permission.  Their concern was understandable, because they were the ones who severed the leg and they would get blamed most, although we all swore to share the responsibility.  But there was nothing we could do about it.  The water in the glass was spilt already, and the patient survived.

Tick-tock, tick-tock, tick-tock.

Injoo became conscious gradually.  As a matter of fact, it was very fortunate that we were able to save her life from such a fatal accident.  We could've been very proud of it; however, we couldn't help but be concerned about how Injoo would accept the miserable spell imposed on her. 

Injoo's family members finally came to the hospital, and we explained them the inevitability of the amputation.  Graciously they, in particular her fiancé, appreciated our decision and our effort to save her life.  So all our concerns went away.  We were so relieved!

What about Injoo?  Will it be OK with her?

She is a career woman, working at a foreign-based Korean bank.  The bank executives have praised her talent and decided to support her study at an MBA program overseas.  Of course she was very excited about it, and scheduled to leave Korea next month.  But then the accident spoiled everything.  It was not hard to imagine how deeply she was disappointed.

She complained incessantly about our actions without her consent, cursed the driver who ruined her life, and hated her fate.  She even refused to take any follow-up treatments.  Who in the world can accept easily such misfortune? 

She might think she is still dreaming, a nightmare!  She was totally innocent observing all rules and laws, but she is the one who ended up laying on the hospital bed, having a big scar on the abdomen, and above all missing a leg.

Since the surgery, she suffered from the phantomized brain for over a month.  The human brain memorizes a very detailed map of the body parts.  And it orchestrates the muscular activities of all parts to coordinate balanced movement.  When any part of the body is removed, the brain does not recognize the missing part immediately, thus it keeps sending commands as if everything is normal.  If a one-legged person like Injoo tries to walk, the brain commands her to make alternate gaits.  But because one leg does not exist anymore, she tips the balance and collapses easily.

     

Even worse, severe pains coming from the 'missing leg' terrified her.  Huh?  How is it possible? 

An area of our brain makes us sense 'pains' that originate from the wounds.  If the painful sensation is quite intense, the brain remembers it and makes us feel the same way even if the wounds had been treated and healed.  This is exactly what happened to her. 

Her brain just remembered the pain she had felt at the moment of accident.  

Every night she cried out because of the extremely painful feelings from the 'missing leg', even though the leg had long gone.  We had to simmer her down by giving her a high dose of sedatives for many days, until a new body image was formed in her brain.  During this period, her depression further deepened. 

Time is the best medicine. 

Things had gotten better gradually over a few months.  And finally a moment came that she did not need medical treatments any more.  Her depression had also been disappeared quite a bit mostly due to the psychiatric treatments and her fiancé's bottomless support.  However, she could not hide completely the face that was overshadowed by the handicapped body.

On the day when Injoo was finally discharged, she visited my office with her fiancé to say goodbye.  She supported herself with a crutch.  She was wearing a pair of trousers, which bragged her intact left leg. In contrast, the empty right one was flapping like an inflatable air dancer.

I felt sorry for her loss, but I pretended to be dull and said to her while I tied up the right leg "you'd better tie this one, otherwise you might get entangled with it."  She did not say a word, instead replied with a subtle smile.

Although her recovery was my primary concern, I also worried about the future relationship between Injoo and her fiancé.  It is no doubt that they have substantial physical and psychological hurdles to overcome.  I wished their relationship goes on like before the accident.  Thus, I called him more often than I did her parents and explained what's going on with her treatments.  I gave him advice about rehabilitation, how to take care of the intestinal recovery, and talked about psychology of patients who had lost their body part, etc. He listened to me seriously.

After being discharged, Injoo visited as an outpatient once a week.  She seemed to be getting better as time went by.  She used the crutch well, and gained strength to hold it quite a while.

She said that she quit her job, and tried to find another one.  I was just about to ask her whether she quit voluntarily or she was forced to do, and what kind of new job would be.  But I swallowed my curiosity, as I believed that she is strong enough to move forward without someone's help.

What I was concerned about most was the absence of her fiancé, who used to be with her like a shadow.  He did not escort her the last four or five visits.  But I was afraid of asking her about it.  
Two to three months had passed and she did not have to come anymore.  I said to her, " Please come see me if anything bothers you.", and bade farewell to her. 

After about three months since then, Injoo made a surprising visit with her fiancé.  And she handed me a white envelope.  It was a wedding invitation! 

She said smiling, "I know you are too busy to come, but we felt obliged to let you know."  At that moment I sensed what she meant by a new job.  A new family!  Seeing this couple who vowed to be a husband and wife made me so ecstatic. 

But I got even more dazzled by recognizing her wearing a miniskirt!! 

How weird!  The intact left leg was showing off its beauty under the skirt as usual, but not the other one.  But from this view, I witnessed the utmost triumph she achieved.  This was an absolute beauty that cannot be compared with anything else in the world! 

Miniskirt with a single leg!  This means she finally gained victory from the excruciating battle with herself.  Who in the world can claim that he/she is braver than Injoo?

Injoo's miniskirt!  Wouldn't it be the most precious lesson for those who gave up easily?