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A Surgeon remebers - Dr George Sava

What followed was one of the most curious experiences I have ever had. AII of us know, I suppose, the 'still small voice' of conscience which argues with us when we try to deceive ourselves that we are acting under compulsion, though, in fact, we are merely choosing an easy way out.

That exactly defines my state of mind at that moment. It was as though a second self within me was disputing my honesty, accusing me of accepting the idea of amputation without considering any other course and trying to dismiss a possible alternative as fantastic merely because I was too lazy to think about it.

Moreover, added this censorious double, it was only because I was in a hurry and wanted to get away to the Boat Race and enjoy myself that I was acting as I did.

To the surprise of the anaesthetist and the house surgeon who was going to assist me, I told them to wait for a moment or two as I wanted to think. About what they clearly had no idea, to judge from their expression; this was a case that barely demanded thought. That was precisely the problem.

Was I deciding on amputation merely because it was the routine, the conventional thing to do? And I knew that I had to resolve that problem before I could carry out the operation with a clear conscience and a good heart. What else could be done? Even if the practical, surgical problems of reconstructing that shattered, crushed arm could be solved, what of the other risks? The patient was heavily shocked and in no state to undergo extensive surgical treatment. Above all there were the menacing spectres of gangrene, sepsis, and septicaemia. The patient’s life was by no means unthreatened as it was; it would be foolhardy to expose it to further dangers, criminal to depart from the principle that the first consideration in an emergency of this kind is to save life.

Nonetheless, the uneasiness remained.

The look in the man's eyes seemed to say to me: 'Take what risks you like. I don't care if I do die if I lose my arm. I would rather be dead than have only one arm. I'm a labourer. My arm is to me what your hands are to you. Please -please don't amputate.'

The experience was so vivid that I had to look at him to make sure that his lips were not framing the actual words. They were motionless, though drawn into an expression of suffering. The anaesthetist was getting impatient now, and my house-surgeon was looking at me in puzzlement. So I roused myself from mv brown study and set my jaw. 'I shall not amputate,' I said decidedly. I knew there would be argument, and I was quite right...........

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'It was wonderful, doctor-a miracle if ever there was one. They told me his arm was sure to go and I wondered how we'd manage, because, you see, he's not the type of man who'd be happy in the sort of job you can do with one arm. And then you sent him back to me just as he was. Apart from the wrestling, that is', she added with a sudden smile, 'and to tell the truth I'm very glad he's through with that. I never did like it.'

'Thank you,' I said. 'It has turned out well-better than anyone could have hoped. But to do it I had to subject your husband to risks that were really beyond all justification. He almost died on the table. And if he had done, I wonder what you would have said then I expect you'd have cursed me for attempting the impossible-and you would have been right.'

Jim smiled grimly and shook his head.

'No, sir. That's where you're wrong. I know why you did what you did,' he said; and I glanced at him in amazement.

'Yes,' he went on. 'You remember the way you looked at me just before they started to give me the gas? I was praying then-I couldn't speak, though I did my best to. I prayed as hard as I knew how. I don't often pray, sir, I'm ashamed to say, but I did then. And I asked God to tell you not to amputate my arm, but do anything else-even if it meant I'd die. I could never work with one arm. No, sir-never. And God was good to me, sir. He did tell you what to do-and you did it-and right glad I am, sir. I'm back in the old job and got a bit of a leg up.'

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Nor can I explain to this day why I took those risks, changing my mind at the last moment. Perhaps it was telepathy-perhaps Jim's concentrated thoughts forced their way through to me, though he could not speak. Certainly that was the impression I had at the time-but emotional convictions in times of crisis are not always reliable guides to the truth.
No, the reason lies deeper I am sure, in the dark recesses of the mind but what it was and how the urge came to the surface, I do not know.