One particularly bad day brought three ICU patients, among them a bilateral lower extremity amputation, an open femur fracture with an external fixation device applied, an upper extremity amputation at the shoulder, open radial and ulnar fractures, a disarticulation at the wrist, intestinal evisceration, and 70% burns. Yes, this is only one of the three patients that day brought to the ICU. Standing there in the unit, I couldn't help but be struck by the paradox that all these spaces were filled with men and women younger than 30.
With six years' background in cardiac and thoracic surgery, followed by 12 years in orthopedics, I felt more than prepared to offer the mechanical and medical interventions that this assignment would entail. But the level of personal gratification I experience has come on a much simpler level. It's the privilege of being involved in the care of these dedicated young men and women. Some of the most deeply satisfying moments occur when I am invited to enter into their stories; even hearing the snippets are an honor. Sharing their experiences, I believe, is the best I can offer my patients.
Often the greatest difficulty lies in not minimizing a patient's injuries while acknowledging the tremendous losses he or she has suffered. The caring, trusting environment I try to maintain makes the sharing possible.
And that's what I was offering to that young IED survivor who had lost his lower leg—and possibly the thumb of his nondominant hand. As he looked at me, then around at the other patients in the unit, I thought I sensed a wave of guilt pass over him—remorse over seeking any emotional support for his loss. "I guess I'm lucky," he told me, with tear-filled eyes, "when I think of what happened to my buddy."
When a patient is able to talk like that about what happened or about his or her fears for the future, I feel as though I've provided something greatly needed. Time rarely permits me to follow my patients through the end of their surgeries. But in my allotted time, I offer analgesics, years of orthopedic experience, an attentive, watchful eye, and a caring ear—the greatest gifts I can share.
Nancy M. Giunta practices in the Department of Orthopaedics at Landstuhl Regional Medical Center, the US military hospital in the German state of Rhineland-Palatinate.