Monday, January 20, 2014

The Handbone's Connected to the Leg Bone

A worker in China cut of his right hand in a workshop recently. He had the presence of mind to place the severed hand in a plastic bag, and later on ice in a cooler. He then began visiting various hospitals. His search was reportedly geographical, starting with hospitals close to his workplace and expanding to greater distances. Why the greater distances? According to news reports, local hospitals turned him away. They reportedly told him that they lacked the expertise to deal with his injury. 

At a hospital two hours from his work, he eventually found a hospital with the skills to render aid. With the unsuccessful stops in between, however, the hand was detached for about seven hours before the injured worker found this hospital. Physicians there concluded that the best chances for reattachment would involve partial healing of the arm first. Therefore, they faced a dilemma of restoring blood flow to the hand, while allowing time for the arm to heal sufficiently to allow reattachment. The solution was to attach the hand to the injured worker's lower leg, restoring blood flow. There the hand remained for a month, after which it was successfully reattached to the arm. 

The story makes a couple of poignant points that are worth consideration. 

First, in my estimation, is that any hospital in America would provide some level of initial care in a situation like this. While the reattachment surgery might need to be performed in a hospital with a higher level of sophistication, I hope that there is not a hospital in this country that would turn someone away in such a situation. 

As I understand it, hospitals in this country are obligated to stabilize a patient who presents, rather than turning them away to wander in search of  more sophisticated facility. The news reports have not been all that clear as to whether this worker was "stable" when he presented to these facilities. with a severed hand in a cooler and a fresh trauma to his arm, I tend to doubt he was stable. I remain unclear whether he was driving himself from facility to facility. But, I am confident (I hope not naive) that less delay and more rapid care would have occurred in the vast majority of American towns. 

Second, this process for keeping the tissue viable is simply fascinating. When I was a kid, I knew a man who was missing the better part of a finger. He had been involved in the sheet metal portion of a manufacturing business, had a bad day, and severed it in a metal press. I never perceived any limitation on his activities from the amputation and I never heard him complain. I always thought of him when adults warned me of the perils of power tools, knives, etc. I am not saying I did not do some stupid things over the years, but I did think of that missing finger. Just a generation ago amputation was permanent. Today, not so much.

Recently I heard a story of a head trauma that involved a piece of the skull being removed. The removal was necessary to relieve cranial pressure from swelling. The piece of skull was actually "stored" in the patient's abdomen for weeks while doctors treated the injury issues. The skull tissue remained alive in that host environment until the doctors removed it and replaced it on the patient's head. 

Is it not amazing that the modern world of medicine has figured out how to preserve human tissue in this manner? So much is advancing, changing, improving. Do we not have much for which to be thankful in terms of the medical facilities we have at our disposal in this country? There is much debate about improving medical care, and ample examples of problems to fix. But at the end of the day, some of the care today is simply fascinating, and we have much for which to be thankful for and amazed by. 

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