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Defining Moments: THE FIRST 4 SURGERIES

WARNING: GRAPHIC IMAGES INCLUDED IN THIS POST

The surgery began at about 3:30am, 6 hours after the initial accident.  Dr. Schaub was kind enough to take pictures of my hand as he went through the process of repairing it.  2014-05-10_5_IMG_0418aThis first picture was taken at the beginning of my first surgery.  At this point, the medics in Yuma had already reset the broken bones in my arm, but the injuries to my hand hadn’t even began to be addressed.

I have some very vague recollections of waking up in recovery and being moved to ICU, but my first clear memory happened a little later that morning when I began waking up in my room.    As soon as I became aware of my surroundings, someone was there, hugging me, holding me and comforting me.  “Are you trying to scare us all to death?” she asked me.  My first thought through this interaction was that I had an incredibly compassionate nurse.  As she pulled away and I saw her face, I realized that it was my dear friend, Lara…and my drugged mind immediately wondered when she had become a nurse and how I had been lucky enough to be life-flighted to the hospital she was working in!

Those impressions didn’t last long, but the feelings that were illicited stayed with me. In reality, Jim and the kids had stayed the night in Yuma and were en route to Phoenix that morning.  Jim didn’t want me to wake up alone, so he sent Lara to be there with me.  I don’t know if either of them could have known the impact her presence would have on me.  You see, Lara and I were supposed to be sisters.  I’m not sure how we ended up in different families, but we were fortunate enough to find each other as adults.  Like most sisters, we are about as different as two women can be, but I love her with all my heart and I know she loves me, too.  Having her there was like having a guardian angel sitting by my side.  As a matter of fact, the experience left me with the distinct impression that there were many guardian angels watching out for me and my family…and that has proven to be true!

When I woke up that morning, one of the first things I noted was that my fingers were still there, peeking out from beneath the huge swath of white bandages wrapped around my arm.  I HAD A HAND!  When Dr. Schaub came to visit later that day, I thanked him for saving my hand instead of amputating.  He then uttered the words that I came to despise over the next few weeks:  “We’re not out of the woods yet!”  Weeks later I learned that, at this point, all he had done was clean and debride the wounds, then align and set my hand and arm with an external fixator.  The fact of the matter was that we had just barely entered the woods!

Over the next 3 days, I underwent 3 additional surgeries to complete the rebuilding of my hand and arm, each one lasting from 5-7 hours.  During the second surgery, Dr. Schaub continued the cleaning and debridement, removing a total of more than 600 square centimeters of tissue.  In many areas, the flesh was removed all the way to the bone in order to ensure that all contaminants had been flushed out.  He then placed 6 inch plates on the ulna and radius to stabalize the fractures in both of those bones.  During that surgery, he also removed my right latissimus dorsi muscle and prepped it to become a part of my hand.  This involved trimming and shaping it for the area it was to cover, and then locating a vein and artery that could supply the needed blood flow to keep it alive.  Once this was completed, he attached a doppler monitor to the muscle so the arterial and veinal flow could be carefully watched over the next 24 hours to ensure the muscle was going to live before he permanently attached it to my arm.

doppler baby

Unfortunately, when I was wheeled back to my room in ICU, someone forgot to inform the nurse that she needed to monitor both the arterial AND the veinal flow…and that they were connected to two different channels on the doppler.  By the time I got back to the OR for surgery #3, the vein had collapsed and the muscle was well on its way to dying.  Dr. Schaub was not happy.  However, he was able to locate a new vein in my arm, attach it successfully and revive the muscle. Crisis averted!  Dr. Schaub personally escorted me back to my room post-op, and taught a mini-course to all who would listen (myself included) on monitoring the flow to my hand.  I’ll never know exactly what was said outside of my room, but whatever the case, it was almost comical to see the attention my “Baby” received from there on out.

Surgery four took place on Tuesday, May 13.  This was to be my last surgery during my hospital stay.  As Dr. Schaub was going over the consent forms that day, he told us that he would be resetting some of the bones in my fingers that had been dislocated, as well as fusing my wrist.  Jim mentioned to him that I am a violinist and that it would be really important to be able to move my wrist if I am ever going to play again.  The doctor told us that he would see what he could do, mentioning that he might be able to partially rebuild my wrist, but giving no guarantees.  He explained to us that your wrist is made up of seven little bones, all connected by ligaments.  During the accident, the carpal bones were completely dissociated…or in other words, nothing was where it was supposed to be.  At this point, he hadn’t even located all of the missing bones and had no idea if they were still hiding somewhere in my body or if I had left them somewhere in the dunes.

All things considered, the surgery went incredibly well.  Dr. Schaub was able to locate six of the seven carpal bones. At the time of the accident, they had been shoved up into some of the soft tissue of my hand and were just waiting for discovery.  He reconstructed my wrist with the available bones and pinned it all together with several K-wires.Wrist X-ray He then set about repairing my thumb, which had been crushed and detached from the other bones in my hand.  He reattached it using a plate and several screws. When he was satisfied that he had done all he could for my thumb, he did some work on my other fingers…and then it was time to put it all together.

One thing we have learned through all of this is just how amazing the human body is.  It’s ability to repair itself and to provide the necessary tools for its repair is incredible.  Dr. Schaub likes to talk about our “spare parts”.  He says there are lots of things in our bodies that can be used to repair other places that are damaged or destroyed.  The latissimus dorsi muscle is one of those.  It is often used for reconstructive procedures, and studies have shown that the only people who are really affected by its absence are swimmers and mountain climbers who are competing at professional levels.  (There goes that ambition!!)  A couple of our fingers also have “extra” tendons that can be used to replace damaged tendons in other  fingers.  (That’s coming in a later surgery for me!)  Not only can these “spare parts” be moved around, but they will adapt to whatever part of the body they are moved to.

So, on this day, my latissimus dorsi muscle became a permanent part of my hand and wrist.  At the time, it was huge, at least 3x the size my hand would have normally been and maybe even larger than that around my wrist!  Post op, the doctor explained to us that it would take a while, but eventually, my back muscle would figure out that it is now part of my hand and it would remake itself to become the basic size and shape of the area it was now attached  to.  Again, the human body is amazing!

It would be many days before I saw my hand and arm, but with the completion of this surgery, I was feeling pretty certain that this man, Dr. Timothy A. Schaub, had been an instrument in the hands of God to repair my body.  I’ve been told by several people that there isn’t another surgeon in the valley that would have even been willing to try to save my hand.  Amputation was the obvious answer.  To me, it is clear that there was someone watching over me that night.  To just happen to have the on-call doctor be the best hand surgeon in the area on the night that I would need him, seems like a lot of coincidences to me!  However, we aren’t out of the woods yet!

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