February 27, 2014

"I wish I had a better story to tell you about why I am typing this with one hand..."

Wrote TV science reporter Miles O'Brien, who had his left arm amputated above the elbow as a consequence of an injury that occurred as he was "stacking the Pelican cases brimming with TV gear onto my cart."
As I tried to bungee cord them into some semblance of security for movement, one of the cases toppled onto my left forearm. Ouch! It hurt, but I wasn’t all “911” about it. It was painful and swollen but I figured it would be okay without any medical intervention. Maybe a little bit of denial?
2 days later he sought medical attention. (It's not clear but I believe he was in the Philippines.) He was admitted to the hospital with Acute Compartment Syndrome.
Over the next few hours, I endured probably the longest, most painful experience I could ever imagine. My forearm developed some dusky discoloration, but more alarming was the numbness. I could not feel my forearm!

The doctor recommended an emergency fasciotomy to relieve the pressure. This is a gruesome enough procedure on its own, but the he was clear that the problem was progressing rapidly and there was a clear and present threat to my limb.

It was getting real. Of course I wasn’t awake for the action but I was told later that things tanked even further once I was on the table. And when I lost blood pressure during the surgery due to the complications of compartment syndrome, the doctor made a real-time call and amputated my arm just above the elbow. He later told me it all boiled down to a choice…between a life and a limb.

28 comments:

Jason said...

How much Brien?!?!?

mccullough said...

Sounds like he's happy to be alive. What a freak accident.

Ignorance is Bliss said...

As a TV science reporter this should make him ideal for reporting on global warming.

On the one hand, global warming advocates say the temperature will rise 5 degrees in the next century... Back to you, Jim.

gerry said...
This comment has been removed by the author.
Ignorance is Bliss said...

Yes, I realize I'm going to hell.

CStanley said...

He's laughing at the bad thing that happened,

Ann Althouse said...

"How much Brien?!?!?"

LOL. That's an old "Mystery Science Theater" joke (in my book anyway).

Ann Althouse said...

I note that he's not naming the foreign country or blaming the doctors in any way, but this is a risk you take when traveling. Would American doctors have solved the problem without needing to resort to amputation? Would O'Brien have waited 2 days to seek help if he were near an American hospital?

Martha said...

My son had anterior compartment syndrome in his lower leg when was a freshman in college. The student health service first diagnosed his problem as an ankle sprain and gave him a cane. The pain and swelling got so severe that two days later he was sent to a hospital-- initial diagnosis was cellulitis or deep vein thrombosis. It was not until the next morning that the correct diagnosis of anterior compartment syndrome was made by an orthopedic surgeon. When the doctor called to tell us emergency surgery was necessary, he said the surgery should have been done two days earlier to prevent extensive muscle necrosis. He did manage to save the leg with a fasciotomy. The leg muscles were so swollen and damaged, the wound could not be closed. After months of debridement and wound care the wound did close-- nasty scar but leg intact.

Compartment syndrome is rarely diagnosed on first visit to the doctor. Patient beware-- persistent, worsening pain and swelling of a limb with numbness and loss of function may indicate compartment syndrome. Emergency fasciotomy is the only treatment.

madAsHell said...

I think the guy is riffing on the typing-with-one-hand-cuz-I'm-masturbating jokes, and making light of himself.

I dunno. I don't think I could do that.

Curious George said...

Too bad he wasn't in Cuba. He would be doing cartwheels today.

Martha said...

There is danger of renal failure from necrosis of muscle tissue (rhabdomyolysis). My son's compartmemt syndrome was called exercise induced compartment syndrome EICS common in long distance runners.

If enough muscle tissue becomes necrotic, this condition would be life threatening and the limb would have to be amputated to save the life of the patient.

My son was almost discharged from the hospital ER after being treated for suspected cellulitis with antibiotics but something about the history did not add up to us --both parents are physicians--so we asked the ER doctors to keep our son in the hospital overnight for consultation in the morning by an orthopedic surgeon or a vascular surgeon. The orthopedic doctor got there first and made the diagnosis immediately and performed the fasciotomy ASAP. That saved the leg.

Jeffrey said...

LOL. That's an old "Mystery Science Theater" joke (in my book anyway).

Q: "How much Keeffe?"

A: "Miles O'Keeffe!"

That's why we love you, Ann.

tim maguire said...

I'd never heard of this before. Horrifying that such a seemingly commonplace injury could lead to amputation.

traditionalguy said...

Life is also called the school of hard knocks. Many fights or fender bender accidents wreck fragile humans for life. That was a big awakening from being an attorney. TV and movies taught us that terrible fights and crashes are recovered from without even hard breathing...just jump up and go on.

Brennan said...

My first reaction to this story was he diagnosed himself like any man would do.

"I'll just wait this out."

Freeman Hunt said...
This comment has been removed by the author.
Freeman Hunt said...
This comment has been removed by the author.
Freeman Hunt said...

Sheesh. Bad day.

There was a mother of four in the area where I live who was moving furniture, got a little scrape, became infected with flesh-eating bacteria, and died. All inside of a week if I remember correctly.

MadisonMan said...

Many things can kill you. Something always will.

jdallen said...

I was discussing with my son the residual numbness in my hand and forearm after removal of a blood clot just below my elbow...

Told him I look at such as the incremental damages of usage we get throughout life. Like dings and scratches on your car.

jdallen

David said...

Wow. Very nice job by the doctor.

I'm assuming that medical negligence claims are not a big threat to docs in the Philippines. I wonder if an American doctor would be more or less likely to take such decisive action with the patient unconscious, given the lawsuit risks.

Tacitus2 said...

It is a very sneaky diagnosis. Could happen with most any injury to arm or leg, even minor ones. But almost never does.

I am an ER doc. This one scares me regularly. There is no convenient test for it, just pain way, way out of proportion to the injury. If you wait for numb and cold the limb is gone.

And realizing how variable people's pain tolerance and compliance with follow up care....

Tacitus

donald said...

I know Miles. Really nice guy. I'm heartbroken for him.

Moxie D. Hoxie said...

He seems to be a very even keeled guy. He's taking it incredibly well.

The TV medical dramas would occasionally show a compartment syndrome episode. And judging by what the doctors hear said, and those TV episodes, it's a tricky diagnosis, and success depends a lot on moving quickly.

I Have Misplaced My Pants said...

Martha, your son is very lucky that his parents are doctors.

Jonathan Card said...

He *is* a really nice guy. I know people that know him; I don't, though. I laughed at Ignorance is Bliss's comment, though. I remember O'Brien was the MC at National Space Society's ISDC 2008 Gala, and they gave an award to Burt Rutan. O'Brien ushered him off the stage when he used the opportunity to bash global warming. Good naturedly, but I remember it enough to laugh at this.

Michael K said...

"Compartment syndrome is rarely diagnosed on first visit to the doctor. "

One additional risk of compartment syndrome in the leg is that it may destroy the nerves and leave the foot competely numb. This will almost certainly lead to subsequent amputation after the multiple minor traumas that ensue. This is also the most common cause of diabetic amputation. The neuropathy and numbness is worse than the vascular problems of diabetes.

I testified as an expert witness against New York City and their hospital system about this 20 years ago.

The story about the emergency amputation is fishy. They have things called tourniquets, you know.