A prominent trauma surgeon once said amputations would “never” happen without anesthesia. What happens when “never” arrives?
I am a partial amputee and survivor of a surgical disaster that “keeps orthopedic surgeons up at night.” My bones are aching as I watch catastrophe after catastrophe unfold for injured and disabled people in Palestine. It’s estimated that at least ten children are losing limbs each day in Gaza due to the Israeli war. Many of these procedures are happening without the proper drugs, including anesthesia, because of the blockade of medical supplies, which is creating numerous infections and secondary complications.
There’s a constant stream of horror, as I’m sure you have seen, unless you’re purposefully not looking. There are videos of doctors operating on dirty ER floors, amputating their own adopted children’s legs on kitchen tables, kids in hospital beds asking when they can go for a walk and not understanding that they no longer have legs.
Over a decade ago, a top surgeon made a comment to the LA Times where he emphasized that things like this would never, ever happen. The comment is on repeat in my mind. It is a devastating false prophecy, emphasizing to me that if sick or disabled people are in the wrong place at the wrong time, basic medical facts–basic humanity facts–will no longer apply to us.
And that is a promise of many horrifying headlines to come.
The comment has not aged well. In 2010, an LATimes columnist recapped the season 6 finale of House, M.D and asked some Los Angeles-based orthopedic surgery experts to weigh in about the episode, which sticks out for its unusual emotional devastation. It featured the titular Dr. House trying to help a woman named Hanna, whose leg gets pinned under a chunk of concrete after a parking garage collapse. She developed acute compartment syndrome, meaning part of her limb was suffocating internally, cut off from the vital flow of nutrients in blood.
It put her limb and life in danger, and yet the collapsed structure was too unstable to remove the concrete holding her down. Amputation was the only chance to save her life. Getting Hanna to agree to let him amputate part of her leg–and do it while she was awake, with no anesthesia, for maximum drama–forced House to reckon with his own leg injury, accept his trauma, and willingly take the burden of doing a torturous surgery on a conscious patient.
It felt like a breakthrough moment for the Vicodin-addicted anti-hero doctor, and Hanna survives the horrific conscious amputation procedure–which made it even more heartbreaking when she died in the ambulance. Her resilience meant nothing. House’s moral injury of enduring a patient’s screams of agony meant nothing. It was too late.
This horrific combination of factors–that someone could be trapped under rubble alive for hours, could lose a limb like that and have it happen without anesthesia, a doctor could be forced to cause extreme pain, that the patient could die anyway–left an impact on viewers. The experts interviewed in the article were quick to soothe people’s imaginations.
“An amputation might be indicated if the limb remained trapped or if the patient was unstable,” Dr. Donald Wiss, the Director of Orthopedic Trauma at Cedars Sinai, ranked as the second-best orthopedic surgery hospital in the country, told the paper at the time. “But it would never be done without anesthesia…morphine would be the minimum used.”
Never be done without anesthesia. Morphine would be the minimum. He seemed so confident about that.
The remark was made to reassure people that such terrible things would only happen in fiction, never in real life. But the truth is far more fucking brutal than fiction, isn’t it?
I discovered this column back in 2022 after surviving my own brush with acute compartment syndrome, which gave me permanent damage and forced me to get part of a fingertip amputated after it grew back without soft tissue and became infected. I can’t get that surgeon’s overconfident quote out of my head these days–it plays on repeat whenever I read about the cataclysmic medical situation in Palestine. Every news report is chilling. Hospitals in Gaza are being shelled, occupied, and leveled; clinics in the West Bank are being raided by soldiers dressed as doctors. Every never is being washed away, every supposed red line is crossed.
As of this writing, 693 patients and medical professionals have been killed in Palestine since the beginning of Israel’s brutal war, according to the WHO’s data. That’s over five times the amount killed in nearly two years of the war in Ukraine.
The devastating airstrikes–some of the most intense this century, according to experts–indiscriminately kill innocents and leave countless survivors with orthopedic injuries and internal bleeding. Doctors are performing thousands of amputations, and in a population that’s nearly half children, that translates to a lot of kids losing limbs–one of the most painful experiences possible and one that will forever change their lives.
Dr. Ghassan Abu-Sittah, a British-Palestinian reconstructive surgeon, was evacuated from Gaza after serving 43 days in Gaza City. In an interview with the Telegraph, he recalled performing six amputations on children in one night. The whole time, he knew that the horrors were just beginning for his patients. “When you start operating on children, you know this is going to be around one of 10 to 15 surgeries a child will need before they reach adult age [and their bodies stop growing].”
A majority of hospitals in the Gaza Strip are now not functional, many are not even standing. What hospital will this generation of medical refugees be treated at when they need the next surgery, and the one after that? How will they be able to grow up in their own homeland if their bodies cannot survive there?
As a patient who has experienced extreme orthopedic trauma and someone with a boatload of other pre-existing conditions, I’ve been dismayed that so few doctors and medical institutions in the West have spoken out against the siege on healthcare and the unprecedented attacks in Gaza. So many promises are just left broken.
In America, where hospitals and clinics are already subject to increasing mass shootings, anti-vax disruptions, and scrutiny over reproductive healthcare, it seems especially sad and foolish not to demand that hospitals and healthcare workers are protected. What message does it send if we’re silent? What happens when attacks against healthcare are normalized? How do people not see what we’re creating in the future?
There is some rising outrage in the larger medical community–but it’s being met by heavy censorship from significant institutions. The National Nurses Union called for a ceasefire on November 7th of last year, and on December 15th, 1199SEIU, the largest healthcare worker union in the US, did as well. But meanwhile, the American Medical Association shut down a resolution calling for a ceasefire in Gaza and the protection of healthcare workers because it “did not meet the organization’s criteria for speaking out about an issue affecting the healthcare community.”
However, the AMA did issue a statement back in April 2022 referencing Russian attacks on healthcare clinics and civilians in their invasion of Ukraine. “Targeting civilians and health care in war is unconscionable,” the headline read.
The injuries being inflicted by USA-made bombs in Gaza are life-changing for those lucky enough to survive. Orthopedic trauma is supposed to be treated with heavy pain control because the pain is unholy, especially when it comes to burned or suffocated skin. There are many opportunities for things to get infected and heal incorrectly, and there can be permanent impacts even under the best of circumstances, which Gaza is decidedly not operating under.
When I first saw photos of patients with still-bloody limbs cast, faces twisted in pain, being wheeled past dead bodies on Salah al-Din Road after being forced to evacuate from hospitals, and the most prominent medical association in the world chose to stay silent about it, I felt torn apart by outrage and grief. I am terrified for the future–for me, for other people with disabilities, for other folks who will be unlucky enough to be sick at the wrong place and wrong time.
After my compartment syndrome, I spent three weeks at Cedars Sinai with my right arm wholly wrapped, getting surgeries every few days, doing daily dressing changes, and having IV painkillers pushed into my veins every 15 minutes–and everything was still so exquisitely agonizing. I do not think I would have survived without those anesthetics — anesthetics that Palestinian patients don’t get right now.
If the orthopedic surgery floor at Cedars had been forced to evacuate, I would not have been able to. I would have been at the mercy of occupying soldiers, or I would’ve been one of those people being wheeled in a hospital bed down an apocalyptic road with no medicine to quell the agony, at the mercy of anything and everything.
That Cedars surgeon told the Times that amputations without anesthesia would “never” happen, but now they are, amidst a host of other medical horrors. When the line of “never” is crossed, the bare minimum we owe to ourselves, the healthcare system, and humankind is to respond.
If we do not commit to atoning for our betrayal of basic humanity, dedicate ourselves to supporting the patients of Palestine, and make it very clear that the sanctity of care must never be crossed again, I’m afraid that one day, we’ll know what it’s like to be behind a blockade too.
