Death by Inches

I have a constant question on my mind every time I go to work. It's the constant torture that we put vascular patients through. They come with poor circulation to a foot, where there is usually a gangrenous ulcer. After an angio and some IV antibiotics they usually go home, only to come back a couple months later. Then they need another angio, maybe a stent, or even a bypass graft. They go home again, only to come back a few weeks later with a failed bypass graft, then they need a toe amputation or transmetatarsal amputation. Then......that fails to heal and they undergo several revisions. Finally, maybe a year after it all began, and ten surgeries later, they end up with a below the knee amputation. Usually after we get one leg dealt with, within months to a couple years we start the same process on the other leg.

We see this happen to person after person, so much so that we designate them as "frequent fliers." It's a bad thing when you recognize at least 1-2 names on the board every shift.
The question I constantly think about is why we just don't go for the amp the first time? I know it's possible that a person only needs to get an angio or bypass graft, but it just seems like such a huge percentage end up needing the amp. I think it may improve quality of life as they wouldn't spend months and months of the year in the hospital, and instead go through the whole process ONCE and move on with their lives.

The sad part is this terrible disease is not only brought on my poor diabetic control, but by smoking. I often think we need to forget all the lung cancer campaigns and switch to a vascular campaign to scare people into quitting smoking. I often find that hardcore smokers aren't afraid of dying...they are too tough. But to lose both their legs and have to live the rest of their life like that? That might makes them think.

As for my question to amp right away......I wonder if I'd feel differently if it was my leg.