Ambrose

Age at interview: 44

Brief Outline: Ambrose broke his ankle for the third time in 2000. He had surgery to reconstruct his foot and ankle. In 2012 he chose to have his leg amputated below the knee after an infection spread throughout the bone in his leg and caused him a great deal of pain.

Background: Ambrose is a research nurse, but was not working at the time of interview. He is single, has four children, aged 26, 23, 20 and 18, and lives alone. He also has grandson, aged 4. Ethnic background' White/Irish.

More about me...

Ambrose had gone out with his friends for a drink at the weekend. He was running to catch up with them on their way to another pub when he slipped on the wet ground and landed awkwardly on his foot. He went to hospital where initially they thought it was a minor injury. However, x-rays showed that it was badly damaged and Ambrose was taken to surgery just hours later.

 

A later x-ray revealed that the bone wasn’t healing properly and Ambrose spent three weeks in hospital having intravenous antibiotics. In another operation the surgeons managed to reconstruct it using bone, muscle and skin grafts.

 

Two years after the initial injury, Ambrose returned to work as a research nurse, a job which allowed him the flexibility of managing his own hours which was good because he was on a lot of pain medication that made him feel “lightheaded sometimes”. 

 

In 2010, Ambrose woke in bed to find his leg was “more sore than expected”. He pulled back the covers and noticed the bed “full of blood and pus”. Fortunately a friend lived nearby and was able to rush him to hospital where it was discovered that two of the screws holding his reconstruction together had moved and were breaking through the surface of his skin. 

 

At this stage it was discovered that his bone was badly infected and it was unlikely that it could be fixed to the extent where Ambrose could walk on it and that it would not cause him pain. So, he decided that he wanted to have his leg amputated. He explained “For me to be able to get back to work and back to normal life it was no good because I can’t use it as a leg”.

 

His amputation took place two months before he was interviewed. He had been given medication to ensure he would not experience phantom pain and this had worked well. However, he does get phantom sensation in his amputated foot, which feels like his “socks are on too tight”. He had been fitted with a prosthetic leg and was “very pleased with the progress” he had made. The surgeons who operated on him have also reassured him that he “made the right decision”. 

 

Ambrose always knew that he was going to have to have an amputation at some point. He advises people who are in the same position as him to “keep the communication going between you and health professionals” and to ask questions, but to trust that the doctors are trying to make you. 

Ambrose tripped and broke his ankle for the third time, and needed to have it reconstructed. He...

And so the plastic surgeons came, the bone doctors came and microbiology doctor came and they, then the microbiology doctor said, “What there is growing in there” – and then obviously looking at the x-rays – he was saying, “It would be very, very difficult to actually completely clear it of infection. It would be, you know, four months of intravenous antibiotics then goodness knows how long oral antibiotics.” And unfortunately, well fortunately for me, but unfortunately for the plastic surgery team was that the pain wasn’t being controlled properly. So I was saying to them, “Well yes, I can see that your new fangle dangle machine is healing the tissue, but I can’t put any weight on it.” So for me to be able to get back to work and you know, back to normal life it’s no good because I can’t use it as a foot, and an ankle and a leg. And because that would then be, you know, like a planned amputation, their procedure, which is right to make sure everybody, you know, the person who’s asking for the amputation and the doctors that are, you know, going to perform it, you know, we had meetings with the psychologist, the leg amputation team, the plastic surgeons, the orthopaedics, who after discussion and discussion with me, and you know, they’d … because I’d known them for years they were able to say, “Ambrose has had this for a long time. He knows what it feels like. He knew when we first did the reconstruction there was a chance, well not a chance, it probably would need taking off at some point in the future, and it appears that we’ve got to that point now. That now is the right time to have it amputated.” 

When he was in hospital, Ambrose had morphine injections. He said some nurses were good at...

You said at the start as well in the initial operation or may be just after that you were getting morphine injections.

 

Yes.

 

And you said that some were good, and some were bad. Can you tell me what you meant?

 

It was the technique. Because it has to be injected into the muscle some people were very good at doing intramuscular injections and some people weren’t very good at doing intramuscular injections. And you know because it is you know, a motor skill some people would be good at it, and some people won’t be so good at it. Because you know, obviously if people have had that sort of injection you know that it’s always going to be uncomfortable but it’s a difference between you know it’s had it done or it really hurts. But you know, you could always rationalise that of okay well it’s hurting but what she’s just stuck in my leg is a painkiller, so it’s only going to hurt for a little while. But it was just that thing of, you know, if you’d, if you’re in bad pain and all you want is just the painkiller like, if it’s really, really hurting and then somebody else does something else that hurts as well then it just… I think it was just where there was such a difference between people who did it well, and people who didn’t do it well and you’d see who was coming at the bed with a tray in their hand and you’re either thinking, oh yeah, she’s knows what she’s doing or oh no, okay. And just prepare yourself for, it’s all going to be lovely or it’s going to be okay. 

 

The parts of Ambrose’s stump that haven’t quite healed hurt when he puts weight on them. He uses...

Okay and then tell me a bit about your prosthetic leg?

 

It’s a beautiful thing. Well I was very, very lucky in a way, because my leg, initially after the surgery, healed so well. Normally after this sort of surgery the type of system for the prosthetic leg would be based on a suction system. So you’d have a sheath put onto the stump to protect that, then another cap put on top of there, with so it would be like because they showed it to me, but it was a long time, basically what the idea is, that you’ve got one, the one end of the stump has got, not a sticky but like a, a suction cup on it and then inside the prosthetic leg there’s another suction bit, so when those two stick together, it creates suction and holds the, holds the leg on. And they’re just used normally for initially, because it’s not designed for, you know, long term walking. It’s much more of initial hold it on, get it there and it’s usually just for a little while that you use that system and then change over to the system that I’ve got which is the sort of more permanent as such, where we put a sheet onto the stump which has got a pin sticking out the end of it, which I’m now going to show you hopping Mildred, hopping.

So that bit goes on and that’s sticking out the end, okay and I’ll put it on.

 

Would you mind if I film this?

 

No, no, no. So the idea behind this system is that it’s still working on suction as its principle so that this silicone goes on like that, and then you can pull it, because apparently you can bungee jump. I’m not going to have a go. That is completely, if it’s on properly it’s completely solid. And then so I’ve got the screw bit there and then inside of the bottom of there is the hole, okay and so what we do, we’re supposed to put it on properly do it sitting down. Put the sock on, sometimes it will go, sometimes it won’t. Sometimes we need the slippery sock.

 

And what is this for?

 

That actually just because this is obviously quite sticky. If I haven’t shrunk my leg down properly I need this to help it slide in.

 

And to shrink your leg down that’s why you wear that tight sock?

 

Yeah, which is this one.

 

Yes.

 

So the idea of yes, this one is that it shapes it. And sometimes, the sock and sometimes you don’t. …. I need to do it sitting down and you hear the first click so you know it’s in the right place, that’s it done. And that now is completely. It will stay on completely fixed and then just press that button that releases it. Take if off again.

 

Okay. And how does it feel?

 

It just feels like your legs because squashed. Because it’s not completely healed yet, it will… I mean the worst it ever is, is at the moment because you can see there’s still just those couple of bits that aren’t quite healed. It’s stingy just like its tender. So you put weight on it and it hurts, but as soon as you take the weight off it stops hurting. So it’s not causing pain it’s just literally you know, if you’ve got a sore bit and you poke it, it hurts. But if you’re not poking it, it’s fine. 

After his elective amputation Ambrose was put on a fixed care pathway, which meant he had a...

And as it’s turned out it was the most appropriate thing to be done, because as I said nine weeks afterwards you know, back at home, perfectly fine, can put the new leg on, go out for a walk with the crutches. It’s healing well, you know, and everybody is very pleased with the progress, because as I said earlier, of having this very fixed care pathway – you do that, and you do that, then you do that. I wasn’t, you know, I was expecting to take a bit longer knowing older, lots of surgery that potentially would take a bit longer, but as it’s turned out I’ve actually sort of stayed on the milestones of the care pathway, you know, of out in the chair that day, first physio that day, first leg casting at three weeks, wearing it at four weeks, checked. And so I’ve actually gone along very well, and as I said last week when I saw the consultants, you know, they gathered everybody together again to actually look at it, what it looked like afterwards and they were saying, “Well yes, that was the right decision” because, you know, I’m taking now a quarter of the painkillers that I was and most of those are actually on reducing doses, you know, a planned reduction down to the aim of being back for, you know, paracetamol now and then for the leg obviously the rest of my body’s aches and pains aren’t relevant, but, you know, specifically for that it’s going really, really well. 

People have to be assessed for benefits now because the system has been taken advantage of.

How do you feel about the fact that you know, you would be reassessed?

 

I think it’s…it’s obvious having, you know, looked at things over the years and years, the system has ended up in this position it’s in now, because unfortunately people took advantage of it, and, you know, so there’s always been this, you know, to be able to claim any sort of sick pay as such you have to have your doctor’s certificates and your hospital certificates and, you know, whatever. But because unfortunately people have taken advantage and have been caught taking advantage, you know, just sending in a sick note every now and then, now under the present system isn’t just okay, you have to, you know, go and see them and say, “Look, this is the situation. This is my physical ability at the moment.” You know, and… it’s the thing I was having a talk to the woman on the phone the other say about, “Well I’ve got a certificate from a hospital consultant saying I should not work. Why have I got to come for an assessment?” And she was saying well it’s just a procedure of the system that you have to, you know, one of their independent physical assessors has to see you, assess you, discuss what you can and can’t do and then they make their report back to the Department of Work and Pensions of is it still suitable for, you know, what benefits this, that particular person should be receiving, or is it, you know, is appropriate for them to be receiving.

 

Getting back to work as soon as he can is important for Ambrose. He feels he needs structure and...

Well, because it is going so well, I’m, as soon as I’m physically able to, I’m going to get back to work. Because like I say before, because I need structure – just sitting around all hell breaks loose [laughs]. So, yes, at the moment, you know, the future is as I imaged it to be, you know, when we were having the discussions about what is the correct treatment? You know, so it will be, you know, get better, get used to the leg, go back to work, you know. And because I’ve, you know, chosen to have this done myself, you know, it is a part of a very definite plan of right that was how it was, that didn’t work, change it to this, carry on. It’s not going to be that thing of oh it’s terrible, and I can’t do this and I can’t do that, and so I’m just going, you know, get assigned to the sick bench for the, you know, for the rest of the time. That isn’t, you know, in the plan at all. The plan is, you know, we’ve looked at the situation, that is what we’ve chosen to do with a view to, you know, going back to work and then carrying on as it was six years ago. When it was, you know, it was reconstructed, I had a build-up shoe but it was fine, I could work, I could go and do whatever I wanted to do, where I want, when I want, and that’s, you know, sort of where I want to get back to, but just with, instead of having of having a build-up shoe and a reconstructed leg having a prosthetic leg. But being at the same sort of point psychologically and physically if I can work I’m happy, everything good. 

Ambrose recommends that people ask questions about their treatment, but they should trust the...

But I think you know, it’s easy to say oh just stay positive it will be fine. But I think the really important thing that I’ve learned that other people have said as well is you know, just keep that idea that, you know, you can ask questions and say why are you doing it like this. Is there any other different way of doing it? You know, what are we hoping to get out of whatever treatment it is. It doesn’t matter whether it’s for a broken leg, broken arm, stroke, heart attack you know, it’s all that thing of, you know, keeping the communication going between you and health professionals and thinking, right these people are actually trying to make me better and so we need to be having discussions amongst me, family, professionals of, you know, what are the options? 

 

And then obviously the progress to say, you know, you said this is how it might go along. Are you happy with how it’s going? Like how I understood what was going to happen is that is it the same is it different? Because obviously, you know, when you first start on a treatment and they say this is the plan, we’re doing to do this, this, this, this, this and you say okay right that’s the plan, but, you know, I think the most important message is you know, don’t be afraid to ask. Because we’re past the, like the old generations now of yes, doctor, whatever you say doctor, you know I’ll keep taking the pills and my leg will fall off, but it’s fine because you just said keep taking the pills. So it’s much more of, you know, the whole, the whole system has changed, you know, like the, the new consultants and nurses and occupational therapists. You know, there’s a whole different ethos now of you know, we’re all going to work together for the benefit of the patient, the person that needs the help. So that’s the thing to really remember, it’s not you and them, you being told what to do, it’s us altogether you know, and then it does seem for me personally to work very well doing it like that.