Sepsis Amputation Surgeon: What I Learned After Losing My Legs

Siobhan Harris

Disclosures

June 16, 2020

A consultant vascular surgeon who has amputated hundreds of limbs in his career is back at work after having both of his own legs removed below-the-knee.

Image source: Mr Neil Hopper

43-year-old Neil Hopper underwent the operation after becoming seriously ill with sepsis in April last year.

Mr Hopper, who works at the Royal Cornwall Hospital in Truro, has carried out his first operation since returning to his role. It was an amputation. He returned just before the COVID-19 pandemic and since then has been working with his colleagues to help tackle the virus.

Medscape UK asked Neil Hopper about his experience and what he has learnt from it.

Q&A

What were the circumstances that led to your amputation?

Around Easter last year I went for a camping trip with my two children. My daughter and I fell ill on the first night that we were away with fever and vomiting – so early the next morning we abandoned the camping trip and came home.

Over the next couple of days my daughter got better but I still felt lethargic and feverish. We were due to visit my in-laws that week. My daughter had recovered, so we decided that my wife, Rachel, and children would travel up country and I would stay at home. The day after they left, I felt a bit better and thought I was improving. I still felt tired, but generally I thought I was improving. I had developed aching in my shoulders and feet so I decided to have a whisky and go to bed early. I don't remember much after. My next concrete memory is of being on the intensive care unit at the Royal Cornwall Hospital. I have flashes of recollection – but I am not sure how reliable they are.

I have heard since that Rachel had tried to phone me and I had answered the phone but had spoken gibberish to her. She had asked Rachel Barnes, a colleague who lived nearby, to check on me. When Rachel found me she immediately called an ambulance. My blood pressure was low and I could not stay awake.

I improved quickly with intravenous fluids and antibiotics. I remember that my feet hurt and I remember, on ITU, thinking that they were in serious trouble.

The only hope for saving my feet was for me to have hyperbaric oxygen therapy. This was not available in Cornwall. I was therefore transferred to the DDRC [Diving Diseases Research Centre, also known as the Hyperbaric Medical Centre] unit in Plymouth and had emergency oxygen therapy, which involved going into a pressurised chamber and breathing 100% oxygen at high pressure for 3 or 4 hours. It is the same chamber that they use to treat deep sea divers with "the bends".

The course of treatment consisted of a 3 hour "dive" per day for 2 weeks. Between dives I was cared for in Derriford Hospital by Mr Francis Dix and Commander Christopher Parry. I knew both surgeons professionally. They looked after me supremely well. I vividly remember the effort that they put in to save my feet – but after a couple of weeks it was obvious that the hyperbaric oxygen treatment was not working.

Although I could see that my feet had been deteriorating and I had suffered several episodes of sepsis, it was exceedingly difficult to finally hear that I was going to need amputations. I had understood it on an intellectual level – I knew it was the only option - but it did not seem real until I had to sign the consent form the day before the planned operation.

The evening before my operation I had a panic attack. I had never had one before and it was incredibly frightening. I felt like there was a massive weight on my chest and I could not breathe. I could not stop thinking about what was going to happen to me. I felt as if I had lost control and this was a completely alien feeling to me. I knew it was a panic attack, yet I could not rationalise myself out of it.

The next day I had the operation. I have no idea what it must have been like for Chris and Fran to perform the op but it went well and almost immediately I felt physically better. My energy levels improved and things seemed brighter. After a week or so I was discharged home.

What's it been like returning to work?

I'm a surgeon. For me it is not a job – it is a vocation. If you cut me in half it would read "Neil Hopper – vascular surgeon". So, it was difficult not to be working. I was not even sure if I would ever be able to return to my job. I was not sure if I would be able to walk well or if I would be able to stand for long enough to perform vascular surgical operations.

However, once I had been fitted with my prosthetic legs, I relaxed a little. I found that I could walk reasonably well, and I made quick progress. I got my legs in late August and by October I felt ready to return to work on a phased return. I began with clinics and paperwork and gradually built up to operating and on-calls. In February (10 months post-surgery) I returned to full duties and full on-calls. I never imagined that I was going to be able to achieve this.

My biggest difficulties were convincing people to let me do things, as I was very frustrated, and recognising the psychological impact of my situation. I had concentrated so hard on my physical rehabilitation that I suspect I had not taken enough time to process everything. I had a few unexpected episodes of "reality" hitting home. Returning to work really helped me come to terms with things as it was good to see my friends, colleagues, and patients and get some normality back in my life.

What was your rehabilitation like post operation and what did you learn from the experience?

I do not think any surgeon really understands what it is like for a patient to have an amputation. I understood it on an intellectual level – but oh boy did I not have the first clue of what it is like! It changes absolutely everything. It changes the way you interact with the environment. It changes the way you are seen by other people. And it changes the way you see yourself. I learnt an awful lot about myself through this. I learnt that I was more resilient and stubborn than I had imagined. I also learnt that I could be impatient and downright indignant! I learnt that, as a patient, you sometimes have to push to get the best care.

My experience of rehabilitation was one of frustration. I must have been a nightmare patient. I wanted to make progress and I had an inclination of the service that should be available.

Every single practitioner I met on my journey through rehab and the fitting of prosthetics worked extremely hard and were incredibly good at their jobs. The problem was that everything took too long, interactions were too short and too infrequent and there were gaps in the care. For example, at my rehabilitation centre there is no ready access to a psychologist. Also, living in Cornwall meant having to travel to Plymouth for prosthetic appointments and specialist physiotherapy. In retrospect, I did not know it at the time, but I really could have done with more psychological support. I made it through the anger and depression – but I suspect this would have been easier with the input of a counsellor or psychologist.

It became apparent to me that the system was, in many ways, inflexible. What works for a 70-year-old missing one leg did not really work for a 43-year-old missing both legs.

Amputees seem to be a bit of a lost cohort. Resources have gradually been diverted to address other patient groups. I am hoping that I can work to redress this imbalance and improve the situation for amputees in Cornwall.

How does your experience give you a fresh perspective on what it's actually like having the operation and living as an amputee?

I learnt so many things. I now know what phantom pain feels like (bloody awful!). I know how thick-headed the drugs make you feel (being on pregabalin is like having treacle poured into your brain). I know how difficult it is to come off the medications (I had no idea how addictive they are). I know what it's like to live in a wheelchair. I know how difficult it is to use a disabled bathroom or take a shower when you cannot stand up. I've also learnt what it is like to be reliant on other people. Even simple things like the irrational embarrassment of asking someone to take away the commode after you have used it are a big deal when you're a patient in hospital.

I already knew that the staff of the NHS are universally amazing. This was only reinforced. I also became more aware of the unsung members of the therapeutic team; the health care assistants who provided amazing care and kept my spirits up, the physio assistants who provided additional motivation to exercise and the catering staff who put a naughty spoonful of sugar on my Weetabix when my appetite was not great.

I learnt lots of practical things as well – tips and tricks. I always wondered why lower limb amputees often wear shorts. It is simply because it is so much easier than wearing trousers. You can adjust stump socks more easily and you do not have to keep threading prosthetic feet through trouser legs. An added bonus is that it is shorthand, so I do not have to keep explaining why I can't stand still for too long, or why I waddle a bit when I walk or why I am slow going up stairs.

I also learnt that amputees are a tight, friendly, and helpful community. I have met so many new friends and they are often the only people who understand things such as that embarrassing situation when the air escapes from your prosthetic leg socket and makes a farting noise!

It must be encouraging for your patients who are having an amputation to see how you have dealt with it.

I was never sporty. I was never renowned for being nimble, or physical in any way. I am unremarkable. I am probably the most surprised out everyone as to how things have gone. Sat in a hospital bed a year ago I never thought I would have returned to this level of function. I am therefore incredibly happy to encourage my patients that they can do similar, but of course it can be a bit of a double-edged sword. Not everyone is going to get on as well with prosthetics as I have. My patients are mostly more elderly and often have cardiorespiratory disease – so its important to temper their expectations. I also make sure to explain that it is difficult to walk, it is very tiring and that watching me walk up and down the flat ward is completely different from watching me trying to walk upstairs or on cobbles or sand!

I certainly now speak to patients who are about to have an amputation in a different way. I have a better idea of what is going through their heads and what may be worrying or concerning them. I can tell them about the difficulties I faced and that it will be OK.

There is also nothing quite like popping a leg off for them so they can see how everything works!

What have you been doing during the COVID-19 pandemic? What's the situation like now?

My timing was not brilliant! I returned to full duties around the time that COVID-19 hit. The whole hospital was turned upside down and it felt important to me to "muck in" and be part of a team with my colleagues. I really did not want to be sat on the benches during all of this. As it transpired, the crisis meant that elective surgery was severely curtailed and many interactions with patients were over the telephone. This worked well for me as it turned my job into a series of short bursts of activity – which initially was easier for me to manage than long, lower level activity. It also meant that my colleagues were more easily available had I struggled and needed help.

Things are now slowly returning to normal. It's very strange. I look back on the last year and can barely believe what has happened – things are almost boringly back to normal!

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