The patient was rushed to the hospital in an ambulance. It was early in the morning and I had been assigned to the casualty ward. Doctor in charge worked hard trying to stop the bleeding from the brachial artery of the patient. He had been he had thrust a sharp object directly into the artery which was bleeding profusely. The patient stabilized and was admitted in the ward. The condition was not obvious as the patient looked fine. He wasnt sickly and was healthy. The doctors were baffled as most had not witnessed such a condition before. After much interrogation and consultations the psychologist came and explained the condition the patient was suffering from (body integrity identity disorder).
This is a very rare psychological disorder. He tried his best explaining to the patient that he had a condition that could be managed with frequent counseling. The patient was reluctant accept the advice and was willing to pay any price to get his hand amputated. After intensive talks with the patient, the communication seemed effective and the patient looked convinced.
The patient was uncomfortable with his left hand and thought that it was not supposed to be a part of his body. He wanted his hand to be amputated or disabled. He was confident that disabling his left hand would relieve the discomfort. Since it is unethical for a BIID sufferer to be amputated his request was not honored but instead he was given diazepam in an attempt to relieve the feeling. The patient seemed okay and was left to rest in the ward. A psychologist passed by his bed and requested to be covered with a blanket as he was feeling a little bit cold.
After sometime the patient led out a loud cry and we rushed to check what went wrong in the ward. He seemed to be in deep pain and when we uncovered him his left hand had turned bluish. He had tightly tied the catheter tube around his distal arm close to the elbow. This restricted the blood flow to his hand and the hand was hypo perfused. Psychologist went fast trying to untie the knot but he was cut short by the surgeon. The cells started undergoing ischemic necrosis and turned bluish due to accumulation of excess carbaminiohaemoglobin and less oxyhaemoglobin. The cells produced inflammatory factors due to ischemic injury, among the pain mediators. The knot could not be untied since the necrotic cells were producing massive amounts of mediators and electrolytes especially the intracellular mediators. Of interest are potassium ions that leak out of the cell due to cell membrane lysis in necrotic cells. In case the knot was untied the potassium ions would leak into the blood vessels and cause hyperkalemia which is fatal as it can lead to cardiac arrhythmias and subsequent death.
Some doctors were mad at him and could not control their fury at the sight of the necrotizing forearm.
They lashed a few bitter words as they were unable to control their temper. The patient was immediately transferred to the ICU. His hand was amputated from the elbow distally he was given counseling and the wound was managed properly by the nurses. He was discharged after four weeks and he was happy, he felt comfortable free at last and was grateful to the doctors.
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