BMJ  2004;328:1375 (5 June), doi:10.1136/bmj.328.7452.1375

Filler

Am I my father's keeper?

My 84 year old dad was in a nursing home and had pretty lousy short term memory. He also had a chronic and painful diabetic ulcer on the great toe of his right foot, and intermittent spasm of the calf muscles caused him to wince in time with an incessant and involuntary knees-up.

The vascular surgeon recommended a below knee amputation. After explaining this to my dad as softly as possible, I discussed with the registrar the level of the amputation (suggesting as high a level as was thought advisable to avoid a poor outcome from a more conservative amputation). I returned to my dad and spent some time explaining again that it was all for the best. Surely he would be better in a wheelchair without this intractably painful foot, and no longer having the risk of falling all the time.

However, when I returned the next day I was told that dad had undergone a lumbar sympathectomy because he had refused an amputation. His words were unambiguous: "It's stopping there—I'm not having it." (Or, I guess, more accurately, "You're not having it.")

"You bloody fool," I unsympathetically muttered sotto voce, "You just don't understand." I was exasperated.

But within weeks his ulcer had healed, and he was pain-free up to his death two years later from an unrelated illness. So, in retrospect, I am contrite about my superficial attention to his feelings. It might have been that the sympathectomy was more than palliative, but I have a sneaking suspicion that he did know best—that somewhere between his fossilised long term memory and the sieve of his irritatingly short term retention there was a deep pool of sagacity.

I smile anew at his reply to the nurse who admitted him to the ward, reiterating his name back to him condescendingly as, "Ah, Frederick the Great," and going on to ask, "And do you know where you are, Fred?"

To which he made the exquisite riposte, "Well I'm not in Russia."

University of Wales, Swansea

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