Highly Commended Artistic Entry Winner for the MWF Junior Doctor Prize 2022 'Whole Person Care?'
‘More Than A Foot’
A completely edible ischaemic-looking foot made with a lemon Madeira sponge, iced with marzipan and fondant icing, airbrushed colouring and marzipan toenails.
‘Isn’t it just a lot of horrible feet and amputations?’
A slight look of horror crosses most faces when I tell people I want to be a vascular surgeon. As one of the smallest surgical specialties, vascular surgeons help treat atherosclerosis, a precursor to ischaemic heart disease which is the leading cause of death in the UK1. Patients with Peripheral Arterial Disease (PAD), which is caused by atherosclerosis, suffer with issues such as decreased physical functioning, poor mental health2 and a reduced quality of life3.
An ischaemic foot with ulcers may not be particularly appealing to examine but how is it any different from examining a skin condition in dermatology, or even auscultating a chest in a respiratory exam? A foot with these signs is just that – a collection of signs. At the other end of the foot though is a person, a person who is experiencing debilitating symptoms which are having a knock-on effect on the rest of their health – constant pain, not being able to sleep comfortably in bed (or not sleeping at all), reduced mobility and strength. All these factors contribute to the process of frailty, leaving someone at high risk of adverse outcomes, such as disability and hospital admission. For a vascular surgeon, treating someone with PAD, particularly Critical Limb Threatening
Ischaemia, amputation-free survival (an outcome that results in a patient with an intact limb after revascularisation) is a key goal. Whilst amputation might be the final step, it is by no means a symbol of defeat and not what defines vascular surgery as a specialty. Amputation may give a person a newfound freedom, free of the symptoms they have struggled with for years.
From the vascular scientists and occupational therapists to the podiatrists and amputee rehab team, the expert knowledge of the multidisciplinary team is invaluable to improving the quality of life and health in an often-complex group of patients. Working in vascular surgery is an honour and a privilege and has demonstrated to me the true nature of whole person care.
1. Office for National Statistics. Leading cause of death, UK: 2001 to 2018. Registered leading cause of death by age, sex and country. March 2020
2. Brostow DP, Petrik ML, Starosta AJ, Waldo SW. Depression in patients with peripheral arterial disease: A systematic review. Eur J Cardiovasc Nurs. 2017 Mar;16(3):181-193
3. Aber, A., Lumley, E., Phillips, P. et al. Themes that Determine Quality of Life in Patients with Peripheral Arterial Disease: A Systematic Review. Patient 11, 489–502 (2018)