Issue Date: October 04, 2004
Tough call for amputee
War-wounded staff NCO pushed docs to cut off his leg — and has no regrets
By Laura Bailey
Times staff writer
When Staff Sgt. Mark Graunke was rushed to the hospital in critical condition after an explosion in Iraq ripped apart his body, Navy doctors said they could save his severely mangled leg.
It would be a long, hard road with numerous reconstructive surgeries, a great deal of pain and no hope of returning the leg to perfection. But Graunke, a tough-minded explosive ordnance disposal technician and former embassy guard from Texas, was onboard with the plan.
Almost two months later, however, the beefy staff noncommissioned officer was still bedridden, his body wasting away from inactivity. A golf ball-sized hole in his leg was not going away and he had so much pain that the slightest touch of his hospital bedsheet would set off shock waves of agony.
So when surgeons at National Naval Medical Center in Bethesda, Md., suggested a second try at using muscles from other parts of his body to patch the open leg, Graunke decided he’d had enough.
That’s when he began the unusual battle to convince doctors that amputating was the right thing to do.
“I just saw it as something that was keeping me from getting better,” he said. “It was basically a piece of meat hanging off my body.”
But Graunke said his doctors did not like his idea.
“At first they didn’t help me at all,” Graunke said. “They were dead set on salvaging it.”
The leg injury was just one of many the Camp Pendleton, Calif., Marine sustained when a bomblet exploded in his hands in Iraq in early July 2003. The 26-year-old lost his left eye, his left hand and the thumb and index finger of his right hand. Both of his legs were ripped open and missing large amounts of skin, muscle and soft tissue. But the right leg was a particularly terrible mess. Tissue was missing from his knee to the bottom of his shin and his leg bone was blown open.
After months in recovery, Graunke was so sensitive to pain that he wanted no one to lay a finger on him except for his wife, Len, who temporarily left her job at a hospital in California to help take care of him at Bethesda.
The pain was excruciating and getting worse, and because amputation is often less painful than a salvage operation, doctors said they were concerned that Graunke’s request for an amputation was based on his level of pain.
“You’ve got this guy who is missing both of his hands and he looks at you and he says, ‘I want you now to cut my leg off.’ … It was difficult,” said Lt. Cmdr. (Dr.) David Dromsky, one of the Bethesda surgeons who worked on Graunke. “We did everything we could to make him understand what he was asking for. We wanted to make sure this was not despair talking.”
Differing opinions
A patient electing to amputate a limb, while rare, is not totally unheard of. In cases where there’s no guarantee of success, or significant walking problems or where there’s a great deal of pain in the cards, patients will opt to amputate.
“A lot of young guys just want to get on with their life. Amputation provides that for them,” said Army Maj. (Dr.) Michael Frisch, an orthopedic surgeon at Walter Reed Army Medical Center in Washington. “Once the amputation is healed, they really get moving on.”
In most cases, especially with young and motivated people, patients can function almost normally with a prosthetic leg, said Dr. Lawrence T. Donovan, a former Army surgeon who now has a private orthopedic practice in Spirit Lake, Iowa.
But Donovan said doctors can be reluctant to perform amputations if they feel a patient is looking for a quick fix for the pain.
Graunke said he firmly believes his decision was based on having a more active life.
In order to keep the leg, Graunke, who had already undergone multiple operations, would to need continue his trips to the operating room and keep wearing a set of external pins and rods to keep his bones in place. Even once the repairs were made, he would need a brace to walk and would have little range of motion in his knee, causing him to drag his leg.
But, most importantly, doctors would have to steal muscles from his stomach, back or thigh to cover the hole in his leg. They had already tried the procedure once.
After losing so much already, Graunke said, he simply didn’t want to continue raiding healthy areas of his body for the benefit of a losing cause.
Graunke convinced his wife and mother that an amputation was the best choice, but winning over the doctors proved more difficult. Every time he brought the idea up they would go straight to the benefits of salvaging, he said.
After a back-and-forth with hospital officials, Graunke interviewed several Vietnam war amputees, as well as veterans whose legs were saved after being severely wounded. The interviews made him more resolute.
“Everyone I talked to who had their limbs salvaged just didn’t seem to be enjoying their life,” he said.
So Graunke got a second opinion.
After meeting with the Marine, doctors from Walter Reed agreed to the surgery. Graunke was transferred to the hospital in mid-September and the leg was removed on Sept. 18, 2003.
The Army surgeons who performed the operation could not be reached, but Dromsky said it was simply a matter of differing professional opinions. He stressed that there is no textbook answer to the question about amputation because every situation and individual is different.
No regrets
The amputation turned out to be a bright light at the end of Graunke’s recovery tunnel. After months of pain and isolation in his hospital bed, Graunke was finally able to sit in a chair within a week of the operation. Within two weeks, he was in a wheelchair, and within a month, he was discharged from Walter Reed.
The operation, was like a huge weight being lifted off his chest, said Graunke’s mother, Maggie Brown.
“He wasn’t who he is when he had his leg. He was mean and crabby … but then after that, he was back to being who he was,” Brown said.
More than a year later, Graunke is a different man. With regular trips to the gym, he’s gained back most of the 85 pounds he lost in the hospital. Now living in Texas, he’s mastered his prosthetic hand and leg, and he is getting back to a life of normalcy, including occasional hikes, joy rides on his new three-wheeled Harley-Davidson and planning for college this spring.
“He’s enjoying life again,” Brown said.
Graunke also returned to Washington in July on the anniversary of the explosion to visit two hospitals that nursed him back to health. During the trip, he spent hours talking with wounded service members, many of them with fresh amputations, hoping to give them encouragement.
Graunke says he doesn’t regret the decision to amputate for a moment. “I’ve never had any feeling of loss. I refer to it as ‘that thing I had removed,’” he said. “It was a good decision. I had no doubt in my mind.”
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