It has been just over two years since Julie Marsh, partner in the medical negligence team, settled a claim for Jan McFadden. In 2012, Jan went into hospital to have a colostomy reversal procedure. After the operation, she awoke in excruciating pain. Her condition deteriorated and she developed sepsis. She was not treated with the appropriate antibiotics, and there was a delay in taking her into surgery. Then she developed necrotising fasciitis, but this was not recognised initially, resulting in a delay in treatment. Jan underwent a number of debridement procedures, but became increasingly unwell and suffered with septic shock. She developed multi-organ failure and extensive vascular compromise, which caused gangrene in her hands and feet. Jan went onto have treatment at the Royal Free Hospital in London. She needed a skin graft to her thigh, and her left hand and half her fingers on the right hand had to be amputated. She also lost toes on her left foot and half of her right foot. Later, as a result of ongoing pain and her poor mobility, Jan opted for a right below knee amputation. Since the conclusion of the claim, Jan and her husband, Martin, have retired to a more suitable, single storey property down on the south coast. Jan has access to a bigger bathroom and a walk-in shower. Jan has a right lower limb prosthetic, can walk with the aid of a stick over short distances and uses a mobility scooter over longer distances. Jan has a car which has been adapted so that she can drive despite her injuries, and the car has a hoist at the back to lift the mobility scooter in, so that Jan can be truly independent. Julie spoke to Jan in 2019 to see how she was enjoying life in her new home and coping with her ongoing limitations. At the time, Jan was investigating being able to use an upper limb prosthesis and the provision of silicone fingers for her left hand. A year on, Julie caught up with Jan again to see how she was getting on. Julie: It is great to speak to you again, Jan, and to hear that you are both keeping safe and well. Last time we spoke, you were looking into getting prosthetic silicone fingers. How did you get on with that? Jan: It’s great to hear from you, Julie. We are both very well, thank you. Yes, I did look into having silicone fingers but decided against them in the end. They would not have given me the flexibility or dexterity I ideally wanted, and would really have only been cosmetic. I have been living as I am now for so many years, coping as I do, so I was not worried about having them purely for cosmetic reasons. Julie: In the past, you struggled with the NHS upper limb prosthesis that you were given, and you found it clunky and poor fitting. I know when we last spoke, you had tried a microprocessor upper limb prosthesis with some success. Have you made any progress with that? Jan: Yes, that’s right. When we moved down south, I saw an NHS doctor who felt that I would be a good candidate for a new upper limb prosthesis. I was a bit reluctant at first because the first NHS arm I was given was very poorly fitting, and just fell right off. I think I only ever wore it once, on the way back from the prosthetic clinic. I went through the process, and I was given a new arm prosthetic. Unfortunately, it did not turn at the wrist, which meant the hand was always stuck in one position. The only movement I could achieve with the hand was a pincer grip with the thumb and forefinger. Although it looked ok, it was clear to me that the hand was a man’s hand in terms of size. I am quite petite and it was not a good fit. I tried, but I just could not get on with it. I decided to see the prosthetic team at Dorset Orthopaedic and made an appointment there at the beginning of this year. As a result of their input, I ordered a microprocessor limb, which is a much better fit. Although the arm is obviously robotic and does not look like it is part of me, it works. The hand is a better size, and I can manually change the position of the wrist. I am able to do individual finger movements, and all the fingers can bend at the knuckles. There are eight programmes or settings that I am learning to use. I can do a pinch and a fist at the moment. I have to learn to train my muscles to do the right movements. I can manually move the thumb into two different positions, but I find that hard as I have to do it with my other hand, and I am missing fingers on that hand. I have a button on top of the hand that I can push manually to give me more options and movement. After so long, it’s hard to get used to having the hand and carrying something in it. Because I do not get any sensory feedback and can’t feel that I am holding something, it is easy to relax and forget to keep the muscles engaged. When that happens, the hand opens, and I drop whatever I am holding. I am still getting used to the prosthesis. It can be a bit cumbersome, but I try to wear it most of the day. I have been told it could take me two years to fully master it, but I am determined to do so. Julie: And how has the new prosthesis changed things for you? Jan: I can do a few more things now than I used to be able to. I can iron using it, and the pinch function is good for that. I am sure that I will be able to do more as I get more used to it. Julie: How is everything else going? Are you still feeling the benefit of your new property? Jan: Oh yes. We love it down here, and we are so pleased we made the decision to move. The only thing that I still struggle with, is that Martin is still more my carer than my husband. I have thought a lot about getting carers in, but we are independent. I want to be able to do things on my timetable, and not be reliant on someone else coming into our home to get me up before I can go out. I have worked out various ways to do things by myself and can get dressed more or less on my own. Martin still has to help me in the shower, and he is still very protective of me. Julie: Thank you for catching up, Jan. It’s been great to find out how you are, and exciting to hear about the new prosthesis. We wish you the very best of luck with the new kit, and look forward to speaking again soon.
