My name is Michael Wackers. I am a 55-year old German librarian living in Southwestern Germany, close to the major US airbase at Ramstein. In 1989 I was diagnosed with a liposarcoma in my inner right thigh. I have written an account of my illness.
LUCKY ESCAPE MINUS RIGHT LEG: a survivors story
The events of the summer of 89 that would forever change my life, and my appearance, are indelibly etched in my memory. I remember them as vividly as if it had all happened yesterday.
D-Day [= day of discovery]:
Friday, 28th July, 1989, 1600 hrs
I had just come home from work and was looking forward to a wonderful summer weekend. As I changed my clothes I happened to be standing right in front of the life-sized mirror, when I noticed a large swelling/lump in my inner right thigh. Strangely enough, the fi rst thought that crossed my mind was: I only hope I’m gonna keep my leg. [As a matter of fact, twenty days later it would be gone]. I had already witnessed an aunt and uncle die of cancer, so by that time I had already lost my medical innocence. I suppose that is why the idea that this growth might be benign never occurred to me.
D-Day + 3:
Monday, 31st July, 1989:
Went into Landstuhl General Hospital. Standard scans and examinations such as X-ray, angiography, and sonography soon confirmed the suspicion that it might be a sarcoma. I was aware of what the standard German clinical dictionary stated about all types of sarcoma:
1) High rate of local recurrence
2) Tendency to metastasize early.
The thought that at any moment a cancer cell might be detached from the primary tumor and swept via bloodstream to some other part of the body to settle there, as a micrometastasis was constantly on my mind and kind of driving me mad. I soon concluded that there was only one 100% sure method to keep the tumor from spreading: amputation. I told the doctor and he agreed. Finally, the head of the X-ray department personally checked my lungs for signs of any metastases. Fortunately there were none.
D-Day + 7:
Friday, 4th August, 1989:
Was referred to the Surgical Oncology Department of the University Clinic at Heidelberg, the most renowned medical institution in Germany, and was dismissed from Landstuhl General Hospital.
D-Day + 10:
Monday, 7th August, 1989:
My trusted doctor of many years standing had returned from his summer holiday. Took one look at the tumor, took a couple of medical books from the shelf, looked something up, and then tersely advised: Get rid of the leg as soon and as high as possible. He had confi rmed my conclusion.
D-Day + 13:
Thursday, 10th August, 1989:
Admitted to Heidelberg University Clinic. There were three senior doctors in charge of the ward (plus two junior assistants). Several colleagues, including the head of the department, were away on their summer holiday. Remember, it was the height of the holiday season.
Additional scans and examinations followed, such as MRI (I kept that MRI scan as a souvenir!), and finally an excision biopsy. With all the stress, I do not remember the result. It was supposed to be an even rarer type of sarcoma. The postsurgery histology, however, identified the tumor as being a liposarcoma. At the time, I was baffled by the fact that the experts did not seem to be able to make up their minds what type of sarcoma it was. Today I know that these differing results seem to indicate that the tumor was NOT well differentiated. The size, by the way, was ca. 7,5 x 10 cm. We did not discuss details such as the staging or grading of the tumor.
The doctors decided to carry out a so-called compartmentectomy, that is, removing the entire muscle group affected. However, there were a couple of snags: The tumor was too close to the main femoral vein so that a vein graft would be necessary, which in turn would
a) Rule out any radiation therapy!
b) Compel me to start lifelong medication with blood thinners (to prevent blockage), long-term negative side effects such as turning me into an artificial hemophiliac!
c) Blockage of the graft could eventually make amputation unavoidable!
A date for the surgery was set. Oddly enough, up to that point nobody had as much as mentioned the option of amputation. I was nervously pacing the corridors when Dr. F. approached me and said: Well, now youve got all the necessary facts, and you can make an educated decision. Though I was understandably dumbstruck at first, it did not take me long to regain my composure and ask: You mean the choice between compartmentectomy and amputation? He said: Yes, and I immediately answered: OK then, I shall opt for amputation. Dr. F. must have read in my file from Landstuhl that I myself had considered the option of amputation, and to this day I am convinced that he tried to nudge me.
Quite agitated about this sudden turn of events, I called my wife to tell her of my decision. Back in my room enter: The complete team of 5 surgeons. Here I was, a medical layman, defending my decision against the combined wisdom of 5 surgeons of one of Germanys most renowned medical institutions. Actually, they were very nice, and patiently heard out my arguments. I must grant them that they wanted to save my life AND my leg. I was determined to save my life.
They were convinced that amputation would not make any difference, that amputation would not increase my chances of survival, as there was no way of telling if the tumor had already spread to the lungs. I told them my main concern – for the time being at least – was to prevent a local recurrence, and to that end remove the primary tumor as radically and totally as ONLY an amputation could guarantee. They realized my determination and finally relented.
After they left, I went to Dr. Fs room. I turned the argument upside down by asking him: If the remaining risk of a local recurrence werent substantial enough, you would never be prepared to amputate, would you? He nodded. In the meantime, I have done some research, and come up with the following stats: Of 117 sarcoma operations performed at Heidelberg between 2001 – 2004 43 (= 37 %!!!) dealt with local recurrences!!! They did, however, dispatch the resident psychologist to have a fi nal interview with me, obviously to check my motives and determination. I easily convinced him by arguing that from my point of view the option of amputation was LESS risky and therefore MORE cowardly.
The evening before surgery, the plastic surgeon and trauma specialist who was going to carry out the hip-disarticulation introduced himself and – this scene had defi nitely something surreal about it – produced a couple of geometrical instruments with which he drew some ominous lines on my hip. Well, at least I could be sure they would not amputate the wrong leg, in which case even I would have lost my composure!!!
You may think my decision was somewhat rash, and wonder at my willingness to part with my leg. I felt little sympathy or pity for my leg, as it had sheltered and thus conspired with a terrorist and assassin who was out to kill me. I had grown up with my beloved grandfather who as a young man in his twenties had lost a leg in the First World War. His example made my decision much easier than it might otherwise have been. I reckoned that – with a life expectancy of 80 years (hopefully) – 40 years on two legs + 40 years on one leg would not be so bad after all. If the tumor had been much smaller, if I had been twenty years younger at the time, if I had not been living in a stable marriage with my wife, I might not have been prepared to sacrifice my leg.
I distinctly remember the handsome young doctors shaking their heads at my decision, obviously imagining how many beautiful nurses would give a one-legged doctor the slip. I was also painfully aware that the cancer might already have spread to the lungs or some other organ, thus making the sacrifice of my leg futile. However, I was convinced that life minus one limb would be worth living. You can enjoy traveling, watching a beautiful sunset, listening to Handel or Springsteen just as well with one leg as with two.
The fact that as a local government employee I enjoyed the privilege of a high degree of job security, even more so as a recognized invalid, and that the nature of my profession would allow me to continue in my job, was also helpful. Finally, my intimate knowledge of history helped me put the loss of my leg in the right perspective. After all, I would not be the fi rst or the last human being to lose a leg. After the battle of Borodino in 1812, the famous Napoleonic surgeon Dominique Larrey performed 200 amputations within 24 hours. And there was no such thing as anesthetics, opiates or antibiotics!!! I wonder how many of those poor bastards made it.
D-Day + 20:
Thursday, 17th August, 1989:
Too many of you, unfortunately, know how awkward one feels going into the operating theatre with all four limbs, knowing that you will come out missing one of them. However, sometimes an illness turns out to be a blessing in disguise. I had been suffering from bipolar disorder since I was a boy of 15. The condition had been left untreated so far and I had not mentioned it to anyone. When I came to in the intensive care unit, I immediately went into the longest hypomanic phase of my life. Thank God!
This meant that the doctors and nurses were more than baffl ed by unexpectedly facing – instead of a deeply depressed patient – the most upbeat and fi ttest amputee in the history of medicine. I had always been a sun worshipper and the fact that the summer and autumn of 89 were extremely sunny and hot helped a lot to keep my spirits up. Fortunately, these events did not take place in November or December, for if they had, I dont know how I would have coped with this crisis.
Next, I went into a renowned rehab clinic where I was fi tted with a prosthesis. Actually, after I put the prosthesis on for the fi rst time, I was really depressed. I had imagined I would put it on and away I would go. It was not to be all that easy, and it took me several months to get the hang of it. At home I move around in my wheel-chair. Outside the house, in addition to the prosthesis I use crutches.
After my surgery I traveled more than ever – to Brazil, Chile and Argentina among others, and struggled up the banks of the river Nile. For the next fi ve years after that I tried hard to banish the constant threat of metastases from my mind, and succeeded most of the time. However, at regular intervals a letter would arrive from Heidelberg to remind me of the next check-up. Waiting for the results was as nerve-wracking as waiting for a jurys verdict. The psychological stress of it all had to get to me somehow, and ever since my operation, I have been suffering from irritable bowel syndrome. I shall never know if I would have survived without amputation. It was a gamble, and I guess I was just lucky.