1. Cavanaugh, Kay MA, RN, EdS

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Hearing his son's screams, Philip's father turned to see what was wrong. The boy was holding the bloody stump of an arm to his chest; an artery was exposed and blood was shooting from the wound. His face and clothes were saturated. Stopping the tractor, he removed his brown leather belt and applied it as a tourniquet to what was left of Philip's arm.

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Twelve-year-old Philip had been helping his father clear dry corn stalks in the field of their 55-acre farm. It was August. Philip rode on the back of the tractor. When a thick piece of cornstalk got caught in the razor-sharp, rotating blades below him, he stretched down to knock it loose. His arm was severed immediately, just above the elbow. The amputated forelimb was tossed back into the blades.


As his father tended to him, Philip screamed: "Daddy, daddy, get my arm back." Bright crimson blood sprayed his father's shirt.


I made a home visit two weeks after Philip's hospital discharge. Surgeons had repaired the damage to what remained of his arm, and he was waiting for a prosthesis. I'd expected a scared and depressed boy, but I found an impish one playing catch with his dad. He wore a catcher's mitt on his left hand, and he caught the ball by using his stump to bring it close to his chest.


After introducing myself to the family, I asked Philip, "Will you let me change your dressing? I want to make sure everything is healing all right."


"Only if you'll play catch with me afterwards," he answered.


"You drive a hard bargain. I'll play catch with you before I leave."


Eight-year-old Rebecca, Philip's sister, looked curiously at my black nurses' bag. "You got a new arm in there for Philip?"


"No, just some bandages. His new arm will be here soon. Would you like to be a junior nurse and help me take the gauze off his arm?" She was excited about assisting, and Philip was willing to have her help.


I gave Rebecca a pair of latex gloves. "You go ahead and start unwinding the gauze on Philip's arm," I instructed. She began to unwrap the stump slowly.


No one winced as it was exposed. The surgical site was healing nicely, with healthy-looking pink skin and no signs of irritation or infection.


After I dressed the stump, Philip and I played catch.


On my third visit, Philip wanted to take me to the scene of his accident. I agreed.


He crawled behind the wheel of the white Ford pickup and demanded, "You coming, or not?"


The boy could barely reach the pedals or see over the steering wheel, but he knew how to drive that truck with one arm. Over the uneven field we traveled. There were no seat belts, and I bounced off my seat every time we hit a bump. This made him laugh.


"How long have you been driving a truck?" I asked.


"Started when I was a kid. Seven years old. Good at it, ain't I?"


We arrived at the spot where the accident happened and climbed out of the truck. "I came out here once before to see if I could find my arm. You reckon the cows or dogs gobbled it up?"


"I'm not sure. I think your arm was probably turned into the soil by the blades."


"I can still help my daddy run the tractor. He lets me steer it sometimes, but I have to sit in his lap."


Philip led me to a spot in the field. Tapping his foot on the ground he said, "Right here is where my arm got chopped off." I searched his face. He didn't seem to be traumatized. He was simply telling me a story.


"That must have been a pretty scary day for you."


"Yeah, guess so. I don't remember it hurting much. Too bad I can't grow a new one, huh?"


"Yes, it's pretty disappointing, isn't it?"


"Ah, it's okay. I'm gonna get one of them bionic ones. You oughta see what that arm can do. It looks real." Looking at me he asked, "Do you think girls will go out with me if I have a pretend arm?"


"Philip," I answered, "you will knock the girls over. They'd be fools not to go out with you."


He smiled. "When I'm old enough, will you come dance with me?"


"You're already old enough," I said. And the dusty, wide-open field became our dance floor.