By Will Dabbs, MD
I’m not a drinker myself. Most of my friends are, and I am happy for them. In moderation, alcohol can be a great social adjunct. When abused, it accounts for 178,000 dead Americans per annum.
My perspective on such stuff changed once I started working in the ER of an inner city Level 1 trauma center. Curiously, that’s when I swore off of motorcycles as well. Prior to that time, the carnage had been abstract. Afterwards, it was real.
Decisions
Our hero had been out clubbing when he decided to head home on foot. His sole piece of sound judgment was that he knew he was too drunk to drive. His hacienda was just a mile or so distant. The route took him across a series of railroad tracks.
In his profoundly intoxicated state, that distance suddenly seemed nigh insurmountable. About halfway there, he figured he’d just stretch out and take a brief nap. Once refreshed, he’d complete his trek. As foul luck would have it, this dude passed out with his feet draped across one rail of the train track. He was unconscious in this unfortunate configuration when the next southbound freight came roaring past.
The locomotive engineer spotted the poor guy and leaned on the horn, but it was too late. The railroad man called 911, and the cops scooped him up. He and I met soon thereafter.
Details
The technical bit was easy. The patient had suffered a bilateral below-the-knee guillotine amputation of both legs. The ambulance crew had secured the stumps with tourniquets, so the bleeding was fairly underwhelming. This guy was so drunk he still didn’t know what planet he was on.
I paged the ortho team and introduced them to their new play date. Before you ask, while the stumps were clean, a fair amount of that was simply pulverized. It was, after all, a freight train. There was no putting that back together in the OR.
As I retreated to the charting area to document the details, I noticed a bit of commotion in Trauma 1. Curiosity not being the sole purview of the feline, I felt compelled to investigate. Once there, I noticed half a dozen highly-trained ER staff members hovering over a big red biohazard bag.
The ambulance crew had brought the red plastic bag with them. With the patient now passed off, the ER staff had time to investigate. Inside, they found a nice pair of exceptionally heavy cowboy boots. You can see where this is going.
Discoveries
There is a weird rank structure in a place like this not unlike what one might find in the military. As the sole physician present, it fell to me to serve as primary investigator. With everyone else gathered around so as not to miss anything juicy, I retrieved my trauma shears.
Yes, I destroyed the boots getting at this poor guy’s feet. However, it’s not like he had any further use for them. In short order, I had these two disembodied feet standing tall on the exam table.
For starters, human feet are shockingly heavy. I don’t know what I had expected, but it wasn’t that. The human head is really heavy as well, but that’s a story for another day. What was extra special fascinating about these particular feet was the specific way they were separated from their previous owner.
When Life Gives You Lemons …
The bone, skin, and connective tissues were severed as though cut with a giant cleaver. The wounds were surprisingly tidy. However, the sundry tendons remained as wispy appendages atop the cleanly-severed stumps. That’s when I had the idea.
I scared up a few hemostats and got down to cases. By now, it seemed like half the hospital had shown up to watch. That might seem weird, only it’s not. Had you been there, you’d have been mesmerized as well. There resulted quite the festive atmosphere.
Tugging on specific tendons made those feet do some of the most fascinating things. I could make each individual toe flex and extend. Rolling the digits sequentially seemed a natural trick. I even got one foot to shoot the bird, something that I appear incapable of doing with my own feet no matter how hard I’ve tried.
Eventually, life intervened and some other bloody crisis demanded the space. I helped the charge nurse pack everything back into the big red biohazard bag, and he shipped the whole shebang off to the incinerator. It seems that all one needs to turn a good party into a great party is a handful of hemostats and a pair of freshly-liberated feet.
