The man, in a drunken stupor, staggered into the local railroad marshaling yard. He stretched out across the tracks and fell into a slumber most luxurious. The next handy freight rolled by and cleanly amputated both legs about mid-shin. At least it wasn’t his head.
There wasn’t actually a great deal for us to do. We got IV lines running and put tourniquets around the stumps. Once the poor guy was stable we called the surgeons. They took him to the OR and made what remained of his legs look pretty. I then departed to go write in the chart.
A short while later I walked past the big trauma room and heard a commotion. Inside I found perhaps a dozen highly-trained ER staff all huddled around something interesting. I pushed my way to a proper vantage and caught sight of a pair of high-mileage cowboy boots. It seems the cops had brought the guy in along with a big red biohazard bag with a knot tied in the top. When the charge nurse opened the bag he discovered the boots. I’ll give you one guess what was still inside the boots.
Beat Feet
It was Friday evening in the urban ER where I worked, and the freaks were out in force. These were the days before Electronic Medical Records, so one whole wall was comprised of a giant whiteboard. On it was written the chief complaint of each of the evening’s guests.
The first night I reported to the ER as a student, one piece of that big whiteboard stumped me. Many to most of the customers of such a place are fairly grouchy. However, the lack of tact the staff used to describe them on the board surprised me. I eventually came to appreciate the fact that in that context “SOB” actually meant “Shortness of Breath” and not the other thing. Everybody starts someplace.
Our hero this evening was posted next to “BLE Trauma.” “BLE” is medical shorthand for “Bilateral Lower Extremity.” This gent had a problem with his legs.
The cops filled us in. The guy had been wandering around downtown three sheets to the wind, drunk as Napoleon’s horse. He soon began searching for a handy place to sleep it off. When one is that intoxicated one can sleep most anyplace. However, he chose particularly poorly.
A railroad marshaling yard is a crummy place to take a nap. Thomas Thompson photo.
I was the only physician present, so it fell to me to lead the expedition. I produced some trauma shears and soon had the feet freed. Fret not over the boots. Their previous owner obviously no longer had need of them. Given their ghastly state nobody of reasonable intellect would have touched them again anyway.
In case you were wondering, no, reattaching those rascals was not a viable option. He had been out on the tracks for some while before he was found. It was a tribute to God’s design that he didn’t exsanguinate in the interim.
Human feet are shockingly heavy when separated from their owners. I hefted the things, one in each hand, and simply marveled at their prodigious mass. They were also unnaturally cold, but I suppose that goes without saying.
The train wheels had removed both feet mid-shin as cleanly as a guillotine might. The bones were nicely cleaved, and the remains of the flexor and extensor tendons were just wispy threads above the wound. As I studied this poor man’s disarticulated extremities I had an epiphany.
Most of the muscles that make your hands move reside in your forearms. Likewise, most of the muscles that move your feet and toes live in your lower leg. These muscles attach to the bones in question via tendons. I fetched a hemostat and began an impromptu anatomy lesson for the accumulated crew.
Tugging one set of tendons made the toes curl. Tugging the other set in aggregate caused the toes to draw upwards. By isolating certain tendons I could get that guy’s feet to do things they never could have done in life. The most entertaining of the lot was to shoot the bird.
We grew weary of the entertainment in short order, and the charge nurse dispatched the liberated feet to the incinerator. However, I can attest that all it takes to turn a good party into a great party is a pair of severed feet, a dozen close friends, and a pair of hemostats. It also helps if the event is held in a certifiable asylum like ours.
