How To Amputate A Leg, by Clifton

From A System of Practical Surgery, Fifth Edition by Sir. W. Fergusson, M.D. (1870)

From inside the darkened hut you can hear flurries of automatic weapons fire, mostly from the South (stereo left). A distant, muted explosion shakes the walls. The light of the suddenly-opened door reveals a crude table in the middle of a dirt floor, a footlocker on one end of the room, a huddle of brightly-coloured blankets in a corner. Through the door, three men enter: two on the sides support the one in the middle, his arms draped over their shoulders, his head hanging limply. They drag him to the table and lay him on it.

“Open the footlocker. Brett, are you still with us? Brett.”

“Uhn. Yeah.”

“Hang in there. We’re going to do something about your leg.”

“Deke. Deke, I’ve got to talk to you.”

“Talk.”

“No, I mean, over here.”

“What do we have in that locker, Hem?”

“Come over here, Deke, will you?” Deke walks over to where Hem is crouched by the footlocker.

“What’s in here? We need to work fast. He looks like he’s lost a lot of blood.”

“Deke.”

“We’ll need lots of bandages, good. Maybe sutures—”

“Deke. You can’t sew that leg up.”

“What.”

“You can’t sew that leg up.”

“We can’t do nothing, Hem.”

“No. Not nothing. We’ve got to take it off.”

“What?”

“Look, the guy’s leg is torn to bits. It’s not going to heal like that. The only way we can keep him from bleeding to death is to amputate it.”

“You’re nuts.”

“Is he still awake? Brett. Brett. Give him some water.”

Deke goes around the table to face Brett, avoiding looking at his right leg. Brett looks up at him blankly. Deke unscrews his canteen and pours water in Brett’s mouth. He tightens the tourniquet on Brett’s thigh. Hem stands up from the footlocker, reading from a green book. The book’s pages look brittle and brown. The book’s cover is falling off. He holds the book out to Deke, open to the page he had been reading.

“Read this out loud, and I’ll follow your instructions.”

“You’re nuts.”

“Brett,” Hem says. “Brett, can you hear me? We’re going to have to take the leg. Brett? Do you understand?” Brett nods, closing his eyes. He lays his head back on the table.

Hem walks back to the footlocker, taking out a bottle of morphine and syringe. He hands these to Deke. He then takes out bandages, a long knife, and a saw.

“Give him some morphine.”

“How much?”

“I don’t know. Some.”

Deke injects Brett’s arm with the morphine. Brett has already gone slack.

Hem lays the instruments next to Brett on the table.

“Start reading.”

“You’re really going to do this?”

“Our truck is down by the roadblock, burning. Even if we had another way out, the rebels would stop us outside of town. And even if we fast-talked the rebels into letting us through, it’d be four hours to the nearest doctor. On foot. No, this leg isn’t going to get him there. He’d die before nightfall. Start reading.”

“‘Much has been said about the necessity of the surgeon’s standing on a certain side of the limb in these operations. Some of the highest authorities have contended for the one side; others, equally good, have asserted that the opposite is better.’ Christ, who wrote this book? Dr. Livingstone?”

“Another legacy of colonialism.”

“Like this war.”

“Just be thankful it’s in English. Read the part about actually doing the thing.”

“‘Amputation at the knee may be done in the following manner: The circulation being arrested as usual—”

“Tourniquet.”

“Yeah. ‘The circulation being arrested as usual, the surgeon, standing on the outer or inner side of the limb as he may feel disposed, should lay the heel of an ordinary amputating knife—’ is that what that is?”

“I think so.”

“‘The heel of an ordinary amputating knife over one condoyle of the femur, draw the blade to the other condoyle across the front of the joint in a lunated course, on a level with the middle of the patella, and divide the tissues down to the bones; the little flap—”

“Ok, wait. Let me do this.”

Hem grasps the handle of the long knife and lays his other hand on Brett’s shin. He’s sweating but his hands are steady.

“All right, so what the hell am I supposed to do with my hands?” Hem shouts over his shoulder.

“Cut!” says Hans, the director. “What?”

“What is this supposed to look like, with my hands?”

“We’re not shooting your hands. We’re going to be seeing your face. Your hard, beautiful face, twisted in disgust and determination.”

“But I have to be doing something with my hands.”

“Just make a cutting motion. I don’t know. We’ll edit it.”

“Fine.”

“Take it from ‘the heel of an ordinary.’”

“‘The heel of an ordinary amputating knife over one condoyle of the femur, draw the blade to the other condoyle across the front of the joint in a lunated course, on a level with the middle of the patella, and divide the tissues down to the bones; the little flap—”

“Ok, wait. Let me do this.” Hem makes a cutting motion with his hands, holding the long knife above Brett’s knee.

“Cut! Look, Brett, you’re not unconscious, you’ve just been sedated. We need you writhing in unimaginable pain and making noises of unintelligible horror. This is pathos.”

“Ok, boss. Writhing and horror, got it.” Brett winks at Hans.

“From ‘Ok, wait.’”

“Ok, wait, let me do this.” Hem makes a cutting motion with his hands. Brett writhes in unimaginable pain, emitting short guttural noises of unintelligible horror. “What’s next?”

“‘The little flap should then be pulled upwards, and the knife should again be applied so as to cut the quadriceps extensor immediately above the patella.”

“Ok.” In Hem’s face, stolid determination forces down evident nausea. His arms continue their cutting motion.

“No, Hem. The quadriceps extensor.”

“Oh. Oh, right.”

“Stop! Not that way!” says the medical consultant, Dr. Frank Levine.

“Cut! What is it?”

“You’re not sawing at this point, you’re just cutting with the knife. Flesh, not bone. You shouldn’t be jerking back and forth like that with your arms.”

“Ok, fine. Cutting, not sawing.”

Brett props himself up on one elbow. “Can I have a Pepsi?”

“No, you can’t have a Pepsi. We’re finishing this fucking take first.”

Brett lies back down.

“From ‘the quadriceps extensor.’ Cutting, not sawing.”

“No, Hem. The quadriceps extensor.”

“Oh. Oh, right.”

Hem moves his arms to the left of where they had been and continues his cutting motion. “Ok, keep reading.”

“‘The point of the blade should then be pushed in at one end of the wound, thrust behind the femur, and made to appear at the other end, when it should be carried downwards in the line indicated on drawing 277—’”

“Let me see.”

Deke holds the book out to Hem, to show him the illustration. A second camera gets a tight shot of this page, on which an engraving depicts a leg being grasped at the shin by a hand with its surgeon’s cuffs turned up to the wrist and dotted lines describing arcs around the knee. The artist took particular care with the draping of the dressings rolled up at the thigh.

“Ok, got it.” Hem continues his cutting motion, moving further down Brett’s leg. On his face is a look of detached revulsion. Deke glances down at what Hem is doing and turns to retch in the corner. Brett amplifies his noises of unintelligible horror. Hem lays down the knife and picks up the saw.

-- Clifton