Betty’s toes

When you work in a particular area for some time, you soon get used to the ‘regulars’. These are patients with chronic illness or disease, drug users, alcoholics, asthmatics, diabetics, and housebound people requiring different kinds of help and assistance. Betty was in this category. She was in her 70’s, and she had Diabetes, as well as circulation problems and arterial disease,  caused by decades of heavy smoking. She may have been a widower, or divorced, as she lived alone, in a small terraced house, not too far from our base.

It was common to receive calls to attend her address, either emergency calls made by Betty, or as an arranged admission by her G.P. She was a cheery character, and seemed to manage well, despite constant pain in her legs and feet. When this got too bad, or life got on top of her, she would either dial 999, or contact her G.P., in the hope of getting some additional pain relief. As she did not manage her medical conditions well, there was little more that could be done, though we did not mind going to her, as she was always friendly, and pleased to see us.

On one particularly cold and bleak evening, we had such a call, made by Betty, complaining of pain in the legs, and asking for assistance. She met us outside her house, smoking a cigarette, and she apologised for calling us, assuring us that it was just that she had no sensation in her feet, and that they were cold. We went into her tiny living room at the front of the house, and asked her to sit down, so we could examine her.

The room was stifling, with a gas fire going full blast, all windows closed tight, and the overwhelming odour of disease, and old age. She had moved a foot-stool dangerously close to the fire, where she told us she had been trying to warm up her feet, as well as putting on some long thick socks, which were as tight as balloons, due to the obvious swelling. The skin on her legs above the socks was discoloured, with a sinister purple hue, that did not bode well. The overriding smell in the room, even defeating the well-stuffed ashtray, was one of morbidity of the flesh, like meat that has long since gone off. The undersides of the socks were damp and squelchy, soaked by leaking fluid, pressed through by Betty’s insistence on walking out to greet us.

She lit another cigarette, and asked us what we thought. I exchanged a glance with my partner, no more needing to be said. I told Betty that we would have to take her to hospital immediately, and that we should not delay to await her G.P., who she had also called out. She agreed to follow our advice, and went to get up to go to the ambulance. I had to sit her down again, as my colleague had gone out to the vehicle to get our small carrying chair; and we could certainly not allow her to walk any further than she already had. We took her to our ambulance, and transferred her over to the trolley bed. She was chatting away, lamenting the fact that she was not allowed to have a cigarette during the short journey to the local Casualty Department.

On arrival at hospital, I advised a male nurse that in my opinion, Betty should be seen as a matter of urgency. He knew her well, and was used to her constant appearances in the department, so was unimpressed by my apparent overreaction to her condition. I went off to book her in at reception, exchanging a look with my partner that said, ‘he’ll be sorry’. When the nurse appeared again, I asked him if he had looked at Betty yet. He gave me an exasperated look, and marched off grumpily, mumbling under his breath.

Shortly after, we heard him shout something unintelligible from behind the cubicle curtains, though it did include many expletives. He then rushed into reception to telephone a Doctor, telling him to attend immediately. It transpired that he had unceremoniously removed her right sock, probably presuming that she was wasting everyone’s time again. As he did so, most of the flesh of her foot came away with it, exposing some of the bones in her feet and toes. The gangrenous tissue had simply rotted away, becoming fused into the sock. It was amazing that she had managed to stand, let alone walk. Poor Betty was oblivious to all this. Lying flat on the bed in the cubicle, unable to feel any pain, she was bemused as to why everybody had started rushing about.

Our part of the job was now complete. We had to clear up the ambulance, and get ready for the next job. My colleague, who as the driver that night, was responsible for tidying and cleaning, took the trolley bed back to the entrance, and removed the carrying chair from its place, ready to clean off Betty’s fluids from it. He came and got me, telling me that there was something I needed to see. On the metal footplate of the chair, exactly where we had placed Betty’s feet during transport to the ambulance, was a row of neat and shiny toe buds. They had obviously protruded through the socks, and become attached to the cold metal, like the bizarre footprint of a fleshy spectre, the sight gave us both a shudder. Cleaning those off was not a pleasant task.

We never saw Betty again. Both her feet had to be amputated shortly after arrival at hospital, and due to ongoing circulation problems after that surgery, parts of her legs were also cut off. She remained in hospital until her death, not long after. I will never forget her, neither will my crew mate on that night. She was a nice lady, a salt-of-the-earth type, who blamed nobody for her problems, and got on with things as best as she could.

They don’t make them like that anymore.