Emergency Call

The missing leg

It doesn’t matter how much experience you have, you can still miss something. At the time referred to in this job, I had around 15 years experience working in emergency ambulances, and my colleague that night was also no new boy, having been in the job for about 10 years. So, with 25 years service between us, you think that we could get it all right, without schoolboy errors.

That night had been busy. Weekends usually were busier, especially in Central London. We found ourselves at the Accident and Emergency Department of St. Thomas’s Hospital, just south of Westminster Bridge, opposite the Houses of Parliament. This was not one of our usual haunts, but the level of work that night had pushed us across from West London, and we had finally ended up here. As soon as we became available, we received a call . It sounded serious, a motorcycle had hit a pedestrian, and there were three casualties.

The Police had also closed the road, which was Victoria Embankment, an arterial route around London beside the river. Luckily, it was very near, just across the bridge, so we arrived in a couple of minutes. There was a man lying motionless in the road, and a bit further along, a large BMW motorcycle was on its side, with two crash-helmeted figures lying nearby. The Police told us that the motorcyclists were father and son, and the son had been on the pillion; they were injured, but both conscious, so we should concentrate on the pedestrian. We called for more ambulances to attend, and went to examine the man in the road.

What we saw, was a well dressed man, wearing a dinner jacket and bow tie. He was tall, about 6 feet 4 inches, and had a large build. He also only had one leg. Removing part of his trouser leg with scissors, we could see that the leg had been ripped off with some force, probably from contacting a part of the fast moving motorcycle, and was missing from about four inches above the knee. The man was also unconscious, had poor vital signs, and there was an obvious head injury. Our main concern was the loss of blood from the traumatic amputation of the leg. There was a small river of the stuff running from underneath the man, leading down into the kerb; so, no time to mess around.

My colleague set up an infusion, and I applied a large dressing, incorporating a bag of ice, kindly supplied by the nearby Savoy Hotel. We got the victim into the ambulance, connected oxygen, drip bag, and monitor, then put in a radio call, to tell St. Thomas’s that we would be there very soon, with a serious case. I asked a policeman where the detached leg was. He hadn’t seen it, he replied. Frantic requests to his colleagues produced the same answer, nobody on scene had seen the missing leg, or had even thought to look for it. A cursory search was made in the immediate area, but we did not have time for niceties, so would have to go without the leg, losing any chance of it being re-connected later, if found. I asked the other ambulance crews, who had arrived to tend to the motorcyclists, to look out for it, as and when they got the chance, and we left at great speed, making the short journey back to the hospital.

On arrival, we were met by the trauma team, who wasted no time getting the poor man straight into the Resuscitation Room. I sheepishly told the staff that we had not brought the other leg, as we had not managed to find it. They were not too concerned, as he had deteriorated rapidly, and they would have to work fast to save his life. As they began to remove his clothes, one of the nurses had difficulty with the cummerbund, which was wrapped tightly around his waist. I proffered my large shears to help, and she cut through it with ease. As she did so, something fell out of his shirt, crashing heavily onto the floor. It was his other leg.

Amazingly, the impact had not only severed the leg, it had been forced back up the trouser leg, wrapping around his waist, giving the appearance of a pot belly. In all the excitement, and the adrenaline rush of a serious accident, none of us had noticed. You couldn’t make it up if you tried.

I don’t know what happened to the man, but he was not expected to live, and I very much doubt that he did. Fortunately, the matter of the missing leg was immaterial to the outcome.

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.