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I bent over Tom and used scissors to remove as much of his trousers as possible. I asked the two men to clean the wound with disinfectant. As they started to wipe away the blood and dirt I looked at the state of the leg. Blood vessels and tissue had been ripped and shredded beyond repair, and what I saw confirmed my belief that there was no other option than amputation. All injured tissue had to be removed while simultaneously sparing as much healthy tissue as possible. Should we amputate beneath or above the knee? I couldn’t recall ever having seen amputees with a part of the lower limb missing. There are two bones in the lower limb, but only one in the upper, and I thought the procedure might be easier and more likely to succeed if done above the knee.
I didn’t mention any of this to the two men. I was playing this game with the skimpiest of knowledge and in the belief that if I didn’t act, this man would die. I pulled up Tom’s eyelid and checked his heartbeat. As far as I could tell, he was sleeping happily. Without too much difficulty, I found the vein in the crook of his elbow and hooked him up to an infusion. Rummaging through the drawers, I collected bottles of medication. I passed them to one of the men outside the door and asked him to find a medical book and check what the substances did. He hurried off.
I had found a rotary reciprocating saw, designed to cut through bones. I had used them in anatomy class—but never on a living human. We were getting closer to the decisive moment. The three of us removed our soiled gloves and cleaned our hands again.
Sooner than expected, the man returned with a book, which he handed to me. He pointed at a text about chloroprocaine, a local anesthetic that apparently also constricted blood vessels and reduced blood loss. He also handed me back two of the bottles that I had given him. My hands were trembling slightly as I pulled the liquid into a hypodermic needle. I ordered the Big Man to pull a tourniquet tightly around the patient’s thigh. I asked the other man to start tracking Tom’s pulse. Deftly, I injected the anesthetic in several spots above Tom’s knee, taking care that the area was disinfected beforehand. I threw the needle in the bin and grabbed a scalpel.
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