A nurse asked David to sit down and asked what was wrong with him. He gave her Dr Lee’s admitting order. The attending physician, a bespectacled man in a blue-striped shirt with a stethoscope around his neck, took the order and frowned as he read it. He leaned over the counter to take a look at David’s leg. He noted the bandaging and asked if David had suffered an accident. No, said David, and he quietly repeated the sequence of symptoms. The man got up and walked away. David was subdued.
Patrick, wearing his prosthetic leg, appeared to be feeling fine; he had been through this scenario many times. David, beneath his quiet demeanour, was nervous, as was I, even though I was just an observer. My mind raced through all that could go wrong. What if the attending doctor asked more questions? What were the three of us, two of whom were on crutches, doing in this part of the world? What if they called the police? Then, as David was finished with the paperwork, a nurse brought him a wheelchair. She inserted a catheter into David’s left hand and hooked it up to an IV bag hanging off of a pole on the wheelchair. She left. I looked at Patrick. “I can’t believe it’s really happening,” he whispered in relief. A male nurse came in, and we got up and followed him as he wheeled David up to his hospital room. They had bought the story.
In the hospital room, we sent the surgeon a text message to say that he had checked in. Dr Lee told me later that his own nervousness usually sets in the moment he receives that message. Now all was in motion.
As we waited in the hospital room, Patrick started giving David advice about life as a leg amputee. Don’t ever close your eyes when you’re standing without support, he said. You’ll lose balance and topple over. Always carry powerful painkillers: stumbling and landing on your stump can be excruciating.
A nurse came in and informed David that the doctor would operate in a few hours, then left us alone again. We counted the saline drops dripping into David’s veins: about 12 drops per minute. I asked David about his cover story for when he got back home. He said he would tell people at home the story he had told the hospital. Dr Lee would provide him a full medical report to take back.
Patrick recalled his own cover story: he'd picked up a rapidly spreading infection called St. Anthony’s Fire on vacation; the rampant infection turned the leg gangrenous, leading to the amputation. It had worked well for him. Then Patrick told David to do something that would soon be impossible, once the operation was complete: cross his legs. It was as if we were mourning an impending loss with a collective minute of silence. Soon, two male nurses wheeled in a gurney. David lay down on it and he was taken away to surgery. Patrick gave him a thumbs-up. I didn’t know what to say, so I just muttered “good luck” under my breath.
The hospital was quiet, and empty benches lined the dimly lit corridors. Only the operating room, off limits to outsiders like me, showed signs of activity. Dr Lee would later describe events to me.
Inside, David lay on the table, anaesthetised and oblivious to pain. An overhead surgical lamp illuminated his upper thigh. Dr Lee picked up a scalpel and made a long, deep incision precisely where David had requested, in a leg that was athletic, muscular, healthy. The surgeon cut through muscle, working hard. He cauterised the smaller blood vessels as he went while keeping clear of the large veins, arteries, and nerves. He pulled at the nerves, teasing them free of the surrounding muscles, cut, then let go. The nerves retracted into the soft tissue of the upper thigh like rubber bands. He clamped the large blood vessels, snipping them, and tied up the proximal and distal ends, the proximal end three times for peace of mind.
The surgery was taking longer than anticipated, because the leg was so robust, engorged with blood. Finally, he slipped a wire saw under the femur. An assistant pressed down on the leg. Dr Lee began sawing and soon pulled the saw through the strongest bone in the body. He then attended to the blood vessels, nerves, muscle and skin on the underside of the bone, until the leg was finally detached. It was time to suture. First, he sewed up the muscles, then the fascia, the strong fibrous tissue surrounding the muscles. Suturing the fascia correctly was critical, because mistakes could lead to muscle herniation. Finally, the surgeon stitched up the skin and the subcutaneous tissue. Where once there was a leg only a stump remained.
While the operation was taking place I walked the empty corridors outside, trying to peer discreetly over the frosted glass panes of the doors leading into the theatre. I have thought about the surgery many times since. Each time I have felt fear, and sadness. Here was a perfectly healthy man with a perfectly healthy leg. Yet he went under the knife voluntarily, in a foreign country. He trusted a surgical team that worked under a cloak of deception. How much must a man suffer to come to this: lying by himself on an operating table, attended only by strangers, in a small, obscure hospital thousands of miles from his home in America?
§
Patrick was asleep when I heard the knock on the door. It was more than three hours since David had been wheeled away. It was a male nurse in surgical robes and rubber gloves. He turned to Patrick and said, “The leg has to be buried as soon as possible.” He needed money to take care of the burial. Patrick handed it to him. “Do you want to see the leg?” the nurse asked. “It’s already in the box.” Patrick didn’t. The nurse left. “Well, he’s an amp now. I’m glad,” said Patrick. “It’s what he wanted. It’s what he needed.”
Dr Lee appeared. The surgery went well, he said, though it had taken longer than usual. David was fine and lay asleep in recovery. Dr Lee offered to give me a ride back to my hotel, and I accepted. During the ride he talked about David’s long surgery. “His muscles were well-built,” said Dr Lee. “They contract and they also bleed more. You have to be careful.” Still, there was the satisfaction of a job well done. “What’s fascinating is that you can really see the transformation,” he said. He meant the change in the demeanour of his BIID patients after surgery. “You’ll notice it tomorrow.”
The next day, I couldn’t wait to get back to the hospital. I purchased a bitter-sweet chocolate bar for David and hailed a taxi. When we arrived, I walked in through the front door, past the ER, and halted for a moment at the frosted glass doors of the operating room. Then I walked to David’s room and knocked on the door. Most patients would be flat out recovering after such a major surgery, but David was sitting up on his bed, his stump heavily bandaged and covered in white gauze. He was still on an IV. Tramadol, a narcotic-like analgesic, was dripping into his veins. He was tethered to a urine bag. He looked tired, but then it was only 12 hours since the operation. I shook his hand and gave him the chocolate. David opened the wrapper, broke off a piece and began to eat. He sat on the hospital bed as if nothing dramatic had happened last night. Our conversation eventually wore him out. He fell asleep.
When I returned the next day, the IV and the urine bag were gone. A pair of crutches lay next to his bed; he had already crutched to the bathroom and back, just as the surgeon had said he would. He smiled and laughed easily as we spoke. The tension that had lined his face was gone. I sensed relief, happiness. David’s leg had plagued him for much of his life. He was free of it, and now he seemed whole.
//.
CREDITS
Anil Ananthaswamy is a science writer focused on physics, neuroscience and climate change. He is a correspondent for New Scientist and the author of The Edge of Physics (Houghton Mifflin Harcourt, 2010)
Roger D. Hodge is the editor of The Oxford American, a former editor of Harper’s magazine and the author of The Mendacity of Hope (Harper, 2010)
Photography by Brian Lee
Fact-checking by Sophia Li
Copy editing by Christian Lorentzen
Publishers
Bobbie Johnson and Jim Giles
Do No Harm is the first issue of MATTER
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