Harry Parker - Anatomy of a Soldier

I was now at the end of the table next to the body.

‘Someone go and tell the family.’ He lifted the leg and inspected it, moving the puffy flesh.

‘How high?’ he asked. No one answered. He was over the body, still assessing it and the others looked at him and over his shoulder, waiting for his decision. He glanced at the body’s head and paused.

‘Al, we’re a bit low on blood. Pressure has just decreased dramatically.’

The woman was watching a machine.

‘How can we be low, Sarah?’ He looked up at her. ‘Well, go get some more. And can someone please clean this off the floor? I’m slipping.’

He then spoke very little and the team around him started to move to each command he gave. A man cleaned the floor, smearing sweeps of blood by his feet, but he ignored them as more blood dripped down onto the tiles.

‘Right, I’m going to do it around here.’ His finger traced a line of blood over the intact skin of the thigh. ‘There’s no muscle in this region to do a myodesis, so I’ll use what’s left of the vastus lateralis and femoris to wrap over the distal limb,’ he said as the flesh wobbled in his hands. ‘We can use this skin to cover it and avoid too much exposed tissue. We then graft up the inner thigh. That should provide good function.’

‘Al, his levels are stable, but I advise we get a move on.’

‘Right, let’s do it. Scalpel.’

He slashed decisively across the skin, smoothly splitting the flesh apart. The cuts of the scalpel swept down through the subcutaneous tissue and fascia, deep into the flesh and through muscle and membrane that covered the bone. He slid the blade around and through dead and dying flesh; blood paused after each cut before seeping out the ends of the vessels. He asked for the tourniquet to be tightened.

He went carefully in some areas and created a flap of muscle that hung down. He dissected the sciatic nerve proximally. Sweat showed on the bridge of his nose. He used absorbent sutures and then repositioned the grey sheaths of nerves with prods of his finger.

Then he told them he was now going to address the femoral vessels and the woman helped him transect an artery and two veins. Dark red blood pulsed out and the tubes collapsed. One slipped free and disappeared into the mess. She swore and delved in with forceps to pull it out. He asked for a stick-tie for the double ligation, which he manoeuvred with long metal tweezers before letting the sutures clamp around the rubbery tubes.

He grunted that he wanted the electrocautery forceps, and a small machine resting next to me on the trolley was handed to him. He placed it against the arteries and it sparked as it cauterised the ends of the vessels. He told them they had achieved haemostasis and the smell of burnt flesh wafted up.

He told them he was happy so far and he glanced down at me. He stretched his back and said that he was getting too old for this.

He asked for a Cobb elevator. A small metal implement was picked off the trolley and he cleaned away soft tissue from the bone until the white showed. He shaved away a thick ridge and all the periosteum he could get to.

The soft fleshy areas of the leg were now held apart by a bar of bone that was dry and hard between them. Two others helped him position retractors that pulled the flesh out of the way so the bone was clear. They had worked faster than I had experienced before.

He asked for the oscillating saw.

I was passed to him. He gripped my handle and placed a gloved finger on my metal trigger. He held me like a weapon, and down at the end of my barrel was my flat stainless-steel blade, with its sharp teeth pointing forward in overlapping rows. He pulled my trigger and my motor whirred and my blade-end blurred.

This was when I became useful.

He said he was happy to make the cut. He asked one of them to hold the limb. His masked face looked down over me and his head torch lit my matte surface. I was in the valley between two banks of flesh, pointing straight down at the exposed shaft of the femur.

He pulled my trigger again and I made my blade vibrate so that its teeth distorted together as one. He pulled harder until my blade was cycling sixteen thousand times a minute. My high-pitched buzz was new in the room and the men and women shifted uncomfortably.

He held me an inch above and then lowered me so my ninety-millimetre-wide blade touched the bone. The pitch changed as I started to cut down. My blade heated quickly and they squirted saline solution onto me and into the cutting face. It evaporated in steam that swirled around the bone and prevented me from overheating.

He let my weight descend. My blade-end cut through the bone, flashing splinters and dust from the thin trench I gouged out. The juddering of bone passed through the pelvis and into the body so that its skull trembled. The sound of my blade changed tone again as I cut deeper and into the marrow. A small pile of dust and shards grew on the table below me.

He concentrated, his hand steady around me as I cut smoothly down. And then I was nearly through and the trench started to pull open under the weight of the limb. He told them to support it firmly until he was through.

Suddenly I jerked down and was oscillating free in the air. The bone pulled apart and the leg and its foot moved away, the gap widening until it was no longer below the body but being placed on another trolley that was quickly wheeled away. The body had no feet.

He released his finger and my motor stopped. It was quiet in the room and the beep of a machine returned. I was placed back down.

‘Make sure we take samples from that,’ he said, nodding at the leg being pushed through the door.

I had changed the body’s proportions for ever. It no longer filled the space it should. The bone stuck out of the muscle and tissue, the end flat with deep red marrow and surrounded by the sharp white where I had mutilated it.

He told them that he was pleased so far but wanted to get everything closed up before anyone took a break. He asked for the rasp to remove the sharp edges I had left. And then the woman near the body’s head told him something wasn’t going according to plan.

‘Al, I think he’s crashing.’

‘What? Why now, Sarah?’

‘I’m not sure.’

‘Is he going into arrest?’

‘Just keep going, but you need to be quick.’

‘Mike, irrigate now,’ he said. ‘Get as much bone dust and fragments out as you can. And let’s check ligation quickly, release the tourniquet.’

One of them poured water over the wound and brushed the pearly mass with a hand. Someone released the tourniquet and the vessels showed red and pulsed. ‘Looks good.’

‘No, that one’s split.’ Blood seeped and then burst out in a sudden rivulet. ‘Quick, tourniquet back on.’ He worked rapidly and re-clamped the vessel, holding his breath as his hand shook.

‘Well done, Al. Shall we rasp the sharp edges?’

‘No time, Nadia. I’m going to perform the myodesis now. Drill.’

The drill next to me on the trolley was given to him. He placed it against the femur and drilled holes through the end of the bone.

‘Sutures,’ he said. They were handed to him, and he threaded them through the holes and into the centre of the bone. He passed the curved needle back through the holes so six lengths of thin white cord lay out across the table.

‘Nadia, get the medial hamstring ready. I’m going to do it straight away.’ She used forceps to stretch a white band out of the tissue. The needle was squashed through the tendon and the white thread followed until the band was pulled tight across the end of the bone.

‘Secure?’ he said.

‘Looks good,’ she said.

‘Sarah, how’s he doing?’

‘The quicker the better, Al. His cardiovascular system is stressed.’