Liability (part 1)

Short fiction - First of (probably) 3 installments

Warning: kinda gross.

In her sleep, they sawed off Chamille Vanderwheel’s left leg, just above the knee. They said, when she woke up, that below the knee could have been done, but then she would have been looking at extensive surgery (ACL, MCL, kneecap reconstruction, cartilage repair) followed by 12-18 months of rehab. If prosthetics were necessary (which… they were), why not just cut a few inches higher and let the knee become a mechanical one? Because, Chamille later wished she could have told them before they made the executive decision without her consent, there’s a big difference between a little peg-leg and a full-blown robot limb.

She wasn’t consulted on the matter. Nor could she have been. She’d already been passed out for 14 minutes by the time she got to the hospital and the dose of anaesthegiac administered through an IV in the ambulance made sure she stayed that way. They brought her straight to the OR, chopped it above the knee, and pumped enough general analgesic into her that she wouldn’t notice its absence until Dr. Fried came in to deliver the news softly.

They waited exactly 12 minutes after she woke up to break the news. The most important consideration immediately following an emergency amputation is how the patient discovers the loss. If the discovery is made in a psychologically damaging manner, research shows there is an increased likelihood of unfavorable outcomes.

They’ve found, historically, that 10-15 minutes post-op is the perfect window to let the patient in on the secret. 10 minutes after regaining consciousness, the drugs have worn off enough that the patient is likely to remember the information. They will also be sufficiently aware of their actions to consider and consent to future treatment recommendations. 15 minutes after waking up, though, there is a risk that the patient will remember the accident, decide to take a look under the blankets and bandages, and discover their new condition the hard way. Seeing a bloody stump is not the preferred way for a patient to find out that they have lost a limb. Also, before the 15 minute mark has passed, the patient will still be groggy and docile, which reduces the possibility of any so-called “knee-jerk” reactions.

The attending nurse, June, stayed with Chamille during her first moments of wakefulness. She started the timer the moment she saw the lids flutter open and prayed the girl wouldn’t start asking too many coherent questions before it came time to call the others in.

Chamille started with the usual nonsense. “Don’t go that way, it’s too busy” and “You’re not my brother” and “Does it cost money to get in?”

Soon (sooner than June hoped), she moved on to the person, place, and thing questions. “Who are you?” “Where am I?” “What is this?”

Finally, around 9 minutes into the countdown, the patient found the questions June didn’t want to answer. “Why am I in the hospital?” “Who brought me here?” “Did something really bad happen?” “Why won’t you give me a straight answer?”

With 11:09 left on the stopwatch, June pressed the “call” button.

Four people came in: Rita (the nurse on staff who was considered most qualified to perform restraints), Dr. Jaspen (the operating surgeon), Roger Rassmussiman (of Rassmussiman’s Prosthetics), and Dr. Fried. Dr. Fried was not the type of doctor who ever operated on anyone. His virtue was that he had a kind voice and euphemistic way of putting things. They reserved his services for delivering tough updates to patients and loved ones.

“Hello Chamille,” he said.

“I want to speak to my lawyer and my mother,” Chamille fired back, coherently but not quite reasonably. She strained to lift her head from the pillow and bulge her eyes, in an attempt to appear intimidating. The rest of her body was still pretty slow to respond to the impulses she was trying to send down her motor neurons.

Dr. Fried looked compassionately at Chamille, then at June and Dr. Jaspen, bringing everyone onto the same level of respectful disappointment for the situation they found themselves in. He said, “Chamille, we won’t ask you to make any decisions until we’ve given you all the information from our end and let you mull it over with whoever you want to mull it over with.”

Chamille made a face to indicate that she would be staying mute, in protest. But she also turned her ear ever so slightly towards attention.

Dr. Fried delivered the news. “You took quite a tumble, Chamille. Fortunately, there was a young woman in the vicinity who happened to witness your fall and responded to the emergency within one minute. Emergency services were then able to ensure that your condition was stable by the time you arrived here. You had a few guardian angels watching over you today, Chamille. I mean that figuratively, of course. By the time they set you up in this room, you entered into the care of some of the state’s top doctors including Dr. Jaspen and myself. Dr. Jaspen is one of the leading surgeons who specializes in limb replacement, removal, and reconstruction. While she was operating on you, she was able to save almost 50% of your leg mass. It might sound dramatic, but it is actually one of the most routine procedures we encounter in these types of situations. I like to say that Dr. Jaspen could receive the same amount of anesthetics as the patient and still perform a successful transfemoral amputation. Now, obviously, she would never do this, but-”

Chamille passed out again.

When she came to, it was only her, June, and the prosthetics guy.

He wasted no time. “Hello. I’m Roger Rassmussiman of Rassmussiman Prosthetics. I have a few routine-”

Chamille had full control over her arms by now and feeling in her whole body. She disregarded Rassmussiman’s remarks and threw off the bed sheets. Her leg terminated in layers and layers of gauze, medical tape, and various types of cloth. She only had to lean slightly forward to reach her arms to the end of the leg nub. She started clawing away at the gauze and unwinding the wrapping. June jumped to attention and assumed an athletic stance.

“Oh. Ma’am?” Rassmussiman murmured.

“Shut up, guy,” Chamille commanded. She kept tugging and unwinding, like a magician pulling an endless stream of handkerchiefs from his sleeve. She flung bloody fabric off the bed, held it tight in her teeth, and wrapped it behind her neck, to get it out of the way. The nub kept getting smaller and smaller with every unit of medical dressing she removed.

June wasn’t sure how to engage. She didn’t remember any of the patient restraint protocols she’d learned in nursing school and learned again when she was hired by Mountain Valley Hospital. She always assumed a bigger, stronger nurse would be on hand if it ever became necessary.

She saw a need to intervene, though. She felt pretty sure the bandages were supposed to stay on. Theoretically, the sew-job the doctors had performed after the amputation should have been sufficient to keep the wound closed, so Chamille wouldn’t be in danger of losing too much blood if it wasn’t wrapped. But then again, the wound was fresh. Why would they have wrapped it if it was ready to experience the open air? June, Matthew (another nurse), and Dr. Jaspen had spent 15 minutes wrapping it tidily before Chamille woke up. If nothing else, June hated to see their hard work go to waste.

She shuffled side to side along the bedside, looking for an entrance point. Finally, she lunged in, from the base of the bed, aiming for the nub with both flat hands extended, in an attempt to hold the bandages in place. Chamille, unbothered by the nurse's efforts, kept pulling the loose end from above with such force that June’s hands received friction burns from the uncoiling cloth.

In pain, she yanked her hands back. Feet off the ground, hands no longer on the nub, and belly only precariously balanced on the bottom board of the bedframe, she toppled forward onto Chamille, who took the presence of her new bedmate personally and started digging her bloody fingers into June’s ribcage.

Rassmussiman mumbled more rapidly, hoping someone competent would hear and appear.

He was clutching his binder close to his chest. It contained laminated pages with photos and specifications of various lower-body prosthetics. On his way over to the operating room, he’d grabbed the binder labeled “AKA’s” (Above-Knee Amputations). There were over 25 base options for someone in Chamille’s condition, each with additional add-ons and customizable features. People assume prostheses are simple. They figure a fake leg is a fake leg. Rassmussiman often had to inform new patients and members of the non-amputee public that this is far from the truth. Every artificial limb is unique. Even within the world of transfemoral implants, a variety of variables must be considered when choosing a new limb. There are hand-drawn and computer-generated designs, personalized aesthetic considerations, size and proportion adjustments, lifestyle and need-based determinants, material options, existing-limb replications, and, of course, the biggest factor: how much the patient is willing to spend.

All of this information and more could be found in Rassmussiman’s red binder, which he’d assembled 12 years before and updated regularly as the technology and trends of prosthesis evolved. There were more like it, one for each type of amputation his company helped treat. His binders had been coveted resources for countless patients over the years. After the emotional low of losing a limb, they felt their first new glimmer of hope for a normal life when flipping through photos of people just like them who had received mechanical reconstruction from Rassmussiman and company. When multiple patients were concurrently treated for the same amputation, the binders became hot commodities. At times in the past, Roger Rassmussiman had been forced to implement intricate custody schedules, to quell patients’ calls for more time with the single-copy binders.

Recently, his daughter, Marcy, had come onboard to digitize the information in each binder, but, for reasons Rassmussiman didn’t quite understand, it was a slow process. He had a hunch it might have to do with the fact that he paid her hourly.

June was still splayed face down on the bottom half of Chamille’s bed. The patient was attempting to kick her nurse with her phantom limb. There was no foot to make contact with June’s abdomen, but the bloody thigh-stump, now completely free from its bandage and leaking all sorts of fluids, was repeatedly bludgeoning her in the face.

If she’d been able to assess the situation from a medical perspective, June probably wouldn’t have blamed Chamille for the violence. She would have attributed her actions to an excess of fear-induced epinephrine produced in her adrenal glands as a reflex and triggering exaggerated activity of the so-called “fight or flight” mechanisms of the sympathetic nervous system. Dilated pupils, a rapid heart-rate, increased intestinal motility, racing thoughts, perspiration, paranoia, surging bloodlust: all part of her body’s very ordinary reaction to such a drastic discovery. June might have been able to understand Chamilles behavior, but that didn’t mean she wished to endure it. 

She yelled, “Help!”

Rassmussiman, timid in every way but prosthetic-pushing, couldn’t raise his voice much higher than a mild grouse. He kept turning to the door, saying things like “Please, someone, we need assistance,” hoping someone with any ability to defuse the situation would appear in the doorway. None did.

Aided by a rush of adrenaline to the brain similar to the one Chamile was experiencing, he realized this was a moment, if any existed, for him to take matters into his own hands. The binder was already in his hands. He looked at it and saw its modest potential as a weapon. Half-heartedly, he unclenched it, raised it up, and brought it down on Chamille’s shoulder. The back cover snapped, and the binder fell out of his hand. Chamille didn’t seem hurt by the blow, but she stopped thigh-butting June and turned to Rassmussiman with a face of disgust and confusion. In retaliation, she took the binder, held it high, and, staring directly into the prosthetics man’s eyes, unlatched the three-rings and threw the loose pages across the room and out the open 7th-story window.

Free from the onslaught, June staggered off the bed and hastily connected a vial of heavy sedative into Chamille’s IV line.