Amputation scene

[allmywires]

I assume most of you won't have direct experience of performing an amputation, but does this sound feasible/medically correct? Also, grammar stuff, any else critique-worthy I'm all ears to.


Note: Mona's arm was crushed by the elephant, and they're in the aftermath of a battle.

*


Simeone had managed to gather the few uninjured men to lift the elephant; among them was Vigo, the man from Sixpoints, whose face was grey and his eyes never left Mona. Ricardo waited as they heaved the elephant up and over, and Mona gave a fresh cry of pain, weak and broken like a newborn.

‘Hush, now,’ Simeone said levelly, holding Mona’s injured arm down, dabbing at her forehead with the other hand. Ricardo walked over on uneasy legs, the knife slipping in his sweaty palm.

‘No!’ Vigo said, when he saw the blade, stepping in between them. ‘You can’t-’

‘I have to,’ Simeone said, as Mona began to writhe and cry, her arm swollen and bloodied, bones protruding from the flesh of her crushed fingers. Ricardo swallowed the bile down and focussed instead on his own pain, his own horror, the shape of the girl and her injury blurred in his crossed vision.

‘Let me do it,’ Vigo insisted, jostling with Ricardo, his eyes wide and wild. ‘I won’t let anyone hurt her.’

Simeone stood up, pushing him back.

‘Do you love her?’

‘I – what kind of a question is that?’

‘Then you won’t be able to,’ Simeone said, gently but firmly, giving him another shove. ‘Now, please, Ricky.’

He knelt down. Simeone had placed Mona’s broken arm on a wooden block, and had tied a heavy leather belt around her upper arm. She was holding Mona around the neck with one arm, the other holding onto the belt. ‘Cut two inches from where the swelling starts,’ she told Ricardo. He pressed the blade against her skin, concentrating on each breath. In, out. Just one movement, then it would be done.

As he was just preparing to slice, Carmela burst through, Safa in tow, cradling his giant desert cat in his arms.

‘Where is she?’ Safa demanded, his face wet with tears, glinting in the firelight. Simeone let out a sigh of frustration.

‘Over there, but please, I am trying to save this girl’s life-’

‘There’s no time,’ Carmela said shortly, tightening up her armour, waving a flaming torch. ‘The Orians are coming. I sent Emile and Enzo to search for survivors, but we should really have gone an hour ago. We’ll move slowly, and they’re on horseback.’

‘How far?’ Ricardo asked.

‘They’re just approaching the hill. Come on,’ she ordered, but most stayed put. ‘What are you waiting for?’

‘Do it now!’ Simeone ordered. Ricardo looked at Carmela, and back at Mona, and drew the first cut. The girl screamed. ‘Good,’ she said, holding Mona tighter as she yelled and cried, staying calm as blood rushed up out of the laceration and spilled down Mona’s swollen arm. ‘Right down to the bone, and then around. Gently saw it. Like you’re cutting a ring of steak.’ Ricardo bit the inside of his cheek hard as he sliced through her flesh, more and more blood coming, until he saw the soft pink of bone underneath. Carmela was incensed at the noise Mona was making.

‘They’ll hear us!’ she hissed, drawing her sword. ‘We have to go. Make it quick!’

‘Very good,’ Simeone said again, ignoring Carmela as he sliced down and around, like she had instructed, tendons snapping, muscles rendering. ‘General. Pass him the saw.’

‘The saw?’ Carmela echoed, and Ricardo knew she was tempted to disobey. Instead, after a moment of hesitation she dropped her sword and picked up the instrument lying next to Simeone, thrusting it at Ricardo.

‘Hurry,’ she snapped at him. He placed the saw teeth on the bone, and heard distant voices.

‘Pull the skin back. Cut the bone a couple of inches from the flesh, so I have room to stitch it. Slow and steady,’ came Simeone’s voice. Mona was silent; the pain had overtaken her, and her consciousness had stepped in. The others were already moving, scrambling up and away from the dead bodies, Safa trying to carry Entelemon and Nala at the same time. Ricardo started to saw through the bone, gritting his teeth so hard he thought they might snap, before finally the swollen arm came loose with a heavy thump onto the ground.

[RcGrant]

Please note I know nothing about the medical technicalities of amputation; I only have experience from what I have read (in fiction) before. Frankly, I loved it. I felt it was very realistic, and I adore the instruction for the arm to be cut like a steak.

I think what really stood out for me was the emotion surrounding it. The one man who loved the girl who was told he shouldn't do it, the worry over the approaching people etc. All of that bound it together.

A strong piece of writing. I want to read more. Very well done!

[Mouse]

Originally Posted by allmywires

Simeone had managed to gather the few uninjured men to lift the elephant; among them was Vigo, the man from Sixpoints, whose face was grey and his eyes never left Mona (I'd re-order this sentence as I read it a little weird). Ricardo waited as they heaved the elephant up and over, and Mona gave a fresh cry of pain, weak and broken like a newborn.

‘Hush, now,’ Simeone said levelly, holding Mona’s injured arm down, dabbing at her forehead with the other hand. Ricardo walked over on uneasy legs, the knife slipping in his sweaty palm.

‘No!’ Vigo said, when (as?) he saw the blade, stepping in between them. ‘You can’t-’

‘I have to,’ Simeone said, as (I'd change the comma to a full stop and delete the 'as') Mona began to writhe and cry, her arm swollen and bloodied, bones protruding from the flesh of her crushed fingers. Ricardo swallowed the bile down and focussed instead on his own pain, his own horror, the shape of the girl and her injury blurred in his crossed vision.

‘Let me do it,’ Vigo insisted, jostling with Ricardo, his eyes wide and wild. ‘I won’t let anyone hurt her.’

Simeone stood up, pushing him back.

‘Do you love her?’

‘I – what kind of a question is that?’

‘Then you won’t be able to,’ Simeone said, gently but firmly, giving him another shove. ‘Now, please, Ricky.’

He knelt down. Simeone had placed Mona’s broken arm on a wooden block, and had tied a heavy leather belt around her upper arm. She was holding Mona around the neck with one arm, the other holding onto the belt. ‘Cut two inches from where the swelling starts,’ she told Ricardo. He pressed the blade against her skin, concentrating on each breath. In, out. Just one movement, then it would be done.

As he was just preparing to slice, Carmela burst through, Safa in tow, cradling his giant desert cat in his arms.

‘Where is she?’ Safa demanded, his face wet with tears, glinting in the firelight. Simeone let out a sigh of frustration.

‘Over there, but please, I am trying to save this girl’s life-’

‘There’s no time,’ Carmela said shortly, tightening up her armour, waving a flaming torch (this sounds a little like she's waving the torch and tightening the armour at the same time... but only a little and I don't mind the sentence). ‘The Orians are coming. I sent Emile and Enzo to search for survivors, but we should really have gone an hour ago. We’ll move slowly, and they’re on horseback.’

‘How far?’ Ricardo asked.

‘They’re just approaching the hill. Come on,’ she ordered, but most stayed put. ‘What are you waiting for?’

‘Do it now!’ Simeone ordered. Ricardo looked at Carmela, and back at Mona, and drew the first cut. The girl screamed. ‘Good,’ she said, holding Mona tighter as she yelled and cried, staying calm as blood rushed up out of the laceration and spilled down Mona’s swollen arm. ‘Right down to the bone, and then around. Gently saw it. Like you’re cutting a ring of steak.’ Ricardo bit the inside of his cheek hard as he sliced through her flesh, more and more blood coming, until he saw the soft pink of bone underneath. Carmela was incensed at the noise Mona was making.

‘They’ll hear us!’ she hissed, drawing her sword. ‘We have to go. Make it quick!’

‘Very good,’ Simeone said again, ignoring Carmela as he sliced down and around, like she had instructed, tendons snapping, muscles rendering. ‘General. Pass him the saw.’

‘The saw?’ Carmela echoed, and Ricardo knew she was tempted to disobey. Instead, after a moment of hesitation she dropped her sword and picked up the instrument lying next to Simeone, thrusting it at Ricardo.

‘Hurry,’ she snapped at him. He placed the saw teeth on the bone, and heard distant voices.

‘Pull the skin back. Cut the bone a couple of inches from the flesh, so I have room to stitch it. Slow and steady,’ came Simeone’s voice. Mona was silent; the pain had overtaken her, and her consciousness had stepped in. The others were already moving, scrambling up and away from the dead bodies, Safa trying to carry Entelemon and Nala at the same time. Ricardo started to saw through the bone, gritting his teeth so hard he thought they might snap, before finally the swollen arm came loose with a heavy thump onto the ground.

There. Only teeny comments. I second RcGrant!

[JoanDrake]

If you want to add some ambience throw in the strong smell, general filth and some buzzing flies. Accounts of Civil War hospitals abound with them.

The only thing I can tell you about pre-anaethesia battlefield amputations is that the majority of successful ones were the ones done most quickly, as the patient was likely to die from just the shock of the pain alone, so working fast was the major premium for doctors here.

Also, wasn't the wound usually cauterized rather than stitched? And how does the arm fall on the floor when it's tied to a heavy block?

However, these are just details, the main point is that it's well-written and, like Rc said, emotionally unified. These are the important things. (If someone is really knowledgeable about the finer points of pre-anaethesia amputations you may not WANT them for readers, just kidding.)

[Vertigo]

And I third those comments (Edit: okay fourth them; Joan got in before me!). Enjoyable if grim reading. My main complaints were that I found some pronouns a little ambiguous. I could always (I think) work them out but they did pull me out of the narrative.

I particularly like the action sentences. They were crisp, concise and clear which in turn made them nicely punchy.

Anyway here's my comments:

Simeone had managed to gather the few uninjured men to lift the elephant; among them was Vigo, the man from Sixpoints, whose face was grey and his eyes never left Mona. I found his ambiguous and could have referred to Simeone. Maybe: whose face was grey, his eyes never leaving Mona. Ricardo waited as they heaved the elephant up and over, and Mona gave a fresh cry of pain, weak and broken like a newborn.

‘Hush, now,’ Simeone said levelly, holding Mona’s injured arm down, dabbing at her forehead with the other hand. Ricardo walked over on uneasy legs, the knife slipping in his sweaty palm.

‘No!’ Vigo said, when he saw the blade, stepping in between them. ‘You can’t-’

‘I have to,’ Simeone said, as Mona began to writhe and cry, her arm swollen and bloodied, bones protruding from the flesh of her crushed fingers. Ricardo swallowed the bile down and focussed instead on his own pain, his own horror, the shape of the girl and her injury blurred in his crossed vision. I think I’d dropped the ‘crossed’

‘Let me do it,’ Vigo insisted, jostling with Ricardo, his eyes wide and wild. ‘I won’t let anyone hurt her.’

Simeone stood up, pushing him back.

‘Do you love her?’

‘I – what kind of a question is that?’

‘Then you won’t be able to,’ Simeone said, gently but firmly, giving him another shove. ‘Now, please, Ricky.’

He knelt down. Simeone had placed Mona’s broken arm on a wooden block, and had tied a heavy leather belt around her upper arm. She was holding Mona around the neck with one arm, the other holding onto the belt. ‘Cut two inches from where the swelling starts,’ she told Ricardo. He pressed the blade against her skin, concentrating on each breath. In, out. Just one movement, then it would be done.

As he was just preparing to slice, Carmela burst through, Safa in tow, cradling his giant desert cat in his arms. Again ambiguous to me who is cradling the cat. Though that might be more obvious from what has passed before.

‘Where is she?’ Safa demanded, his face wet with tears, glinting in the firelight. Simeone let out a sigh of frustration.

‘Over there, but please, I am trying to save this girl’s life-’ Over there? I had the impression Simeone is sitting holding Mona and I wouldn’t say there, but rather “Here, but please…” Or is this actually referring to a different person?

‘There’s no time,’ Carmela said shortly, tightening up her armour, waving a flaming torch. ‘The Orians are coming. I sent Emile and Enzo to search for survivors, but we should really have gone an hour ago. We’ll move slowly, and they’re on horseback.’ We’ll move slowly, sounds like it is her intention to move slowly rather than inevitable. Maybe: We’ll be moving slowly…

‘How far?’ Ricardo asked.

‘They’re just approaching the hill. Come on,’ she ordered, but most stayed put. ‘What are you waiting for?’

‘Do it now!’ Simeone ordered. Ricardo looked at Carmela, and back at Mona, and drew the first cut. The girl screamed. ‘Good,’ she said, holding Mona tighter as she yelled and cried, staying calm as blood rushed up out of the laceration and spilled down Mona’s swollen arm. ‘Right down to the bone, and then around. Gently saw it. Like you’re cutting a ring of steak.’ Ricardo bit the inside of his cheek hard as he sliced through her flesh, more and more blood coming, until he saw the soft pink of bone underneath. Carmela was incensed at the noise Mona was making.

‘They’ll hear us!’ she hissed, drawing her sword. ‘We have to go. Make it quick!’

‘Very good,’ Simeone said again, ignoring Carmela as he Again ambiguous although we know who is doing the cutting this suggests either Simeone or Carmela is actually male and doing the cutting. I think you should use Ricardo here. sliced down and around, like she had instructed I’d prefer just “as instructed” here or “as she’d instructed”, tendons snapping, muscles rendering. ‘General. Pass him the saw.’

‘The saw?’ Carmela echoed, and Ricardo knew she was tempted to disobey. Instead, after a moment of hesitation she dropped her sword She was tightening her armour and waving a flaming torch around a minute ago and picked up the instrument lying next to Simeone, thrusting it at Ricardo.

‘Hurry,’ she snapped at him. He placed the saw teeth on the bone, and heard distant voices.

‘Pull the skin back. Cut the bone a couple of inches from the flesh, so I have room to stitch it. Slow and steady,’ came Simeone’s voice. Mona was silent; the pain had overtaken her, and her consciousness had stepped in. I don’t quite understand the reference to her consciousness stepping in The others were already moving, scrambling up and away from the dead bodies, Safa trying to carry Entelemon and Nala at the same time. Ricardo started to saw through the bone, gritting his teeth so hard he thought they might snap, before finally the swollen arm came loose with a heavy thump onto the ground.

One final comment, though I'm on much shakier ground here as I'm no doctor! Would they really have cut the arm off right there on the battlefield, especially with their enemies closing in (see I'm with Carmela here!). Having decided the arm had to come off I suspect they'd have applied the tourniquet and then got going. Knowing the arm would have to come off anyway any concerns about having the tourniquet on for too long would be largely irrelevant.

Also, wasn't the wound usually cauterized rather than stitched? And how does the arm fall on the floor when it's tied to a heavy block?

Again I'm on shaky ground here but isn't it a bit of both. Cauterized and then stitched over. And you have got Carmela standing there with a torch in one hand

[allmywires]

Thank you all for your thoughts - some of the ambiguous bits are clearer with context, because obviously there are a lot of characters in transit here. I thought about cauterisation, but wouldn't the torch do more damage in this instance?

I suppose the reason they decide to take the arm then is because they don't think they're in any danger; as far as they know, they won the battle, then Carmela comes and tells them they're still in danger.

Also, RcGrant, glad you liked the steak thing! I did umm and ahh about it, and whether a medic would actually say it (having neither de-boned a steak nor amputated an arm in my life...)

[RcGrant]

Originally Posted by allmywires

Also, RcGrant, glad you liked the steak thing! I did umm and ahh about it, and whether a medic would actually say it (having neither de-boned a steak nor amputated an arm in my life...)

I think it made it so the reader can relate to it, but at the same time showed the reader what an awful, out of control situation it is. I'm very impressed.

[HareBrain]

Originally Posted by allmywires

I thought about cauterisation, but wouldn't the torch do more damage in this instance?

As far as I know, cauterising was always done with a red-hot iron. I don't think a torch would be hot enough.

[JoanDrake]

One final comment, though I'm on much shakier ground here as I'm no doctor! Would they really have cut the arm off right there on the battlefield, especially with their enemies closing in (see I'm with Carmela here!). Having decided the arm had to come off I suspect they'd have applied the tourniquet and then got going. Knowing the arm would have to come off anyway any concerns about having the tourniquet on for too long would be largely irrelevant

IND either, but I do think Gangrene sets in FAST and then you die, amputation or no. (At least that's what they say in all the John Wayne movies) Also, a crushed arm would hurt a lot more moving than a recently amputated one

[Vertigo]

Yes you are probably right there HB. Actually just done a quick google and turned this up:

From the time of ancient Greek physician Hippocrates (460-370 B.C. ) until the 1500s, amputations usually involved cutting through dead rather than living tissue because dead tissue did not hemorrhage (bleed uncontrollably). Stumps, or the remaining limb tissues, were then sealed with red-hot irons or boiling oil or tar. This burning procedure stopped most bleeding and was also thought to help prevent gangrene (tissue rotting). In the mid-1500s, German surgeon Fabricius Hildanus (1560-1634) began using a red-hot knife for amputations, which both removed the limb and controlled bleeding at the same time.

And yes AMW I suspected that some at least of those ambiguities would be more obvious with familiarity with the protagonists.

Also I would add that I'm only being picky about the amputation stuff. As it stands it would not have thrown me out, I am obviously, when critiquing (at which I am an absolute amateur you understand), trying to be even more picky than an average reader would be. One last idea though, why not throw in a comment from one of them saying the cauterisation will have to be done later when they are clear of the enemy. That should be enough to make everyone happy.

[allmywires]

Originally Posted by Vertigo

One last idea though, why not throw in a comment from one of them saying the cauterisation will have to be done later when they are clear of the enemy. That should be enough to make everyone happy.

I may just do that, cheers

[Vertigo]

You're welcome, I enjoyed the read!

[Bowler1]

‘Do it now!’ Simeone ordered. Ricardo looked at Carmela, and back at Mona, and drew the first cut. The girl screamed. ‘Good,’ she said, holding Mona tighter as she yelled and cried, staying calm as blood rushed up out of the laceration and spilled down Mona’s swollen arm. ‘Right down to the bone, and then around. Gently saw it. Like you’re cutting a ring of steak.’ The steak image pulled me out of the scene a bit, for me anyway, more so considering how much realism follows – different readers, different opinions. Ricardo bit the inside of his cheek hard as he sliced through her flesh, more and more blood coming, until he saw the soft pink of bone underneath. Carmela was incensed at the noise Mona was making.

‘Pull the skin back. Cut the bone a couple of inches from the flesh, so I have room to stitch it. Slow and steady,’ came Simeone’s voice. Mona was silent; the pain had overtaken her, and her consciousness had stepped in – has she fainted?. The others were already moving, scrambling up and away from the dead bodies, Safa trying to carry Entelemon and Nala at the same time. Ricardo started to saw through the bone, gritting his teeth so hard he thought they might snap, before finally the swollen arm came loose with a heavy thump onto the ground.

That was very good with nice realism. I missed emotion and internal thoughts/POV from one character which would have drawn me in more. The scene is set for emotion, characters feeling shock and wondering if their firend will make it etc. I accept it’s an action scene and internal thoughts are not key to the scene, but just a bit here and there would I think, up the tension for the reader. I liked it and it hints at a good plot going on, so good stuff.

[Phyrebrat]

Hello,

Repeating what has been said, I wanted to say I enjoyed the passion and the choppy pace (no pun intended; by that I meant that I like the will-he won’t-he, as we wait to find out if the amputation will happen).

I'm curious though; where does the wooden block appear from? And is it strictly necessary? It seems a little convenient. If they are in a hectic battle situation, is the block necessary?

I see people have brought up cauterisation, but regardless of the question of sufficient heat, wouldn't the amuptator sterilise the blade with fire?

This line; '...drew the first cut...' suggests the butcher will be making many cuts, and using the word ‘cut’ suggests a small or neat process. I’d be more inclined to use a heartier word like chop, hew, sever, hack and slash.


‘Gently saw it.’ Doing this would be agonising and slow, possibly killing the patient from shock and blood loss.


Okay, so this suggestion will possibly repulse you but....Have you ever tried to cut a goat leg for stewing? I have a chef knife and a cleaver – the chef knife is great for sawing (it is super thin and super sharp) but it would take a long time to get through bone. The cleaver, however.... well.... one heavy chop and that shin is in two pieces (with marrow on the wall, admittedly)*. So, my suggestion is to get a goat leg and try it. The sight, sounds and smell will really give you a bit of realism to add to your piece - and goat legs are cheap!


Well done, I'm with RCGrant, I'd like to see more


pH
*Before anyone accuses me of being crazy as a latrine rat, to mitigate can I advise that I often cook curried goat.

[allmywires]

Thank you Bowler and Phyrebrat

Probably need to revise the consciousness thing, just me trying to be too clever

I think I'll take a pass on the goat's leg thing - not sure the rest of my family would appreciate my experiment 'in the name of writing'!

The wooden block - hmm, could replace that with something battle-esque, I suppose, and yes, come to think of it cutting slowly would be horrible.