feet

one

At the top of the road that leads up to the railway station we can see a frenetic chain of flashing blue lights: transport police, a response car and the first ambulance on scene that we have been sent to back up. Many of the people who live in the houses along this road have been drawn outside to watch. I am aware of their collective focus as Rae jumps out and goes to grab her paramedic response bag. I turn on the KRS to leave the engine running whilst taking the keys with me. We both stretch on our blue rubber gloves as we stride over to where a couple of police stand guard to the platform entrance.
‘Follow the stairs, you’ll be directed at the top,’ says a female officer, and smiles encouragingly, like a stage manager to the next actors out.
Up the stairs, and we emerge onto a platform of bright sunlight and a small crowd of fluorescent jackets, mostly rail staff, waving us on.
‘Just over there a bit and down on the track. Don’t worry – power’s off.’
‘But don’t stand on any rails, just in case,’ adds another.
We recognise two of our colleagues in an ambulance huddle around the figure of a woman lying across the rails: Frank, holding her head still, and Kent, busy dismantling a scoop stretcher. We jump down to join them. Richard, the officer on scene, lays out the story so far. We listen, whilst at the same time registering the bloody devastation to the woman’s lower legs. They have been rendered to a butchery mess along the shining rail, but elsewhere there is a curious absence of trauma. The only other potentially dangerous sign seems to be the worrying way in which her arms are crooking up and inwards. Head injury? It would be inconceivable to escape without one.
’Guys. This lady jumped in front of the train as it passed through the station and was rolled underneath it. She’s suffered massive trauma to her lower legs, has good, bi-lateral air entry, is conscious but GCS eleven, if that.’
We are all aware of the need to get things moving quickly now. We set to work, following Richard’s direction: Rae attempts to cannulate the woman around the rest of us as we manipulate the scoop stretcher beneath her. The left foot is nowhere to be seen; a policeman is dispatched to locate it. The right one is attached by the merest strip of flesh. I have to pick the remaining oil-blackened foot up so that the stretcher can be clicked shut either end; it feels cold and heavy in my hand. The extent of the trauma to the woman’s legs is so awful that despite our efforts, some fatty tissue snags in the mechanism. Rae cannot get the cannula in as the woman is moving her arms too much, but by this time we are ready to raise her off the rails and up onto the spinal board placed on the platform just above us. Once on, we secure the straps and then climb up ready to go. I take the foot end, Kenton takes the head, the others around the middle, and we all set off back along the platform towards the exit.
As we go backwards down the stairs, a sudden gush of blood pours down the front of my trousers and splashes onto my shoes.
As Rae and Richard put a line up in the ambulance, I make an attempt to bandage up the woman’s legs. I cut away the remains of her trousers as best I can, tangled as they are amongst the splintered bone. There is surprisingly little blood; the major vessels seem to have retracted, reducing the flow. I improvise a bandage from an incontinence dressing, then, after checking that there is nothing more for me to do, I rip off my gloves and jump out to move my ambulance out of the way and clear the exit.
A man is running up towards me.
‘My wife!’ he says. ‘It’s my wife in there, isn’t it? Please. Let me on. Let me be with her.’
I glance behind me into the ambulance and Kent is shaking his head vigorously. So I put my arms out to the man. I am aware of Kent shutting the door as I start to say to that there are too many people on board the ambulance, that everything possible is being done, that he can come with me to the hospital and meet his wife up there. He pushes past and tries to force his way round and on to the vehicle through the side door. Two policemen standing there hold him back, but after a second or two of rapid negotiation he is allowed to kiss his wife, then taken into a police car to follow the ambulance up.
It leaves on lights and sirens, along with the police car.

After I’ve turned the ambulance around, I drive away from the scene normally, calming myself down, radio on, windows open to let in the fresh air. I wave to the woman who lets me out at the end of the street, and she gives me a friendly wave right back. I start to think about what I need to do now. Change these trousers, for one.

two

Later that afternoon we’re called to an elderly man who has a laceration to his foot. We are met outside the block of flats by a round-faced, pleasantly smiling man with a plastic washing basket.
‘He’s inside, the old fool. He’s been walking around without anything on his feet, he’s trodden on something and his foot has bled. There. I tell him, but what’s the use? He bled quite a lot. Such a mess. But I’ve cleaned it up. Anyway. How are you? Lovely day. Thank you so much for coming out. I hate to trouble you when I know you’ve got better things to do.’
He leads us inside. The heat in the hallway, the dull light and the man’s sugary chatter combine to make me feel a sudden, crushing burden of sleep. When he introduces us to the patient, it’s all I can do to stop myself grabbing a cushion and lying down on the carpet. But with a lurch of consciousness, I force myself to see that the patient is a semi-naked, bulgingly fat man sitting in an easy chair with one foot up on a red, rattan stool. He smiles down at me as I kneel before him. I pull out my little black torch and inspect the foot. There is a little dried blood on the sole and around the toes, but no obvious cuts. Rae helps me open up a sachet of sterile water, and together we clean his foot. The only thing I can see is perhaps a tiny wound, almost like a paper cut, along the crease of one of his toes. But nothing serious. I push and prod his foot.
‘How’s that? Feel anything?’ He continues to smile down at me, happy with the attention. His friend still hugs his washing basket.
‘You should have seen the blood,’ he says.
‘How about that?’ I ask the patient, prodding his foot some more. No reaction.
‘A bit of shiatsu,’ I say. ‘No extra charge.’ Then I look at Rae and say ‘I think I’ve had enough feet today.’ And I have a clear vision of the policeman wandering slowly off along the track like a beachcomber in the sunshine.
‘You’re fine,’ I say, squeezing the man’s big toe. ‘But get yourself some slippers.’