Painting by Sir Edward John Poynter (1836-1919) - La nymphe du ruisseau

 It's almost a sacred moment. The sun is setting. The day is done. It's taken us three days of driving to reach this quiet, secluded lake. We've pitched our tent. Outside the tent we have carefully positioned our provisions in trees away from the ever resourceful raccoons, bears and other scavengers. We decide on a quick dip into the lake before we set about the preparation of our dinner.

Shirley chimes in, "Let's fish while there's still some light. Look at the surface - the fish are biting. Let's bait our hooks and catch our dinner."

We're standing, totally bare, anticipating the quick dip, so I respond, "But what about our dip?"

Shirley playfully pinches my butt and promises, "Right after the fishing we swim, then we eat and then ….." and her voice and her tone fade out with hints and visions of wonders to come.

I bend over to replace my jeans and T-shirt and she grabs them, "No! No! This is nature. This is us and the great outdoors, everything, even the fishing, everything as bare as the day we were born."

I shrug and drop the jeans. I had promised her a primal experience.

We're standing at the edge of the lake balancing ourselves on very slippery stones. Shirley grasps her rod with both hands and in as deft and misguided a motion as I've ever witnessed, sweeps the baited hook from the dry grass river bank in a wide curling swath until the barbed hook finds its way into my right buttock. I, involuntarily, let out a stupendous shriek. Shirley, totally unaware of the cause of my shout or the whereabouts of her barbed weapon, promptly drops her rod into the swirling currents of the river into which our pristine lake empties. Now the rod is writhing to and fro in the frothy waters even as I, much like a hooked trout, am writhing to and fro on the slippery rocks.

"Shirley! Shirley! Cut the line…..Cut the line… it's digging deeper…..quick, please….cut the line"

"With what, what do I use? Do we have a knife? …Scissors? …What can I use? … Wait! Wait! In my toilet kit I have manicure scissors – don't go anywhere! I'll be right back."

I'm lying on my stomach on the slippery rocks, struggling with one hand to keep myself from sliding into deeper water and with the other groping to get a hand on the line, whose constant tugging is setting the barb deeper and deeper into my tush.

Shirley returns. She's beaming even as tears are dripping from my cheeks. "Look", she proudly exclaims, "I found the scissors."

"Shirley, cut the line."

Shirley succeeds in cutting the line after several aborted attempts which involved no trivial amount of pulling on the line. She proudly holds the severed line in one hand, the scissors in the other - "I did it."

I'm lying there at her feet crying. In her triumph Shirley has completely forgotten that the hook is still in my butt. "Shirley", I exclaim, "Give me a hand. Help me get up. Help me back to the tent."

We approach the tent. Never before did I realize how small it is and what is required with regard to bending and even crawling to get in through the compact entrance. I stand there hunched over, staring at the challenge. I turn to Shirley. "Do you have any idea as to how to remove a barbed hook? Have you ever done it before?"

She peers up at me sheepishly, her small breasts heaving, "No", she answers, "No, I've never done anything like that before."

I shake my head and pause to think. Either she removes it or we have to go to the nearest emergency room – who knows how many days drive away – at a time when my ability to sit is severely compromised. I turn to Shirley, "You're going to have to try. I'll talk you through the procedure."

By now night is falling. We haven't lit the fire. We have a kerosene lantern and an emergency flashlight. I realize the surgery will have to take place outdoors as there neither ample space nor ample light in our small tent.

"Shirley, bring out my sleeping bag and put it next to the wood for the fire.

"Light the fire and light the kerosene lantern. Position the lantern so the light falls as much as possible on the midsection of the sleeping bag. Hold on to your manicure scissors and get my folding knife out of my backpack'' All this is relayed in an extraordinarily precise tone despite the constant throbbing in my right buttock.

Shirley has completed the necessary preparations. She has cleaned the scissors and knife, held them in a flame to sterilize them, and taken out our Cabernet Sauvignon to irrigate the wound. She's as ready as she will ever be. I gingerly position myself on the down sleeping bag, with my head cradled in my arms and my backside glistening in the reflection of our expensive vino and the flickering flames on the backdrop of pristine lily-white skin.

"I think I'm ready to try", Shirley proudly proclaims. "What do I do?"

"First, grab the base of the hook firmly in your fingers. Watch out because the blood and the wine will make the shaft slippery. Pull backwards with a steady gentle pressure while exerting a to-and-fro twisting motion. The trick is to free the needle without engaging the barbs. "Even as these words leave my lips I feel a sudden searing pain rip through my butt, radiate down to my groin, and a wave of nausea and lightheadedness sweeps through my body. My shouting attracts Shirley's attention. She is now crying. "I can't do it. I just can't do it. I'm too squeamish. I'm afraid of hurting you."

I motion for her to step back from the operative field. "Shirley, you'll have to do something. If you can't pull it out we'll have to cut it out. I can't possibly travel back to civilization while sitting on this hook."

"Wait", says Shirley, "I have an idea. I'll leave you here and I'll walk out to find a phone and I'll call for help." "Shirley", I patiently explain, "you can't walk out to a phone. You'll have to take the car. That means leaving me here alone and you know how bad your sense of direction is, you'll never find your way back."

We're stuck and we are increasingly frustrated, short tempered and without hope when we suddenly hear voices coming through the woods. There is no mistaking the sounds. Talking – walking – thinking human beings. It is like a blessing from heaven; the voices are getting closer. It sounds like a group of girls. "Quick Shirley, cover me with a blanket and cover yourself, we don't want to scare them."

They emerge from the woods; eight adolescent girl scouts, in uniform, with three adult leaders. They were attracted by our fire and are seeking a camping site for the night. They edge forward with shouted greetings. "Hello there! Friend or foe? Can we join you?" They enter our clearing and approach Shirley. One of the leaders extends her hand, greets Shirley, all the while looking quizzically at me lying prone near the fire, head on my arm, sobbing silently that our salvation had to come in this particular fashion.

She asks, "Is everything all right?" The girls crowd around.

"Well not really", Shirley responds, "my friend has been injured."

"Oh wonderful", effuses the scout leader, "several of our girls are working towards their first aid badges. This is great. What is the nature of the injury?"

"Ehhhh, He's stuck on a fishing hook and I can't seem to get it out. It's slippery."

"Wonderful!" the troop leader exclaims, "We just finished a unit on the extraction of fishhooks. This will give the girls a real-life experience."

Her enthusiasm is not contagious. I cringe, unable even in my most exaggerated imagination to envision how the next few hours are going to elapse.

The troop leader turns to Shirley. "I'm Carol, this is Ashley, my first assistant, and that's Tracy who has been giving the first aid course. I'm sure they are as excited about this as I am!"

She turns eagerly to the troop, "Step lively girls. We're going to have a real life demonstration. Tracy is going to extract the fishhook and we're all going to watch. Tracy will explain each step of the procedure. Step lively, put your packs down. We don't want to keep the poor patient suffering." Suffering was a serious understatement.

The group was assembled. Shirley had explained to Carol the sensitive location of the fishhook and after much discussion they decide to cut a hole in a blanket and use it to drape the area so that the surgery would be instructive to the assembled scouts and yet some modicum of my dignity might be preserved.

It was not comfortable under the blanket. It was dark, and three of the aspiring young medics had been appointed to shine their flashlights on the surgical field. All I could see were two pairs of scuffed sneakers, the third flashlight having been positioned near my feet to minimize shadowing.

Tracy begins, "Retrograde technique is the simplest of the removal techniques but has the lowest success rate. It works well for barbless and superficially embedded hooks. Downward pressure is applied to the shank of the hook. This maneuver helps rotate the hook deeper and disengage the barb, if present, from the tissue. The hook can then be backed out of the skin along the path of entry. Any resistance or catching of the barb during the procedure should alert the operator to stop and consider other removal methods."

Even as she is reciting this well rehearsed description, she is exerting said downward pressure along the shank of the hook. The pain becomes sharp, piercing and excruciating. My violent reaction includes a horrific shriek and violent kicking, the latter of which threatens to displace the blanket cum drape, adding to my increasing despair and suffering. I witness the sudden jumping of four scuffed sneakers as the operating theater's lighting system reacts to my screams. Mercifully, Tracy stops the downward pressure on the shank and steps away from my tortured rump.

Totally undaunted and true to the scout motto of being always prepared, Tracy continues, "There is a second, usually more successful technique. A string, such as a fishing line, umbilical tape or silk suture, is wrapped around the midpoint of the bend in the fishhook with the free ends of the string held tightly. A better grip on the string can be achieved by wrapping the ends around a small branch or twig. The involved skin area must be well stabilized against a flat surface as the shank of the fishhook is depressed against the skin. This may be difficult when the hook is embedded in an exceedingly fleshy region as in the present case. Continue to depress the eye and/or distal portion of the shank of the hook, taking care to keep the shank parallel to the underlying skin. A firm, quick jerk is then applied parallel to the shank while continuing to exert pressure on the eye of the fishhook."

As she describes this quick, sudden movement, she executes it as well. The previously experienced pain, shrieking and thrashing was child's play to what happens now. Even the erstwhile Tracy is shaken up by the intensity of my howling and kicking. She continues nevertheless; "the fishhook may come out with significant velocity in response to the sudden jerk so the operator and bystanders should remain out of the line of flight when the jerk is applied." As the jerk to whom the sudden pull had been administered, I knew exactly what she was talking about. Everybody in that forlorn, dimly lighted clearing has, in response to that sudden action, jumped clearly away from me and out of the said "line of flight." I lie there, in considerable pain, abandoned once again by the four scuffed sneakers, completely devoid of said "holy" blanket, experiencing not just severe agony but also being acutely aware that, quite suddenly, a bodily liquid is running down my leg. My fervent prayer is that it's blood.

It has to be traumatic. Not just for me but for the other participants as well. The scene is now highlighted by the awful retching of several of my medical attendants. The situation is getting grimmer by the moment.

Carol, the leader, showing the initiative characterizing scout leadership, takes charge. She issues terse commands. "Anita, take Lisa and Ann, down to the river, wet some cloths and come right back. We have to clean up the blood before it attracts scavengers."

I'm feeling better already; it is blood and not urine.

"Samantha and Ruth, take turns applying pressure to the wound to stop the bleeding. The pressure should be adequate to compress but not enough to cause excessive pain. And girls, replace the blanket before you start."

This is not getting any easier.

"Shirley," I gasp, "Where is Shirley?" I manage to squeal, "We have to do something. We have to get me out of here." Carol continues to lead. "You're absolutely right!" She turns to her erstwhile troop. "We are not able to treat the injury satisfactorily here in the wilderness. Remember our drill on medical evacuation from the field. We're going to implement it immediately. Who remembers the directions for making a makeshift stretcher out of branches and clothing?"

The retching and crying stop. Nothing motivates the troops like authority and command. Samantha and Ruth jump up and abandon the pressure to my bleeding buttock. They grab the branches proffered by Lisa and Ann, snatch the blanket that has been covering me and promptly improvise a make shift stretcher. I am impressed by their alacrity and their skill but somewhat disturbed by the resumption of oozing from the now neglected wound.

"Girls, we're going to lift the victim and transfer him to the stretcher. We will try to position him so that the wounded area is right over the opening in the blanket. This will enable us to transport him over a relatively far distance with minimum pain and trauma. And girls, scout modesty requires us not to stare at the victim's exposed private parts! Let's be professional and mature – and stop the giggling!"

I'm lifted by a multitude of hands – very gingerly rotated, presumably with my private parts being discretely ignored – and placed onto the cleverly conceived but poorly contrived litter. The litter was not designed to take my weight. My body tears through the hole and comes crashing down onto the rocks below. I hear the crack even as I feel a new agony through my left leg. There is no question; my saviors have succeeded in breaking my leg.