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You work in an ER long enough, you see some weird stuff - but most of it is pretty gross. I do remember one lady who came in with massive open fractures of both her upper and lower legs, the injuries incurred from having jumped (or been pushed) out of her husband's car at freeway speeds. When her feet hit the ground, both of her femurs literally exploded, laying open both of her thighs from buttocks to back of knees in what would have certainly been fatal wounds if untreated. Her lower legs were also shattered, with open fractures, and when she arrived on the EMS backboard, her legs were literally tied in a half square knot.

She was conscious and alert, and in such deep tissue shock that I think that she wasn't feeling as much pain as you'd expect. We had to actually untie her legs to begin assessing the full extent of her injuries. These were the single most massive wounds I have ever seen in somebody who survived. When I see pictures or videos of American GIs who've just sustained catastrophic injuries to their legs from IEDs or landmines, they mostly don't look as bad as this woman's legs looked. She had chucks of bone sticking out of her legs all over the place.

11 months later, she walked out of the hospital. I used to see her around town occasionally afterwards. But, she never walked fully upright without a cane again. It was never established by law enforcement whether she jumped or was pushed from that car, but her husband showed up in our ER not too long afterward with a couple of fatal .45 caliber gunshot wounds in the chest.

But seeing two mangled human legs tied in a knot was pretty weird for me.