This girl’s leg was 95% severed in a boating accident. How doctors saved her life — and her limb

Leslie Baker Toews held her daughter, Augusta, and began to sing, because her heart was breaking, because her seven-year-old child, who hiked and biked and skied and swam and laughed and turned cartwheels on the dock at the family’s cottage on Lake Rousseau, was dying in her arms.

Bleeding and dying on a perfectly calm lake in Ontario cottage country on a Monday afternoon in June 2014 that started so innocently, with Leslie driving the family boat and her husband, Eric, waterskiing behind it.

Augusta sat up front, spotting for her Dad. But when Eric fell and Leslie eased back on the throttle Augusta fell, too, tumbling into the water and under the boat.

Peter Munk Cardiac Centre<br />
Peter Munk Cardiac Centre
Nurses at SickKids nicknamed “Sunshine.” She never seemed sad. If anything, she was determined.

“She came up behind the boat and at first I thought, ‘OK, she is going to be OK,’” Baker Toews says. “Then she started screaming, “My leg is gone.”


Augusta’s left leg was 95% severed at the mid-thigh, and left hanging by some threads of skin and muscle, bleeding profusely. A metal fin on the boat’s hull had sheered through the bone, the blood vessels and the sciatic nerve. Augusta’s father would tie off the leg with the boat’s bow line, yanking as hard as he could on a makeshift tourniquet to staunch the bleeding.

Her mother sang to her. Onlookers wept.

“We really believed that we were helping Augusta onto her death that day,” Baker Toews says. “I was trying to keep her awake.”

Augusta was airlifted to in Toronto, a journey that included an emergency stop, midway, so that the air medics could take on additional blood supplies, just to keep Augusta going.

Dr. Thomas Lindsay, a vascular surgeon at the Peter Munk Cardiac Centre across the street from Sick Kids, happened to be at the children’s hospital when they wheeled Augusta in.

“It was very clear when we took off the bandages that the top and the bottom of the leg were practically disconnected,” he says.

But amid a terrible mess were a few slivers of good fortune, and reasons for hope: the wound to Augusta’s leg was clean, almost like a sabre cut. Had it been otherwise, surgeons would have amputated. As it was, Dr. Lindsay and a cast of other physicians saw an opportunity to save both Augusta’s life — and the leg.

“We thought, we can put this back together again,” he says.

They operated for over six hours, weaving together veins and muscles, flesh and bone, making a little girl whole again. But another battle lay ahead. One that would see Augusta become patient zero in an experimental new procedure that had never been attempted on a child before. Anywhere.

Augusta’s sciatic nerve — the longest, largest nerve in the body — remained severed after the initial surgery. The nerve is the command centre for the leg, controlling movement, muscles and sensation. Without a functioning sciatic, a leg might be technically alive, but effectively lifeless, with limited motion and feeling, and rife with neuropathic pain.

Peter Munk Cardiac Centre<br />
Peter Munk Cardiac Centre
The wound to Augusta’s leg was clean, almost like a sabre cut. Had it been otherwise, surgeons would have amputated.

Dr. Gregory Borschel, a nerve specialist at Sick Kids, reconnected Augusta’s sciatic using nerve grafting, a tried and true technique. But to bring it back to life he reached into his medical bag of tricks, zapping it with an electric current in 30 volt bursts by using a machine that, in his words, “looks like something straight out of the 1950s.”

“When we told the family that this is experimental, but this is what we think we can do, they jumped on it,” he says.

The electricity, in theory, would jump-start the nerve’s functions. Stimulating its regeneration — in effect, its growth — from its connection point in the base of Augusta’s spine back down past the point of injury, right down to her toes.

Toews familyToews familyThe family is back at the cottage this week, for the first time since the accident.

The surgery lasted 10 hours. And there was one additional factor at play: Augusta.

Nurses at Sick Kids nicknamed her “Sunshine.” She never seemed sad. If anything, she was determined. She returned home to Calgary in a wheelchair, but parked the chair at her front door and dragged herself around the house. She was given crutches. She decorated them. A walker also sat unused. As Augusta gained strength, she began to crawl. And then she hopped. And then on October 13, 2014 she took her first steps. By mid-November, a follow-up exam showed the sciatic was healing.

“We were surprised, because it typically would take a year to get some movement back,” says Dr. Borschel, who has since incorporated electrical stimulation to treat a host of other pediatric nerve cases. “Augusta has an indomitable spirit.”

Toews family photoToews family photoAugusta jumping off the boathouse at her family's cottage.

Augusta was back at the family cottage last week for the first time since the accident. She raced her two older siblings down to the water. She was the first to jump in.

“She was first off the dock,” her mother says. “Nothing can stop Augusta.”

Toews family photoToews family photoAugusta during her recovery in hospital.
Toews family photoToews family photoAugusta visiting the crew of Ornge air ambulance last week.
Toews family photoToews family photoAugusta tubing at the family cottage.

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