How The Legend Of ‘Cheater Akin’ Began

Stephen Barrett DPM FACFAS

Rectus B. Akin was on trial. Those folks back in his settlement in middle Kansas knew him well, respected and loved him. When they heard that the immensely disliked marshal from the northern Dakota Territory had arrested Rectus B. on trumped up charges, they were mad. Mad as hell in fact. The simple fact was that the folks up there did not know Rectus B. and what he had done for the people of the Kansas territory.

Rectus B. Akin was an itinerant foot fixer. He started out a barber as many did but quickly became known for his work on the lower extremity. A posse quickly assembled to make the 10-day ride up through the Sioux nation and since they were comprised of a fair amount of members from the “Straighttoe” nation, passage was easy and without confrontation. The Sioux always welcomed the Straighttoes.

It was cold and dusty in the one-room wooden courthouse located at the end of Main Street. It was a dirt street, no more than 600 yards long, and really the only street in McBrideville. The courthouse had the dubious distinction of being burnt to the ground by disgruntled natives several times in retribution for confiscation of their lands, their water, their women (it was the water that really fired them up) and other unfair rushes to misjudgment. Bottom line: those northern gold mining bastards just did not get it. Let it be, share a nugget now and then, and don’t rustle the other man’s teepee. In our posse was one of the best legal minds, Angle D. Austin, who was quick-witted and had the demeanor of a starving bobcat with its tail caught in the steel jaws of a bear trap.

Angle D. knocked open the doors of the wooden courthouse, kicking the mud off his spurs. Before he was even halfway to the front of the court, he inquired of the judge, in a deeply loud and angry voice, “What are the charges against my client, your honor?”

The scraggly bearded judge pounded his gavel several times in disapproval. “I presume you are referring to Mr. Rectus B. Akin?”

“Damn right, your honor. What are the charges?” he said in his long Texas drawl. There were only a few townsfolk in the courtroom at the time. However, with this great theater about to happen, it was a given that the court would be packed in a day or two when the news spread that perhaps the best event to hit McBrideville (since Cooter Magee stole a wagon full of Kentucky moonshine and sold it to the Sioux) was now about to unfold.

“He’s a scoundrel and a cheater,” the judge stated, flatly pounding his club of a gavel.

Angle D. removed his hat, ran his fingers through his long gray hair and approached the bench. Looking up at the scraggly honorable one, Angle D. turned back to his client, pointed to him and said, “You are alleging that my client is a cheater? Cheater? Cheater in what?” he said with disbelief.

The judge motioned Angle D. away from his bench. “Your client is known around here in these parts as someone who doesn’t follow convention. “What convention?” his defense counsel asked.

Rectus B. sat at the table fidgeting more than a highly perfumed light-skinned girl in a mosquito-infested Alaskan forest. Most folks simply did not know what most of this was about but got the quick and accurate impression that this was going to be a contentious debate. The trial started with the prosecutor explaining to the gentlemen of the jury (there were no women as there were only six in the city and they were prevented from serving at that time because they could not vote).

He stood and approached the jury. “Gentlemen, this is a true case of heresy and never mind that there is not really a true victim here. The patient had a perfect result and is in fact ecstatic with her result.” He pounded on the banister in front of them. “No, gentlemen, this is a crime against tradition. Doing something that flies in the face of convention and doing it the way we normally do the job.”

The prosecutor went over to the blackboard and picked up the chalk. “This is what the preoperative X-ray looked like.” (Don’t get hung up on the anachronistic history of this tale—I just wanted it to take place in something like the OK Corral. Akin didn’t do his deal until about 1925 and Roentgen didn’t discover X-rays until 1895, but what the hell, writers have to have some fun too.)

The tall prosecutor was a great artist and quickly chalked out an “X-ray” showing an intermetatarsal angle of about 14 degrees, a laterally deviated hallux, a perfect joint space and a tibial sesamoid position of 7. He even drew the overlapping second digit. It was a perfect black and white rendering. He then outlined the long list of allegations:

1. Failure to address the intermetatarsal angle with a metatarsal osteotomy
2. Failure to realign the sesamoids
3. Removal of just the bump
4. No catgut suturing
5. Not doing it the way we do it around here and doing it through a little tiny hole

A Closer Look At The Evidence

The jury seemed bored and unmoved. The judge wanted this thing over quickly and prodded the prosecutor to proceed with his case. “Present your evidence, sir,” he commanded.

The prosecutor called Rectus B. Akin to the stand. Rectus B. was now shaking more than a Labrador getting out of cold water as he walked to the witness stand. “Tell me why you did what you did for this condition,” he asked.

Clearing his throat and blasting a spit of tobacco so hard into the copper spittoon it sounded like a gunshot, Rectus B. answered. “There was no restriction or pain with her range of motion. The medial bump was small had no irritation or bursa, and the only problem the patient had was that she couldn’t get into her boot with the second toe up so high. She needed to get back herding quickly and would not tolerate a big open operation. Sir, she simply wanted a straighter big toe and a second toe that was in line with the others.”

The prosecutor shook his head and kept glancing over to the jury to see how they were receiving Rectus B.’s testimony. He couldn’t tell. He turned back to the defendant. “Why and how did you do that through such a little hole?”

The nervousness seemed to be leaving Rectus B. by now and he started back in. He was no longer shaking. “The railroad men showed me the drill bits they were using to hollow out the tunnels for the transcontinental railroad. I thought if they could use these big bits for carving holes in granite, I could make one smaller to cut through bone and I just did that. An old Irishman down at Isham’s Blacksmithing made me a couple and I could cut that bone precisely while protecting the soft tissues and simultaneously created an interdigitation causing the two opposing edges of the osteotomy to ‘suck’ together like Velcro when compacted.” (Again, George de Mestral did not discover Velcro until 1948 but you get it if you have stuck with this drivel for this long.)

“And the other cool thing,” he continued, “is that the drill does not cut through the periosteum. This lets me preserve all the soft tissue around the bone and allows for inherent stability. Therefore, no catgut (read: fixation) needed. It is stable by nature and I can move that damn thing over as far as I want and rotate it at the same time. When you leave the joint alone, patients have virtually no loss of motion and joint function is excellent. So what if you don’t see the tibial sesamoid back where it wants to be. Who cares? Are we doing this for a better chalkboard drawing?”

The prosecutor sat down and Angle D. got up right away. He called his first witness, Ms. Jane. She was so poorly dressed, almost to the point where some would call it a calamity. “How are you today, Ms. Jane?” he asked as she positioned herself in the witness box.

“Fitter than a fat iguana on a hot rock.”

“Please take off your shoe and show us your foot, the one that Rectus B. fixed,” he instructed her. She complied by pulling her dusty boot off as well as the sock with a large hole over the end of her big toe, and rested it on the banister of the witness stand. Wiggling her stinky toes freely, she said, “There you are, sir. Peer away.”

Angle D. stuck his chiseled mug as close to her foot as he could stand and looked intensely at it. “Seems like it looks normal and works well?”

“Damn right it does, sir. Before ole Rectus B. got ahold of it, I couldn’t get that boot on for nothing,” she responded, pointing down at her dusty boot.

“You’re happy?”

Taking a second to spit a big wad of tobacco spittle into the copper spittoon just in front of Angle D.’s feet, she smiled wide, displaying several small pieces of black tobacco on her yellow-stained front teeth. “Happier than I’ve ever been.”

Angle D. looked at the gentlemen of the jury and said, “No further questions, your honor.” The prosecutor hung his head and echoed the same. Cross-examining her would be futile.

It took two hours for the jury to come back. The judge called for the verdict. As he opened the paper, the court was quiet and anticipating. They all knew that Rectus B. would win. “Please rise,” he instructed Rectus B.

“The jury has found you guilty.”

Angle D. was aghast. “Guilty? Guilty of what?”

The judge pounded the bench repeatedly to silence the suddenly buzzing courtroom. “They have found you guilty of not following traditional ways of doing things and your sentence is that you will now be called ‘Cheater Akin.’ Court dismissed.”

Angle D. and Rectus B. sat at the defendant’s table well after the entire room was cleared discussing their verdict. Angle D. congratulated “Cheater” on his victory for surgical improvement and consoled him on his personal loss of henceforth being known as Cheater Akin.

“Ah hell, Angle D., being called Cheater isn’t the worst thing in the world. At least folks will be able to remember that when they’re looking to get fixed.”

And so the legend of the Cheater Akin began.

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