By Matthew D. LaPlante
The Salt Lake Tribune
December, 2014
"IT ALL COMES DOWN TO LUCK"
Sixty seconds, tops, and Bryant Jacobs would be out of the cold, the storm, the sputtering snow. He'd be warming himself on the radiant hardwood floors of the home he shares with his wife and two stepdaughters in this southwest corner of the Salt Lake Valley. He'd slouch back into his favorite recliner, nestled into a fuzzy University of Utah blanket with a tiny white dog on his lap.
But tonight, the 33-year-old Army veteran has told himself, he's kicking this 18-year habit. So damn the cold, damn the wind, he settles into a chair on his backyard patio, staring blankly at a shimmering vinyl fence as it sways in the storm.
Squeezing the cigarette against the stub of his long-lost index finger, he sips it like a good bourbon, as he will the thousand-dollar bottle of Pappy Van Winkle a friend brought over earlier this evening.
Tomorrow, when the sun rises above the bright white ridges of the Wasatch Mountains, Jacobs will wake up, shower, place a single sneaker into a small travel bag, and drive to the hospital.
There, he will go to sleep. And when he wakes up, his right leg will be gone.
It's been nearly 10 years — likely the longest any wounded veteran of Iraq or Afghanistan has endured before resorting to amputation. In that time, he's learned to walk again. With a cart, he can golf. On an ATV, he can hunt. He's grateful for his life.
But he's tied to a cane. A wheelchair for longer trips. Exercise can be excruciating. A careless touch can send shocking pain through his leg. A trip to the mall can cost a day of recovery. He feels so old.
And so he's made a choice — a wager that becoming less will make him more.
Jacobs takes one last drag and gives the ash to the wind. It disappears among the flurries of snow.
•••
Jacobs is 10 or 11 when he gets his first glimpse of war.
His stepfather, a helicopter pilot who earned two Purple Hearts, a Bronze Star and the Distinguished Flying Cross in Vietnam, hangs a sheet on a wall in their California home. He pushes an 8mm projector into the middle of the room.
Jacobs stares in awe at the flickering images of Stephen Scheiding as a young man wearing flight gear and standing stoically beside his chopper.
"I don't even remember what all the pictures were of," he says today. "But I remember thinking that he was cooler for having been in the military."
Scheiding tells his stepson about how he and a close friend joined up. But he never senses Jacobs has any interest in doing the same.
Later, though, between dribbling basketballs, dialing up the 15-inch subwoofers in his Pontiac Sunfire and flirting with girls at Tracy High School in California's Central Valley, Jacobs briefly considers following his stepdad into the service. He likes the idea of being a Navy SEAL.
Like a lot of teenage whims, it's fleeting. After graduating in 1999, he moves to Utah to be close to his dad and other relatives.
Jacobs' parents had divorced when he was a toddler. His father, Rex, is working for a plumbing company and living in the Salt Lake City suburb of West Jordan.
They drink together. They party a lot. One day, at 5 a.m., the younger Jacobs rouses a crowd of revelers in various states of drunkenness and drives them out of their shared apartment.
"That sort of thing happened a lot," he says. "It probably wasn't real healthy, but it was fun for a while there."
He gets a job tracking down debtors and persuading them to make payments on their credit cards.
"It was a job, but not a career," he says. "It sure as hell wasn't an adventure."
For that, he heads for Big Cottonwood Canyon, where there's lots of snow and plenty of speed on the aspen-lined slopes of Brighton's Clayton Peak and in the rifts and gullies of Solitude's Honeycomb Canyon.
For the avid snowboarder, it's an exciting time to be in Utah. The Olympics are coming. The party will be epic.
And then, suddenly, none of that seems important anymore.
•••
•••
Jacobs is grabbing breakfast in the cafeteria at his office when all of the televisions hanging from the ceiling suddenly blink to images of New York's burning World Trade Center towers.
As U.S. troops spread across Afghanistan's rugged landscape in the months after the Sept. 11 attacks, Jacobs and his friend Dustin Marble begin visiting an Army recruiting office in a West Jordan strip mall.
"You're not where you want to be. I'm not either," Marble tells Jacobs. "Let's join."
Jacobs passes the military's vocational aptitude test with fair marks in every category. He scores highest on questions measuring clerical skills, but a desk job doesn't interest him.
Marble signs up for the infantry. Jacobs keeps looking.
"Wanna blow shit up?" his recruiter asks.
"Yeah, that would be neat," Jacobs says.
Fine, the recruiter says, you can be a combat engineer.
It takes more than a year for Jacobs to get a recruiting waiver for the psoriasis that has pocked and scabbed his skin since high school. As he waits, Afghanistan's Taliban-led regime quickly topples.
With a powerful political wind at his back, President George W. Bush looks to Iraq. Bush's defense secretary, Donald Rumsfeld, predicts a war there won't last long. "Five days or five weeks or five months, but it certainly isn't going to last any longer than that," Rumsfeld says on a radio call-in show.
In late February 2003, as U.S. leaders begin piecing together a "coalition of the willing," Jacobs' medical waiver is finally approved. His enlistment contract requires no fewer than four years in the Army. His starting pay is $35 a day.
The United States invades Iraq on March 19. By the time Jacobs leaves for basic training on April 29, the Iraqi military has been decimated. Dictator Saddam Hussein is on the run, though his purported weapons of mass destruction have not been found.
Two days later, as Jacobs drops for his first pushups at Fort Leonard Wood in Missouri, Bush stands aboard the flight deck of the USS Abraham Lincoln before a red, white and blue banner that reads "MISSION ACCOMPLISHED."
"In the Battle of Iraq, the United States and our allies have prevailed," Bush says. "We do not know the day of final victory, but we have seen the turning of the tide."
"I don't want to make it seem like I wanted to go to war," Jacobs says, "but there is this thing where it felt like something might pass you by."
But when Jacobs arrives at his first duty station, with the Army's 65th Engineer Battalion at Honolulu's Schofield Barracks, it's clear the mission in Iraq is far from over.
He's picked up at the airport by a cousin, Army officer Matt Schrom, who is assigned to the same division. Schrom teaches Jacobs how to starch his uniform and shape his beret — and tells him to get ready for war.
Before deploying, Jacobs flies home to Utah. His mom and stepfather are there to meet him; he and his stepfather drive to the desert to shoot guns.
Scheiding reminds the young soldier that he hasn't relinquished his authority to make moral decisions. "But whatever happens," he says, "we're going to support you no matter what."
The politics of the world won't matter much, Scheiding says. "From the minute you get on that plane your only job is to keep the soldier next to you alive."
When it's time to return, the following week, Jacobs pulls his mother into his chest and holds her there as she cries.
•••
Desert fatigues and a hulking camouflage flak vest hug Jacobs' scraggy shoulders. A Kevlar helmet envelops his clean-shaven head. A fellow soldier lifts a camera. Jacobs clenches his jaw and squints his eyes.
It's Jan. 25, 2004, when his unit arrives in Kuwait. Two days have passed since the CIA's admission that Iraq didn't have the stockpiled weapons U.S. leaders claimed. But that changes nothing for Jacobs and his team. Some of the soldiers remain convinced the weapons are still out there. Most don't care either way.
Carlos Muniz, a specialist from South Texas, is among the few U.S. soldiers in the 65th who have already completed a combat tour in Iraq.
"In Iraq it's like, do what you're told and do whatever you have to do to protect your brothers," Muniz remembers telling his comrades. "What's out of your control is out of your control."
As most of the unit's members cross the border en route to the northern Iraqi city of Kirkuk, the military announces the interception of a 17-page letter to senior al-Qaida figures from Abu Musab al-Zarqawi. The Jordanian militant is Osama bin Laden's chief aide in Iraq and, at the time, one of the most famous terrorists in the world.
The American soldiers in Iraq are "mouth-watering targets for the believers," he writes in the letter, apparently intended for bin Laden. "These, as you know, are the most cowardly of God's creatures. They are an easy quarry, praise be to God."
A new war is under way. U.S. forces are no longer fighting pockets of resistance among Saddam loyalists. Now they are fighting insurgents — from Iraq and beyond — including jihadists bent on killing Americans and seeding a sectarian civil war.
The insurgents' weapons of choice are increasingly powerful improvised explosives, often cobbled together using old mortars or rockets from ammo dumps that were left unguarded after the invasion. The bombs are buried underground or hidden in roadside rubbish piles. They are detonated with pressure plates or jury-rigged remote controls.
Twenty-three U.S. service members are killed in Iraq the month Jacobs' unit arrives. The next month, March 2004, the fatalities more than double. And in April, the deaths more than double again.
"They weren't any different than me, they were just in the wrong place at the wrong time," Jacobs says. "One second earlier and you're fine. A second later and you're not. It all comes down to luck — bad luck."
A LIFE-ALTERING EXPLOSION
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| Photo by Paul Fraughton |
There's no time to wonder why. Bryant Jacobs feels his body slam against the ground. He's flailing. Tumbling over and over.
He comes to rest on his stomach. He tries to breathe. The air is hot and black with smoke and dust.
He strains his neck back, lifts his head and tries to push himself up. That's when he notices the top of his left index finger is gone. A bone protrudes from a mess of dirty, bloody tissue.
He wonders, for a moment, where the rest of it went.
"Jacobs!"
The sound of his name breaks through the ringing in his ears.
Sgt. Ming Chu is suddenly at his side. Chu flips him onto his back and puts pressure on his wounds. His stomach. His chest. His hand. Both legs — shredded in the blast.
Specialist Carlos Muniz sees everything from the gunner's perch of his Humvee, two trucks back.
A tremendous boom. A huge black cloud. A wave of dirt and metal and smoke. He cowers in the turret while hell passes over him.
As the dust settles, the driver of Muniz's truck, Chris Harry, creeps the Humvee forward. Two soldiers are lying in the dirt.
Muniz instantly knows who they are.
Jacobs, to the right, is on his back. Sergeant Chu is leaning over him, rolling out a tourniquet, covered in blood.
To the left, his long and slender frame curled up like a child hugging a stuffed animal, is David Mahlenbrock.
The two soldiers had been sitting side by side in the bed of their Humvee.
No one is by Mahlenbrock's side, but Muniz cannot go to him — the gunner stays with the truck. That is how they have trained. He tightens his hands around his rifle, locking himself to his post.
Chu runs back to get another medical kit.
"Now," Muniz remembers thinking. "Now he will help Mahlenbrock."
But Chu goes back to the right.
But Chu goes back to the right.
"Why's nobody helping Mahlenbrock?" Muniz calls after Chu.
"How come nobody's helping him?"
Chu stops and turns. He looks up at Muniz and shakes his head.
They call for a helicopter, then decide not to wait. The soldiers grab handfuls of Jacobs' tattered uniform and lift him into the flatbed of Muniz's truck.
At last Muniz can do something to help. He cradles Jacobs in his lap. He hugs his head and talks to him and tries not to look down at the younger soldier's mangled flesh.
He doesn't tell the 24-year-old how bad things look. He doesn't tell him that Mahlenbrock's tattered body is in the shattered truck they're dragging back to Kirkuk Air Base in northern Iraq.
Jacobs begins to drift asleep.
Muniz tries nudging him. He tries yelling at him. He even tries startling him. Repeating a joke they've been telling each other — in the crude way soldiers joke in war — Muniz tells Jacobs that his penis has come off, and that he has it in his hand, and that he is going to do bad things with it.
Jacobs stirs, slightly.
Muniz slaps him. It feels good, for some reason, to slap him.
Jacobs' eyes pop open, then slowly close.
Muniz slaps him again.
"You gotta stay awake."
"I'm so tired."
"You gotta stay awake."
Muniz keeps talking. To Jacobs, the words are unintelligible.
The helicopter meets the convoy halfway to Kirkuk. Jacobs is yanked from the Humvee. His leg tumbles, dangling from the stretcher.
He screams. Like a big breaking wave back on Honolulu, where he trained with the Army's 65th Engineer Battalion, the pain slams into him and washes over his body.
He screams. Like a big breaking wave back on Honolulu, where he trained with the Army's 65th Engineer Battalion, the pain slams into him and washes over his body.
He passes out.
Then, for a fleeting moment, he's back. There are doctors standing over him with bloodied hands.
For three weeks, that's all he'll remember.
•••
It's late in the evening on Dec. 3, 2004, when Sherry Scheiding gets the call at her sailboat, where she lives with her husband in the San Leandro Marina in San Francisco Bay.
A man who identifies himself as Mr. Rice tells Scheiding her son has been wounded. He's not expected to live.
Sometimes, Rice says, mortally wounded soldiers make it to Landstuhl Army Regional Medical Center in Germany before they pass.
Perhaps she can get there before her son dies. Perhaps she'll have the chance to say goodbye.
•••
The top of his thigh is splayed open just below his groin.
The skin of his lower leg is split along the calf. Blood and fat and muscle gush from the wounds. Gravel, dirt and shiny flecks of shrapnel, embedded in the crimson muscle tissue, glitter under the surgical lights at the U.S. military hospital in Kirkuk on the afternoon of Dec. 3, 2004.
For soldiers in Iraq and Afghanistan, the rate of amputations is double what it was in Vietnam — mostly because combat medics and military field surgeons have gotten better at saving soldiers with severe injuries to their arms and legs.
But military doctors are also saving more limbs — even those as damaged as Jacobs' right leg.
Surgeons always try "to err on the side of limb salvage," says Major Benjamin Potter, an orthopedic specialist at Walter Reed National Military Medical Center who served in Afghanistan's volatile Helmand Province in the summer and fall of 2011.
So long as "a patient isn't trying to die on you on the table," Potter says, combat surgeons will do what they can to "really preserve all treatment options" — even if it's likely a patient will have to have an amputation when he or she arrives at a stateside medical center.
Jacobs' right leg isn't moving. With all the shrapnel and nerve damage, his medical records note, it's certainly possible it will need to be removed.
Over the next three days, as he's moved from Kirkuk to Kuwait to Landstuhl, then into the cavernous cargo bay of a C-17 Globemaster for a perilous nine-hour flight over the north Atlantic Ocean, a relay of care teams watches for signs of infection and clotting that might force an emergency amputation.
But right now, whether he keeps the leg is secondary. Jacobs' caregivers are focused on keeping him alive. And for the moment they're succeeding.
Scheiding gets another call. Don't go to Germany, she's told. Come to Walter Reed — but don't get your hopes up.
•••
Jacobs arrives at Walter Reed Army Medical Center in Bethesda, Maryland, on Dec. 6.
It's a week shy of the one-year anniversary of the capture of Saddam Hussein by U.S. forces in Iraq. A records technician classifies his wounds with the code "E998," meaning the injuries occurred "after cessation of hostilities."
Doctors use tweezers to remove metal shards and gravel flecks as small as grains of sand, and pliers for bomb and Humvee fragments the size of fingernails. They extract hundreds of shrapnel pieces from Jacobs' stomach, back, buttocks, legs, hand and the back of his head.
They pull his intestines away from his body, cut away the ravaged tissue and rechannel what remains to a colostomy bag. They clean and stitch his left index finger at the proximal joint.
It's clear that his right leg could be a years-long work in progress. The surgeons drive screws into his shattered femur. They graft healthy veins onto areas left in tattered strings. They cut away the ragged flesh, binding together the cleanly cut ends with layers of sutures.
It's unclear to what end. Most of the nerve endings past his knee have been blown away.
That gives Jacobs' care team pause. There's no right or wrong answer, they tell his mother, but amputation might help him live a more active life. When not at her son's bedside Scheiding pores through research on nerve damage, looking for answers.
Forty miles south of where Jacobs is being treated, scientists at Johns Hopkins University are exploring the possibility of transplanting stem cells to promote nerve regeneration in damaged arms and legs. Lab tests on mice look promising.
Wanting to preserve all possible outcomes for her son, Scheiding tells his doctors that she doesn't support an amputation.
A decade later, it's still hard for her to talk about.
"It was 50-50," she says. "As a parent, making that kind of decision, there weren't any right answers."
•••
•••
Jacobs comes to believe he slept through his first days at Walter Reed. His medical records, however, indicate he is awake in fits and starts, "anxious at times, and suspicious of everyone."
He fights nightmares and hallucinations. He trashes his hospital room. A doctor signs an order to strap him into his bed.
When he becomes more conscious and calm, nearly a month has passed. He is tangled under a web of tubes and wires, pinned by casts and steel rods in a critical-care unit.
His mother and stepfather are there.
The first thing Jacobs can remember with any clarity is eating breakfast. On the hospital tray before him are waffles and sausage. "You're going to throw that up," Stephen Scheiding warns.
Jacobs eats it anyway. Then he vomits it into a bedpan.
•••
Thirty-nine surgeries come and go in three months.
Surgeons slice thin layers of healthy skin and graft it on areas that are badly damaged. When some grafts fail to take, they rip off the dead skin and start again.
They fight streptococcus, E. coli, and Bacteroides fragilis.
They battle Jacobs' pain with inexact artillery. Among other drugs, he is given acetaminophen, oxycodone, tiagabine, warfarin, ranitidine, nortriptyline, enoxaparin and methadone.
Six months after his arrival, he's permitted his first trip home.
At the Salt Lake International Airport, his plane is greeted by airport police and firefighters, lights and sirens blazing. It's a hero's welcome. At a TGI Friday's restaurant in Sandy the next day, the waitstaff pushes three, then four, then five tables together to accommodate his gathering friends and family. His grandmother has made T-shirts for the occasion. Black with white lettering across the back, they read: "In honor of Spc. Bryant Jacobs."
He rolls cautiously into the restaurant, piloting his wheelchair around a party of a half-dozen women in red hats. He asks for a Dr Pepper and picks up a menu.
"So, what now?" someone asks.
Jacobs stares out the restaurant window.
"Well, if there is one thing I want to do," he says, looking out at Salt Lake City's dominating mountain skyline, "it's to get on my snowboard and ride."
It is early June 2005. The Wasatch Range has just shed its powder-white veil. Utah's resorts won't be open again until November.
Five months. Somehow, battered and mangled as he knows he is, it seems like enough time.
A LIFE WITH NEW LIMITS
Bryant Jacobs expects to soar.
A year after arriving at Walter Reed Army Medical Center, he's still fighting pain and immobility. His legs don't work as they once did and never will.
But he's also come so far. At first he wasn't expected to live; later there were doubts that he'd walk. Now nothing seems impossible.
So, in February 2006, as the Winter Olympic torch is being lighted in Torino, Italy, Jacobs signs on for one of many adventures aimed at helping wounded warriors live fuller lives — a New York snowboarding trip.
He envisions himself cutting back and forth across the slopes, as he did so effortlessly in the canyons near his Utah home.
But that's not how it goes.
When Jacobs falls, he can't even lift himself off the snow.
"I had to have my instructor help me up — and then I'd fall again," he says. "I had been snowboarding for seven or eight years. I was used to being able to go to the top of the mountain, and now I could barely even get off the lift."
When he painfully hyperextends a foot, his instructor gives him a choice: Get down on your own or have ski patrol come get you. Jacobs can't stand, but he can't bear the idea of having to be carried off the mountain. Embarrassed, angry and disappointed, he scoots the rest of the way down on his board like a sled.
The trip is one of many reality checks that will mark the rest of his time at Walter Reed and beyond.
He has graduated from a wheelchair, and then from a walker — but he might always need a cane. The nerve damage in his legs has resulted in a condition called "drop foot," so he'll likely always walk with a limp and a slight dragging of his feet, too.
The damaged nerves around and below his right knee, hypersensitive since the blast, sometimes respond with excruciating jolts to the gentlest of touches. Even pulling on a sock can send shock waves coursing through his leg.
But at least he has his leg.
Three times a week, the medical evacuation flights from Iraq and Afghanistan arrive at nearby Andrews Air Force Base. In each plane, on average, is one person who has already lost an arm or leg or is about to.
"Be grateful," Jacobs tells himself. "It could have been so much worse."
•••
His family and doctors made the choice while he was still living under a haze of heavy sedation: His right leg would be rehabilitated, rather than removed — a process doctors call "salvage."
In the nearly two years that follow, no one has spoken to Jacobs about amputation — until he is about to be discharged from Walter Reed and relieved of his service to the United States Army.
"Why don't you just cut it off?" a therapist casually asks.
It's a question that, once a limb had been saved, would rarely have been asked in the past.
For hundreds of years, doctors viewed amputation as a desperate last resort. Today, with advances in battlefield medicine — and, in particular, the ability to get soldiers to combat hospitals quickly after injury — many limbs that would have been removed in past wars are being saved.
But that triumph has come at the same time as a revolution in medicine and public perception about amputees.
"The fastest man on no legs," South African sprinter Oscar Pistorius is vying to compete in the 2008 Summer Olympics in Beijing, prompting some to ask if his carbon fiber running blades give him an advantage over able-bodied athletes.
Army Capt. David Rozelle, who lost his right foot in a mine explosion in Iraq in the summer of 2003, has become the first amputee in modern history to return to combat. In the years to come, more than 60 others will follow in his footsteps.
"It used to be that society often looked at amputees with pity," says Joseph Webster, the director of the Veterans Affairs Amputation System of Care. "That's shifted, certainly to a large extent, to admiration."
And sometimes a bit of envy. Increasingly, Jacobs' appreciation for his legs is tempered by his desire to be as active as many of the people he sees on prosthetics.
But 22 months of Walter Reed's frustrating mix of medicine and military regulation have taken their toll. His discharge date has already been pushed back several times. It literally takes an act of Congress — an infuriated intervention by Rep. Jim Matheson — for Jacobs to be released to attend his sister's wedding.
"I just want to get home," Jacobs tells the therapist. 'But I'll think about it."
•••
Jacobs returns to the Salt Lake Valley in the fall of 2006 and enrolls at the University of Utah the next year. Between classes, he parties. He dates; he drinks; he gambles in Las Vegas and Nevada's smaller and closer border casino towns.
A veteran's disability check is no fortune, but as a single guy with no kids and no debt, Jacobs has no trouble affording his lifestyle.
Fully disabled veterans receive about what a starting teacher might expect to make. The money is tax-free, and Jacobs pays no tuition for college. His medical care is covered by the government.
"I feel like I'm making up for lost time," he says. "Everybody else was spending their early 20s partying, and I was spending mine in the hospital."
At Walter Reed, he was visited by Adam Sandler, Shaquille O'Neal, Dan Marino, the cast of "The Sopranos," a parade of politicians and two groups of NFL cheerleaders — the latter visits ranking among his favorites. He learned to golf from a wheelchair. He was flown to Chicago for a White Sox game.
There are fewer such experiences in Utah. But in a nation still struggling with how it cared for veterans of past wars — perceived mistakes some have vowed to right — there are still plenty of invitations.
He goes elk hunting and deep-sea fishing. He's a guest of honor at the Army-Navy football game. And, in the spring of 2007, he resolves again to master a mountain — on skis and adaptive poles mounted with ski blades — at the National Disabled Veterans Winter Sports Clinic in Colorado.
And this time it's more like he hopes.
"The outriggers just take some of the weight off my leg, so I can keep stable," he says after returning to Utah. "My preference would still be to be on a snowboard. But for now this is OK."
•••
They sit together, as new dates do, joking, laughing and moving closer as the night goes on.
Introduced through friends, Michele Clark Rogers at first thought Jacobs was a cocky party boy, arrogant and rude. The divorced mother of two young daughters didn't need someone like that.
But then she saw his dedication to his family and theirs to him. She saw his loyalty to his friends. She learned his story.
She reaches down and playfully squeezes his thigh.
"No!" Jacobs screams, jumping from his chair, backing away. "You can't do that! Don't you know you can't do that?"
For a moment it seems as though the entire restaurant stops.
He'll forget this ever happened. For her it will become a crystal-clear memory — one of the moments when she had to decide whether to take on the physical and emotional challenges of being his partner.
Yes, she decides, he's worth trying for.
Slowly she begins to trust him. Slowly, she starts to love him. When he asks her to marry him, she will say yes.
•••
New homes in The Cove, an upscale hillside subdivision in the southwest Salt Lake suburb of Herriman, are going for $350,000.
Jacobs won't pay a dime. Early in 2009, a national nonprofit, Homes for Our Troops, gives him and another wounded Utah veteran, Travis Wood, the keys to new homes designed to accommodate their disabilities.
The two veterans become instant friends, marveling at their fortune and confiding in one another about the tension they feel, having received so much when others didn't come home at all.
More than 4,000 U.S. service members have died in the ongoing wars.
Newly elected President Barack Obama has ordered the withdrawal of troops from Iraq — and has made clear his intention to draw down forces in Afghanistan. Critics say the move will leave those countries less stable; they question whether the lives lost and wounds suffered will be in vain.
Like Jacobs, Wood was wounded in a roadside bomb explosion. And like Jacobs, he fought at first to salvage his injured leg. But a year after being evacuated from Afghanistan, Wood asked his doctors to take his right foot.
In doing so, he joined a small but growing number of delayed amputees — those whose limbs are removed, usually by choice, more than three months after their injuries.
Military officials say about a fifth of all amputations are considered delayed. Like Wood, the vast majority make the decision within a year or two of their injuries.
It doesn't take long for Wood to decide that life is better on a prosthetic foot. He can move more easily and feels less pain. "If I could do anything differently at all," he says, "it would just be not to wait as long as I did." VA researchers doing clinical follow-ups for a study of 22 delayed amputees have found that's not an unusual perspective. Every single one would do it again.
Maj. Benjamin Potter, one of the authors of the study, expected he'd see high rates of satisfaction, but didn't think it would be unanimous.
Still, "amputation is not a panacea," Potter says. "It's a lot easier to take a limb off than to put one back on, so I want to make sure that patients understand that things might not work out as well as they'd like."
Jacobs is intrigued by Wood's experience.
"We talked about it quite a bit," Wood says. "I told him how it was for me — and you could see it was something he was processing."
•••
It's early in the winter of 2010. The snow at Solitude Mountain Resort is still a little light for most locals, but Jacobs can't wait.
He straps on his boots, snaps into his skis and glides up to an empty lift line in one of his favorite places in the world, the same canyon where he fell in love with snowboarding as a teenager.
Now 30, he'll start the day with what he expects to be an easy run using his adaptive poles, up the Moonbeam Express lift and down the Little Dollie run.
It's a beginner's route, but halfway down he has to stop to rest and readjust his boots. It's 40 degrees outside and the sun hasn't touched all of the slopes yet, but when he arrives at the base of the mountain, nearly a half-hour later, his face is dripping with sweat.
Slumping onto a bench, he loosens the buckles on his boots with a groan for each.
"What I don't understand is that I was doing this before — it was fine before," he says, remembering how the specialized poles helped him tackle much harder runs in Colorado. "Now there's just so much pain."
He bows forward and curses.
"I feel," he says, his voice almost a whisper, "like maybe I'm never going to get up there again."
It doesn't happen in a moment, or even a series of moments. The conviction just grows over time.
His mobility has plateaued — and at times it appears to be getting worse. The pills aren't controlling his pain.
He doesn't feel whole.
At an appointment with a doctor at the Veterans Affairs hospital in Salt Lake City, Jacobs asks about amputation.
The doctor laughs; there are so many other therapies to try, he says.
"The thing is," Jacobs says, "I've got all of these friends who are amputees. They're out running and hiking. They're doing all these things I can't do."
It's true that prosthetic technology is advancing, but so are medical interventions that can provide more function and less pain. Give it some more time, the doctor says.
Jacobs concedes for the day.
But he's made up his mind. He'll finish school and then he'll ask again.
Faced with resistance from VA doctors, he'll keep asking.
A VETERAN'S RESOLVE GROWS
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| Photo by Scott Sommerdorf |
He predicted the ball would end up here — it sometimes does when he tries to reach this green from the tee — but he keeps trying to clear the ditch anyway.
An arcing chip shot puts the ball back into play. He flips his wedge over in his right hand and does the same with the putter in his left.
Using the clubs as canes, he shuffles his way up the gully's easiest slope.
Under normal circumstances, he wouldn't be playing this early in the season. But these aren't normal circumstances.
For one thing, it's 62 degrees out. In Utah. In February.
For another, this is likely to be his last round of golf on two natural legs. The doctors at the George E. Wahlen Department of Veterans Affairs Medical Center in Salt Lake City have finally consented to his wish: In two weeks, Jacobs is scheduled to have his right leg amputated.
He knows it's a gamble.
"I could run into complications," he says, lighting a cigarette after the nine-hole round of mostly par golf — played, as always, from a cart. "I could run into infections. Potentially I could lose my leg all the way up to my hip. But I also know that nothing is going to change for the better at this point unless I try."
He pats a hand on his belly. He's 50 pounds heavier now than he was when he joined the Army. He's tried to stay in shape, but his limited mobility makes it tough.
Two men in yellow sweaters — one who looks to be in his 60s and the other who might be a decade or two older — pass in a cart.
"Look at me," the 33-year-old says. "I'm walking slow. I need a cane. I can golf — and that's great because I love to golf, but I didn't think this would be my entire life.
"Tomorrow when I wake up, I'm going to be in pain. I'm going to be in pain and I'm really not going to be able to do anything at all — just because I played nine holes of golf today."
The cigarette is gone now. Jacobs grabs the remaining pack of Marlboro Lights from the golf cart dashboard and shoves it into his pocket.
"I'm ready to act my age," he says.
•••
Aerosmith is blasting from the boombox outside.
There are alligator and crawfish sausages on the grill. Forty men are downing Buds, Coors and Millers, tossing horseshoes in alternating sun, rain and piercing wind.
This is Scott Generazo's second annual backyard horseshoes tournament. He was going to host it later in the spring, when the weather will be warmer and the sun will set later. "Then you went and screwed that all up," he tells Jacobs, whose upcoming surgery prompted the earlier date.
"This guy …" Generazo says, squeezing Bryant's shoulder. "This guy."
A retired Major League Baseball pitcher named Rheal Cormier goads Jacobs to do a shot of Fireball. Neighbor Nick Hoggan does a little online window shopping for prosthetic fairings — specialized coverings intended to give amputees a more natural contour; one is designed to mirror the matte black-and-chrome motif of its owner's motorcycle.
"That's cool," says Jacobs, who sold his Kawasaki Vulcan to his younger brother when he realized it hurt more to ride than it was worth. "But I don't need anything like that."
"Yeah, you do," Hoggan replies. "You just don't know it yet."
Another friend, Les Patterson, gives Jacobs a camouflage all-weather hunting coat as soon as the Army veteran mentions how much he likes it.
"I'm seriously not asking for your coat, man," Jacobs says. "You seriously don't need to," Patterson responds.
Noticing that others have gathered to watch the gesture, Patterson seems to grow a bit self-conscious. He grabs a chunk of Jacobs' shoulder.
"This guy," he says.
As the tournament grinds on, Jacobs sits alone on a worn gray sofa in Generazo's unfinished basement with his foot propped up on a cooler of Bud Light, nursing a Dr Pepper. "I don't really like to drink that much anymore," he says. "It doesn't mix well with my pain meds."
The tournament is entering its fifth hour. Jacobs has been out since the second round. But Dustin Marble, the friend with whom he enlisted a decade ago, is still throwing strong. And so Jacobs waits — patiently, though clearly hurting.
Horseshoes. That's all it took to leave him in pain.
•••
Back home after the tournament, Jacobs' living room is madness.
Marble's kids, Zander and Mason, are playing with Jacobs' stepdaughters, Karsyn and Lillian. They're screaming and laughing and sliding in their socks on the hardwood. The Disney Channel is on.
Jacobs disappears into his bedroom and returns in pajama bottoms. He's limping hard.
Marble fills a glass with Red Bull and vodka and begins an affectionate homily to his best friend's heroism.
"This guy," he says, "was working at Discover Card. He was young and having the time of his life. Getting drunk all the time. Girls — all the girls he wanted. Am I not right?"
"You're right," Jacobs says.
"Then 9/11 happened. And we loved our country so goddamned much, so we joined up. Am I not right?"
"You're right," Jacobs says.
At some point Marble's ode to the past becomes a lament for the future.
"You know that I'd trade with you, right? I'd give you my leg. You know that, right?"
"I know," Jacobs says.
"Like, like we could share the leg," Marble says, laughing. "You could get the leg today. And then I would get it tomorrow. And then sometimes we'd fight over it."
Jacobs rolls his head back and laughs. His belly shakes and his eyes water. It's the most relaxed he's looked all night.
•••
The car is gassed up. A small bag of clothes with a single shoe is waiting by the bedroom door.
It is nearly midnight on the night before his amputation, and everything is ready. But Jacobs is feeling unsettled.
Not uncertain. Not afraid. His resolve is unshaken.
When tomorrow comes, there will be a lot of pain. When that subsides, there will be struggle — for him and everyone around him. And most of all, he knows, for the woman he married last year. In some ways, he thinks, this will be harder on her than it will be on him.
He looks at her; he knows she'll understand. She won't see it as a cry for help, just a need for sleep.
"Babe," he says, "can I have one of your pills?"
Michele Jacobs gives her husband one of the pills she takes for stress. Tonight she'll go without.
•••
It's a few minutes after sunrise on March 18. Their mother and stepfather haven't yet stirred as 8-year-old Karsyn and 11-year-old Lillian slink from their bedroom to the family couch.
A map of Iraq flashes on the television as Lillian blasts past the cable news channels. This week marks 11 years since the beginning of the American war there. Officials are reporting 15 people have died today in a series of bombings in Baghdad.
The girls will spend their day playing board games with their aunt Sara, who emerges from the guest room to make an espresso.
"We are going to have a very good day today," she tells the girls in a breezy Italian accent.
She met Jacobs' younger brother, Zach, when he was in the U.S. Air Force and she was in the Italian Army. "If Bryant had not been injured, then Zach never would have joined the military," she says. "And if he hadn't joined, we never would have met in Afghanistan. We wouldn't have fallen in love. And I wouldn't be here right now."
She pauses for a moment to sip her coffee.
"I don't want to imagine my life any other way," she says. But of what her brother-in-law is about to do, she adds, "I would do anything if he didn't have to go through all of this."
Maybe, Karsyn adds, her mom and stepdad still would have found each other if he hadn't been injured — but they wouldn't be in this house, built for Jacobs by the nonprofit Homes for Our Troops.
Karsyn says she likes this home. She loves her neighborhood and her friends at the school down the street. She enjoys walking to the fishing pond just up the road. But she wishes her stepfather could enjoy life more.
"He really wants to take us snowboarding, but he can't because it hurts so bad," Lillian says. "He had a motorcycle but he couldn't use it. And one time he tried to get on a four-wheeler but couldn't even sit down."
"When he's in pain, he's in a bad mood," Karsyn says. "That happens a lot."
"It doesn't happen a lot," Lillian says. "It happens all the time."
"Maybe after the operation he'll be happier," Karsyn responds.
It's another hour before Jacobs limps from his bedroom, falls into his recliner and begins flipping through dozens of prayers and well wishes on the Facebook feed on his iPhone.
When it's time to go, Lillian and Karsyn rush across the living room and fall into Jacobs' arms, nearly knocking him over. He steps out the garage door, right leg first.
•••
Outside the window of the pre-op room at the VA hospital in Salt Lake City, the west grandstands of Rice-Eccles Stadium are glowing in the morning sun.
Between visits from nurses, anesthesiologists and doctors, Michele Jacobs glances out the window and reminds her husband of their first date — the 2008 Utah-BYU rivalry game.
The final operating team member to check in is Erik Kubiak. He's an affable, quirky and — by the accounts of everyone else on the operating team — brilliant orthopedic surgeon from the University of Utah. The VA has asked him to handle Jacobs' case.
If all goes well, in a year's time, Jacobs might be a candidate for Kubiak's study of osteointegrated prosthetics. Jacobs is enthralled by the idea of snap-in, snap-out interchangeable legs that would connect to an implant in his femur.
Kubiak, an avid ice and rock climber, is wearing a red Patagonia jacket, brown slacks, yellow socks and leather Euro-style sneakers. He reaches over and cups his hands around Jacobs' right knee.
"What's the sensation?" the doctor asks.
Jacobs' face twitches.
"That's really sensitive," he groans.
Kubiak releases his hold. He ticks off all the things amputees are doing with the latest prosthetics. Climbing. Swimming. Triathlons. Jacobs adds to the list. Hiking. Hunting. Snowboarding.
"You'll get there," Kubiak says. He signs a chart and leaves the room.
Lydia Scholes, a nurse who was at Walter Reed the same time as Jacobs, arrives to go over the pre-operative checklist. They didn't know each other there, she says, but "it's like an instant bond — like we know something other people don't."
"What did you eat today?" she asks him. "Nothing," he says, "but I could really use a Dr Pepper. Do you think you could put Dr Pepper in my IV?"
Scholes rolls her eyes and laughs.
"OK," she says, "it's time."
Michele leans over, runs her hand through the thick tangle of hair on her husband's face and kisses his lips. An orderly comes to roll him away. Her fingers brush the blanket over his leg.
Alone in the room, she slumps into a chair, then rises to gather her purse. She pauses for a moment at the window. A tear rolls across her right cheek. Her jaw trembles.
"I'm so scared," she whispers. "Everything's about to change."
A SOLDIER'S AMPUTATION
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| Photo by Scott Sommerdorf |
"What's this button do?" he asks the anesthesia technician, Nate Organ. "Where's that tube go? What medicine is in there? What's on that screen?"
"What screen?" Organ asks, randomly snatching one of the rapid-fire questions out of midair. There are more than a dozen computer screens surrounding the operating table.
"That one."
"That's your femoral artery," Organ says as he works a catheter up a vein in Jacobs' thigh.
"How can you tell?"
"Lots of practice — and see that? That black dot? That's the medication working on your nerve."
Jacobs clenches his teeth. "It's not working," he says. "Still hurts."
"Give it a moment."
Organ pushes the rest of 30 ccs of Bupivacaine through the catheter; the cold liquid surrounds the tender nerve. Jacobs grits his teeth and seethes in pain. "It's not … oh God, that hurts … it's not working."
"We're trying to get it as close to the nerve as possible."
"It's OK," Jacobs moans. "I'll toughen up. I'm sorry. I'll toughen up."
His hands are shaking. Sweat beads across his forehead. He grinds his teeth. Soon his whole body is trembling. Blood drips from his leg where the catheter has entered his body.
Anesthesiologist Suresh Raman drops a mask over Jacobs' face. "OK, take a deep, deep breath for me," he says.
Jacobs takes three. He's out.
•••
Within minutes, Jacobs is all but hidden beneath a wrap of plastic, towels and sheets.
A light blue curtain separates his body at the chest. On one side, only his face is left exposed — his eyes are taped shut and an inch-wide tube is protruding from his mouth. On the other side, his right leg flops back and forth as a nurse wraps his thigh in plastic, just above the knee.
Tall and trim, orthopedic surgeon Erik Kubiak drifts into the operating room, picks up an antibacterial applicator and waves it around like a conductor's baton. With it, he paints the exposed skin with the bright orange solution, humming as he goes.
From the top of his calf down, Jacobs' leg is wrapped in blue plastic, bound over with bandages. A tourniquet is wrapped around his thigh and engaged.
"OK," Kubiak says. "Let's get started."
Working from Jacobs' left side, Kubiak traces an imaginary line above the patient's knee, then dips his scalpel into the exposed flesh. Working from the right side, surgeon Linsey Etherington does the same. The two scalpels move in opposite directions, drawing a deep red circle around Jacobs' leg. A blue towel below the surgeons' hands turns crimson.
Within seconds, they are an inch deep all the way around. Globs of creamy yellow fat billow from the incision.
Seconds more, and Jacobs' patella is exposed — bright white against the yellow and red. The surgeons work through the ligament and tendon below his knee, which snap back as they are snipped through.
It took hours to prep him for surgery. Now, without comment or ceremony, Jacobs' lower leg is detached from his body.
Holding it by the calf and the toe — straight up, to keep fluids inside — a nurse carries it away and places it into a blue plastic bag.
Freed from having to work around the lower leg, Kubiak and Etherington have a better angle from which to attack the knee and femur.
They begin with incisions up the thigh, on each side of the knee, then dig in with their fingers, detaching loops of fat. Embedded in the muscle, black flecks of metal glint under the brilliant surgical lights. Kubiak wrests out a few of the larger pieces. For the first time since being embedded in his body nearly 10 years ago, the shrapnel is set free.
With a metal rake, like a long fork with bent tines, Etherington pulls back the skin and muscle of Jacobs' thigh. Kubiak nips at the tissue surrounding the end of the femur, which is as thick as a man's wrist.
Kubiak grips a bone saw. It's strikingly small, shaped like a hand drill but with an oscillating blade. When it is turned on, it emits a high-pitched buzz. Against the bone, the buzz transforms into a low-pitched grind. A faint burning smell, like charred sapling wood, fills the operating room.
Kubiak disengages the saw and takes hold of a chisel. Four taps. A loud crack. Ten taps.
It's off.
•••
Everything Kubiak has done today is brisk and precise. His bedside conversation is amiable but swift. In surgery, he works with such alacrity that it appears almost routine.
But for this, he'll take his time.
Stripped of his bloodstained smock, but still in his blue-green scrubs, the surgeon finds Michele Jacobs curled up in a chair in the waiting room.
"That went well," he says.
"Is it all done?" she asks.
"They're still closing up, but it won't be long."
Michele asks about the osteointegrated implant, which would allow Jacobs to fasten a prosthetic leg directly to a connector in his femur. Is that still looking like an option?
The surgeon thinks for a moment. There's some hardening of the muscle tissue along Jacobs' femur — more than Kubiak expected to see. Essentially, Jacobs' body is turning a small pillar of thigh muscle into bone — a phenomenon that seems to happen more often in patients who have suffered traumatic brain injury. It could complicate matters, Kubiak says, "but I don't think anything we saw changes things."
What about phantom pain? Kubiak says it's likely to be an issue, though it's hard to know what will happen when an amputee's brain tries to reach out to the nerves in a missing limb.
How long will the recovery take? If Jacobs wants to, Kubiak says, he could be running triathlons in a few months.
That sparks a thought in the doctor's mind.
"Does he know any other amputees?" Kubiak asks.
"Lots of them," Michele says. "They're already talking about swapping legs and stuff."
"Oh yeah," Kubiak says with a laugh. "That's just weird."
He reaches into a satchel and draws out a business card.
"You can call me if you need anything at all," he says. He rises and reaches out to shake her hand.
"Cutting off his leg was the easy part," Kubiak says, looking into her eyes. "The hard part is everything else. The hard part starts now."
•••
Raman peeks through the pale blue curtain of post-op's Bay Three.
"Bryant, are you awake?" the anesthesiologist asks. "You're in the recovery room. Your surgery went well."
"So I have no leg?" Jacobs asks. He strains to lift his head.
"That's correct. You had an above-the-knee amputation."
Jacobs groans. "I'm in a lot of pain," he says.
"Where? Can you point to where it hurts the worst?"
Jacobs reaches out, pressing two fingers through the invisible divide separating where his body is and used to be. "Right … here?"
His head falls backward into the pillow. He's asleep again.
When Jacobs comes to, Michele is there. She lays her palm on his forehead, brushing back his dark brown hair.
"What have you been doing?" he asks. "Have you eaten?"
"They fed me," she answers.
"A lot?"
"No," she says softly. "When you eat, I will eat."
He contemplates food for a moment. A Vietnam veteran in Bay One is throwing up.
"I'll wait," Jacobs says.
He rests for a few moments, fighting to keep his eyes open. "You know," he says, "my leg hurts really bad."
"Well," Michele says, "I'm not sure you know this, but your leg just went through a lot."
•••
Dustin Marble arrives a few hours after the surgery, carrying a bag of food.
"How are you?" asks Marble, who joined the military with Jacobs more than a decade ago.
"Can't complain," Jacobs says.
Marble nearly drops the bag. "Um, yeah, you could," he says.
They share a hug. They talk about work. They discuss the weather.
Five minutes go by. Ten minutes. Marble keeps glancing down at the blanket covering his best friend from the waist down.
"So," he finally says, twisting his mouth. "How is it?"
Jacobs pulls back the blanket. His hospital gown falls halfway down his thigh, which is mummy-wrapped in bandages ending where his knee once was.
"Huh," Jacobs says flatly.
"Had you looked at it yet?" Marble asks.
"No," Jacobs says. "I guess I just didn't think to."
Marble's gaze moves swiftly from Jacobs' bandaged leg to his face. He doesn't believe his friend didn't think to look, but he keeps the thought to himself.
"Huh," Marble says.
The blanket goes back up again. It will stay there for the rest of the night.
•••
"Look," 4-year-old Marley tells her father, Kyle Dansie. "Uncle Bryant is like a pirate."
She turns to Jacobs, who is laughing at his friend's daughter. "Uncle Bryant, I have a pirate costume," she says. "Next time I'll bring it and we can be pirates together."
She hops around on one leg, lasting 10 minutes before collapsing in a corner.
"Uncle Bryant," she says with an exasperated sigh, "it's too hard to be a pirate."
It's been two days since the operation. Jacobs has gone through six or seven nursing shifts, greeted dozens of visitors and submitted to scores of X-rays.
He's also made two trips to a narrow, sun-drenched hallway that has been converted into a physical-therapy space. His therapist, Bart Gillespie, works him through exercises designed to introduce him to the way the muscles in his hips and thigh work, now that some have been trimmed and redirected inside his residual limb.
"Really, at this point, it's about doing everything we can to get you on that leg as soon as possible," Gillespie says.
"That's exactly what I want," Jacobs responds.
Jacobs groans and his face contorts as he works his bandaged thigh up and down and tries to extend it to the side, Jane Fonda-style.
"The other thing that we're going to have to work on is patience," Gillespie says from out of earshot as Jacobs takes a break. "Before we can get him into a prosthetic, his leg is going to have to heal and firm up. If I know Bryant, he's going to want to go faster than his body."
Sure enough, down the hall, Jacobs has struck up a conversation with another patient about triathlons and snowboarding.
"I'm not going to be the guy you see in a wheelchair," he says. "That's fine for some people, but not for me. I'm ready to get active."
Jacobs has been cleared to leave — and after four days in the hospital, he's ready.
First, though, there's a question he wants answered.
Weeks before the surgery, he'd asked whether it would be possible to keep the ashes of his amputated leg. Patrice Kennedy, the orthopedics nurse who scheduled his operation, ultimately said the hospital couldn't separate out a specific patient's limb from the rest of its biological waste.
Jacobs accepted the answer. It was, he figured, a strange request, though Kennedy assured him she'd heard it before.
Since then, he has contented himself with the promise of something else — knowing how much his leg weighed. He'd like to know, in some quantifiable way, what he gave up — and he's asked no fewer than a dozen times since his surgery.
Only now, as he dresses to leave the hospital, does a pathology report reveal the answer.
15.5 pounds.
Jacobs laughs. It's a much smaller number than most of the guesses
from 25 people in a pool to estimate the leg's weight. A few sore losers speculate the leg must have been drained of blood before it was weighed. And having come off in two pieces, it's possible that not all of it made it onto the scale.
As the sole arbiter, Jacobs declares a winner. Marble's wife, Christine, hit it on the dot. Her prize is $25.
Does betting on an amputation make light of the seriousness of his sacrifice? Jacobs hopes so.
"I don't want people thinking that I'm going to change the way I look at life because of this," he says. "This is going to be hard enough without taking everything so seriously."
As further evidence, he pulls a black T-shirt over his head — "Well, I'm Stumped," it says in white letters — before hefting his body from his hospital bed into his wheelchair.
There's no fanfare for his departure, just a few handshakes from nurses and orderlies along the route.
Michele pushes her husband to the elevator and down two floors to the pharmacy. An older amputee, also in a wheelchair, offers Jacobs a fist bump.
"That's an awesome shirt, man," the man says. "I want one, too."
Michele leaves her husband at the turnabout in front of the hospital's main entrance. It's the first time he's been outside in four days. He draws a breath and gazes over the south Salt Lake Valley.
That's where he's headed. In an hour, he'll be home.
THE LONG WALK TO RECOVERY
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| Photo by Scott Sommerdorf |
Two weeks after his amputation, his surgical wound has closed everywhere but the outside corner. Until it fully heals, he won't be able to wear a prosthetic. Between physical-therapy appointments, he spends a lot of time in his living-room recliner.
"It's not that I want to be just sitting around," he says, "but there's not a lot else I can do when Michele goes to work. It's not like I can drive myself anywhere right now."
To get Jacobs out of the house, neighbor Nick Hoggan invites him and their mutual friends over. In his theater room, Hoggan plays a video of his recent hiking trip to Havasupai Falls in the Grand Canyon.
Jacobs is nearly bouncing off his chair with excitement.
"That!" he cries as the video shows Hoggan and his friends cliff diving into Havasupai's vibrant blue waters. "That's exactly what I want to do. I want to be out having adventures like that."
"Just tell me when," Hoggan says.
"Soon," Jacobs says. "As soon as I can."
•••
Lane Ferrin's office is decorated with black-and-white posters of amputee athletes riding bikes, hiking trails and climbing mountains.
"You probably have a lot of questions for me," says Ferrin, the co-owner of Northwest Prosthetics, just up the road from Brigham Young University in Provo.
"Actually I don't," Jacobs says. "I don't even know what to ask. I just know I'm ready."
Ultimately, Ferrin tells Jacobs, he'll probably have several prosthetic legs. One for running. Another for golf. Maybe one specifically for snowboarding. Each will move and twist in a different way to accommodate the most common repetitive motions of those pursuits.
But right now, he says, "you need to learn to walk."
For that, Ferrin says, there's really only one choice: the Genium, by German prosthetics manufacturer Ottobock .
"It'll basically walk for you," Ferrin says. "It senses heel and toe load. Positional space. Motion. It's got accelerometers and gyros. It'll know if you're lifting up to walk on steps. It knows if you're walking downhill. It knows if you're walking backwards. And the second you stumble, it knows that, too."
"Holy crap," Jacobs says.
Few insurance carriers will cover a computerized knee joint like the Genium — which costs $35,000 and is expected to last only a few years.
"But the VA will," Ferrin says quietly, as though he's sharing a secret.
Jacobs is skeptical. He's been waiting for months for Veterans Affairs to approve his request for a hand cycle. "How long will it take to get one of those?" he asks.
"I can have one here in a few days," Ferrin says.
Jacobs pivots in his chair to high-five his wife.
"Hey," she says. "You're going to be part German now."
"How soon can we start?" Jacobs asks.
"It really just depends on how your leg heals," Ferrin says. "Let's take a look."
The next few minutes are a lesson in the relationship the two men will have in the coming months. Ferrin sits on the floor by Jacobs' foot and reaches up the leg of the patient's shorts to feel around the area where the top of the prosthetic socket will meet his torso.
"This scar is going to be a challenge," Ferrin says, tracing his finger on an area of Jacobs' inside thigh, the size of a table knife, that was lost in the blast. Just under the skin, the tissue has calcified into bony ridges, as though Jacobs' inner thigh has grown a set of knuckles.
Ferrin frowns. "I have no idea what we're going to do about that," he says.
"You have no idea?"
"Not yet."
•••
The tissue around Jacobs' incision is hard and hurting. The pus seeping from the wound has shifted from slightly pink to sickly yellow.
A month after surgery, his leg is infected.
Jacobs was warned about this before the surgery: A spreading infection could eat away at the healthy tissue above his amputation. If that were to happen, he could lose even more of his leg.
But this, at least, is a familiar foe. In the 22 months he spent recovering at Walter Reed Army Medical Center, he had more infections than he could count. Treated quickly with antibiotics, this should clear up soon.
Two weeks after the infection is brought under control, the outside segment of the wound, an area about the size of the last knuckle of his pinkie, still hasn't closed. VA doctor Alvin Kwok tells Jacobs there's a chance it simply won't.
The surgeons who stitched him up after the operation were working with skin that was badly scarred and, in some places, grafted from other parts of his body. It's not easy to mend skin like that, Kwok says during an appointment in early May.
"I think it will close eventually," the doctor says. "We could probably do surgery, but that would just mean another wound that would have to heal."
Kwok advises Jacobs to wait two weeks to see what happens.
The next stop is physical therapy. In the elevator, Michele rubs her husband's back.
"If surgery can fix it, let's just fix it," he says.
"We don't know if that will be faster," she says. "I know it's hard, but you've got to be patient. Your body isn't used to any of this."
In the six weeks since surgery, Jacobs has come to trust his physical therapist, Bart Gillespie, above all others at the VA hospital. "We'll see what Bart thinks," he says.
Gillespie concurs with Michele. "It looks like it's healing, just slowly. I think we should stay the course."
Jacobs accepts the advice, but he's frustrated and surly.
"This fucking sucks," he says as Gillespie steps away. "On the way home we're going to go to the gas station so I can get some cigarettes."
"You're not doing that," Michele replies — he hasn't smoked since the surgery. "That's not going to solve anything, and we don't have the money."
"We have money — my money," Jacobs says.
Michele winces. The start-up energy-drink maker where she's typically employed as a bookkeeper hasn't had enough work for her over the past few weeks. They've been living on Jacobs' disability pension and a small stipend she gets from the VA for helping provide for his care.
She takes a deep breath and looks away from her husband. "I'm not taking you to the gas station," she says. "And you can't get there yourself — so there."
"I should have hidden a pack for situations like this."
"You're acting like the world is coming to an end," she says. "Do you really think the world is coming to an end?"
"Yes, it feels like that to me," he says. "This wasn't part of my plan."
•••
Fifty-five days have passed since the amputation. Jacobs was confident he'd be in his prosthetic by now. Instead, he's heading back to surgery.
Surgeon Erik Kubiak, whom Jacobs hasn't seen since the amputation, squats in front of Jacobs' wheelchair and looks at the area where the wound is still open.
"This isn't a problem," he says. "We'll get you in and out."
Kubiak explains the surgery. He'll cut a football-shaped piece of skin out from around the area that isn't closing. Then he'll pull the healthy skin together with new sutures.
Fifteen minutes after Jacobs is wheeled into the operating room, the surgeon peels off his gloves and heads to the waiting room to speak to Michele.
"How's he been doing?" Kubiak asks.
"Mostly good," Michele says.
"Mostly?"
"Yeah, mostly."
She doesn't tell Kubiak that her husband has confided in her a tormenting secret.
He's afraid the amputation might have been a mistake.
•••
A fall is coming. Jacobs knows it. Everyone around him knows it.
Amputees fall. It happens to everyone who loses a leg. No leg, no symmetry. No symmetry, no balance.
Jacobs is leaving his friend Dustin Marble's home when it happens. Michele is still driving her husband around, as she will be for months to come. He puts his crutches in the back of her car, then hops on his left leg to the passenger door.
He doesn't make it. His foot hits the curb, but not enough of the curb. His stump strikes the pavement as he collapses to the ground.
Another friend, Rian Andrus, races to Jacobs' side. Jacobs is already trying to get himself up.
"Just stay down," Andrus, a professional firefighter, remembers saying as he cupped his friend's bloody leg in his hands. "Let me look at you."
Jacobs wrestles away. "Just let me up," he says. There are tears in his eyes. "Just let me get up."
"Lie down. Just let me take a look first."
Andrus makes a quick scan of the scar. It's bleeding, but the stitches have not split.
"Let's go," Jacobs says. "Let's just go home."
"It's not bad, but you should go to the hospital to get it looked at and cleaned up. You don't want another infection, right?"
"I don't want to go," Jacobs argues. "I don't want another setback. I can't have another setback."
•••
By the time Jacobs arrives back at Ferrin's prosthetics office, it's clear no long-term damage has been done in the fall.
Ferrin has spent months considering what to do about the bony growth on the inside of Jacobs' right thigh. The growth is almost certain to rub up against the socket — the fiberglass shell the prosthetist will make to fit over Jacobs' residual limb, like a thimble over a thumb, connecting him to his mechanical knee.
The growth is likely to cause friction, which could in turn cause swelling, blistering, abrasions and scarring. But the socket has to fit snugly — the less surface area stays in contact with Jacobs' skin, the more the prosthetic connection will slip and slide. For now, Ferrin will build it as though there is no growth.
"Every person is a puzzle," he says. "Some just take longer to solve than others."
•••
Terrorists from the Islamic State — better known as ISIS — have taken Mosul.
Over the next two weeks, they will spread across northern Iraq, town by town. Their black flags will soon fly over Hawija, about 2 kilometers northwest of the now-abandoned Army outpost known as Forward Operating Base McHenry, where Jacobs spent the majority of his time in Iraq.
He's long tried to ignore developments in Iraq. And in spite of the news that the area where he fought has fallen to jihadists, today that's proving easier than many other days.
Because today he will try out his new leg.
"I slept horrible last night because it feels like Christmas," he says on June 10 as Michele turns onto Interstate 15. "And I'm super nervous because I want everything to go perfectly."
He gasps as Ferrin brings it into the room. The socket is a plastic job — a work in progress — but if everything goes well today, Jacobs will get to bring it home.
Ferrin shows Jacobs how to roll a cushioning sleeve over his residual limb and how to slide the socket over that, expelling air through a hole at the base that is then closed to create suction. With Ferrin's help, Jacobs stands. And as he does, he smiles.
At the first tentative steps, though, he is already in pain.
"I don't know how it's supposed to feel," he says. "But I think it's riding too high."
Over the next few months, eighths of inches at a time, Ferrin will guess and check his way toward a better fit. Even as the socket improves, there are other problems. Days into the process, Jacobs' bionic knee stops working and has to be sent back to the manufacturer. The company sends a replacement stamped "loaner."
He tries to spend a little more time on the prosthetic each day, but Jacobs finds it challenging to get the joint to do what it's supposed to. He arrives for VA appointments in his wheelchair. At home he hobbles around on crutches.
One maneuver — intended to signal the knee to help the wearer climb stairs — is particularly hard to master. The user guide and online videos instruct Jacobs to swiftly pull back the leg then lift up, as if striking a match. When he does, the leg simply hangs limp.
•••
Bob Chappell is turning pirouettes like a ballet dancer, and alternatively lifting his natural leg, then his prosthetic one, like a goose-stepping soldier.
It's a display of strength and flexibility few able-bodied people could match — fewer still who are in their 60s, as Chappell is.
"The thing you're going to have to mentally overcome is learning to trust the leg," says Chappell, a retired salesman from North Carolina. He has come to Utah to be considered as a candidate for an osteointegrated snap-on prosthetic that VA doctors are readying for medical trials.
"I feel like I might fall," Jacobs says.
"Everybody falls," Chappell says. "People with two healthy legs fall. Get over it."
Chappell, who lost his leg in 2000 after falling off a roof, shows Jacobs how he climbs stairs: leaning to one side as he swings his prosthetic to the other in a looping motion. "I could never get that matchstick thing to work," he says. "I do what I have to do to make it work."
Chappell glances over at Jacobs' wheelchair. "And get rid of that," he says. "It's a crutch."
"You don't bring your chair with you anywhere?" Jacobs asks.
"I haven't seen my chair in a long time," Chappell says.
Bryant walks away on his prosthetic leg, pushing his wheelchair, but the socket is biting into his leg and rubbing up against his pubic bone. Before he even gets back to his car, he has to return to his chair.
•••
It's 6:30 a.m. on the five-month anniversary of the surgery, and Jacobs wakes his wife. He's shivering uncontrollably.
She checks his temperature. It's normal, but his residual limb is hot to the touch and he's in pain — more than he's felt since the surgery.
On the day of the amputation, Kubiak had given Michele his card and invited her to call if she needed anything. She hasn't done so until now. In a text message, she explains the situation.
Kubiak responds in seconds. "Bring him in," he writes.
At the VA an hour later, an initial blood test shows signs of an infection. Where, though, is unclear. Jacobs feels as though his whole body is on fire. He's sweating through his hospital clothes. The surgical staff begins to prep.
Then, just as unexpectedly as it began, the pain subsides. The shivering ends. More tests. It's not clear now whether there is, in fact, an infection.
A day later he's cleared to return home. The hospital staff can't explain what happened.
"What the hell was that?" Jacobs asks Gillespie, his trusted physical therapist, before he leaves.
"Maybe you pushed things too hard," Gillespie says.
"I thought that's what I'm supposed to do."
"It is."
MILES BEHIND HIM, MORE TO GO
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| Photo by Scott Sommerdorf |
He makes a turn around a set of treadmills and takes another lap inside the hospital's new $5 million physical-therapy center.
His physical therapist, Bart Gillespie, looks on.
"Time," Gillespie finally calls. "That's 6 minutes. Stop right there."
The walking path is 172 feet long. Jacobs has gone just shy of eight laps. At that rate, it would take him about 24 minutes to walk a mile. It doesn't seem likely he could do that, though; he's sweating and panting at the quarter-mile mark.
"That's not a bad start," Gillespie says.
"It sucks," Jacobs replies. "I'm getting cramps in my stump."
"But you're walking — you're moving pretty good," Gillespie says.
The way Gillespie sees it, Jacobs has made solid progress since his amputation, now nearly six months in the past. His gait is consistently improving; if Jacobs were to wear pants, rather than his usual shorts, few people would suspect he was missing a leg.
He's driving now, using his left foot as most drivers would use their right. The phantom pains he suffered in the months after the surgery used to keep him up all night; now they're rare. He's been able to cut his intake of painkillers in half — and has plans to go lower.
But Jacobs isn't satisfied.
"Everybody says it's a fast progression, but I don't really feel that way," he says. "Day to day, I'm getting sores on my leg. My socket still doesn't fit right — and that's distracting. I'm ready for the day when I can just put it on and be done with it."
It never really works that way. Residual limbs are swollen after amputations, so prosthetists know the first plaster cast they make for a socket is just the start. When amputees get into shape, as Jacobs is trying to do, the residual limb often shrinks. And in the hours between morning, when fluids have gathered in a limb overnight, to the afternoon, when everything is circulating better, a residual limb can lose an inch in circumference.
"It's a moving target on top of a moving target," says Jacobs' prosthetist, Lane Ferrin, who has employed suction, snowboard boot-style dial-down cables, and even Velcro to try to get Jacobs' socket to hold snug. "I know how frustrating that can be for some patients. But little by little they get more comfortable with it."
•••
After nine years of limited exercise, Jacobs is battling to drop weight and get into better cardiovascular shape.
He was certain that by now he'd be golfing. But as the oak leaves start to fall on his home course, it looks increasingly as though he might have to wait until the spring.
"During all of this my expectations have been higher than the reality of what my body was willing to do," he says.
Slowly, he's grown more comfortable with his prosthetic. He's in it more each day. And each day he's thinking less about the fact that it's even there.
A year ago, just about any kind of exercise would put him out for a day or two afterward. His body would punish him with pain. Now, he could exercise all the time if he wanted.
"It's been hard to adjust to the mentality that I can actually do all this stuff every day," he says.
In early October, he heads to central Utah for a three-day hunt arranged by nonprofit Warriors Afield Legacy Foundation at the Castle Valley Outdoors lodge. By the final day of last year's hunt, Jacobs was in a lot of pain.
Now, as a Polaris four-wheeler driven by a foundation volunteer rumbles across the scrub grass, Jacobs feels as though he could keep going for days.
When a shorthair pointer named Pete freezes up ahead, nose still and tail stiff, Jacobs slides from the passenger seat and steadies himself against the roll bar. Pete's quarry takes to the air. Jacobs trains his shotgun on the bird — a fluttering rainbow against the redrock buttes. He pulls the trigger, and then again. When the bird falls, Pete runs joyously after.
"Yeeeee-ah!" screams a craggy voice from the other side of the field. "Hooah Bryant! Great shooting!" Jacobs' hunting partner, a retired Army colonel named Dick Rock, is overjoyed. "That was beautiful!"
This is the second year that Rock, a Vietnam War veteran, has been assigned as Jacobs' mentor. When they met up last year, Jacobs had told doctors at the VA he was ready to have his leg removed. But Rock says the younger vet still seemed uncertain.
Jacobs tells Rock that he's battled doubts in the wake of the surgery too, but now he knows the amputation was the right choice.
And next year, he says, he hopes he won't need the four-wheeler.
•••
Jacobs never felt any ambition to participate in a marathon.
But Travis Wood, his friend and fellow amputee, has suggested competing in New York with a group of disabled veterans sponsored by the nonprofit Achilles Foundation. Jacobs agreed.
Jacobs will wear bib 444 in the handcycle division of the 2014 New York City Marathon.
Rising in his room at New York's Union League Club at 3:30 a.m. on Nov. 2, the day of the race, he's feeling wary.
"I'll finish," he says. "There's no way I'm not going to finish my first marathon. But I feel like I could have done more to get ready."
He's not sure how many miles he's put in on his handcycle since it arrived about two months ago, though he's worked up to hourlong sets on the rowing machine at the VA hospital's physical-therapy center. "Nothing close to 26 miles, though," he says with a sigh.
A stream of veterans pours into the Union League banquet room. There are single amputees, double amputees, triple amputees. Some are in their 20s. Others are in their 60s. They wear Achilles Foundation race jerseys and smiles that belie the hour.
At 4:30 a.m., the group walks and rolls down to Fifth Avenue, where it loads onto a bus in a miles-long convoy of buses and waits for thousands of other racers to do the same. Some sleep, others listen to music or read paperbacks. Some racers are sharing stories about other marathons.
"You done Chicago?" someone says. "Nah man, Chicago's on my bucket list," another responds. "Oh yeah, man, you gotta do Chicago," yet another racer proclaims. Like a soldier awaiting his first mission, Jacobs quietly takes it in.
Bad news comes before the bus even gets underway: 50-mph wind gusts over the Verrazano-Narrows Bridge, connecting Staten Island and Brooklyn, have prompted race organizers to rule that wheelchair racers won't be permitted to start with the rest of the competitors. Instead, their race will begin in Brooklyn — 3 miles into the course.
A collective groan takes over the bus. Someone jokes about making a bumper sticker that reads "23.2." Jacobs' face tightens.
"It's not so bad not having to go over that bridge, because I heard that part is really hard," he says. "But this was supposed to be my first marathon."
•••
Michele is waiting in the grandstands as her husband's teammate Freddie De Los Santos — also an above-the-knee right-leg amputee — sprints across the finish line at the 1:17:28 mark to take first place in the handcycle division. Wood rolls through 20 minutes later.
She's there as the first able-bodied runners — a virtual United Nations delegation of Kenyans, Ethiopians, Latvians, Portuguese, Ugandans and Americans — finish to an eruption of enthusiastic applause, flag-waving and photo-taking.
She's shivering. Her nose is running. She needs to use the restroom. But she won't leave here until her husband crosses.
The two-hour mark comes and goes. She'd planned to track him on her phone — but since the wheelchair racers were forced to start 3 miles in, the tracking chips in their race bibs weren't logged into the system.
The three-hour mark comes and goes. A handcyclist rounds the final corner. It looks like Jacobs, at first, but it's another racer.
He told her it would probably be a long wait. But he promised that, as long as he knew she was there, he wouldn't stop until he finished.
"Bryant comes from a big family of runners," she says. "His grandpa, his brothers — they've all done all these marathons and races. And I think this is his way of being part of that, even though he can't be a runner quite yet."
Finally he appears, heaving his body up and down, driving the wheels up the final hill. She screams and whoops and calls his name as he passes. He crosses the line at 3:08:43 — 48th in a field of 59 handcyclists.
"Oh man, that sucked," Jacobs says when he's reunited with his wife a few minutes later, a medal dangling from a rainbow ribbon around his neck. "It hurt so bad. Especially the end. The wind was so rough. And it's so cold."
"But you did it," Michele says.
"I did it," he says. "That feels pretty good to say."
•••
It takes just under five hours to get back to Utah on the morning after the race.
There is no snow on the Wasatch Mountains as their plane approaches Salt Lake International Airport.
But it's coming. And when it does, he wants to be ready for it.
That's his next goal.
BALANCING GRATEFULNESS, AMBITION
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| Photo by Scott Sommerdorf |
His carbon-fiber foot is the result of decades of research and development.
But the socket that connects all that technology to the stump of his amputated leg works about the same way as ones developed during the Civil War.
Back then, sockets were made of leather or wood; today, they're plastic or carbon fiber. Modern materials can be better fitted to the contours of a patient's residual limb, but the function remains the same for an above-the-knee amputee. The socket is intended to hold snugly around the limb, distributing the load of the user's weight across as much area as possible.
When the fit isn't quite right, or Jacobs wears it too long, he gets sores, abrasions and blisters.
Skin problems that develop under a socket frequently force amputees to take a break from using prosthetics. When that happens to Jacobs, he has to return to his wheelchair.
These challenges are why, just months after learning to walk in his prosthetic leg, the 34-year-old Army veteran is eyeing his next bionic step.
•••
It's a crisp winter morning in Salt Lake City, but Jacobs opts for a loose pair of athletic shorts for an appointment with Erik Kubiak and Jay Agarwal, the surgeons who teamed up for his amputation back in March.
Kubiak and Agarwal are looking for 10 veterans to test an osteointegrated implant they recently developed. If Jacobs is selected for the trial, the implant will connect his prosthetic directly to a stud rooted in the end of his femur.
The Department of Defense, Department of Veterans Affairs, National Institutes of Health and other agencies are eager to know if the Salt Lake City team's implant will work. They're investing millions — and there is far more than that at stake — in the device, described in a patent obtained by Kubiak, Agarwal and six colleagues in February.
"You'd have a rod sticking out of your skin," Agarwal tells Jacobs at the VA hospital in Salt Lake City. "You've got to remember it's not normal for humans to have that. There are animal models for that — antlers, you know — but those are natural parts of their body."
Jacobs listens intently and enthusiastically nods — even when Agarwal describes the potential consequences. If this doesn't work or if an infection takes root, he says, doctors might have to cut off more of Jacobs' leg.
"So tell me why you want to be part of this," Agarwal says.
"It would be nice to get rid of the socket," Jacobs replies.
"You've only been in it for, what, four months?"
"It's already clear that it would be great to be able to get rid of it," Jacobs says. "I want to better myself. To potentially wear my leg 24 hours a day if I wanted to. The socket's good — everything is better than it was before — but I'm ready to be better than that."
Agarwal jots some notes and shakes Jacobs' hand. Until a decision is made, he says, Jacobs should work toward the goals he would pursue if there were no study.
"That's definitely my plan," Jacobs says.
•••
Jacobs hoped to mark the 10-year anniversary of the day he survived the explosion in Iraq by getting back on a snowboard.
That would fulfill a promise he'd made to himself early in his recovery at Walter Reed Army Medical Center.
"For me," he says, "what that would represent is really an achievement of independence that I haven't had before. I feel like, when I can do that again, that will feel to me like success."
As Dec. 3 approaches, two storms have dropped enough snow that most runs are open at the resorts outside Salt Lake City. And Jacobs' strength, stamina and flexibility have improved.
Ironically, his improving fitness has created one of the obstacles he faces as his "alive day" nears. As he's gotten into better shape, his right thigh has shrunk so much that his socket is no longer holding fast.
A 3 p.m. appointment with his prosthetist on the day before the anniversary stretches well past closing time. Lane Ferrin fills Jacobs' socket with plaster, carves it away to make a narrower casting, then shrinks the plastic socket onto the new mold.
That improves the fit, but a new Velcro strap, intended to help keep the socket from twisting under torque, is irritating Jacobs' skin. At 5:30 p.m. — hoping to find a solution that will let Jacobs do whatever he wants the next day — they're still battling to make it work.
Buoyant and talkative when he arrives, Jacobs is growing cold and quiet.
"This just isn't working," he tells Ferrin. "I'm not a fan."
Ferrin removes the strap and makes a few final adjustments to the coupling that attaches the socket to Jacobs' prosthetic knee.
"It's going to feel tighter, obviously, because it is tighter," Ferrin tells him. "Every time we do this it's going to be a little bit like learning to walk again."
By the time Jacobs leaves, it's clear he won't be spending his alive day on the mountain.
If this feels like yet another setback, though, Jacobs is keeping it to himself.
"I'm just not ready," he says. "And that's the way things go. One of the things I've learned is that you really have to control the urge to get your hopes up. I want to be ready and I am willing to work for my goals, but things are going to happen when they happen. If I try to push against that, there's a chance I'll get hurt."
•••
Neither his wife nor his stepdaughters are awake when Jacobs rises, crutches to the bathroom for a shower, disconnects his prosthetic leg from its charger and quietly leaves out the nearby garage door.
He's made the 40-minute trip from his home to the hospital so many times that he doesn't have to think about how to get there. Today, the time is flooded with memories.
Because this is his day.
He remembers the two years he spent in the hospital. He remembers the years of pain and immobility after his return to Utah. He remembers his decision to remove his leg. He thinks about the challenges he's overcome and those that are still to come.
And he remembers the man who died when he survived. Today is David Mahlenbrock's day, too.
Mahlenbrock enlisted after the Sept. 11 attacks. He knew he would be going to war. That was OK with the high-school wrestler from Maple Shade, New Jersey. His brother Chris had joined after high school, "and he had nothing but good things to say about it," remembers their father, Russell Mahlenbrock.
Russell Mahlenbrock says his son left for Iraq with pride and determination — even after learning that his wife, Melissa, was pregnant with their first child.
David Mahlenbrock met his daughter just once, while on leave in November 2004.
Kadence was 10 weeks old when her father was killed.
"If you are reading this, then I've died for our country," the 20-year-old soldier wrote in a letter to the other members of his squad. "I just hope it wasn't for nothing."
That's a question his father does battle with every day.
"I don't mind the fact that what happened to him happened to him," Russell Mahlenbrock says. "That's understandable and acceptable. That is what happens at war and it's something we were both ready to face."
But the turmoil that has overtaken Iraq since the last U.S. combat troops left in December 2011 has left Russell Mahlenbrock in despair. "As I move forward from year to year," he says, "I become a little more bitter."
•••
No matter what Jacobs does on this day, he has this day. There's no way, he says, to explain the depth of his gratefulness.
When he left Ferrin's office last night, he wasn't feeling comfortable in the newly shaped socket. When he slid it on this morning, it felt a lot better.
"Do you have any soreness right now?" physical therapist Bart Gillespie asks when Jacobs arrives at the VA hospital's physical-therapy center.
"No," Jacobs says.
"No soreness at all?" Gillespie pushes.
"No," Jacobs says. "Why do you keep asking me about soreness?"
"I don't know," Gillespie replies. "Every time I see you, you're complaining about soreness."
Embedded in Gillespie's teasing is a gentle reminder: Jacobs' leg is feeling fine.
"Sometimes patients have a hard time seeing how far they've come," Gillespie says. "When you're doing well, sometimes you don't think about how you got there."
Together they take a few laps around the room, work on stepping over objects of various heights, and then head to a nearby stairwell to climb and descend.
"You're doing all of this like it's no big deal," Gillespie says.
"Yeah, Bart," Jacobs says with a sarcastic tone. "Because it's not."
Gillespie smiles and tucks his thumbs into the back pockets of his light blue scrubs. "Yup," he says, "it's not."
•••
The VA serves more than 900,000 veterans of Iraq and Afghanistan, about one-third of the military members who have served in those wars since 2001.
More than a quarter-million suffer from post-traumatic stress disorder. Another half-million fight joint and back disorders. About 450,000 are thought to suffer hearing loss.
Among the wounded, amputees are the minority. The military has counted 1,573 limb amputations between 2001 and 2014. The VA figures another 20 to 30 Iraq and Afghanistan war veterans receive amputations each year in its system.
But amputees are hard to ignore. Jacobs figures there's some responsibility in that fact.
"Most of the time, like when you're walking down the street, you can't know whether someone is a veteran or not," he says.
So rather than feeling offended when people stare at his prosthetic leg, Jacobs thinks his presence might reconnect people to the struggles of veterans.
"Seeing someone who is missing a leg — that's not people's usual experience," he says. "So if they're staring, trying to figure things out, that's fine. Maybe for a minute they remember that there are veterans all around them. And then maybe they'll think about the fact that our obligations as a country don't end when a war ends."
•••
The bottle has been waiting since the day before his surgery.
It's a 20-year Pappy Van Winkle — one of the hardest-to-get bourbons in the world. But when Nick Hoggan presented it to his friend on the eve of the amputation, it was without any of the pomp that typically accompanies a bottle of Pappy these days.
"We can drink this when you're ready," Hoggan simply said.
Tonight Jacobs is ready.
A small crowd has gathered to celebrate Jacobs' alive day. His brothers, Zach and Andy, are there, along with a few friends and neighbors — and everyone's kids. Jacobs' wife, Michele, has bought a cake; it's decorated with an American flag and says "10 years" in blue cursive frosting.
Jacobs bounces from person to person, giving hugs, making jokes. He's been in his prosthetic since 6 a.m., but there's still a spring in his mechanical step.
When Jacobs decides it's time for a toast, he slips the bottle from its red velvet sack.
"I wouldn't be here without all of you guys," he says as eight glasses rise together. "So thank you."
He sips the bourbon. It tastes like a long time coming.
•••
There was a time when just about any excuse for a party was good enough to warrant an all-night bender. These days, Jacobs is usually in bed by 9 p.m.
And on a school night, like this one, he's not disappointed when things start breaking up early. One by one, the guests leave with hugs and handshakes and hearty pats on his back. They thank his wife for the party. They thank him for his sacrifice.
His stepdaughters, Karsyn and Lillian, help clean the house and head for bed.
In his room, Jacobs lines up six pills on the comforter of his bed. He takes them all at once, chasing them with a swig of Gatorade.
"Babe," he calls out to Michele, "do you need me to do anything else before I take off my leg?"
"Go ahead," she says.
He slips off the socket. He rolls down the underliner. He connects his computerized knee to the charger on the wall. It buzzes three times as it begins to power up.
Tomorrow he'll rise and put it back on.
Tomorrow he'll take the next step.
