CHAPTER 12

New Year’s Resolution

If you would attain to what you are not yet, you must always be displeased by what you are. For where you are pleased with yourself there you have remained.… Keep adding, keep walking, keep advancing….

SAINT AUGUSTINE

I BELIEVE IN NEW YEAR’S RESOLUTIONS.

Oh, I know. They can be trite devices of self-delusion. Lots of people, myself included, have made sacred vows in late December that are already long forgotten by January 15.

Did I really say I was going to lose fifteen pounds? I think I’ll have another slice of Tres Leches holiday cake instead! But still, as each year comes to a close, I do find myself reflecting on how things have gone, how they’re going, and how I might make improvements.

And so it was this year. On Christmas Day, I had a nice phone call with my parents. They were in Miami, where they had moved to enjoy their retirement. I was on the opposite coast of Florida with Tuesday.

Mamá and Papá had resolved never to live in snowy environs again. Looking out the window at palm trees and sunny skies, I didn’t see any reason for them to break that resolution. I’d also escaped the cold, but weather wasn’t the main thing on my mind. “One of my biggest resolutions for the new year,” I told them in that phone call, “is to regain control of my physical health.”

It was about time. Over the past decade, I had spent an enormous amount of energy getting my head together. It would forever be a work in progress, but I had undeniably made huge progress. My life was so much better. The worst of my full-blown PTSD was securely in the past. Gradually, with Tuesday’s help, I had dug myself out of that very deep hole. Our lives were living proof of that progress. My mind, on most days, was truly mine again.

But what about my body?

The truth was that I had worked so hard getting my head together, I really had neglected the rest of me. I had a feeling of now-or-never. I had to devote some serious energy to regaining control of the physical me. Partly, this meant an honest commitment to losing weight and working out again. I’d been an athlete for most of my life. My career was that of a warrior. But it had been a while since I’d stepped foot in a gym or on a battlefield. And did I really have what it took anymore? There was no excuse for me to spend the next couple of decades sitting around and deteriorating. That sounded almost as depressing as being paralyzed with PTSD. I didn’t want either of those conditions to define me.

There was no pretending anymore.

I’d been living with pain for several years already. My bones were as creaky as an old man’s. My nerves were shot. My spine was getting stiffer. My walking was labored. My posture was off. I couldn’t imagine leaving the house without a cane. How could I? My right leg was constantly killing me.

I didn’t publicly complain much about any of this. When it came to my physical ailments, I did what the army had taught all of us to do, a message reinforced at home, by my father especially: Suck it up and drive on! That’s what warriors do! That’s what Montalváns do! Strangely, the frankness and openness I brought to my struggle with the invisible wounds of war were severely lacking when it came to these more visible ones. In that way, I was precisely the opposite of many military veterans. For several years, I had been talking openly and publicly about my mental anguish. I hardly ever got around to mentioning the physical wounds.

I had seen many doctors, in and out of the VA system. The doctors seemed to agree that much of my condition could be traced to the ambush on the Iraqi-Syrian border and the tumble I took on the parade grounds at Fort Carson in Colorado. Whatever the causes were, the doctors all agreed on one other thing: My condition wasn’t getting better. It was getting worse.

I still believe in the old Greco-Roman adage: Sound mind and sound body lead to sound spirit. But what was I doing about it? I was sorely lacking some soundness here. I needed to put some oomph in my efforts. I couldn’t just feel sorry for myself and suffer in silence. That wouldn’t do any good.

But what could I do? Whatever it was, I knew, it had to be something dramatic if I was going to see real results. This had to be a genuine transformation. Not changing a few bad habits or losing a few pounds. Real transformation. Demolition and reconstruction. A wrecking ball followed by bricks and mortar. Something real.

“I’m gonna do this,” I told my parents in that holiday phone call. “I’m not quite sure what it is yet. But I promise you. I am going to figure that out and give it my all.”

I just had the sense I couldn’t wait any longer, like I was at some kind of crucial decision point. It was now or never, and I didn’t like the way that never sounded. Looking back, I can see that Tuesday’s cancer scare played a role in my thinking—or at least its urgency. Life can be shorter than we ever imagined, for dogs and people, too. There is no excuse for not living fully, making whatever bold moves there are to be made. That didn’t just mean deciding. It meant acting too. Once I had diagnosed the problem, I knew I had to find the cure.

What was I made of? Was getting out from under PTSD going to be my biggest achievement in life? What could I learn from the distance I had traveled so far?

Those were the questions bouncing around in my head as one year was ending and a new one lay just days ahead. Everyone on television, online, and in the Fort Myers Starbucks seemed to be nailing down resolutions meant to improve their lives. I figured I should probably take a basic assessment of my own.

I was tired of hobbling.

I was tired of aching.

I wanted to run.

I wanted to play happily with Tuesday.

I wanted to be the man I had been, the man I knew I could be again.

I already knew I had someone on my side. I had been there for Tuesday when we discovered what could have been a life-threatening illness. Would you be surprised to hear that, this time, Tuesday would be there for me? Of course not.

None of what I resolved to do was as easy as joining Weight Watchers or signing up at Gold’s Gym. That I knew.

“Tuesday, how would you like it if we could go to the beach much more often?”

Tuesday ran to the door, smiling, tail wagging. His movement reflected a resounding “Yes!”

Now all we had to do was navigate the health-care system of the U.S. Department of Veterans Affairs. How hard could that be?

Being a patient with the VA is like having a difficult job. I have certainly learned that the hard way. You have to work at it if you are ever going to succeed. Your first and most important task: finding good clinicians. It’s an art, a science, and a heavy lift every step of the way. If you are wise—and most former warriors are pretty wise—this means maneuvering your way into relationships with your own Holy Trinity of Care. You need a competent and capable primary-care physician. You need a competent and capable mental-health therapist. And you need a competent and capable psychiatrist who can prescribe whatever meds you may require. Depending on your particular issues, various other specialists will also come into play. But it all starts with the trinity. If it’s high-quality health care you’re looking for, you will never get anywhere without those three.

The first and most important is the primary-care physician. He or she is the general contractor of your health. Almost everything radiates from there. Finding the right one is challenging enough in the civilian world. At the VA, everything is five times as hard. Long waits for appointments. Heavy caseloads for the doctors, especially the good ones. Endless questions about your need for treatment and reams of forms to fill out. The best VA doctors don’t tend to stick around very long. They figure out they can make more money and have easier lives working elsewhere, and they leave. There are a handful of talented, dedicated, committed primary-care physicians in the system, but you might have to try out a dozen before you find one who has the right know-how, temperament, experience, and concern. Along the way, you’ll find yourself channeling Donald Trump on The Apprentice: “You’re fired. You’re fired. You’re fired, too.” The stakes are high. This is your health, after all. And the search can be mentally exhausting.

But once you find the right VA doctor, it’s like you’ve discovered gold. You treasure it. You remind yourself how valuable it is. You can barely get over your good fortune. When I finally found Dr. Jeri Jones at the Brooklyn VA, known officially as the Brooklyn campus of the New York Harbor Healthcare System, I felt like John Belushi in The Blues Brothers, the chubby white guy in dark glasses doing backflips down the aisle of the Triple Rock Baptist Church. I couldn’t do anything approaching a backflip. Not yet, anyway. But in my mind, Tuesday and I were right there with Jake Blues. I could hardly contain my enthusiasm.

Dr. Jones was smart, caring, and open-minded. She urged her patients to be actively engaged in their own health-care decisions. She actually listened to me. She was a doctor who didn’t gloss over her patients’ overall health or focus on only one single element. She spent the time and energy getting to know me in a holistic way, basing her advice and prescription choices on that. It may sound trite to say Dr. Jones cared—but Dr. Jones cared.

As my pain had intensified and my walking had grown more labored, I consulted with numerous specialists inside the VA system, before and during my time as Dr. Jones’s primary-care patient. As we spoke about my mobility issues, she encouraged me to do some of my own research. She believed strongly that a patient who understands exactly what he wants to achieve will be far more likely to achieve it. Medicine can’t be left entirely to the professionals. I had been seen by neurology specialists already, who put my brain and nervous system through endless testing. I was examined by orthopedists, who focused on bone and muscular issues. Then by physical and occupational therapists, who manipulated my body in many directions and set up exercise regimens. They also sent me to the pain management clinic, where potent drugs were prescribed.

My right leg is what all these physicians were hyper-focused on. The basic issue, most of the specialists agreed, was vascular. The veins in my leg were not delivering blood throughout like they should. Without sufficient blood, the leg was being undernourished. This was causing a lack of feeling, a lack of control—at times an utter lack of usefulness. That’s an oversimplified explanation, but once you stripped away all the medical jargon, that’s what the various specialists all seemed to agree on.

The doctors had one other thing in common: They all said they couldn’t cure it, which was equally maddening and disappointing to me. All those tests, treatments, examinations, medications, and therapies had all led me exactly nowhere. We’d gone round and round for two or three years—appointments, more appointments, more testing, more specialists. All these different well-trained specialists—and not one of them had anything useful to offer me.

However, Dr. Jones was patient and encouraging the entire way. She kept coming up with new avenues to go down, new possibilities, new research. She seemed as dedicated as I was to finding a solution, wherever it may be. But even the most hopeful road comes to an end. Finally, it was time for Dr. Jones and me to have a come-to-Jesus moment, the heavy and inevitable talk we’d been putting off for years. It wasn’t quick in coming. By then, she had been my doctor for three or four years.

Dr. Jones sat across from me and Tuesday in her small VA office and reviewed where we stood.

“We have tried neurology,” she said.

I nodded.

“You’ve been to ortho.”

I nodded again.

“We have tried PT and OT.”

“We have,” I said.

“We have tried pain management.”

“We have,” I said. “So what’s next?”

“Well,” she said, “as you know, they are working on new braces, robotics, and non-robotics. Those will be available eventually.”

“New braces,” I said. The tone in my voice said what I am sure the doctor knew I was thinking. We both know new braces are not going to solve my mobility issues.

“What I would like to hear,” I told her, “is your best estimation of what I am looking at down the line as far as mobility in my day-to-day life, how my condition is likely to develop in the years to come.”

Whenever I asked Dr. Jones a direct question, she always answered it. That’s one of the reasons I had such high esteem for her. Now, I decided, I was finally ready to hear her answer to the key question about my future.

“You will walk with a cane, though walking will likely become more difficult for you. Some years from now—five years, ten years, it’s hard to say—but some years from now, you will likely be in a wheelchair.”

I had been carefully charting my own physical decline. Dr. Jones watched me closely for any sign of distress. But the truth was I’d been wondering if this was what the future held. My slow but steady degeneration was happening right in front of my eyes. Still, thinking it and hearing it from a doctor are two different things. It was more shocking than I’d prepared myself for. Her words reverberated in my mind.

I leaned back and took a deep breath. Instinctively, I reached for Tuesday. Just feeling him leaning against my leg kept me steady. Dr. Jones was finally saying out loud what both of us had long ago come to recognize. In a single moment of honest discussion, nothing and yet everything had changed. So much about my life had gotten better. I was happy. I was productive. I loved the people Tuesday and I were meeting and the work we were able to do. Every day, I got emails and social media messages of friendship and encouragement from people we touched and inspired. We were traveling to interesting places. We had each other. We were living a beautiful life. But physically, I was in undeniable decline. My walking was getting more difficult. I was in frequent pain. The tricks that used to help me—shake it off, massage my muscles, take a warm bath—weren’t working like they used to.

And now the one doctor I trusted was talking about a wheelchair.

“I haven’t run since 2006,” I told her. “I want to run again.”

“You are not going to run again,” she said.

“Running used to be my work,” I said. “That was a requirement. That wasn’t an extracurricular activity. It wasn’t just a hobby.” I shook my head, trying to get the words out, trying to explain how much I’d already lost. “Running has ceased to be a part of my life.”

“I know,” she said. “I know.”

Pause. Deep breath. More.

“You will be in a wheelchair.”

Those six words just sat there in the air. I could barely make myself draw them in. They exploded in front of me, then seemed to collapse on the floor.

“You will be in a wheelchair.” That is what she said.

Even if I sort of knew that already—and somewhere inside me I guess I did—hearing those words spoken so plainly by a medical doctor who had earned my trust—damn, that hurt.

I sat there, digesting the meaning, petting Tuesday, hoping he hadn’t heard the same thing I had. Finally, I leaned forward and broke the silence, “That’s not me. I don’t want to be in a wheelchair. I don’t want to evolve from a cane to a wheelchair.”

“Well,” Dr. Jones said, “you asked, and I feel a responsibility to answer your question realistically. You will most likely walk with a cane for a number of years, and then that won’t be enough. I don’t know exactly how many. We have already exhausted neurology, ortho, PT, OT, pain management. We’ve been through the medical gamut. This is reality.”

That’s what she said. Here’s the way a drill sergeant told it to the soldier in me:

“Here’s your reality card, Private.”

She wasn’t being overly dramatic or purposely harsh. For the news she was delivering, she was remarkably matter-of-fact.

She was, I realized later, trying to be as positive as she could be under the very dark circumstances. “Luis,” she said, “there are new braces that are coming out, as you know, that may be supportive, robotic, and there are other non-robotic ones that are also available. Or…,” she continued, pausing another second, “there is elective amputation, which some people opt for if they feel it will enhance their mobility.”

Did she just say amputation?

Amputation?

Amputation?

I had not considered that.

That is not something anyone ever really thinks about.

“There are benefits,” she said. “They are making advances with prosthetic technology. People are walking, even running sometimes. It’s a serious decision. It’s certainly not for everyone. It’s not something anyone should do lightly. But it is an option when there is little else that will work.”

The words that came out of my mouth were not quite as dismissive as I might have imagined they’d be. I didn’t say, “Forget about it.” I didn’t say, “Are you nuts?” What I said was: “Well, this is obviously something I have to think about.”

And I did. As I began my due diligence, I discovered three practical realities right away—one procedural, another bureaucratic, and the last one technological.

As a medical procedure, a leg amputation—even an above-the-knee amputation, the kind I would need—isn’t considered all that complex. Doctors have been amputating diseased or injured limbs for as long as we’ve had doctors. Strong guys with sharpened stones were doing something similar before that. Modern medicine has the technique down cold. It involved cutting and stitching with anesthesia to dull the pain. While there is still some artistry involved—mostly involving where exactly to cut and at what angle—this is not a procedure that requires the highest-tech equipment or the most extensive surgical team. I don’t want to say, “Any hack can do it.” But there are certainly trained professionals who can.

That said, the bureaucratic reality featured some maddening rules and regulations of the U.S. Department of Veterans Affairs. Since the VA was my health-care provider, it would have been natural for me to explore the pros and cons of an amputation with one of its many surgeons. But that was a no-go. The surgery I was considering—a leg amputation to relieve constant pain and promote greater mobility—was considered elective surgery. Therefore, the VA would neither perform it nor pay for it, no matter how beneficial the results promised to be. If I decided to have my leg cut off, I was on my own. I would have to find a private surgeon. I would have to arrange and pay for everything, a total somewhere in the neighborhood of $10,000 to $15,000. My decision, my dime. There was one oddity here. While I was on my own in getting the surgery done, if I went ahead and did it, the veterans’ health-care system would spring back into action on my recovery. Most importantly, the VA would provide the prosthetic leg for me and whatever other rehabilitation I might need. That was major.

I didn’t understood the logic of this half-approval. Then again, it was the VA.

Finally, there was the burgeoning technology of prosthetic legs. Huge advances have been made in recent years. The new designs are sleek and beautifully crafted. They are loaded with shock absorbers and the latest electronics. In their functionality, they are getting closer and closer to healthy human legs. People are running, jumping, swimming, skiing, and doing virtually every other kind of activity on prosthetic legs. Para-athletes are clocking extraordinary times. It wasn’t yet true that prosthetic runners are routinely outsprinting the regular kind, but that is beginning to occur. This technology helped me grasp what Dr. Jones was talking about when she said that by cutting my leg off, I might actually improve my mobility. I could walk without one of my legs and maybe even run again.

No matter how encouraging the prosthetic research sounded, this was an excruciating decision to make. I certainly didn’t want to lose a part of my body, especially a part as important as my right leg. Even the terms—“cut if off” and “amputate”—sent chills down my already aching spine. I could just imagine the looks on the faces of my family and friends when and if I explained the idea patiently to them. “You might do—what?” And Tuesday, too. What would he think? How would he react? The health-care system kept using the word “voluntary.” Would anyone not facing it understand such a radical choice? Obviously, I could continue down the path I was on, most likely ending up in a wheelchair as Dr. Jones had described. And no one would blame me. But what kind of future was that for me?

Slowly, gradually, with plenty of mulling and more than a few sleepless nights, I wrapped my head around the idea of something that a short time earlier would have seemed totally shocking.

I decided I would have my right leg cut off.