CHAPTER 18

Getting Fitted

The future is the shape of things to come.

H. G. WELLS

THE JEWELL CLINIC REALLY WAS A CROWN JEWEL.

Over the years, Tuesday and I have visited scores of veterans’ medical facilities across the country, probably more than a hundred by now. Some are old. Some are new. Some are staffed by wonderful, caring people. Some are not. But we haven’t seen too many that are like the state-of-the-art Jewell Clinic of the Eastern Colorado Health Care System. Opened in 2010, the Jewell Clinic definitely does not live up to the downbeat VA stereotypes. It is small for a VA facility. Clean. Modern. Friendly. Not teeming with my fellow walking-dead zombies. All the employees seemed to know each other, and were unfailingly friendly to us each time we arrived.

Tuesday and I had come to Denver because of the clinic’s reputation for helping patients with mobility and rehabilitation issues. I’d asked around and done quite a bit of online research and concluded that this would be the right place for me to get my new leg. The Jewell staff had deep experience. They had access to all the latest prosthetic technologies. And they had Bill-the-prosthetist, who everyone seemed to agree was uniquely talented in the art and science of properly fitting artificial limbs.

Here was something else: We had a 9 A.M. appointment. Tuesday and I arrived a little early, prepared for the usual VA wait. Instead, we were greeted by Bill and led into the examining room at precisely 9 A.M. Wow! Just wow! On time? No way!

On our way in, I noticed quite a few people with canes, crutches, walkers, and wheelchairs. There was actually something comforting about that, as I rolled along in my own chair with Tuesday trotting by my side. I’d been feeling self-conscious and different. Here, I wasn’t a freak. For the first time since my surgery, the world didn’t seem populated entirely by perfect bipeds. The world looks very different from 6 feet 2 inches than it does from 3 feet 1 inch.

I would describe Bill as a slightly more muscular version of TV’s Gilligan—tall, lanky, sinewy, and sandy-haired. He gave off what I would describe as an artsy, mechanical vibe. I could tell he was a guy who worked with his hands. The room had a typical examining table and a stool and also a set of parallel bars, about twelve feet long.

Tuesday had to say hi before we got started. He nudged up against Bill, who petted him nicely. “Do you have a dog?” I asked.

“Yeah, I do,” Bill answered politely. But he was clearly focused on getting started—quite businesslike, actually—so I didn’t try to make any more conversation with him. Some people, I know, just aren’t the talkative type.

Bill asked me to climb out of the wheelchair and stand inside the parallel bars, holding on with both my hands. He looked. He poked. He prodded. Then, he handed me a long, rubbery item he called a sleeve. The sleeve was maybe a foot and a half in length and a foot in circumference. The rubber felt slightly sticky. It was roughly three millimeters thick. He asked me to sit back in my chair and slide the sleeve onto my stump. “This should be just large enough to slide up the full length of your residual leg and fit snugly,” Bill told me “Roll it up your thigh to the point where your thigh meets your hip.”

I pulled it carefully over the stump. That created a strange sensation, but I didn’t care. This was the first step.

It seemed snug to me. “Fits like a glove,” I marveled.

“We need it to fit better than a glove,” Bill said. “Much better. Now stand up again.”

With both his hands, Bill pulled and pinched at the rubbery material, maneuvering the excess to the top of the sleeve. With a pen, he marked where the excess began. He felt around my right glute and my inseam, making sure he squeezed all the extra rubber to the top. Finally satisfied, he slid the sleeve off my stump and, with a pair of industrial scissors, he cut off the excess along the pen marks.

“Slide this back on,” he told me.

The man was good. There was no excess rubber anywhere. “Definitely better than a glove,” I said.

With the trimmed sleeve in place, Bill handed me what looked like a cutoff set of long underwear, made of a slightly gauzier material. “Pull these on,” he said. I slid one side onto my good leg and the other side onto my stump.

The long johns were extra high-waisted, reaching almost to the middle of my chest. Bill told me to pull them up as far as I could, stretching the wrinkles out. All of a sudden I felt like uber-nerd Steve Urkel from Family Matters.

“Did I do that?” I muttered to myself in Steve’s nasally voice.

One thing you learn real quick in the military. You’ve gotta maintain a good sense of humor.

Bill wanted everything to be as smooth as possible against my skin.

Then, he stopped for a moment and began to prepare a mixture that looked exactly like plaster of paris, the stuff we used to make models with as kids. Then, he returned his attention to my leg.

At the end of my residual limb, he pulled the excess long john material into a point, keeping the material as taut as possible. He cinched it together with strong, thin string—could it really be dental floss?—carefully, almost surgically winding up the excess into a perfect little ponytail, wagging from the bottom of my stump.

“Will you stand now?” Bill asked.

With me upright and between the parallel bars, he leaned back and inspected the rubbery sleeve and the long johns one last time, making sure everything was smooth and taut and no wrinkles had slipped in.

“Sit back down,” he said.

As kids, when we played with plaster of paris, we poured the plaster powder into a bowl or a bucket of water and stirred it up. He had a bucket of water and something in there acting as an accelerant, but he also added rolls of white gauze to the mix. The mixture mustn’t have been anything too toxic. I noticed he wasn’t wearing gloves.

“Stand,” he said.

With every abbreviated instruction, I was struck by how little narration Bill was offering on this amazing day. But I did as he asked me to. I stood.

I stepped back between the parallel bars, which gave me some added stability and helped me remain still while I balanced on one leg and he went to work. He squatted in front of me like a sculptor assessing his raw stone or clay. He lifted some gauze from the plastery liquid and began wrapping the soggy strips around my residual leg. This went on for several minutes. Wrapping. Laying on plaster. Wrapping some more. Laying some more. Around and around he went, up and down and middle, the entire length of my residual leg. From the tip of the stump all the way to the top of the inseam, all of it was being wrapped in this plaster-soaked gauze.

Now I could see why Bill insisted that the rubbery sleeve come all the way to the top. He couldn’t allow any imperfections in there at all.

“The higher we go,” Bill finally said, “the more leverage you will have. That’ll give you that much more control.” Bill was the expert, and I had no doubt he was right.

He spent maybe ten minutes rolling on the wet, gauzy layers and making sure there were no bumps or wrinkles or looseness or excess material anywhere. The more he wrapped, the more I realized this was definitely tighter than a glove.

As Bill slapped on more and more water, I could feel the plaster hardening and tightening around my residual leg. It wasn’t painful, just noticeably constricting, gripping around the entire circumference of what was left of my leg. You know what it felt like? It felt like a more extreme version of one of those blood pressure cuffs. The pressure kept increasing, and all that plaster was hardening into a cast. Unlike a blood pressure cuff, it didn’t deflate. It just kept feeling tighter.

So how would this pressure be relieved? The long johns, Bill told me, weren’t just to protect my skin. They would make it easier for him to slide the hardened plaster away.

When he decided the plaster was hard enough, Bill got his fingers around the cast and delicately began to shimmy his new creation off my stump. He tugged smoothly but firmly so the plaster wouldn’t crack. After a few more shimmies and one small pop, he was holding a three-dimensional mold of my residual leg. Not a picture. Not an estimate. An actual impression of what was and wasn’t there.

Now, I really did feel like a model for one of the greatest sculptors of our time. And the mold Bill had created would help him forge a new body part for me.

Then, he handed it me. “Pretty cool, huh?” he said, nodding his head appreciatively at his latest work.

“Yep” was I all I could manage. But it definitely was.

He peeled back what was left of the long johns. He helped slide off the rubber sleeve and clean up the mess. He told me something, proudly, that he hadn’t before. Some other prosthetists, he said, have started using 3-D printers and computer-assisted design to help establish the dimensions they will try to achieve. “The new technology has its benefits,” Bill said. “But I still get better results with an old-school cast.”

It’s ancient technology, he said. But it’s human scale, and if done correctly it produces an eerily accurate representation of the residual limb. “That’s the craftsmanship, right there,” he said.

I liked the sound of that.

One person, working with another, bringing talent and experience and a caring human touch. If plaster casting was Bill’s preferred method, count me as a plaster-cast guy.

“I’ll make a vacuum socket for the interim prosthetic based on the cast we have made,” he told me as Tuesday and I prepared to go. That socket is what would fit around my limb and hold the actual new leg in place. Bill wouldn’t be subcontracting any of this to an orthopedic workshop somewhere, he assured me. He would create the all-important leg socket himself. He had taken the measurements. He had interacted with the patient. He had the mold. And I was completely certain he had the talent and skill to get it done.

“So go make me a leg,” I said with a smile.

“I will,” Bill said in that same deadpan tone. But then I noticed a slight change. The more Bill talked the more he sounded almost excited. “I’m going to fit you with a leg with a microprocessor,” he said. “A C-leg, it’s called. C for computerized. It’s made by a German company named Ottobock. Top of the line. It’s popular with para-athletes. It’s an amazing piece of equipment that blends the latest technological achievements with some old-school prosthetic craftsmanship.”

Between Bill’s version of enthusiasm and the idea of coming at the challenge from two directions, I was smiling even more than before. I was thankful that we had chosen Jewell and Bill. His approach and knowledge was exactly the kind of thinking that appealed to the army officer in me. I’d spent much of my life studying old and new battle strategies. Now, I was working with someone who’d obviously been studying the strategies and science of prosthetic legs.

Bill mentioned the C-leg’s electronic innards, how the leg’s sensors could absorb fresh data from my real-life experiences and feed them into the operating software. He mentioned Bluetooth remote connectivity. He said something about “constant refinements.” I couldn’t take all of it in so quickly. But I knew that I’d soon be spending hours on the Ottobock website, soaking up every last detail about this magic-sounding device that was going to help me walk and move well again.

My mind was flying with possibilities that seemed finally within reach. Bill made sure I didn’t get ahead of myself. “This will be your interim leg,” he cautioned. “The size of your limb is still changing, even though most of the swelling has gone down. Your leg will keep changing in the months ahead. You probably won’t get your permanent leg for two or three months—maybe even a year from now.”

I should be prepared for a steep learning curve, Bill warned. “It’s a good piece of equipment, but it won’t walk for you. You still have to do that yourself. Be prepared. You are facing many grueling hours ahead. You’ll be working with a physical therapist who will help you build your strength and show you some techniques. Balance, leverage, stopping, starting, climbing stairs, leg swing—you’ll have to learn all of that. It can take a while.”

“I know and understand,” I answered. And I did.

However long it took, I knew I was going to be impatient. I was mentally ready to start right away. Slap on a leg and get going. But I’d been warned by doctors and psychologists, by surgeons and nearly every firsthand report on the Internet that this was a slow, painful process. However hard it was going to be, I told Bill, I was ready for it. I was ready to start right away.

From beginning to end, it was a great visit with Bill. We were in and out in an hour. I could almost see my future ahead of me, standing once again 6 foot 2 inches tall.

“Is next Friday okay for you?” Bill asked. “Same time?”

“Absolutely,” I answered.

This was all moving very quickly, something I wasn’t used to at the VA. I didn’t come this far to spend an extra weekend in a wheelchair. I was grinning as Tuesday and I rolled out of there.

For most of the next seven days, I stared at my laptop in the hotel room, digesting every morsel I could about the Ottobock Genium C-Leg, “proven to support your active life through amazing microprocessor technology.” It wasn’t just a leg. It was one of “the world’s leading microprocessor prosthetic leg systems.” Tuesday and I went out for food and to let him do his business. But other than that, I was committed to becoming a Rain Man–caliber expert on this sleek piece of hardware that I was convinced would enable the return of my mobility.

Nothing else seemed half as interesting as that.

This thing was loaded. The easy swing initiator. The preflex knee. The enhanced-response shock absorption. The equalized stride control. The Adaptive Yielding Control. Dynamic Stability Control. Adaptive Swing Phase Control. I wasn’t sure what all those features were, but I liked the way they sounded. The careful accommodations for sloping and uneven surfaces. My time on crutches and in a wheelchair had certainly highlighted plenty of those.

“The Genium microprocessor prosthetic leg is quite simply the closest technology has come to natural walking,” the website said. “Imagine work, family, or leisure time activities without having to think about your next step. If your active life demands more function, this is the system you need.”

Yes, I could imagine all of that. Yes, my active life demanded more function. Yes, I was ready for my C-Leg. Now all I’d have to do was trust Bill’s fitting technique and learn to walk again. And I didn’t have to imagine when. That date was not only in my calendar. It was a constantly ticking countdown in my mind.

Friday, April 29, was going to be L-Day, Leg Day, the day I would finally walk out of this place and into the world on my new bionic leg. I would remember that date, as surely I would remember February 27, seven weeks and a lifetime earlier, the day my right leg was severed and carried out of the room. Tuesday and I might even start celebrating those dates every year. They would be my other birthdays.

I could hardly wait.