CHAPTER 21

Test Drive

We cannot walk alone. And as we walk, we must make the pledge that we shall always march ahead. We cannot turn back.

MARTIN LUTHER KING JR.

THERE WAS SOME CONFUSION ABOUT OUR WEDNESDAY APPOINTMENT time. Tuesday and I showed up forty-five minutes early at the VA hospital in downtown Denver to see Triathlon Tom.

The hospital’s physical therapy clinic had none of the quiet efficiency of the Jewell Clinic, which I was starting to think of as the Department of Veterans Affairs’s exclusive boutique. The downtown facility was tiny and crowded with old equipment. I half expected to see the Universal weight machine we’d used in high school gym class or one of those madcap 1950s vibrator belts. But the downtown clinic did have Triathlon Tom, and that’s the reason we were there.

As we waited for the appointment, a short, stocky man was struggling inside of the clinic’s parallel bars, taking painfully labored steps with his new leg prosthesis. He wasn’t moving very much. “You mind if we watch?” I asked him as Tuesday and I plopped down on a padded table, me on crutches. “I’m trying to learn.”

“Please,” he said. “Then, I’ll watch you. We’ll both learn something.”

I liked his attitude.

His name was Quiñones. He was around sixty-five years old, and balance was not coming naturally to him. I didn’t know how long he’d been practicing—but longer than I had, since this was my first day.

His posture was tilted. He gripped the bars like he was scared he might fall off a cliff. His baby steps weren’t even baby steps, more like a stand-in-place shuffle. He seemed terrified he might fall. I didn’t know what to tell him, so I went with vague encouragement.

“Keep going,” I said, the sort of thing you say when you aren’t sure what to say. “One step at a time.” But you know what? It turned out that such words are near to the truth. Learning to walk with a prosthetic leg takes persistence, and it really does come one step at a time.

Tuesday and I are such fortunate creatures. When you are on a mission that millions of people believe in, a lot of them are willing to help. Or maybe that’s just what happens when half your pack is an irresistibly cute canine. Whatever. Talented people keep stepping forward in the most generous ways. They share their ideas and their expertise. Some host us in new cities and help organize events. Sometimes, they act as if it’s their job to help, extending boundless kindness, decency, or professionalism. That was Triathlon Tom.

A 6-foot-tall, athletic, happily married father of young fraternal twins, Tom was a staff physical therapist with the Denver VA, one of thousands of caring men and women toiling admirably in America’s often-maddening veterans’ care bureaucracy. He was also a top-notch team member of the Eastern Colorado VA system’s Amputee Clinic. So it didn’t surprise me when Tom told me offhandedly that he would be competing in a triathlon the next morning. He approached everything, including me, like an all-in, multi-event, leave-nothing-behind competition that he couldn’t wait for. This man was on a mission of his own—showing me and other disabled veterans, amputees especially, how to walk again. He was so much more than a “federal bureaucrat.” As far as I could tell, there was nothing he couldn’t do, up to and including dealing with my impatience to walk again and getting me to swing my new bionic leg as if it were my own.

Tom had many ways of achieving this. Encouragement. Criticism. Precise readjustment. Endless repetition. Channeling my impatience and frustration in productive ways. He used all of it. “Point your toe a little to the left,” he’d say. “It’s heel-to-toe, heel-to-toe. You walk the leg. The leg doesn’t walk you.” Walking, it turns out, is far more complicated than putting one foot in front of the other, to use another expression I think I might have tried on Quiñones. It’s a far more complex activity than most lifelong walkers realize, a fact that I only fully appreciated when I was the one expected to master it all over again.

In my first session with Tom, he had me climb into my new leg, which Bill-the-prosthetist had delivered to him. Then, Tom strapped me into a harness with a hook attached to the ceiling and told me to take a step. Then another. And another. The only other time I’d seen a contraption like this was in a community theater production of Peter Pan. With so much of my weight being supported by the harness, cable, and pulley, those steps were easy. Too easy, I thought. “This isn’t walking,” I told Tom. “This is hanging on a hook. I want to walk.” I asked him politely if he would remove the harness. “Can we get rid of the freakin’ harness?” I asked with a devilish grin. He agreed to let me try without it. I think he liked the fact that I was already pushing boundaries, his and my own, though he might have doubted how well I would do. We moved to the parallel bars.

Without the harness, the full weight of my body was now divided between two legs, one that God had given me, one that was manufactured by Ottobock. But let’s be frank, I wasn’t exactly trim. During my time in the wheelchair, I’d put on a few extra pounds. I was tipping the scales at 220 without my right leg, which had been my previous weight with the leg.

The leg definitely felt awkward. It felt exactly like what it was, a foreign object smack against my body. It didn’t feel like part of me. But using the parallel bars to help my balance, I was able to sort of walk. I have to add the “sort of” because it was not a smooth walk. I wasn’t gliding along. I was stiff. My motion was labored. It wasn’t a confident gait. But I was, indeed, putting one foot in front of another, and that was hugely encouraging to me.

“Very nice,” Tom said.

He had some suggestions about how I was plopping my new foot down. “There is a rhythm we are trying to achieve,” he said. “We’re not just dropping something on the floor.” But he seemed pleased I was taking steps, one after another, and I was pleased not to be suspended in a stupid harness like some oafish Peter Pan.

Tom made me leave the leg with him after that session. “The next time I see you, you can take it home,” he said. I would much rather have taken it back to the hotel with us right then. I spent the next two days frustrated I wasn’t practicing with my leg.

When we returned to the VA hospital on Friday to see Tom, I got right to walking in between the parallel bars.

I really wanted to progress as quickly as possible. In fact, I needed to progress rapidly because Tuesday and I had an ambitious travel schedule planned in the months ahead. I told him I really wasn’t sure if I needed the bars anymore to stabilize myself.

“You want to skip the bars?” Tom asked.

“Yes, I want to skip the bars,” I said.

“Sounds good.”

Again, I didn’t go very fast or very far, just around the cramped physical therapy clinic. I would call my steps labored and tentative. But I was making them and stringing them together, far more of them than I had the last time we were there. Now, it was starting to feel like walking. But apparently, I wasn’t done with Tom’s stability aids. He seemed concerned I might fall. So he cinched a belt around my waist and held it behind my back, following me as I stepped across the room. I felt like a dog on a leash. Sorry, Tuesday. I didn’t like that at all.

Tom seemed overly concerned about me falling. Partially because I’m a big guy, which meant he’d have a difficult time catching me. Partially, I think, because other hospital patients had fallen and then needed urgent attention from the clinic staff. Nevertheless, I was perturbed by the onslaught of Tom’s be-carefuls and take-it-easys and watch-your-steps.

“Listen,” I snapped after a few steps with the belt. “I’m gonna fall. People fall. Kids fall. Bike riders fall. We all stumble and fall. Then we pick ourselves back up.”

Impassioned by the situation, I went on.

“With or without amputation, I’m going to fall.”

And I did.

A couple of times.

At my first U-turn and then later on.

It hurt.

But nothing terrible happened.

I got up and kept walking some more.

Thank you, Airborne School in Fort Benning, Georgia. With the number of falls you have to endure learning to become a paratrooper, I’d better know how to fall.

As much as I was pushing to do more and do it more quickly, Tom seemed to like my drive and my positivity. “A lot of people are scared of the leg,” he said. “You can’t be scared of the leg.”

As I kept practicing, he called over two other therapists—and a couple of physical therapy interns—to watch. “This is his second session,” Tom said. “He thinks he’s ready for stairs.”

He seemed proud of me.

That’s why I was so pissed when, after that second session, Tom still wouldn’t let me take my leg with me. He had promised, hadn’t he? “I get that you’re impressed by my progress and how much I’m walking,” I said. “But I need to practice on my own.”

“You’ll take the leg on Monday,” he said. “Not today. You shouldn’t push yourself too quickly. You won’t be happy if you injure yourself. Monday, you’ll get the leg.”

“That better happen,” I warned him, just making sure. “If not, I swear I’ll take it hostage—or I’m going to Home Depot and making a peg leg. I need to practice a lot. Tuesday and I have places to go and things to do.”

Was I joking? I’m not sure.

It was a long weekend. I wouldn’t call it a waste, as there are always things to do, but someone in my shoes needs a lot more “homework” than the average soul. So, that weekend I remained a prisoner of the crutches and the wheelchair.

On Monday, Tom offered some intense gait critiques. The swing was still the tricky part. Mastering the swing, making the leg go back and forth in a natural manner, is the real skill of walking with an above-the-knee prosthesis. I’m not saying I got it instantly. That wouldn’t be true. But I was feeling the knee and it was bending and I was starting to get a rhythm down. I felt incredibly good about what I was mastering and had no doubt that, in another week or two, Tuesday and I might well be climbing Pike’s Peak.

Then, Tom made a suggestion that brought me right down to earth. “You want to try the stairs?” I think he’d been at least partially joking when he made that stair comment to his physical therapy colleagues. But now this was serious, and we were going to give it a try.

What a humbling experience that was!

“Okay, Luis,” Tom said after we rode an elevator together up to the second floor, and he led me to the top of a stairway. “When you go down a step, you need to make sure your foot is halfway off the step before you take the next motion. Otherwise, if it is not halfway, the knee won’t bend when it’s supposed to, and you won’t step down naturally.”

That seemed like an awful lot of instruction to walk down one step. But looking down, I realized I had never thought about exactly how that stair-descending rhythm works. Climbing requires an entirely different motion, Tom warned me.

I tried what Tom suggested and let me just say: It’s amazing how high six inches can be. I felt like I might need mountain-climbing pylons to lower myself one small step.

This seemed crazy, like it couldn’t possibly be the way a normal person goes down the stairs. It couldn’t be how I’d been walking down stairs my entire life. Tom assured me that it was. It seemed like too much planning, too much positioning, and too big a drop. And I didn’t quite get it that first time.

“Gives me something to work on,” I half mumbled as Tom and I retreated to level ground.

We did end that third session on a happy note. If we hadn’t, I really might have done something reckless.

“You ready to take the leg home today?” Tom asked.

“Yes,” I answered firmly.

“Are you sure?”

“I am very sure,” I said.

Tom gave me a big smile. I knew he was playing with me. But as soon as I had the leg in my hands, Tuesday and I exfiltrated the area as quickly as possible before there was any chance for the plan to change. I took the leg back to the hotel and finally started practicing on my own.

Now, my process was divided in two—with Tom and without Tom. Both were vital to my progress.

Over many physical therapy sessions spanning a few weeks’ time, Tom looked on as Tuesday and I walked the hallways of the hospital. He wasn’t merely following us around though. He spotted and coached me as I walked, turned, and negotiated around people and obstacles. He kept giving me pointers, and I kept trying to walk as naturally as I could.

Swing, balance, land, don’t fall, walk.

You have to learn to sense when and how to swing the prosthetic leg so you take even, smooth, rhythmic steps forward. Besides balancing, that’s the hardest part. You’ve got to train your brain to understand how the leg swings itself and also how the leg moves. And you’ve got to practice where the foot and the leg land in relation to your gate. I never thought about any of this complicated coordination before my operation. We take all that for granted, those of us who have spent our lifetimes walking on our own two legs. Too bad I didn’t pay more attention when I was two.

The mechanics, the balance, and the locomotion of sitting, standing, and walking are all different with a prosthesis. The new leg, no matter how advanced it is, isn’t you exactly. It’s an $80,000 contraption that’s jammed up against your thigh and groin. Mastering that takes real mind control—and time.

As I walked around the VA hospital, I wanted Tuesday walking with me. But the first time we tried that, I had trouble keeping him under control. He hadn’t seen me walk much in the past couple of months. He seemed thrilled for me—and for himself as well. We were walking together again. But as we did, people kept coming over, wanting to pet Tuesday or just say “hi.” Patients, staff, techs, trainers, everyone. Often at the VA, I let Tuesday interact with people. They almost always want to meet him. Military veterans love dogs. And Tuesday loves them. It’s a win-win situation. Except for times when I need Tuesday to perform tasks for me, which happens more often than people think.

Initially, he wouldn’t sit and stay. He wanted to walk beside me. He wanted to help me. He knew I was struggling.

A few times, I got impatient with him.

“Tuesday, STAAAAY,” I said sharply.

I rarely have to admonish Tuesday in public. But he wouldn’t sit and stay as I practiced my walking. I really needed to focus on the leg and on myself—not on Tuesday’s many fans and tripping over him.

I didn’t want to yell, but I couldn’t whisper. With so many people around, he wouldn’t have heard.

Back at the hotel, we took walks through the building’s many hallways. Smooth. Level. Carpeted. Mostly empty. We circled the lobby and went to the restaurant. Then, ever so slowly, we ventured outside, a vast expanse of crooked sidewalks, uneven entrances, and daredevil curbs. Tuesday accompanied me everywhere. As I got better at this, he’d be at my side wherever I went. I liked having him and he liked being there. This was our longstanding reality. We might as well both learn the new mechanics.

I tried to take things slowly. I couldn’t leave the leg on all day. My body wasn’t ready. Even I could see that. The leg was attached to the socket, which in turn was vacuum-squeezed onto my stump—it took a lot of energy to maintain all that. Honestly, it was exhausting. It wasn’t easy on my muscles, my nerves, my bones, or my skin. This was all just part of the deal, I told myself. All I could do was get stronger, get more comfortable, and improve my technique, which meant continuing to work and learn with Tom.

In all our sessions, Tom watched me keenly. He kept making adjustments, some large, some small, analyzing my gait. Straight steps. Turn around. Up and down. We hadn’t done backwards, but I had to think that was coming. He was really honing in on all the little things. And with each new maneuver that I got right, he gave me loads of positive feedback.

“I want the critical feedback too,” I reminded him. “This is how I’ll get better.”

Tom, I was happy to learn, was willing to offer plenty of that.

With his guidance, positive and negative, and my obsessiveness plus Tuesday’s love, I continued to make progress. I was determined to be the fastest-learning walker in the history of above-the-knee amputees. Every second I wasn’t on the leg, I felt like I should be. Some days, I pushed myself till my stump was tender, my thigh was raw, and my back ached. Eventually, I learned to pace myself a little. But I was right to believe that learning to walk was worth the effort and not a job for slackers. Fearlessness—or was it stubbornness?—was a huge advantage.

There was something else I noticed as I continued working with Tom at the clinic and taking short walks around the hotel lobby. I was starting to feel some limb sensation. Not phantom limb sensation. The real thing. As if that Ottobock leg was actually becoming more a part of me.

This was something I wasn’t sure I would ever feel again, and now I knew I would never get tired of it. It felt like I was getting back a piece of myself down there, and that was even better than just getting back on my feet.

Tom’s valuable instruction kept coming. “Allow your right hip to extend outward. Make sure your arms swing naturally as you walk so your entire movement flows.” I appreciated the advice and critiquing, and I was walking pretty well, I thought. Upright. With confidence in the leg. Without too many missteps. Together, we worked hard. And the progress was right there to see.

Things you take for granted with a natural leg are a lot less intuitive with a manufactured one. Oxygen use is one. It’s harder to walk on a prosthesis. It takes more effort. It requires more energy—researchers say an above-the-knee amputee uses a full 80 percent more than a normal two-legged person walking.

Another thing I never noticed so clearly before: Sidewalks are all uneven. Curb cuts aren’t where they are supposed to be. Ramps aren’t there when you need them. The leg gave me far more mobility than the wheelchair had. But it still wasn’t a walk in the park, though, come to think of it, the ground in most parks isn’t so level, either.

Suddenly, that hospital hallway seemed like a breeze, even with Tuesday occasionally two-stepping around my feet.