In the eighteen months after my first osseointegration operation in Sydney, I set about establishing a more formal support structure. I created a full team to assess and recommend patients: psychologists, anaesthetists, orthopaedic fellows, nurses, pain-management professionals, perioperative-care managers, physiotherapists, prosthetists, rehabilitation experts, biomedical engineers and an amputee representative.
The team examines every potential osseointegration patient. We’ve created strict inclusion and exclusion criteria. In Australia, for example, we rule out children, pregnant women, current smokers or people who’ve smoked in the last three months, diabetics, people with peripheral vascular disease, anyone receiving active chemotherapy or who has irradiated bone. And we must be convinced patients will be prepared to follow our instructions.
Word that the new procedure was available spread quickly. And it wasn’t long before inquiries started coming in from potential patients in other countries.
In his home town of Nelson on New Zealand’s South Island, Phill Coulson runs a company supporting people living with mental health issues. One of Phill’s hobbies is restoring rare Ducati motorcycles.
In October 2010, he was taking the first ride on his latest restored motorbike when he collided with a campervan on a country lane in Nelson. He lost his right leg above the knee in the accident.
Because of an allergy to silicon, Phill was having trouble with the liners for the socket prosthesis. He started researching more suitable alternatives and soon found my mobile number. Phill called me as I was driving to another osseointegration operation.
He then flew across the Tasman to find out whether he was suitable for the procedure. He was—and in March 2012, he became my first international osseointegration patient. The surgery wasn’t straightforward, and there were a number of complications. But the procedure did successfully restore Phill’s mobility.
‘I have a young family, and I wanted the best system in the world so I could share as much as possible with them,’ Phill says. ‘We have a tennis court and a swimming pool at home. I play tennis and go swimming. I do boxing and go to the gym. I even considered climbing Mount Kilimanjaro with a friend—but, in the end, he couldn’t make it.’
Phill contacted the New Zealand media and told them he was coming to Australia for osseointegration. The two operations were filmed by the TV3 current-affairs show Campbell Live, hosted by John Campbell. After coverage of the operations went to air, Phill was dubbed New Zealand’s first Bionic Man. His motivation wasn’t individual fame or fortune, though. Rather, Phill wanted to raise awareness of people with a disability and the need for the expansion of support services.
Another Kiwi, Iain McGregor, watched Phill on television and immediately wanted to undergo osseointegration. He contacted me in Sydney and, in April 2012, he came over for the first stage of his surgery.
Iain’s a typically dry, unflappable farmer from the small town of Otorohanga in the King Country, not far from the North Island city of Hamilton. You may or may not have heard of Otorohanga, but it has carved out a bit of an offbeat reputation.
In the late 1980s, Mohamed Al Fayed—then owner of the Harrods department store in London—launched legal action claiming exclusive worldwide rights to the name Harrods. He wanted to force anyone who operated a retail business under the name of Harrods to drop it.
Henry Harrod owned a fish and chip shop in Palmerston North on New Zealand’s North Island, and he had a shingle outside his shop saying ‘Harrod’s Fish and Chips’. Because of Al Fayed’s legal action, it had to go. The whole of New Zealand closed ranks behind Henry, and the town of Otorohanga even went as far as officially changing its name to Harrodsville!
As a result, there was a hue and cry in the British media, which set its sights on Al Fayed and unmercifully lambasted him until he backtracked and dropped the lawsuit. At that point, Harrodsville reverted to its original identity.
These days, Otorohanga is best known as a tourist attraction for its display of ‘kiwiana’ in the main street, including representations of New Zealand icons such as the flightless kiwi bird, farm dogs, the All Blacks and pavlova. Although I think the average Australian might have something to say about the origins of the pavlova!
Iain’s laidback approach to life very much reflects the community where he lives. This relaxed existence was shattered in February 2012. The then 48-year-old Iain set out along the nearby main road on his Harley Davidson. A fully loaded logging truck pulled out from a side road and started driving up a steep hill. As he approached from behind, Iain misjudged how slowly the truck was travelling and crashed into the back of the heavy vehicle.
He remained conscious and looked down to see the left leg of his motorcycle leathers was ripped from ankle to thigh. Shattered fragments of bone were visible through the torn leathers. From his experience with injured animals on the farm, Iain knew what to expect. Rather than being thrown into a blind panic, he recalls thinking, ‘Looks like that leg’s buggered. I wonder whether I can still drive a tractor.’
Iain’s left leg was amputated above the knee. He was measured up for a socket prosthesis, but it was never actually fitted. Within four months of the accident, he had a new robotic leg—my first patient to go straight from amputation to osseointegration.
He’s had absolutely no medical problems with the new leg, although he did bend the implant when he slipped on a wet surface. Eighteen months later, the shaft of the implant snapped. He was on crutches for seven months—a restriction that nearly drove him crazy—before the implant was removed and replaced by a surgeon in New Zealand who’d observed his original operation.
Iain’s a mechanic by trade, and is a resourceful character. He carried on with his dairy farming for around a year after losing his leg, but reluctantly gave it away when the lease on the property ran out and the contract terms changed. He turned his attention to buying and renovating houses in the area—carrying out the plumbing and electrical repairs himself and even climbing on roofs when necessary.
In 2018, Iain and his partner bought a 100-hectare farm—which at one stage had been owned by former All Blacks captain Sir Colin Meads—in nearby Te Kuiti. He runs sheep and beef cattle on the property and is president of the local Sheep Dog Trial Association.
Iain is philosophical about the accident, but makes the most of the quality of life his robotic leg provides. ‘Everyone gets dealt shit,’ he says matter-of-factly. ‘Things happen to people all the time. It’s how you deal with the shit that’s important. I wear shorts most of the time, but if I have long pants on and I’m walking on a flat surface, no one knows that I have an artificial leg.
‘I miss being able to jog. It would come in handy when I’m trying to catch a lamb or a calf. That’s a bit of a pain. But I’ve bought an automatic motorcycle that helps me get around the place. Other than that, it hasn’t really slowed me down. In fact, it has made me stronger.’
One patient who’d been injured in more unusual circumstances was another New Zealander, Brian Coker.
Tuesday, 22 February 2011 started out as little more than a standard working day for Brian. He’d dropped his wife, Helen, at the airport, as she was flying to Palmerston North to visit relatives. Then he’d driven into the Central Business District of Christchurch, the largest city on New Zealand’s South Island, to his job as a financial planner in the Pyne Gould Corporation (PGC) building on Cambridge Terrace. He’d spent the morning at his desk on the first floor, next to a window overlooking the Avon River.
Just before one o’clock, Brian—who was only a couple of weeks away from his 53rd birthday—decided to head out into the fresh air and sunshine. He left his office and walked to the top of the sweeping staircase that led down to the foyer. On reaching the landing, he felt the building start to shake. Minor tremors weren’t unusual in Christchurch, so Brian assumed these were nothing out of the ordinary. He was wrong. This was a massive earthquake that, in a matter of minutes, destroyed much of Christchurch.
Brian grabbed the balustrade to steady himself. But the shaking intensified … and the building started to collapse around him. Before he could escape, Brian was thrown onto his back and was covered in debris. The noise was deafening. Amid the chaos, Brian’s legs were pinned under a concrete beam.
In agony, he instantly assumed most of Christchurch had been flattened by the tremor. He feared the emergency services would be overwhelmed. There would be no hope of rescue or escape.
Brian decided to bid a last farewell to his beloved family while he was still conscious and capable. He found his mobile phone in his pocket and sent a final text message to Helen. The message was frank. There had been an earthquake. He was trapped under rubble at work and didn’t think he’d get out alive. Then he added the most important part. ‘Never forget how much I love you.’
Next, Brian sent a text to their son, Jonathan, who was at university in Christchurch, asking whether he was okay and outlining his own circumstances. This time, for no particular reason, he mentioned exactly where he was trapped in the PGC building.
Finally, he tried to send an SMS to their daughter, Olivia, in Auckland. But by now, the mobile networks were overwhelmed, and there was no connection. He switched off the phone to preserve the battery, on the off-chance it would be needed later.
The concrete beam had pinned his legs above the knees. Brian wasn’t aware of the full extent of his injuries, but he could feel blood dripping down the remains of his legs. ‘The pain was excruciating,’ he recalled. ‘It’s hard to believe the human body can endure such pain. But, at the same time, I felt reasonably calm. I think I had simply accepted the inevitability of the situation and that there was little or nothing I could do.’
Brian could hear screaming from others trapped in the debris, but in the darkness had no idea exactly where they were or what their situation was.
‘I went through some wild mood swings,’ he recalls. ‘At some points I wished for one more huge aftershock to bring the rest of the building down on me. At others I arranged wooden panels over my head to protect me from rubble falls. Why? I have no idea. I didn’t think there was even a remote chance of being rescued. Maybe there’s an inherent will to survive in all of us.’
Brian drifted in and out of consciousness. He sensed he was becoming weaker as the hours passed and the blood was literally draining from his body. He made another effort to switch on his mobile phone, but by now his condition had deteriorated so much he couldn’t focus on the screen.
In Palmerston North, Helen had made contact with their son, who told her where Brian was in the collapsed building. Unbeknown to Brian, Helen dialled 111 and was connected to the National Crisis Management Centre in Wellington. She passed on the vital information about her husband’s whereabouts.
Out of the blue—and more than four hours after the earthquake—a rescuer pushed his way through the rubble and made contact with Brian.
‘Hello … what’s your name?’
‘Brian Coker.’
‘Are you married?’
‘Yes.’
‘Do you have any kids?’
‘Yes. Two.’
‘How old are they?’ The questions went on.
The rescuer left, reassuring Brian that someone else would be back to see him shortly. Soon, another emergency service officer wriggled through the debris and asked the same questions. Then a third rescuer approached Brian … and repeated the list of questions. It reached the point where Brian felt like saying, ‘How about you talk to the last guy? He has all the information!’
Eventually, though, Brian realised that the point of the questions wasn’t to confirm his identity. They were to keep him conscious and as alert as possible. One rescuer asked Brian if he played any sport. ‘A bit of squash,’ was the ironic reply.
Around five hours after the quake struck, Dr Bryce Curran—a Christchurch-based anaesthetist—edged his way towards Brian. He explained that he was there to help and started cutting through the legs of Brian’s pants. Australian urologist Dr Lydia Johns-Putra, from Ballarat, had been attending a conference nearby. She joined them in the wreckage of the building.
Outside, the newly qualified paramedic on duty didn’t usually have approval to carry ketamine, a strong anaesthetic. But before he left the base, he’d asked higher-ranking officers for special permission to be equipped with the powerful drug. He was quickly given the go-ahead. By an odd coincidence, the approval came from Brian’s paramedic brother—who had no idea of the identity of the patient who would soon be in need of the anaesthetic.
After applying the ketamine, Dr Curran and Dr Johns-Putra set about their task. Nothing could prepare them for the events that were about to unfold. Rather than the standard floodlights of an operating theatre, the only sources of light inside the collapsed building were the torches held by firefighters. The surgical instruments were equally basic: a Leatherman knife—a pocketknife normally used on camping trips—and a hacksaw, which had been sourced from the Fire Brigade. To complicate matters further, major aftershocks struck the area as the delicate procedure was underway.
Remarkably, the operation to amputate one of Brian’s legs was successful. His other leg was freed and he was carried outside to the care of another Australian urologist, Dr Stuart Philip from Brisbane, who was waiting with an ambulance.
Brian was rushed to Christchurch Hospital. His life was hanging in the balance. He’d lost most of his blood and, with his vital signs diminishing, a cardiac arrest was an imminent prospect. When he arrived in the Emergency Department, the medical specialists actively discussed the level of care he should be given. They decided Brian had a reasonable chance of survival—but only if his other leg was amputated. His wounds were cleaned in the operating theatre, and his condition stabilised. He needed 46 units of blood.
Within eighteen hours, he was transferred to a hospital in Hamilton. At the time, Helen was philosophical, but forthright. ‘We don’t care about his legs. He is alive. We will carry on,’ she said.
Over the coming weeks, Brian learned that the colleague who worked next to him had died at his desk. Seventeen more people perished in the rubble of the PGC building. It was pure chance that Brian had decided to duck outside in those seconds before the earthquake struck.
Brian spent six weeks in hospital in Hamilton and another six weeks in a rehabilitation facility in the city, under the guidance of his wife, who was a nurse. They returned home to a house that had suffered minor damage in the quake.
Brian remained in a wheelchair until September 2011, when he was fitted with socket prostheses. He could walk with them, but only with difficulty—and plenty of pain. He persisted for six months, but then watched the current-affairs show covering Phill Coulson’s osseointegration operation.
Brian and Helen contacted me and came to Sydney to check whether he was suitable for the procedure. He was. However, they struggled to raise all the money they needed for his operation. Hours before he was due to fly to Australia for the second operation, the finance finally came through.
A surgeon from New Zealand also came over, and I’ve helped develop his skills in osseointegration. He has since carried out more than a dozen of the operations across the Tasman.
Brian’s surgery was a success, and he now walks each day. He chooses to use two walking sticks, largely for a sense of security. ‘It’s a mental issue as much as anything,’ he explains. ‘Rather than anything else, I want to feel safe.’
While he’s in the house, Brian mainly uses a wheelchair. But when he and Helen are working in the extensive garden of their new home on a 3600-square-metre block, Brian operates on short, stubby artificial legs with no knees.
‘Osseointegration has made an immeasurable difference,’ he says. ‘I’m convinced that without osseointegration I wouldn’t have been able to walk. It’s given me a life outside a wheelchair. It’s reopened a whole world for me.’
In February 2015, Brian’s new life included walking his daughter down the aisle for her wedding in Christchurch.
Up to this point, Steve Borton was the only former military person I’d performed osseointegration on. The others had all been civilians.
However, amid deepening global conflicts—especially in Iraq and Afghanistan—thousands of soldiers from Western nations were being exposed to weapons and battlefield tactics that had been designed to maim as well as kill.
Truck and car bombs, individual suicide bombers and other IEDs were the weapons of choice for jihadist movements such as Al-Qaeda and various militia groups. In addition, conventional artillery shells, RPGs, mortars and bullets were inflicting horrific wounds on soldiers and civilians.
Casualty numbers were rising rapidly, especially amputees. There were more amputees than in previous decades because advances in medical treatment meant more people were surviving devastating injuries. At the time, I couldn’t help reflecting on the words of the ancient Greek physician Hippocrates, who said that the only proper school for the surgeon is war.
By the end of the first decade of the 21st century, the British Army had suffered a huge death toll in Afghanistan, and thousands more soldiers with amputated limbs were being airlifted home. Above- and below-the-knee amputees would be sent to the military rehabilitation centre at Headley Court in Surrey, south of London. Some would spend as much as five years living in Headley Court for five or six weeks at a time, undergoing specialist treatment and being fitted with standard socket prostheses. The people who were there longest were above-the-knee amputees.
Over the years, the medical staff had seen many patients struggle with traditional artificial limbs. Even though the wounded service personnel had adapted well, their mobility was often severely limited. One of the senior officers at Headley Court, Lieutenant Colonel Rhodri Phillip, began looking for fresh approaches. He came across osseointegration and started discussing the prospects with some of the soldiers there.
He’d had a bad experience with the first case of a soldier who’d undergone osseointegration carried out by a team at a hospital in the UK using a technique I’d never tried. There were severe complications and the patient had the implant removed.
It was a major setback for the project, and at the time the authorities at Headley Court were reluctant to follow through with further osseointegration operations. Rhodri decided to explore all the other approaches and heard about our success from some British civilians who’d undergone the procedure in Sydney.
Plenty of his patients were encouraged by the possibilities of osseointegration but, particularly after the unsuccessful surgery, no one wanted to be the next. At least one serviceman turned down the opportunity through fear of the unknown.
Then Rhodri started talking to Rifleman Michael Swain, who was nineteen years old when he lost both his legs above the knee after standing on an IED in a field in Afghanistan. That was in 2009, and over the next four years he had struggled to walk with socket prostheses. Despite his best efforts, Michael was virtually confined to a wheelchair. His last throw of the dice was to travel to Sydney for osseointegration. I operated on him in December 2013 at Macquarie University Hospital.
Michael’s recovery was swift, and three months later, almost immediately after his second-stage surgery, he walked onto a Qantas aircraft at Sydney Airport for the flight back to the United Kingdom on his new robotic legs, using only one crutch. Once he landed at Heathrow, he was driven back to his home in Luton, north of London. As he walked up the path to the front door of his home, his then wife and young son were watching from the window.
‘Look, here comes Daddy,’ his wife told their son.
The youngster responded, ‘That’s not Daddy. Daddy can’t walk!’
What his son didn’t realise was that his father could walk once more. And he has done ever since. Indeed, I was privileged to go to Windsor Castle in April 2014 to watch as Michael walked unaided to meet the Queen and receive an MBE for services to charity.
Naturally enough, Michael spoke about osseointegration with other wounded soldiers at Headley Court. One of them was a young Welsh fusilier, Shaun Stocker, who, six days from the end of his tour of duty in Afghanistan, had also stood on an IED. He lost both legs above the knee. As well, he lost his left eye, he was blinded in his right eye—although he subsequently regained 30 per cent vision—and, probably worst of all for a young man, he lost both testicles.
Shaun had considered osseointegration some time earlier. But, at that time, no British service personnel had undergone the procedure. Like Steve Borton, he decided against being the guinea pig. But after talking to Michael, Shaun asked Rhodri if he, too, could to come to Sydney for the surgery.
Shaun made the journey to Australia accompanied by a Royal Air Force surgeon, Group Captain Jon Kendrew, who was researching osseointegration and wanted to observe the procedure. Shaun’s operation was as successful as Michael’s. Both men say it has changed their lives.
Since the operation, Shaun has had many amazing and positive experiences. On his new robotic legs, Shaun walked 100 kilometres in five separate stages and raised more than A$120,000 for his chosen charity, Blind Veterans UK. More recently he climbed the highest peak in Wales, Mount Snowdon—in dreadfully wet and windy conditions, I might add—again raising money for Blind Veterans UK.
In mid-2018, Shaun was chosen to come to Australia to record a series of the BBC television program Without Limits to coincide with the Invictus Games in Sydney. It’s a fascinating concept: a group of people who are living with different disabilities are sent out on a challenging journey through rough terrain. The idea is to demonstrate how the group gels to collectively overcome the physical and mental challenges they face.
Shaun has also established himself as a shrewd businessperson, developing a number of properties. Most remarkably, Shaun’s then partner gave birth to their son, Theo, on Christmas Day 2015, thanks to an IVF procedure developed by pioneering reproductive scientist Dr Jackson Kirkman-Brown.
Jackson had seen large numbers of young soldiers coming back from Afghanistan with terrible wounds to the groin after stepping on IEDs. Traditional efforts to harvest semen from them revolved around attempting to find any remnants of the testicles and recovering residual semen from there. In nearly all cases it was unsuccessful. Even if they could locate any semen, it had normally been cooked to oblivion by the heat of the blast.
Jackson developed an innovative technique to remove the vas deferens from the wounded serviceman within 72 hours of the injury. Because these semen-carrying ducts are inside the body, they’re somewhat shielded from the immediate impact and heat of the explosion, and the semen has a greater chance of survival.
Shaun was one of the first soldiers to undergo the procedure—and it worked. He’d always wanted to have a family, and Theo’s arrival brought him immense joy.
Before long, I was invited to go to the United Kingdom to operate on more wounded soldiers. The first patient I saw there was one of Shaun’s close friends from his time in hospital and rehabilitation at Headley Court, an older Scottish soldier named Gary Jamieson. Gary had lost both legs above the knee and his left arm above the elbow in another IED explosion in Afghanistan.
His circumstances were similar to those of Michael and Shaun. All had struggled with socket prostheses. Gary was confined to a wheelchair and felt he had little quality of life. So, assisted by Jon Kendrew, I carried out the first successful osseointegration operation on a British soldier in the United Kingdom.
Gary’s recovery has been transformational. With his wife and children, he now runs a pub in the town where he was born. He drives his car on a daily basis and regularly heads off with mates to watch his football team, Glasgow Rangers.
By early 2017, I’d carried out ten osseointegration operations on British soldiers—nine of them double above-the-knee amputees. They’ve all been outstandingly successful, and the patients are walking freely.
I’ve also operated on a handful of former Australian soldiers. Remarkably, considering the prominent role Australia had played in the various conflicts in the Middle East, none of them had been wounded in recent military campaigns.
Peter Molloy, for instance, lost his right leg high above the knee after being wounded in the Vietnam War. The injury occurred during the peak of Australia’s involvement in the conflict, with more than 7500 troops stationed in Vietnam.
On the evening of 4 July 1969, Peter was a private in the lead section of 7th Platoon C Company as they embarked on an after-dark ambush patrol in the Viet Cong stronghold of the Long Hai mountains in Phuoc Tuy Province, south of Saigon. The mission hadn’t gone smoothly from the start. An armed personnel carrier had bogged in a rice paddy, and Peter’s unit was held back to provide cover while assistance was summoned.
They were under the impression they’d be remaining at the site overnight, but they were soon ordered to follow through with the original plan. As they advanced, the machine gunner closest to Peter stepped on a landmine—an M16 jumping jack device that leapt out of the ground before exploding. Ironically, it had originally been laid by the Australian forces but had been relocated by the Viet Cong. The machine gunner died instantly, and Peter suffered multiple shrapnel wounds to both legs. Soon after, a signaller stepped on another landmine. He was killed. In all, three soldiers died and nineteen others were injured that night.
The platoon medic tied tourniquets on both Peter’s legs. As he carried out the first aid, he pointed out that Peter was fortunate it was dark and he couldn’t see the wounds because they were so severe.
Peter was lifted onto a special sheet and dragged along the ground to a helicopter for evacuation to the nearest Australian field hospital at Vung Tau. From there he was flown to the RAAF Butterworth military base in Malaysia and then to RAAF Base Richmond in Sydney’s west. He was transported by road to Ingleburn before being transferred to Concord Repatriation General Hospital.
He fought infections and underwent bone and skin grafts. But the efforts of the medical team couldn’t save his right leg and after seven months surgeons amputated the leg close to the hip. Altogether, he spent two years in hospital, working through rehabilitation and learning to walk with his socket prosthesis. Back in those days, prostheses were so basic that Peter’s first artificial leg was actually made of wood. He would joke with mates that if he shuffled off this mortal coil before them, they should throw the prosthesis onto a bonfire.
During that time, Peter met his future wife, who was a nurse at Concord Hospital. Initially they lived in Sydney, but after a decade there they moved to Peter’s home town of Tamworth, where they spent another twenty years before relocating to the Sunshine Coast hinterland.
Peter had been an amputee for 45 years before he came to see me. In 2014, he was looking for a surgeon to replace his left knee and came along to one of my patient briefings in Brisbane. As well as talking about knee replacements, we also discussed osseointegration. Straight away, Peter and his wife decided it could be for him. He hasn’t regretted the decision for a moment. ‘It’s made life heaps better for me,’ he says. ‘I put my leg on in the morning and wear it all day. I only take it off in the shower or when I go to bed.
‘You can walk much longer distances. You could hardly walk anywhere with the socket because they were so uncomfortable and made you sweat. And you have a much better gait with osseointegration. It makes walking a lot more natural and easy.
‘I walk around the house without any aids. Outside, I use a walking stick as a bit of added insurance. And it also means people give me a little more space. I recommended it [the operation] to a mate in Caloundra who lost his leg in a motorcycle accident. And he’s had osseointegration as a result.’
Sadly, not all the stories of soldiers who’ve undergone osseointegration have a happy ending. The battlefield experience and the terrible wounds have a lasting mental as well as physical impact. Many suffer from PTS or depression and have trouble maintaining relationships or holding down steady jobs once they’re back in the day-to-day world of the average civilian.
Former US Army Captain Luis Montalván shot to international fame in 2011 with the publication of his book, Until Tuesday. As well as being his memoir, it centres on Luis’s relationship with his service dog, a golden retriever named Tuesday, who he credited with helping him turn his life around.
Luis was born in Washington, DC, in 1973 and grew up in Potomac, Maryland. He came from a Cuban-American family—some of his relatives had escaped the island nation around the time of the failed US invasion at the Bay of Pigs in 1961. At the age of seventeen, he joined the US Army and went on to serve two tours of duty in Iraq—winning two Bronze Stars, a Purple Heart, the Army Commendation Medal and a Combat Action Badge.
One evening in December 2003, Luis and another soldier were on a foot patrol near the Al Waleed checkpoint on the Iraqi-Syrian border in Anbar Province. It was an area where smuggling and corruption were rife, and Luis spotted an unauthorised Iraqi truck with a trailer. The Americans approached and spoke to the driver. As Luis walked forwards, he felt a heavy push in his back. He had been stabbed and fell, hitting his head on the ground and losing consciousness.
Luis suffered a severe brain injury, fractured vertebrae and a serious knife wound. Subsequently, he had to deal with PTS and chronic pain in his right leg. He was honourably discharged from the US Army.
When Luis returned home, he moved to an apartment in the New York district of Brooklyn. There he slipped into a rapid psychological decline and started drinking heavily. Later, reflecting on that time, Luis said that the army was almost his entire life. ‘That’s your identity. To lose it, as well as your mobility, you question your existence.’
While in Brooklyn, Luis cut himself off from society. He had great difficulty climbing a flight of stairs and spent most of his days alone in his apartment. He started to wonder whether he would ever recover. As he sank deeper into despair, Luis received an unsolicited email pointing out that a number of not-for-profit organisations were interested in partnering service dogs with military veterans. He investigated and signed up with one of the groups.
Through the project, he was paired with a male golden retriever named Tuesday. They quickly formed a close bond and, within a short time, Tuesday was helping Luis cope with his bouts of vertigo, reminding him to take his medication and was at his side to calm him during nightmares, anxiety attacks and bouts of high blood pressure.
On top of that, Luis had to take Tuesday out of the apartment a couple of times a day. Inevitably, this brought social interactions.
Luis remembered, ‘It was a very bleak time. I almost didn’t make it out of that time. But, thankfully, like manna from heaven, Tuesday came into my life. When you go through trauma, when your life is starkly altered, when it is spiralling downward, unconditional love is as bright a light as exists.
‘Before Tuesday, I caught glimpses of snipers on rooftops. Before Tuesday, I spent more than an hour in my apartment working up the courage to walk half a block to the liquor store. Tuesday is my barrier against crowds, my distraction from anxiety and my assistant in everyday tasks.’
In a story on Channel Nine’s 60 Minutes program, Luis told reporter Mark Burrows, ‘Tuesday has been able to rekindle my ambitions, my dreams, my hopes, my wishes. And that’s to help other people. The relationship that Tuesday and I have transcends our exterior—our skin, our fur. It’s something—and I think I can speak for him in saying—that we wish for everyone.’
After the publication of his book, Luis and Tuesday gained a much higher profile, at least partly thanks to an appearance on David Letterman’s television show and hundreds of media interviews across continents wherever the book was released. Luis toured the United States, raising awareness about the plight of former service personnel who were suffering PTS and promoting the value of service dogs. He also earned a Masters in journalism at New York’s Columbia University.
But while his new role was satisfying and rewarding, Luis was suffering massive and increasing pain in his right leg. It reached the point where it became intolerable. He made the decision to have the leg amputated above the knee early in 2016 and was fitted with a standard socket prosthesis. It didn’t work well. His mobility was limited, and he was constantly suffering chafing and pain to his leg and groin.
He decided there had to be a better solution and spent weeks researching the options. It was then that he discovered what I was doing in Australia. He contacted me and came to Sydney for surgery in October 2016. The operation worked perfectly and, within a short time, Luis was walking on his new robotic leg. He was delighted and said, ‘It feels fantastic. It feels like you are regenerating your leg, because you are no longer detached from your prosthesis.’
Within a few weeks, Luis returned to New York and was reunited with his beloved dog. Everything seemed to be unfolding brilliantly. Luis was happy, he was mobile, he was busy—and he was back with Tuesday.
In early December 2016, Luis went to El Paso in Texas for an appointment. Unusually, he left Tuesday with friends when he went to stay overnight at the Indigo Hotel.
Luis was found dead in his hotel room the next morning. He had taken an overdose of barbiturates. He was 43 years old.
I was in Tel Aviv in Israel when I received a phone call from Luis’s father, telling me that his son had died. It was a major shock and the last thing I expected. Luis was doing so well. He was perfect. Absolutely perfect.
He was so happy. With his progress and his recovery, he was the star patient. And then, all of a sudden, it ended. I felt I had failed him drastically. But obviously, the biggest loss was to his family. They are the people who have to live with it more than anyone else.
I have enormous admiration and respect for Luis and people like him. He’d suffered a huge trauma that had changed him permanently. Yet he was still an inspiration to others. I truly hope Luis is in a better place.
Around the same time I was carrying out these operations on soldiers, I was also working to improve the technology and techniques of the implants and robotic legs. I would regularly meet the biomedical engineers on my team to develop and assess new designs.
We also studied ways to simplify the surgery, reducing it from a two-step process—first fitting the titanium rod, then attaching the connector to link with the robotic leg in a separate procedure—to a single operation. We achieved that, and these days all osseointegration patients are operated on only once.
Various members of the British Royal Family have played a prominent role in supporting wounded military personnel. I know from talking to some of the injured British soldiers that Prince Charles, Prince William and Prince Harry have been regular visitors to Headley Court. Queen Elizabeth II and other senior royals often present medals to current and former service personnel.
Since his time serving with the British Army in Afghanistan, Prince Harry has taken a particularly deep and genuine interest in the welfare of injured soldiers. On top of regularly attending functions and supporting charities, in 2014 he launched the Invictus Games—a multisport event for wounded, injured or sick service personnel. The first Invictus Games were staged in London. Two years later, the Games were held near Orlando in Florida. Toronto in Canada hosted the 2017 Games, and they came to Sydney in 2018.
Prince Harry’s commitment to wounded soldiers goes much further than that, though. He’s genuinely interested in anything and everything that can improve their lives and living conditions.
A couple of months before Prince Harry’s visit to Sydney in May 2015, I was contacted by his private secretary, who explained that the prince would like to meet me and find out about the operations I was performing on British soldiers. Naturally, I was delighted to accept the opportunity. But that raised the question of Prince Harry’s security, so we had to work out the most appropriate spot for our meeting. Both Macquarie University Hospital and Norwest Private Hospital at Bella Vista in Sydney’s north-west were considered. After consulting Federal Government and security officials, Macquarie got the nod.
In discussions with the Australian Security Service and Macquarie University Hospital Chief Executive Carol Bryant, we decided the royal visit would focus on the Orthopaedic Ward and Clinic. There, Prince Harry would meet both patients and hospital staff. We also moved a set of parallel bars from the Physiotherapy Department into the clinic to show him osseointegration patients practising walking on their new legs.
The prince’s plans remained top secret until the morning of his visit, and it wasn’t until Buckingham Palace put out an official media release that the details were widely confirmed. When he arrived in a heavily guarded motorcade, Prince Harry—dressed in his desert camouflage uniform and wearing a beret—was met by Carol Bryant, Macquarie University Dean Patrick McNeil, Deputy Dean John Boyages and my then practice manager, Belinda Bosley.
I met Prince Harry in the reception area of the clinic building, but at first I don’t think he realised who I was. Maybe he was expecting someone much older. Only when we were squashed in the lift with the security officials, and I explained that he could talk to any of the patients at the clinic, did the penny seem to drop. I saw a glint of recognition in his eye, and he said, ‘I guess you’re the guy.’
I smiled and replied, ‘And I guess you’re the guy, too!’ We laughed and shook hands.
Inside the clinic, I introduced him to several patients, including Juliette Hildom from the United States—who’d lost one leg above the knee and the other below in a boat-propeller accident—a Canadian and a couple of New Zealanders, one of them Penny Gifkins, a mother of two from Napier who’d lost her legs below the knee as well as most of her left hand and three fingers on her right hand after she contracted the blood infection meningococcal septicaemia. Another patient to meet the prince was Iraqi Ali Al Kinany, who’d undergone osseointegration a short time before. He’d lost one leg and badly damaged the other in the Gulf War.
However, one of the main reasons for Prince Harry’s visit was to meet Lieutenant Alistair Spearing, the fourth British soldier to come to Australia for osseointegration. In 2011, at the age of 27, Alistair had been serving in Afghanistan when three of his army mates were blasted by an IED. Alistair had immediately gone to their aid and was delivering emergency medical assistance when a second bomb went off. He lost both legs above the knee. I’d operated on Alistair just three weeks earlier.
Straight away, I took the prince to the clinic room, where I examined Alistair and explained the process of osseointegration. It was there that I handed him a copy of my first book, Walking Free, and asked him to give it to his grandmother when he returned to the United Kingdom. From there, we walked into the main clinic and Prince Harry watched as Alistair took some of his first steps using his new robotic legs between the parallel bars.
Prince Harry was amazed. He couldn’t believe that Alistair was starting to walk so soon after the operation. The prince has been associated with plenty of amputees, and he’s well aware of the difficulties they face with socket prostheses—especially double amputees.
We walked from the clinic to the ward, where he met more patients. Along the way, I reached into my pocket, pulled out my business card and handed it to the prince. ‘That’s my card,’ I explained. ‘If you ever need anything, don’t hesitate to contact me.’
Prince Harry took it. ‘Do you know, you’re the first person who’s ever given me their business card?’ he chuckled.
I must say, like everyone who met him during the visit, I found Prince Harry utterly charming. He came across as humble, approachable and a thoroughly good person.
Oh, and for the record, Alistair’s recovery was so complete that when he returned to Scotland, he set about building his own house!