CHAPTER ELEVEN

THE SECOND FIRST TIME

For we walk by faith, not by sight.

—2 Corinthians 5:7 ESV

PAIGE

The day after my twenty-fourth birthday, we were invited to the White House, not because Josh had received some kind of military award but to see a picture of us praying with President Obama unveiled in the West Wing. In the photo, I have my back to the camera and I’m holding Josh’s hand on my left and holding our president’s hand on my right. The president is holding Cathi’s hand, and the circle continues to Kristie and then Patrick, who’s holding Josh’s left hand on the other side of the bed. There were so many people in the room we didn’t even notice Pete Souza, who took this shot, because our family of four plus the president plus his security person plus a photographer packed us in the room like sardines. By this point, the photo had gone viral and was popping up everywhere. When I saw it on social media or in news articles, my heart skipped a beat. It was so cool to be part of something like that! As we moved on with our tour, a small group behind us got a glimpse of our photo and I heard someone say, “Hey, I think the guy in the wheelchair up there is the one in this picture.”

We toured the rest of the White House, another experience that showed the dichotomy of presidential life. We walked among the artifacts of the birth of our nation in the building’s original architecture, colonial pieces of furniture, and the famous painting Washington Crossing the Delaware. Each room told a story of significance to where we are today. We saw the Brady Briefing Room, which serves as a backdrop to many presidential addresses; the Oval Office, where the preceding president announced the War on Terror; and the Situation Room, where President Obama’s security team watched the successful elimination of Osama bin Laden just one year before Josh’s injury. As soon as we felt like we were walking through a monument, we were interrupted by security: “Folks, we are going to have to ask you to walk this way. Sasha and Malia want to play in the Rose Garden.” I appreciated another reminder that moments are the monuments and presidents are people.

At almost four months after his injury, Josh and I had developed a sort of routine. With surgeries down to every other week, our daily routine was wake up on the fourth floor, eat breakfast, shower, go to at least two doctor’s appointments, PT, wound care, lunch, rest in our room, occupational therapy, and sometimes PT again. Josh experienced weekly setbacks—some minor, some major. One day he was really struggling in PT and tapped out before he had completed his workout. I was afraid he was getting sick again; instead he needed a blood transfusion! Another day, he would have a really sore spot on his arm, and it would be a piece of shrapnel working its way out. We would then wheel over to the wound care station, dig it out with some tweezers, and then roll back with nothing more than a Band-Aid. After overcoming hallucinations, infections, and phantom pain, these issues were usually treated at his bedside, and we kept going. As Josh’s caregiver, I had gotten used to these hurdles, and my mind was always thinking about what we needed to do next. If I saw blood, I assessed it, called up the appropriate nurse, and we got it fixed as soon as possible. If Josh felt sick, I took his vitals myself, updated a nurse, and asked for a certain medication by name. We worked hard for our routine every day by finding ways around the issues.

I felt like keeping the routine was my personal responsibility. Josh was not going to fall back because I wasn’t getting him to appointments or making sure he attended PT every day. As long as Josh was in good health and we weren’t missing appointments, we got invited to more events outside of the hospital, even though Josh couldn’t walk yet. We went to dinners at the US Capitol building and professional sporting events on a regular basis. It may sound weird, but I felt a great sense of accomplishment by maintaining a daily expectation. As his caregiver, I felt like Josh’s opportunities were made possible because of the small things I was doing. I was always looking ahead for chances to show everyone something else that Josh had conquered.

Finally, in August, Josh’s doctors gave him the nod to get fitted for prosthetic legs. I was so thankful to hear that. It will be so much easier to get places when we don’t have to bring a wheelchair. Josh has worked so hard, and he deserves this level of independence. That wheelchair is just holding him back. He is so ready for this. I did what I always do and replied, “Awesome! What do we have to do?” The next day we went to the prosthetics wing of the hospital and had Josh’s legs cast to make plastic sockets. We were there for a few hours during this process and got to watch other guys practicing walking between the parallel bars. I was taking notes on what they were asking their prosthetists and noticing all the different models of legs they were trying on in case we needed any of them.

The next day, the plastic socket for Josh’s leg was ready. I was so excited for him. I wanted to make sure his socket fit and that he got the type of knee the other amputees had suggested for him. Josh was shown how to slip on the socket by first putting on a liner and then the socket to make sure it fit. Then the prosthetist went over the functions of the legs that he was trying on so Josh would know what to expect from the knee, ankles, and sockets. I listened and took copious notes. I wrote, He’s going to need to get some shoes that fit these feet they put on his legs… If he has a robotic knee, we are going to need extra chargers for it… I probably need to buy an extra suitcase for his legs when we travel… I need to make sure we have ice packs before we go back in case he’s sore after this… I need to make sure I keep an Allen wrench in my purse to adjust the joints of his prostheses.

Josh wheeled up to the parallel bars as I jotted my last notes. “Paige, could you grab my wound vac?” “Oh… yep!” I put my notes down and hopped up to grab the wound vac that he still had for his back and made sure the path was cleared for him to walk.

He stood.

JOSH

I glanced at Paige watching me as I sat white-knuckling the bars and preparing to stand. After a minute or two, my legs and body adjusted. Then my prosthetist said, “All right, Josh, stand up.” I felt chills at that invitation and gripped the bars for take-off. In my head, I counted 1-2-3! and launched myself onto my stumps and stood straight on the prostheses. It felt like I had jumped off the high dive, and one wrong move could mean the difference between a clean dive and a belly flop.

Weight bearing somewhere between my knee and my old shin was both strange and awkward. My only remaining knee, on my right leg, had not stabilized me since the morning of my last patrol. The added skin flap wobbled at the bottom of my right shin fragment, and I felt the sweat rolling as I tried to maintain my balance. Logically, I knew that the pounds of metal attached to my legs were unnatural, the sockets weren’t comfortable, and my muscles were weak. But standing up, straightening my back, and seeing the world two feet higher than my wheelchair made me feel the best I had felt in months. The tallest mountain in Washington state couldn’t compare with this view.

I was already tired after the first sixty seconds in my prostheses, but my newfound dignity charged my adrenaline. Let’s get these things moving. I looked down and my right “foot,” nervous about what these foreign body parts would do. Taking a deep breath, I moved to take my step. The shoe skidded across the ground but landed solidly a few inches in front of my other foot. Whew, okay, that wasn’t too bad. Exhaling, I shifted my weight and went to try the same motion again with my left “foot,” except this side was working with my first robotic knee, a knee that would never have the natural connection to my brain that my former knee had. That relationship could only be built on trust, which starts between these parallel bars.

With maximum effort from my left hip, I swung the computerized leg in front of me with a motion like spreading a blanket on the ground: casting it far so it would hopefully land flat. The steps were heavy, but surprisingly, I felt in control of the legs. It wasn’t as weird as I thought it would be. When I imagined wearing prostheses, I could only think about balancing on a part of my body that had never held all my weight. I thought it would be like trying to feed yourself by taping a fork to your elbow—doable but weird. But it wasn’t. Even though these prostheses weren’t part of me, they made my legs feel like they were doing what they were meant to do. Even with half of what I walked with before, my legs wanted this movement. I was mesmerized every time a foot touched the ground, thinking, I did that. I made that happen. Now just do it again.

After five or six steps, the sweat was rolling off my nose. I was tiring fast. With tunnel vision on the weird sneakers that didn’t belong to me, I pushed desperately to make my body synchronize to the bionics that were holding me up. The success of my old walking motions felt a little like beginner’s luck. I needed muscle memory to truly feel control over these things, and even though the pressure on my stumps was rising, I didn’t want to stop. I had been through some grueling training exercises, but nothing compared to the amount of work I was doing just to stay upright. It was painful, but it was freedom.

Whenever I wanted to stop, I would just look up. For months, I had lived at the height of light switches, doorknobs, and belly buttons. It made me feel vulnerable and powerless, which is torture to any soldier. It was the reason I was aggressive to the point of injuring myself in physical therapy. I longed for motion that wasn’t sitting and looking up at people who towered over me. God, I don’t care how much this hurts. I will do anything to not be stuck in that chair all day.

As my hands gripped the bars under locked elbows to create some relief for my lower body, I fired my left hip for another successful step with the robotic knee. Each step was shakier than the last. I looked up from my feet again to take in the view that was getting me through the exhaustion, and I noticed Paige walking next to me. One hand was carrying my wound vac, and the other was clamped over her mouth as tears poured from her eyes, which were locked on my newfound freedom. Those tears were a long time coming for Paige. Her life had become an around-the-clock mission to clear the runway for my success, but no matter how hard she worked, I was the only one who could make me stand again. I just gave her a confident smile that said, Pretty cool, huh? And then I moved another six inches down the walkway.

I turned around between the bars and started the grueling twelve-step journey back to my chair. The sockets painfully squeezed my quads and hamstrings, and I was drenched in sweat, but the prostheses were doing what I meant for them to do. In my training I had done pull-ups, push-ups, lunges, and sprints until my limbs felt like Jell-O, and I just kept telling myself that this was no different. I just had to remember how I took the last step.

I felt like I had run a marathon when I got back to my chair, but I could not wait to stand up and do it again. There was so much I wanted to figure out. I already felt like there were things I might be able to do about the angles of the feet that could help me walk better. I was ready to make these things part of me. I didn’t shy from the pain; I was already too busy envisioning myself as a walker. I was ready for this to be second nature. I was ready for people to stop saying, “Josh is in a wheelchair,” and start saying, “Josh walks on prosthetic legs.” I was ready to see the world every day from five feet ten inches high, and I would go through any amount of discomfort to make it happen.

I was one of the fortunate few who were able to walk after getting blown up, and there was no way I was going back to a wheelchair just because it was hard. Some of the guys in that hospital would never walk again, no matter how hard they tried. Some had lost too much leg to ever fit a prosthesis, and some experienced paralysis, most of whom would do almost anything for the painful opportunity of using all their might to move thirty-five pounds of metal a couple of inches. My entire recovery thus far had been about pursuing things I thought I could do. I could not let that come to a halt because this was harder, slower, and more painful than anything I had tried. Not doing what I can is an insult to those who truly can’t. I wiped the sweat from my face and did two more trips down the walkway, pumped up with one goal in mind: By the time my guys come back from Afghanistan, they will see me standing taller than before—literally.

PAIGE

How many ups and downs had we had? Two months previously, I couldn’t even see Josh being able to bathe himself again. Then, he started making so much progress that I was certain we were going to steamroll every obstacle he faced. We had experienced physical progress, loss and grief, life-threatening sickness, and marital problems that were all still very present the day we rolled into the prosthetics lab for the first time. But seeing my husband liberated from that chair was life changing. Seeing him stand up was seeing him rise both physically and spiritually, and it absolutely took my breath away. It was a graduation of sorts. An uncaging. I was often inspired by Josh in hindsight after I had a moment to recall all the things he had done in a day. But this was a genuine You’re my hero moment. I wanted to cry, clap, fall on my knees, and laugh with joy all at once.

He fought for every inch, even when he looked like he might pass out. Walking in prostheses wasn’t like other things I had seen Josh pursue. Moving at a snail’s pace while using every muscle in his body to stand up was hardly satisfying for the adrenaline junkie who lived for the fast and dangerous. Yet he was laser-focused on each and every tiny step with an incredible determination. I kept waiting on him to collapse or ask for his wheelchair, but he never did. He patiently and carefully put one foot in front of the other without complaint. Before his last trip down the walkway, we stood for a picture that confirmed the best surprise ever: We were finally the same height! Our entire relationship, I had been the taller one. When Josh left for Afghanistan he was around five foot seven. The robotic knee he needed could only be made so short, so he couldn’t keep his original height. For the first time, we stood at eye level at five foot ten. I was overwhelmed with that day.

There is a story in Luke 10:38–42 about Jesus visiting Martha and Mary. Martha stays in the kitchen preparing a big meal, and Mary sits at the feet of Jesus, hanging on to His every word. Martha even asks Jesus to tell Mary to get up and help, but Jesus tells Martha she is worried about too many things while Mary is focused on the most important thing—the thing that won’t be taken away from her. Up until this point, I had been a Martha. It was my job to get things ready, make sure we were on time, take care of setbacks, and keep the ball rolling at the expense of being part of a miracle. August 24, 2012, woke me up to the importance of being a Mary, a person who will stop and listen and watch the valuable thing that’s happening right in front of her eyes.

I was so proud of Josh and for Josh, but the truth is, I almost missed it by thinking I was there to take notes, ask questions, and hold a wound vac like it was just another day. How disappointing would it have been if Josh had just stood on his own for the first time since his injury and I followed it up with logistical banter? “Yeah, honey, that’s great, but we need to hurry because you’ve got an appointment in thirty minutes.” I was caught off guard by my emotions because so much more had happened than what the eye could see. Not only did Josh rise up out of limitation, but there was a literal transfer of power that I did not expect. Making these prostheses walk was the first thing that I couldn’t do for him. He had learned how to bathe himself, propel his own wheelchair, and make himself a sandwich, but if he ever rendered himself unable to do those things, I was ready to step in and reclaim those tasks. I had finally arrived at the threshold I could never cross. There was nothing I could do to make him stand and take steps with man-made legs. That is the miracle I almost robbed myself of. I was enlightened to my own form of numbing this whole hospital experience: plans, schedules, tasks, and busyness. I don’t have to feel things if I’m busy. But busy had the power to become the distraction we were already battling in our marriage counseling. It created an unspoken rule that suggested I didn’t have time to stop and appreciate or encourage. In so many ways I was liberated that day, too. We received a small glimpse into a life of real independence, a word that I once believed meant that we as a couple were independent from the oversight of the military, nurses, and doctors. Today, with clarity, I saw that independence meant Josh Wetzel could take care of himself. I pledged to work on relinquishing myself from this exhausting, numbing sense of false control and to live in the moments that could never be taken away from me.

My favorite part about the family rotation was everyone getting their own emotional moment when they saw Josh walking. I loved taking our helpers to physical therapy. I would sit them down in just the right spot so they could see how far Josh could walk. I would watch everyone’s reaction out of the corner of my eye like I was watching a child being surprised with a puppy. Josh’s physical therapy created most of the content we shared online—Josh walking, throwing a football, riding a hand cycle, and so on. The response was amazing. People from all over the world would tell us they started their business meetings with videos of Josh as their “Monday motivation.” Even churches were pausing their sermons to show these videos to their congregation. We lived and planned to spread encouragement every day in physical therapy.

The hard part was everything our followers didn’t see. At this point, Josh could walk for about five minutes at a time, and then he would have to sit. While seeing him walk every day was miraculous for me, it seemed like every step he took would be one minute of misery later. Josh would be in his legs for about half an hour, then go back to our room needing ice, pain meds, and massages. His legs were unnaturally red and blistered for hours after just a few minutes of walking. Each stride responsible for moving seventeen pounds of steel, plastic, and titanium created rigid soreness in his hips. In the back of my mind, I knew walking would get easier, but would his legs ever feel right? What were they supposed to feel like? Was there just a level of daily pain he would live with from then on? Does anyone ever say that they are comfortable in prostheses? No prior experience is a huge blessing sometimes, but in the back of every amputee’s mind, does “feeling better” just mean it hurts somewhere else?

Life continued to have its highs and lows. Shortly after receiving his legs, Josh had his skin graft surgery to cover the infected donor site. The donor for the donor site was coming from his hip area. He would have to rest for a few days, which meant no walking. Josh wasn’t loving that, but I was so thankful his back would finally be closed. The day after the surgery, Josh’s hip donor site was really hurting him. His symptoms reminded me of how I felt when I had my appendix removed in sixth grade. I remember feeling like a sneeze would bust my guts open. The next day, Josh’s pain had increased and his hip incision was swollen and hard. After a full day of trying to relieve his pain, the doctors decided to take him back for an emergency surgery around 6:00 p.m. Surprise! Josh had a hematoma the size of a tennis ball behind the incision. It was drained and he was given pain medication to get him through the weekend. Maybe this will be the last surgery, I thought for the hundredth time. I hated that Josh had to have another procedure done, but in hindsight, I think it kept Josh from overdoing it in PT on new prostheses and with a fresh skin graft on his back. Josh had proven he was not able to take things slow, and we could not afford for anything to upset the skin graft or the healing scar on his hip.

It was essential for Josh to take time to heal slowly but healthily, because our social calendar was starting to fill up. We had gone from our days “socializing” with doctors and nurses and therapists to actual socializing with friends, new and old. Some amazing things happened: Our friends from down the hall, Jenn and Drew, had their first baby. I was there to take pictures and to welcome baby Easton Mullee into the world. Josh and I also finally got to go to a Red Sox game at Fenway Park with his mother, Tori and Andrew Smith, and our occupational therapist, Captain Johnson. They treated us like royalty. Josh walked onto the field on his own, and then we got to eat in the owner’s box during the game. We had steak and lobster and then had dessert brought to us in our seats. We sang “Sweet Caroline” just like any respectable Red Sox fan would and loved every minute of our time in that ballpark. We were finally doing something “normal” and not rushing to the ICU instead. Josh also had his first public fall during the dinner.

JOSH

Yawkey Way, the Green Monster, watching David Ortiz take batting practice… This was living the dream! All the walking I had been doing had been amplified when my therapists dangled this carrot in front of me. They said if my walking was proficient enough, they would take my mom, Paige, and me to a Red Sox game (my favorite team) at Fenway Park. The Cathedral. I was able to step onto the red carpet of infield turf and watch the best players in Major League Baseball hit missiles off the giant left field wall. Some of the best players of all times played in this stadium—Ted Williams, Babe Ruth, and Carl Yastrzemski had all become legends here. My fanatic desires had all been met, and I had not even gotten to my seat yet. Turns out this evening would be more legendary than I thought.

It all started once we were seated for dinner in the fancy stadium suite that sat directly above home plate. The restaurant was one of those white tablecloth places that give you too many utensils. When Andrew announced he was going to the bathroom, I said, “Race you to the handicapped stall” and attempted to run like I actually had legs. My slow-swinging robotic knee caught the toe of my shoe on the floor, and I was suddenly eye to eye with the table leg next to my wife’s purse. The kitchen staff and our gracious hosts all ran over, but Captain Johnson encouraged everyone to give me some space so I could get myself up as he had made me do a dozen times in the MATC. In the swarm of concerned patrons, I waved everyone off and went to work getting my legs under me to stand again. As I squirmed to figure out which way to bend and straighten my legs to stand up, Andrew carefully walked around me to the handicapped stall. When you gotta go, you gotta go. Finally, I was experiencing that weird chaotic feeling of operating robotic appendages during a real fall. These things clanged and clunked against each other as I wallowed on the floor for several minutes. All the caregivers (including my mom and wife) laughed until everyone was in tears. I finally got my feet flat on the floor and decided on the “down dog” position to stand up. Now, I was right behind him. I would love to say that was the only calamity that day, but after a successful venture to the restroom, I found myself again with a lowly view of the restaurant, this time with my cheek against the wood floor because I had caught my foot on the floor divider between the restroom and the dining area. This restaurant was out to get me! This time was worse than the running attempt. Trying to remember the move I did last time, I had almost gotten on all fours when the door closed on me and knocked me flat. I tried to get my right foot flat, and the door shut on me again. Finally, I had to Army crawl out of the doorway, dragging my tangled heap of metal behind me. A waiter (who missed the fun earlier) rounded the corner and hurried to help me up, but by this time, the whole dinner party had been trained on amputee occupational therapy. As the young waiter leaned down, the whole table yelled, “Noooooo, leave him alone! He can get up by himself!” I did my ever-so-graceful maneuver to stand again (read: awkward as a baby horse walking right after birth), only to see my entire table in stitches. No one could catch their breath and I watched Paige release the tension that outings like this gave her, even if it was laughing at my expense. I’d take it all day long to see her genuine smile and hear her laugh. Only later was I informed that Captain Johnson was nice enough to take pictures—both times.

I was proving step by step that we could handle trips outside of the hospital. It was actually just as reassuring to hospital staff that I could fall and not hurt myself as well as get myself back up. I was excited about this because there were several adaptive sports trips that we kept hearing about, but we had been told I was not “healthy enough” yet to attend. I made it clear to my new battalion, the Warrior Transition Battalion (WTB) cadre, that PT was the most important part of my day. I was not willing to cancel or skip PT for any other appointments or meetings, because I was determined to find the right set of legs and get better at walking. I was going to play sports again. I was going to shoot hoops and take a trail walk and go swimming and climb stairs and maybe even try skiing. Nothing was going to stop me. All I had to do was get the right fit for my sockets. What a naïve thought that was.

I assumed the pain and discomfort from my first steps was from muscle weakness and not knowing how to balance on the new ends of my lower half. Boy, was I wrong. My legs were changing and morphing every time I wore the prostheses. What was left of my lower extremities was rigid with aggressive bone spurring that was still growing, a condition called heterotopic ossification. It’s where the body dumps massive amounts of calcium deposits in an effort to heal a traumatic bone loss. Except the bone formation doesn’t make any sense. For me, I felt extreme pain in my right hamstring, which called for X-rays. Seeing myself as a skeleton was already the weirdest thing I had ever seen, but when I looked at my right femur, a huge chunk of bone mass had collected where my hamstring muscle should be. Instead of a long, skinny leg bone, the middle of my femur looked like it swallowed a brick. I knew I had some of this bone growth, but nothing drew my attention to it like trying to make huge plastic sockets fit comfortably over it.

The shape-shifting bone growth along with the tenderness of my skin and weak muscles made it hard to pinpoint what fixes needed to be made with my sockets. All I knew was that it hurt. This caused me to get recast for new sockets almost twice a week. Each Monday, a prosthetist would wrap my legs in the wet papier-mâché material and take the molds back to make new sockets. By Friday, those sockets hurt so bad that I couldn’t even put them on. Was it because my legs were changing? Was it because I was swollen? Was it because I was sore from yesterday? Were these new sockets too tight? The hardest part was that the people making the prostheses weren’t amputees. None of them could understand how or why it hurt; they just took our word for it and went into the lab and tried again.

After my third week in a row of really awful pain in my legs, I looked at my physical therapist and asked, “Just be honest with me, is it always going to hurt like this? Am I just going to be in this much pain for the rest of my life? These things don’t ever feel better; they just hurt differently.” He confirmed that many of his patients dealt with weeks of pain before the prostheses felt right, but I did not have to just accept whatever sockets I was given that week. While it was going to be a grind, walking should not feel like torture every day. I needed to get more in tune with my body and figure out what discomforts were helpful in breaking in my stumps and which were unacceptable pain that required adjustments to my sockets. I suddenly understood that all of this was a process. At this stage, it was not about making prostheses fit; it was about toughening my skin, strengthening my muscles, and forming my legs to the shape of a socket, not the socket perfectly forming to my leg.

Until this realization, my process had been do PT, go home, swell up, try on sockets that were too tight the next day, do PT anyway, get blisters, get sore, squeeze into them the next day, do PT until I cried and the blisters ruptured, throw the prostheses in anger, take the weekend off, and do it again the next week—all while still holding on to the parallel bars, not even independent enough to walk with a cane yet. My amputee friends were all I had. Knowing someone who was just a few weeks ahead of me would confirm that if I just hung in there and communicated better, the sockets would change along with me. All my friends said there would be a lot of adjustments when figuring these things out. Sometimes I got blisters because the knee was too heavy, not because the socket was too tight. Sometimes the pressure on my shin came from my foot being tilted too far forward. Sometimes my sockets were too tight because I had eaten too much salt. When I tried to cut the salt and hydrate more, my legs shrank!

Getting prostheses was the hard pivot in my recovery. It required my full ownership. Up until this point, the people who took care of me may not have understood my pain, but they knew what to do to help me. There was no cure-all for mastering prostheses, and no one who made prostheses, fixed prostheses, or helped amputees walk in prostheses knew what it felt like. For the first time since I arrived at Walter Reed, my mom and my wife could not speak for me.

I had to separate the gradual buildup of calluses, aggressive shaping of my muscles, and hardening of my flap from the pinching, rubbing, and pressing. My friendships were crucial, because even though I had a physical therapist and a prosthetist watching me walk, sometimes it took the voice of a fellow amputee saying, “You look like something’s pinching you in the right leg,” for me to say, “That’s it! That’s the problem.”