Bryant Jacobs stands with his cane
The Salt Lake Tribune mastehead


Last Leg

A soldier’s amputation

The drugs dripping through Bryant Jacobs' IV line are taking effect. He's glazed. A little goofy.

"What's this button do?" he asks the anesthesia technician, Nate Organ. "Where's that tube go? What medicine is in there? What's on that screen?"

"What screen?" Organ asks, randomly snatching one of the rapid-fire questions out of midair. There are more than a dozen computer screens surrounding the operating table.

"That one."

"That's your femoral artery," Organ says as he works a catheter up a vein in Jacobs' thigh.

"How can you tell?"

"Lots of practice — and see that? That black dot? That's the medication working on your nerve."

Jacobs clenches his teeth. "It's not working," he says. "Still hurts."

"Give it a moment."

Organ pushes the rest of 30 ccs of Bupivacaine through the catheter; the cold liquid surrounds the tender nerve. Jacobs grits his teeth and seethes in pain. "It's not … oh God, that hurts … it's not working."

"We're trying to get it as close to the nerve as possible."

"It's OK," Jacobs moans. "I'll toughen up. I'm sorry. I'll toughen up."

His hands are shaking. Sweat beads across his forehead. He grinds his teeth. Soon his whole body is trembling. Blood drips from his leg where the catheter has entered his body.

Anesthesiologist Suresh Raman drops a mask over Jacobs' face. "OK, take a deep, deep breath for me," he says.

Jacobs takes three. He's out.


Within minutes, Jacobs is all but hidden beneath a wrap of plastic, towels and sheets.

A light blue curtain separates his body at the chest. On one side, only his face is left exposed — his eyes are taped shut and an inch-wide tube is protruding from his mouth. On the other side, his right leg flops back and forth as a nurse wraps his thigh in plastic, just above the knee.

Tall and trim, orthopedic surgeon Erik Kubiak drifts into the operating room, picks up an antibacterial applicator and waves it around like a conductor's baton. With it, he paints the exposed skin with the bright orange solution, humming as he goes.

From the top of his calf down, Jacobs' leg is wrapped in blue plastic, bound over with bandages. A tourniquet is wrapped around his thigh and engaged.

"OK," Kubiak says. "Let's get started."

Working from Jacobs' left side, Kubiak traces an imaginary line above the patient's knee, then dips his scalpel into the exposed flesh. Working from the right side, surgeon Linsey Etherington does the same. The two scalpels move in opposite directions, drawing a deep red circle around Jacobs' leg. A blue towel below the surgeons' hands turns crimson.

Within seconds, they are an inch deep all the way around. Globs of creamy yellow fat billow from the incision.

Seconds more, and Jacobs' patella is exposed — bright white against the yellow and red. The surgeons work through the ligament and tendon below his knee, which snap back as they are snipped through.

It took hours to prep him for surgery. Now, without comment or ceremony, Jacobs' lower leg is detached from his body.

Holding it by the calf and the toe — straight up, to keep fluids inside — a nurse carries it away and places it into a blue plastic bag.

Freed from having to work around the lower leg, Kubiak and Etherington have a better angle from which to attack the knee and femur.

They begin with incisions up the thigh, on each side of the knee, then dig in with their fingers, detaching loops of fat. Embedded in the muscle, black flecks of metal glint under the brilliant surgical lights. Kubiak wrests out a few of the larger pieces. For the first time since being embedded in his body nearly 10 years ago, the shrapnel is set free.

With a metal rake, like a long fork with bent tines, Etherington pulls back the skin and muscle of Jacobs' thigh. Kubiak nips at the tissue surrounding the end of the femur, which is as thick as a man's wrist.

Kubiak grips a bone saw. It's strikingly small, shaped like a hand drill but with an oscillating blade. When it is turned on, it emits a high-pitched buzz. Against the bone, the buzz transforms into a low-pitched grind. A faint burning smell, like charred sapling wood, fills the operating room.

Kubiak disengages the saw and takes hold of a chisel. Four taps. A loud crack. Ten taps.

It's off.

Photo above: Surgeon Erik Kubiak at work repairing an infection in Bryant Jacobs' residual limb, Monday, May 12, 2014.


Everything Kubiak has done today is brisk and precise. His bedside conversation is amiable but swift. In surgery, he works with such alacrity that it appears almost routine.

But for this, he'll take his time.

Stripped of his bloodstained smock, but still in his blue-green scrubs, the surgeon finds Michele Jacobs curled up in a chair in the waiting room.

"That went well," he says.

"Is it all done?" she asks.

"They're still closing up, but it won't be long."

Michele asks about the osteointegrated implant, which would allow Jacobs to fasten a prosthetic leg directly to a connector in his femur. Is that still looking like an option?

The surgeon thinks for a moment. There's some hardening of the muscle tissue along Jacobs' femur — more than Kubiak expected to see. Essentially, Jacobs' body is turning a small pillar of thigh muscle into bone — a phenomenon that seems to happen more often in patients who have suffered traumatic brain injury. It could complicate matters, Kubiak says, "but I don't think anything we saw changes things."

What about phantom pain? Kubiak says it's likely to be an issue, though it's hard to know what will happen when an amputee's brain tries to reach out to the nerves in a missing limb.

How long will the recovery take? If Jacobs wants to, Kubiak says, he could be running triathlons in a few months.

That sparks a thought in the doctor's mind.

"Does he know any other amputees?" Kubiak asks.

"Lots of them," Michele says. "They're already talking about swapping legs and stuff."

"Oh yeah," Kubiak says with a laugh. "That's just weird."

He reaches into a satchel and draws out a business card.

"You can call me if you need anything at all," he says. He rises and reaches out to shake her hand.

"Cutting off his leg was the easy part," Kubiak says, looking into her eyes. "The hard part is everything else. The hard part starts now."

Photo above: Doctors stitch closed what is now called Bryant Jacobs' "residual leg" after successful amputation surgery at the Salt Lake City VA, Tuesday, March 18, 2014.


Raman peeks through the pale blue curtain of post-op's Bay Three.

"Bryant, are you awake?" the anesthesiologist asks. "You're in the recovery room. Your surgery went well."

"So I have no leg?" Jacobs asks. He strains to lift his head.

"That's correct. You had an above-the-knee amputation."

Jacobs groans. "I'm in a lot of pain," he says.

"Where? Can you point to where it hurts the worst?"

Jacobs reaches out, pressing two fingers through the invisible divide separating where his body is and used to be. "Right … here?"

His head falls backward into the pillow. He's asleep again.

When Jacobs comes to, Michele is there. She lays her palm on his forehead, brushing back his dark brown hair.

"What have you been doing?" he asks. "Have you eaten?"

"They fed me," she answers.

"A lot?"

"No," she says softly. "When you eat, I will eat."

He contemplates food for a moment. A Vietnam veteran in Bay One is throwing up.

"I'll wait," Jacobs says.

He rests for a few moments, fighting to keep his eyes open. "You know," he says, "my leg hurts really bad."

"Well," Michele says, "I'm not sure you know this, but your leg just went through a lot."

Photo above: Anesthesiologist Suresh Raman asks Bryant Jacobs where he is feeling the most pain after Jacobs' amputation surgery at the Salt Lake City VA, Tuesday, March 18, 2014. This is the first time Jacobs is aware that his leg is gone.


Dustin Marble arrives a few hours after the surgery, carrying a bag of food.

"How are you?" asks Marble, who joined the military with Jacobs more than a decade ago.

"Can't complain," Jacobs says.

Marble nearly drops the bag. "Um, yeah, you could," he says.

They share a hug. They talk about work. They discuss the weather.

Five minutes go by. Ten minutes. Marble keeps glancing down at the blanket covering his best friend from the waist down.

"So," he finally says, twisting his mouth. "How is it?"

Jacobs pulls back the blanket. His hospital gown falls halfway down his thigh, which is mummy-wrapped in bandages ending where his knee once was.

"Huh," Jacobs says flatly.

"Had you looked at it yet?" Marble asks.

"No," Jacobs says. "I guess I just didn't think to."

Marble's gaze moves swiftly from Jacobs' bandaged leg to his face. He doesn't believe his friend didn't think to look, but he keeps the thought to himself.

"Huh," Marble says.

The blanket goes back up again. It will stay there for the rest of the night.

Photo above: Bryant Jacobs transferred to post-op after having an infection repaired in his residual limb, Monday, May 12, 2014.


"Look," 4-year-old Marley tells her father, Kyle Dansie. "Uncle Bryant is like a pirate."

She turns to Jacobs, who is laughing at his friend's daughter. "Uncle Bryant, I have a pirate costume," she says. "Next time I'll bring it and we can be pirates together."

She hops around on one leg, lasting 10 minutes before collapsing in a corner.

"Uncle Bryant," she says with an exasperated sigh, "it's too hard to be a pirate."

It's been two days since the operation. Jacobs has gone through six or seven nursing shifts, greeted dozens of visitors and submitted to scores of X-rays.

He's also made two trips to a narrow, sun-drenched hallway that has been converted into a physical-therapy space. His therapist, Bart Gillespie, works him through exercises designed to introduce him to the way the muscles in his hips and thigh work, now that some have been trimmed and redirected inside his residual limb.

"Really, at this point, it's about doing everything we can to get you on that leg as soon as possible," Gillespie says.

"That's exactly what I want," Jacobs responds.

Jacobs groans and his face contorts as he works his bandaged thigh up and down and tries to extend it to the side, Jane Fonda-style.

"The other thing that we're going to have to work on is patience," Gillespie says from out of earshot as Jacobs takes a break. "Before we can get him into a prosthetic, his leg is going to have to heal and firm up. If I know Bryant, he's going to want to go faster than his body."

Sure enough, down the hall, Jacobs has struck up a conversation with another patient about triathlons and snowboarding.

"I'm not going to be the guy you see in a wheelchair," he says. "That's fine for some people, but not for me. I'm ready to get active."

Photo above: Bryant Jacobs gets a hug from 8-year-old Karsyn as his other step-daughter Lillian, waits at right, at the Salt Lake City VA, Wednesday, March 19, 2014.


Jacobs has been cleared to leave — and after four days in the hospital, he's ready.

First, though, there's a question he wants answered.

Weeks before the surgery, he'd asked whether it would be possible to keep the ashes of his amputated leg. Patrice Kennedy, the orthopedics nurse who scheduled his operation, ultimately said the hospital couldn't separate out a specific patient's limb from the rest of its biological waste.

Jacobs accepted the answer. It was, he figured, a strange request, though Kennedy assured him she'd heard it before.

Since then, he has contented himself with the promise of something else — knowing how much his leg weighed. He'd like to know, in some quantifiable way, what he gave up — and he's asked no fewer than a dozen times since his surgery.

Only now, as he dresses to leave the hospital, does a pathology report reveal the answer.

15.5 pounds.

Jacobs laughs. It's a much smaller number than most of the guesses from 25 people in a pool to estimate the leg's weight. A few sore losers speculate the leg must have been drained of blood before it was weighed. And having come off in two pieces, it's possible that not all of it made it onto the scale.

As the sole arbiter, Jacobs declares a winner. Marble's wife, Christine, hit it on the dot. Her prize is $25.

Does betting on an amputation make light of the seriousness of his sacrifice? Jacobs hopes so.

"I don't want people thinking that I'm going to change the way I look at life because of this," he says. "This is going to be hard enough without taking everything so seriously."

As further evidence, he pulls a black T-shirt over his head — "Well, I'm Stumped," it says in white letters — before hefting his body from his hospital bed into his wheelchair.

There's no fanfare for his departure, just a few handshakes from nurses and orderlies along the route.

Michele pushes her husband to the elevator and down two floors to the pharmacy. An older amputee, also in a wheelchair, offers Jacobs a fist bump.

"That's an awesome shirt, man," the man says. "I want one, too."

Michele leaves her husband at the turnabout in front of the hospital's main entrance. It's the first time he's been outside in four days. He draws a breath and gazes over the south Salt Lake Valley.

That's where he's headed. In an hour, he'll be home.

Photo above: Bryant Jacobs in his recovery room two days after having his right leg amputated at the Salt Lake City VA, Friday, March 21, 2014. Later that day, he would be discharged from the hospital.

Next: Amputee struggles with new life — and doubt