Bryant Jacobs stands with his cane
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Last Leg

The long walk to recovery

Bryant Jacobs is restless.

Two weeks after his amputation, his surgical wound has closed everywhere but the outside corner. Until it fully heals, he won't be able to wear a prosthetic. Between physical-therapy appointments, he spends a lot of time in his living-room recliner.

"It's not that I want to be just sitting around," he says, "but there's not a lot else I can do when Michele goes to work. It's not like I can drive myself anywhere right now."

To get Jacobs out of the house, neighbor Nick Hoggan invites him and their mutual friends over. In his theater room, Hoggan plays a video of his recent hiking trip to Havasupai Falls in the Grand Canyon.

Jacobs is nearly bouncing off his chair with excitement.

"That!" he cries as the video shows Hoggan and his friends cliff diving into Havasupai's vibrant blue waters. "That's exactly what I want to do. I want to be out having adventures like that."

"Just tell me when," Hoggan says.

"Soon," Jacobs says. "As soon as I can."


Lane Ferrin's office is decorated with black-and-white posters of amputee athletes riding bikes, hiking trails and climbing mountains.

"You probably have a lot of questions for me," says Ferrin, the co-owner of Northwest Prosthetics, just up the road from Brigham Young University in Provo.

"Actually I don't," Jacobs says. "I don't even know what to ask. I just know I'm ready."

Ultimately, Ferrin tells Jacobs, he'll probably have several prosthetic legs. One for running. Another for golf. Maybe one specifically for snowboarding. Each will move and twist in a different way to accommodate the most common repetitive motions of those pursuits.

But right now, he says, "you need to learn to walk."

For that, Ferrin says, there's really only one choice: the Genium, by German prosthetics manufacturer Ottobock .

"It'll basically walk for you," Ferrin says. "It senses heel and toe load. Positional space. Motion. It's got accelerometers and gyros. It'll know if you're lifting up to walk on steps. It knows if you're walking downhill. It knows if you're walking backwards. And the second you stumble, it knows that, too."

"Holy crap," Jacobs says.

Few insurance carriers will cover a computerized knee joint like the Genium — which costs $35,000 and is expected to last only a few years.

"But the VA will," Ferrin says quietly, as though he's sharing a secret.

Jacobs is skeptical. He's been waiting for months for Veterans Affairs to approve his request for a hand cycle. "How long will it take to get one of those?" he asks.

"I can have one here in a few days," Ferrin says.

Jacobs pivots in his chair to high-five his wife.

"Hey," she says. "You're going to be part German now."

"How soon can we start?" Jacobs asks.

"It really just depends on how your leg heals," Ferrin says. "Let's take a look."

The next few minutes are a lesson in the relationship the two men will have in the coming months. Ferrin sits on the floor by Jacobs' foot and reaches up the leg of the patient's shorts to feel around the area where the top of the prosthetic socket will meet his torso.

"This scar is going to be a challenge," Ferrin says, tracing his finger on an area of Jacobs' inside thigh, the size of a table knife, that was lost in the blast. Just under the skin, the tissue has calcified into bony ridges, as though Jacobs' inner thigh has grown a set of knuckles.

Ferrin frowns. "I have no idea what we're going to do about that," he says.

"You have no idea?"

"Not yet."

Photo above: Bryant and Michele high five after prosthetist Lane Ferrin tells them he will be able to get Bryant a new "Genium" knee, Friday, May 30, 2014.


The tissue around Jacobs' incision is hard and hurting. The pus seeping from the wound has shifted from slightly pink to sickly yellow.

A month after surgery, his leg is infected.

Jacobs was warned about this before the surgery: A spreading infection could eat away at the healthy tissue above his amputation. If that were to happen, he could lose even more of his leg.

But this, at least, is a familiar foe. In the 22 months he spent recovering at Walter Reed Army Medical Center, he had more infections than he could count. Treated quickly with antibiotics, this should clear up soon.

Two weeks after the infection is brought under control, the outside segment of the wound, an area about the size of the last knuckle of his pinkie, still hasn't closed. VA doctor Alvin Kwok tells Jacobs there's a chance it simply won't.

The surgeons who stitched him up after the operation were working with skin that was badly scarred and, in some places, grafted from other parts of his body. It's not easy to mend skin like that, Kwok says during an appointment in early May.

"I think it will close eventually," the doctor says. "We could probably do surgery, but that would just mean another wound that would have to heal."

Kwok advises Jacobs to wait two weeks to see what happens.

The next stop is physical therapy. In the elevator, Michele rubs her husband's back.

"If surgery can fix it, let's just fix it," he says.

"We don't know if that will be faster," she says. "I know it's hard, but you've got to be patient. Your body isn't used to any of this."

In the six weeks since surgery, Jacobs has come to trust his physical therapist, Bart Gillespie, above all others at the VA hospital. "We'll see what Bart thinks," he says.

Gillespie concurs with Michele. "It looks like it's healing, just slowly. I think we should stay the course."

Jacobs accepts the advice, but he's frustrated and surly.

"This f---ing sucks," he says as Gillespie steps away. "On the way home we're going to go to the gas station so I can get some cigarettes."

"You're not doing that," Michele replies — he hasn't smoked since the surgery. "That's not going to solve anything, and we don't have the money."

"We have money — my money," Jacobs says.

Michele winces. The start-up energy-drink maker where she's typically employed as a bookkeeper hasn't had enough work for her over the past few weeks. They've been living on Jacobs' disability pension and a small stipend she gets from the VA for helping provide for his care.

She takes a deep breath and looks away from her husband. "I'm not taking you to the gas station," she says. "And you can't get there yourself — so there."

"I should have hidden a pack for situations like this."

"You're acting like the world is coming to an end," she says. "Do you really think the world is coming to an end?"

"Yes, it feels like that to me," he says. "This wasn't part of my plan."

Photo above: Bryant Jacobs reacts in pain as Doctor Dana Johns removes some stitches, Friday, April 11, 2014.


Fifty-five days have passed since the amputation. Jacobs was confident he'd be in his prosthetic by now. Instead, he's heading back to surgery.

Surgeon Erik Kubiak, whom Jacobs hasn't seen since the amputation, squats in front of Jacobs' wheelchair and looks at the area where the wound is still open.

"This isn't a problem," he says. "We'll get you in and out."

Kubiak explains the surgery. He'll cut a football-shaped piece of skin out from around the area that isn't closing. Then he'll pull the healthy skin together with new sutures.

Fifteen minutes after Jacobs is wheeled into the operating room, the surgeon peels off his gloves and heads to the waiting room to speak to Michele.

"How's he been doing?" Kubiak asks.

"Mostly good," Michele says.


"Yeah, mostly."

She doesn't tell Kubiak that her husband has confided in her a tormenting secret.

He's afraid the amputation might have been a mistake.

Photo above: Physical therapist Bart Gillespie watches Bryant's walking form carefully during a physical therapy session at the VA, Friday, June 20, 2014.


A fall is coming. Jacobs knows it. Everyone around him knows it.

Amputees fall. It happens to everyone who loses a leg. No leg, no symmetry. No symmetry, no balance.

Jacobs is leaving his friend Dustin Marble's home when it happens. Michele is still driving her husband around, as she will be for months to come. He puts his crutches in the back of her car, then hops on his left leg to the passenger door.

He doesn't make it. His foot hits the curb, but not enough of the curb. His stump strikes the pavement as he collapses to the ground.

Another friend, Rian Andrus, races to Jacobs' side. Jacobs is already trying to get himself up.

"Just stay down," Andrus, a professional firefighter, remembers saying as he cupped his friend's bloody leg in his hands. "Let me look at you."

Jacobs wrestles away. "Just let me up," he says. There are tears in his eyes. "Just let me get up."

"Lie down. Just let me take a look first."

Andrus makes a quick scan of the scar. It's bleeding, but the stitches have not split.

"Let's go," Jacobs says. "Let's just go home."

"It's not bad, but you should go to the hospital to get it looked at and cleaned up. You don't want another infection, right?"

"I don't want to go," Jacobs argues. "I don't want another setback. I can't have another setback."

Photo above: Michele consoles Bryant during a visit to the VA to check out some pain Bryant is having with his stump after wearing the prosthetic, Friday, May 16, 2014.


By the time Jacobs arrives back at Ferrin's prosthetics office, it's clear no long-term damage has been done in the fall.

Ferrin has spent months considering what to do about the bony growth on the inside of Jacobs' right thigh. The growth is almost certain to rub up against the socket — the fiberglass shell the prosthetist will make to fit over Jacobs' residual limb, like a thimble over a thumb, connecting him to his mechanical knee.

The growth is likely to cause friction, which could in turn cause swelling, blistering, abrasions and scarring. But the socket has to fit snugly — the less surface area stays in contact with Jacobs' skin, the more the prosthetic connection will slip and slide. For now, Ferrin will build it as though there is no growth.

"Every person is a puzzle," he says. "Some just take longer to solve than others."

Photo above: Prosthetist Lane Ferrin shows Bryant the prosthetic he has made for him with the Genium knee at Northwest Orthotics and Prosthetics in Provo, Monday, June 16, 2014.


Terrorists from the Islamic State — better known as ISIS — have taken Mosul.

Over the next two weeks, they will spread across northern Iraq, town by town. Their black flags will soon fly over Hawija, about 2 kilometers northwest of the now-abandoned Army outpost known as Forward Operating Base McHenry, where Jacobs spent the majority of his time in Iraq.

He's long tried to ignore developments in Iraq. And in spite of the news that the area where he fought has fallen to jihadists, today that's proving easier than many other days.

Because today he will try out his new leg.

"I slept horrible last night because it feels like Christmas," he says on June 10 as Michele turns onto Interstate 15. "And I'm super nervous because I want everything to go perfectly."

He gasps as Ferrin brings it into the room. The socket is a plastic job — a work in progress — but if everything goes well today, Jacobs will get to bring it home.

Ferrin shows Jacobs how to roll a cushioning sleeve over his residual limb and how to slide the socket over that, expelling air through a hole at the base that is then closed to create suction. With Ferrin's help, Jacobs stands. And as he does, he smiles.

At the first tentative steps, though, he is already in pain.

"I don't know how it's supposed to feel," he says. "But I think it's riding too high."

Over the next few months, eighths of inches at a time, Ferrin will guess and check his way toward a better fit. Even as the socket improves, there are other problems. Days into the process, Jacobs' bionic knee stops working and has to be sent back to the manufacturer. The company sends a replacement stamped "loaner."

He tries to spend a little more time on the prosthetic each day, but Jacobs finds it challenging to get the joint to do what it's supposed to. He arrives for VA appointments in his wheelchair. At home he hobbles around on crutches.

One maneuver — intended to signal the knee to help the wearer climb stairs — is particularly hard to master. The user guide and online videos instruct Jacobs to swiftly pull back the leg then lift up, as if striking a match. When he does, the leg simply hangs limp.

Photo above: Bryant's step-daughters Lillian, left, and Karsyn, check out their Dad's new leg as he arrives home with it for the first time, Thursday, June 19, 2014.


Bob Chappell is turning pirouettes like a ballet dancer, and alternatively lifting his natural leg, then his prosthetic one, like a goose-stepping soldier.

It's a display of strength and flexibility few able-bodied people could match — fewer still who are in their 60s, as Chappell is.

"The thing you're going to have to mentally overcome is learning to trust the leg," says Chappell, a retired salesman from North Carolina. He has come to Utah to be considered as a candidate for an osteointegrated snap-on prosthetic that VA doctors are readying for medical trials.

"I feel like I might fall," Jacobs says.

"Everybody falls," Chappell says. "People with two healthy legs fall. Get over it."

Chappell, who lost his leg in 2000 after falling off a roof, shows Jacobs how he climbs stairs: leaning to one side as he swings his prosthetic to the other in a looping motion. "I could never get that matchstick thing to work," he says. "I do what I have to do to make it work."

Chappell glances over at Jacobs' wheelchair. "And get rid of that," he says. "It's a crutch."

"You don't bring your chair with you anywhere?" Jacobs asks.

"I haven't seen my chair in a long time," Chappell says.

Bryant walks away on his prosthetic leg, pushing his wheelchair, but the socket is biting into his leg and rubbing up against his pubic bone. Before he even gets back to his car, he has to return to his chair.

Photo above: Bryant playfully tries out the performance of he new leg at Northwest Orthotics and Prosthetics in Provo, Thursday, June 19, 2014.


It's 6:30 a.m. on the five-month anniversary of the surgery, and Jacobs wakes his wife. He's shivering uncontrollably.

She checks his temperature. It's normal, but his residual limb is hot to the touch and he's in pain — more than he's felt since the surgery.

On the day of the amputation, Kubiak had given Michele his card and invited her to call if she needed anything. She hasn't done so until now. In a text message, she explains the situation.

Kubiak responds in seconds. "Bring him in," he writes.

At the VA an hour later, an initial blood test shows signs of an infection. Where, though, is unclear. Jacobs feels as though his whole body is on fire. He's sweating through his hospital clothes. The surgical staff begins to prep.

Then, just as unexpectedly as it began, the pain subsides. The shivering ends. More tests. It's not clear now whether there is, in fact, an infection.

A day later he's cleared to return home. The hospital staff can't explain what happened.

"What the hell was that?" Jacobs asks Gillespie, his trusted physical therapist, before he leaves.

"Maybe you pushed things too hard," Gillespie says.

"I thought that's what I'm supposed to do."

"It is."

Photo above: Bryant's energy is knocked down by feverish symptoms during an emergency room visit on Monday, August 18, 2014.

Next: Amputee takes on New York City Marathon, other new adventures.