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Walking to Paris

Jim Miller's adventurous life was interrupted in a violent collision of metal and flesh. He thought he knew how to get going again. He never imagined how hard that would be.

By BILL DURYEA

© St. Petersburg Times, published July 14, 2002


Jim Miller's adventurous life was interrupted in a violent collision of metal and flesh. He thought he knew how to get going again. He never imagined how hard that would be.

Deciding to go

ST. PETERSBURG -- I should jump.

That's what Jim always said he'd do if he ever found himself in front of an oncoming car. He had worked out the escape plan one icy winter night in college after a car lost control pulling into a gas station and nearly hit him. Jump and take your chances.

His chance had arrived.

Jim was standing in front of his van at a gas station just north of downtown St. Petersburg, about to add a quart of oil. He'd made a quick stop on the way to the mall to do some Christmas shopping.

He heard the squeal and scrape of cars colliding behind him on Fourth Street.

Fender bender, Jim thought. Doesn't involve me.

He turned to see a black Mercedes veering off the road directly at him. He had time for these two thoughts:

Jump.

No time.

The Mercedes struck his van head-on, crushing Jim between the bumpers. The force knocked the van backward. The car's hood buckled. Warm metal pressed against Jim's cheek. Engine heat seeped from the van grille against his back. Jim was still pinned when paramedics arrived.

Both his shin bones and knees had been so pulverized that torn ligaments and skin were all that held his legs together.

The paramedics loaded him with morphine. If the ride to Bayfront Medical Center had been any longer, they would have given him the last dose they had in the ambulance.

The admitting nurse wrote Jim's full name on a chart: James Blair Miller; his date of birth: 2/15/42; and the date: 12/23/99.

Fifteen minutes after the accident, Jim was in the emergency room, where a surgeon looked at the legs and saw nothing he could save. He knew he had to finish what the car's fender had begun. "Life before limb," the surgeon said to himself as he cut through the knee joints and tied off the ruptured blood vessels.

It was dark in the recovery room except for the glowing lights of the machines. Out the window, Jim could see billowing clouds of steam shrouding a dark shape, looming and monolithic.

He couldn't move. He couldn't sit up. He could breathe, but only just. He couldn't speak. He had an overwhelming feeling of fear that he had been abandoned.

He thought he could see other bodies, but he didn't know if they were alive or dead. Had he been left here to die, too?

He imagined he was the victim of a terrorist kidnapping. His life had been hijacked, everything he once was had been taken from him.

* * *

Ivonne came to Jim's hospital room the day after the accident -- Christmas Eve. Jim looked terrible. His face was moon-shaped, swollen from fluid retention. He opened his eyes a couple of times, but didn't speak.

Ivonne returned the following day. Jim was awake. He was glad to see her.

"You won't believe what happened to me," he said.

The circumstances couldn't have been much more difficult for the two of them. In the months since Jim had filed for divorce, they had communicated mostly through their lawyers. Their last conversation before the accident had been an argument about why Ivonne, who was living in Orlando, wouldn't let Jim see their daughter Giselle without a court order.

Ivonne put all that aside when she heard about his accident.

She was all Jim had in the way of family. When he was in intensive care, she would read him the newspaper or just sit with him. After several days when he was moved to the long-term rehabilitation ward, she brought Giselle, who was almost 2. But they didn't stay long. Ivonne, a court translator, had her job and another child, a son from a previous marriage, to take care of at home.

Jim vowed he would not linger in the hospital. He told this doctors he had been through worse, something they found hard to comprehend. They marveled at his optimism, but they suspected he was having difficulty coming to terms with the reality of what had happened.

He kept talking about walking. Jim told Ivonne he knew his chances were slim. He knew that his injuries and his age, 57, made him an unusual and difficult case. But he never stopped saying that he would walk again.

"Life in a wheelchair," he said, "is not an option."

* * *

I first wrote to Jim Miller a little more than nine months after his accident. I remembered reading news stories about the man who'd lost his legs and wanted to know how he was faring. I don't know what kind of answer I expected, but it was not the one I got.

"I certainly could just produce a simple response, and perhaps give a noncontroversial interview that would interest but not disturb your readers," Jim wrote back. "But the event has stirred up larger areas of concern for me. . . . The consequences of a profit-driven health care system have been disastrous for me." I was intrigued, though he didn't offer any more details.

He also sent me an essay titled "Risk" that he had written after his accident. (I learned later that it had been published in a magazine for airplane enthusiasts.) I took the essay as his way of introducing himself.

In the essay he wrote about the death of his first wife in a traffic accident, a day he described as "the worst of his life." He wrote about how being a pilot, and Ivonne, helped him through his grief.

Then he explained briefly the circumstances of his own accident and how flying helped him recover from that, too. "I am grateful to be alive," he wrote, "and to be able to fly again. ... I have a lot of legwork to do before I can fly solo, but I do fly regularly."

About his physical recovery, he wrote: "I am up on 'stubbies' -- prosthetic legs that are simple sockets with very short fittings and small crude feet attached. Sort of like training wheels. I cannot tell you how much joy I take from just staggering around on these things!"

The last part of the essay was a retelling of a trans-Atlantic flight he had made some years before with Ivonne and his stepson, Adrian.

Approaching Greenland for refueling in the middle of the night, Jim's Cessna descended through a thick layer of ice crystals. Static electricity made the sound of frying bacon in his headset. Jim looked out the cockpit window and saw blue flames flicking like small lightning bolts from every sharp edge of the plane's fuselage. He was enthralled by the combination of beauty and danger.

"When I begin to feel sorry for myself," he wrote, "I remember this and the scores of other marvels my life has been blessed with. I have made peace with risk this night. I have taken unto myself the responsibility to protect those I love and I have found that I cannot truly do that without protecting them from wonder at the same time. No risk is no life."

Here was a man, I thought, who had lived a rich life and could articulate his passions in an engaging way. I proposed that we meet for lunch. He was already at the table when I arrived. I noticed he was not wearing the "stubbies" he had mentioned in the essay. He was sitting in a motorized scooter, and because he was wearing shorts, it was impossible not to see the jagged scars of his stumps.

Jim explained that he had tried to wear prosthetic legs, but they were too painful. Contrary to his upbeat tone in the essay, Jim's recovery was stalled. Nine months after the accident he was no closer to walking than when he had left the hospital.

It seemed to me that Jim was struggling with the difference between his life as it now existed and the life he had once enjoyed. The essay was Jim's best version of his new life, an act of optimism one would expect from a man who wanted to believe that his life was not over. Jim was adamant about pushing forward, despite the resistance he felt from the medical establishment. He agreed to let me follow his recovery.

* * *

During that lunch and a series of others over the coming weeks, I got to know the rest of Jim's story.

Before the accident Jim had stood 5 feet 10, which is what his driver's license still read even though he had renewed it since then. In photographs taken before the accident, Jim is almost always in shorts and his legs have the lean, muscled look of a hiker.

He had been in almost constant motion since he was a young man in the 1960s, burning to escape the middle-class strictures of Columbus, Ohio. In the Navy (which he joined in 1964 out of respect for his father and as an alternative to college), Jim got his first taste of Europe while sailing the Mediterranean.

He returned to Ohio State University for a second stab at a degree, but was drawn instead into politics, protesting for racial equality and against the United States' involvement in Vietnam. He met and married Joyce, an art student. They drove to Florida in a Volkswagen van with a gold ox painted on the side.

Jim and Joyce worked for a custom yacht builder in Tampa. Later, they ran their own sailmaking shop. They lived in a converted school bus. In their spare time, they built a 46-foot sailboat. Once it was done, they sailed the Caribbean for more than a decade. Jim had many skills, but none held enough appeal for him that he would be willing to sacrifice the freedom of travel for a cubicle and a regular paycheck.

When they grew weary of life aboard a boat, they returned to St. Petersburg, where, for a time, Jim and Joyce renovated and resold properties. This work had little to do with Jim's engineering and English studies at Ohio State or the undergraduate sociology degree he had earned in 1981 at the University of South Florida, but it suited Jim's talent for working with his hands. They did well enough that they could afford a $200,000 sprawling waterfront house in St. Petersburg with its own pool and dock.

Their lives took an interesting turn in the early 1990s. Jim and Joyce met Ivonne Delamora while taking a Berlitz Spanish class. Ivonne was their instructor.

Ivonne was slender and dark-haired with dramatic, wide-set eyes. Born in Mexico, she was in some ways the opposite of Joyce, who had grown up in a tiny farm town. The three became close. They traveled abroad together, using Ivonne's aptitude for languages.

Then came Joyce's death in 1993. She and Jim had been married for 24 years. Jim was devastated, but Ivonne helped him maintain some sense of continuity in his life. They married in January 1995. Ivonne was 33 and Jim was 52.

With about $400,000 from the insurance settlement Jim received after Joyce's death, they moved to France, a place Ivonne and Jim had become attached to after several trips they had taken with Joyce before she died.

Paris exerted a powerful influence on Jim. It wasn't just the culture that appealed to him, but the profound differences he saw in what Americans and the French value. Instead of anonymous suburban sprawl, Jim discovered small, self-contained neighborhoods that nourished residents' sense of community. Here was a city that did not worship wealth. Here was a city in which ideas had currency.

He would gladly have stayed there for the rest of his life, but his marriage was not as strong as the bond he felt with Paris. In March 1998, he and Ivonne had a daughter, Giselle. They had hoped a child might cement their marriage, which had been in trouble from the start. It did not. By September, they had separated. Jim was back in St. Petersburg and Ivonne returned with her children to Orlando, her hometown.

This began a difficult time for Jim. He was estranged from his family and he was not working. By the time of the accident, he was struggling with depression. Except for Giselle, he felt no attachment to Florida. The accident and his immobility had only compounded those problems.

By the time we had that first lunch, Jim had turned 58. His mussed brown hair was flecked with gray; ditto his push-broom mustache. His wide mouth and flared nostrils gave him a look of perpetual intensity. When he smiled, which wasn't often, he was at his most handsome.

He was not shy about his opinions. He delivered them with the righteous drama of a prosecutor's closing argument. People often felt slightly awed at the breadth of his authority -- sociology, aerodynamics, electrical engineering, race car engines. Though he was not easy to agree with (every attribute of France was by definition a failing of the United States), he was difficult to ignore.

He reserved most of his anger, though, for the American health care system. He believed that because he did not have health insurance, he had been given short shrift by a system that pandered to its wealthiest patients, though he had no hard evidence to support this. He was particularly scornful of the doctors he felt were steering him toward life in a wheelchair.

I didn't understand completely why Jim was not walking yet, and it was far from clear whether the responsibility lay with the health care system or the man. Still, I understood that recovery was more rigorous and complex than I had imagined.

After all, Jim didn't have to endure this. At his age, he could have chosen to remain in a wheelchair for the rest of his life and no one would have thought twice about it.

Early on I asked Jim why he was putting himself through this ordeal.

"I know what I'm missing," he said. "That's why I'm willing to do anything to get back into the real world that I love."

That meant a return to Paris.

To return to Paris, Jim believed, he needed to walk.

'I'm different'

Jim came home after five weeks in the hospital.

Phil and Pete, a couple of handymen he knew, had modified his house for him while he was gone. They knocked a hole in a wall of the living room to accommodate a mechanical lift. Like something on a loading dock, the lift enabled Jim to get from the garage level up about 3 feet to the floor where the living room and kitchen were.

They disconnected the chains that suspended the circular bed from the ceiling in the downstairs bedroom. They bought him a new king-size bed and put it in a corner of the dining room.

They laid a plywood track on the wall-to-wall carpeting so he'd have an easier time rolling his wheelchair.

They hid his gun and the kitchen knives.

Steadily, Jim mastered the techniques of daily living: how to go to the bathroom by sitting backward on the toilet, how to turn on the shower without scalding himself, how to clean up spills on the kitchen floor by pushing around some paper towels with the end of a broom, how to use a pair of long-handled pincers to grab his cereal from the shelf without poking holes in the box.

A week passed before he left the house.

He bought a used car and got it fitted with hand controls -- press down to accelerate, forward to brake. The guy who did the work was a double-amputee also. He told Jim to forget about artificial legs. Get a good chair and get a life, he said. Jim told him he'd walk within a year. In the meantime, Jim decided reluctantly to use a motorized scooter to get around.

He was mostly on his own. After Jim returned home, his relationship with Ivonne resumed the same wary distance from before the accident. Ivonne was concerned for Jim, but she didn't doubt that he'd be okay. Ivonne knew Jim tended to see things in stark terms -- unqualified successes and cataclysmic failures -- but she knew as well that his mood swings couldn't override his innate stubbornness. He would not quit.

* * *

One day Jim went to talk to his doctor. He told him he could not imagine life without walking.

Without legs, he could not fly his plane that now sat unused at the airport. Without legs, he could not live in Paris. Without legs, he could not be attractive to women.

Without legs, he could not be Jim Miller.

This is what the doctor told Jim:

People with above-knee amputations of both legs often find it difficult to use prosthetic legs. A man who loses one leg below the knee has it hard. A man who loses one leg above the knee has it harder. But a man who has lost both knees requires so much extra energy it makes him feel he is carrying almost double his body weight.

How many of them walk again, Jim asked.

Fifteen percent, the doctor said. Some patients try to wear legs, but imagine carrying that extra weight while balancing on your knees.

I'm fit for my age, Jim said.

The legs are expensive and cumbersome. Patients get frustrated and they put the legs in the closet.

Don't tell me about people who aren't walking, Jim said. I've always been successful. I'm going to be walking.

Go ahead and try, the doctor told him. If it works, wonderful. If not, try to accept your situation. Some people prefer using a wheelchair.

I'm different, Jim said.

But weeks and then months passed and Jim didn't walk.

He'd visit the doctor and they'd talk about how his legs were healing. They'd talk about the pain in his stumps, caused by growths on the cut ends of his nerves. They'd talk, too, about the pain he felt in parts of his legs that didn't exist anymore.

This phantom pain was a chronic problem for Jim and also one of the least well-understood medically. Nearly every amputee experiences some kind of sensation in the missing limb -- everything from mild pressure or warmth to stabbing pain and cramping. In Jim's case, it felt as if the top of his shoe were cutting into his ankle bone.

The pain diminishes over time for most patients. Chronic sufferers, in particular lower-limb amputees, report excruciating pain when they urinate or have sex. The brain's sensory centers for the feet and the genitalia are adjacent, but why an amputee would experience crossover sensations is not known.

Just as theories differ as to the cause, no consensus exists on treatment. Jim's doctor prescribed Neurontin, an antiseizure medication used by epileptics. The Neurontin was not without side effects, one of which Jim believed robbed him of his mental acuity.

He could not give up the Neurontin, but he began to cut his pills in half, taking just enough to manage the pain. His head cleared some. As it did, he began to wonder, where's the program to get me legs?

Then he got scared. There was no program.

* * *

Prosthetists had approached Jim in the hospital. He didn't hear them talk about whether he would walk or not. All he heard was a product pitch. So he brushed them off like door-to-door salesmen.

Once he was out of the hospital, though, prosthetists didn't come to him anymore. He had to look for them. He worked briefly with two prosthetists in St. Petersburg, but neither of them could help.

Eventually Jim was referred to a man in Tampa. Bill Copeland was a smiling, solidly built fellow and Jim hit it off with him immediately. Jim paid him $10,000, money his attorney advanced him from the anticipated proceeds of the lawsuit against the drivers in the accident.

Bill's career as a prosthetist began more than 20 years ago in Oklahoma. He had lost his left leg at the knee when it was crushed by a steel rail he was loading onto a flatbed rail car. Watching his own prosthetic leg being made was almost like going to trade school.

The first thing Bill did for Jim -- apart from a few chores such as cleaning his pool -- was make plaster casts of his stumps. The casts looked like fragments of a Greek statue. Bill used them to shape the sockets for a pair of legs.

Bill knew the legs probably wouldn't work. He could tell by feeling the ends of Jim's stumps. Each had a mass of bone the size of a grapefruit, far bigger than the normal width of the thigh bone.

Sure enough, Jim couldn't wear the prosthetic legs for more than a few minutes without wincing in pain. Bill told Jim he probably had bone spurs, sharp growths of calcified bone that were poking every which way. They're like corkscrews cutting into your muscles, he said.

You'll never get legs that fit, and you'll never walk in prosthetic legs, he told Jim, unless you get surgery to remove the growths. If you get the surgery, we'll make a new pair of legs with the same $10,000, Bill said.

Bill told him about a surgeon named Jan Ertl.

He showed Jim an article in a trade publication.

* * *

Jim began to understand what had happened in the hospital.

It was called a guillotine procedure. A French term for a no-frills surgery that looks about the same in any country.

Dr. Kevin Hirsch, the emergency surgeon on call the day Jim got injured, had performed his share of amputations in 17 years in emergency rooms. What he did to Jim's legs was straight out of Zollinger and Zollinger, the illustrated textbook of surgical procedures that is the bible of general surgeons. Pages 466-68; Plate CCXXI; Amputation, Supracondylar.

In the emergency room, Hirsch had done a quick amputation of Jim's legs, cutting through the knee joints just to stabilize him. Then, in an operating room, he had cleaned the wounds aggressively, trying to wash out even the tiniest fragment of the obliterated bones. He left the wounds open, loosely bandaged, for four days while Jim's condition improved to the point he could handle a second operation.

In traditional amputation surgery, the endings of the large nerves and blood vessels are tied off. If the cut bone is sealed off at all, it is done with wax, which is what Hirsch used. Sometimes the quadriceps muscle is pulled over the cut end of the bone and sutured down to create a pad on the end of the stump. Hirsch used that method. Sometimes surgeons simply cut the muscles and leave them slack inside the stump.

Jim was among the unlucky 10 percent of amputees who develop bone spurs, which form when bone-growth cells have a blood supply. If the cells are outside the bone when the blood reaches them, then that's where they grow.

Jim read the article Bill had given him. He discovered that Jan Ertl used a different technique, one that had been developed in the 1920s by his grandfather, a Hungarian surgeon, and later refined by his father.

The technique emphasized the need to seal the end of the femur biologically using the periosteum, the sheath of tissue that wraps around healthy bone. The point was to restore blood flow to the whole bone to prevent decay. Ertl emphasized, too, the need to restore tension to the four major muscle groups in the thigh by sewing the muscles to the bone and to each other.

Jim was certain the doctor at Bayfront had saved his life with a textbook procedure that met the standard of care. Still he questioned why Ertl's technique was not more commonly used. Was it because it was more costly, Jim wondered.

The United States, alone among the large industrialized nations, does not provide universal health care for its citizens. The marketplace economics work in the marketplace, Jim said many times, but profit margins have no business determining who gets care.

It surprised me sometimes how much angrier Jim was at this faceless system than the two drivers who had caused his accident. But this anger also seemed to fuel him.

Jim asked local surgeons if they would do an operation based on Ertl's principles. Never heard of him, one said. Too exotic, said another.

A return to Paris

Jim felt stuck, so he flew away.

In the middle of July 2000 he boarded a flight for Paris. He was alone and apprehensive, but he was thrilled at the prospect of returning to the city where he had been so happy. Of the many agonies Jim suffered after the accident, being estranged from his family was the worst. But being apart from Paris was nearly as bad.

Jim arrived at Charles de Gaulle Airport just before Bastille Day, the national holiday, with no baggage, but weighed down with doubts -- little things such as whether his wheelchair would fit in the taxi, and much scarier things such as whether the city he revered would shun him.

This was a city, after all, that had set the standard for Western beauty and sophistication. As the taxi rolled along through the streets, Jim didn't see a single person in a wheelchair. He thought he was the ugliest thing the eye could see.

Jim made his first stop L'Avenir, a restaurant near his old apartment on Rue Blanche. When his taxi pulled up, the two owners were standing in the doorway, one wiping his hands on his apron. They saw Jim through the taxi window and waved. Then Jim opened the door and swung his stumps out. He watched as the men stared back at him, at first glassy and uncomprehending, and then shocked. One of them sagged against the other and retreated inside.

Jim lost his nerve. He pulled the taxi door closed and told the driver to keep going. The driver said nothing. Truly kind, Jim thought.

There were moments of surprising joy, though. One night he got swept into a pack of inline skaters and he careened through the streets in his wheelchair, thrilled to have been accepted as part of their group.

Toward the end of the trip, Jim talked to an orthopedic surgeon. The doctor mentioned two American surgeons he considered qualified to operate on Jim's stumps. One was a doctor in Sacramento, Calif., named Ertl.

Jim understood that to be happy in Paris, he needed legs. To get legs, he needed to get to Ertl.

* * *

In September, more than a month after he returned from Paris, Jim sent Ertl a letter.

"Dr. Ertle," he wrote, misspelling the name.

"My degree is in sociology, and I am a writer and a pilot. I have a son who is 12" -- this was Ivonne's son, Adrian -- "and a daughter 21/2 years old, both of whom need an active father . . . .

"I am well aware that your surgery will not, in and of itself, make me walk. I have realistic expectations, I believe, and great determination . . . .

"If I fail, so be it. But with your help I believe I can regain useful mobility, and a more useful life. I also feel we may well provide some badly needed revision to the local perception of what is possible.

"My most difficult task is to maintain faith that I will even get a chance to walk, in the face of a knowledge desert, much negativism and disinterest."

Ertl's assistant called him a week or so later with good news. The doctor thinks your case sounds promising. He wants to operate.

When? Jim asked.

Sometime in the next couple of months. The doctor's very busy, she told him.

* * *

Jim sat in his scooter in his living room and rolled back and forth as if he were pacing. He was upset that he had not gone to Ybor City for the massive Halloween street party the night before. He had thought: Who wants to stare at 80,000 belt buckles?

He asked himself, "What's become of my daring? I never used to do the sensible thing."

More and more, he felt stagnation enveloping his life.

His divorce was going slowly. He had hospital bills to pay and no salary to pay them. His lawsuit against the drivers who caused the accident wasn't moving quickly. A settlement seemed far away, and he was depending on that money to pay for the $50,000 surgery in California.

Sometimes Giselle came to stay for a day or two. Jim's transformation during these visits from a solitary and morose figure into a playful father was remarkable. He cuddled with her at nap time. "Many mumbling mice are making music at midnight in the moonlight," he would read. Giselle would make him flower bouquets from wrapping paper and yogurt containers. One day she presented him with a small stuffed animal: "Here, Daddy, someone for you to talk to."

Mostly, Jim seemed lonely. His days seemed empty of engagements and people. With the exception of Phil, the handyman who lived with Jim for a time, I almost never saw anybody at Jim's house.

On the few occasions when he encountered people in public or when people would visit him at home, he would talk manically about himself. He was so desperate for interaction he couldn't help himself. He wondered if he was boring people. Thanksgiving Day he prepared a enough food for five guests, but only two stayed for the meal.

* * *

On the first day of December, almost a year after his accident, Jim wrote a second letter to Ertl.

"To refresh your memory, I am a bilateral traumatic above the knee amputee . . . ."

He complained that he had tried to reach Ertl by phone, but had heard nothing for six weeks. When would he get the surgery, he wanted to know.

"I struggle each day to hold on to my strength and my faith that I will get my chance. We both know that with each passing day my chance gets slimmer.

"I try to hold onto the few job prospects that are available to a legless pilot. I have a 3-year-old daughter who badly needs a useful dad, and who may lose him.

"I have no comfortable retirement awaiting me, and need to work to eat.

"If you continue to put me off or ignore me until it is too late, then at least have the kindness to tell me, so that I can begin to cope with a life in a chair.

"If we fail in this, will it be because I lacked the needed courage? Bull. Will it be because all the local surgeons who wrote me off -- and wrote off your procedure . . . as 'exotic and unproven' -- were right?

"Or is this 58-year-old above-the-knee amputee too much for you to handle?"

"Your silence, your lack of even a phone call or a plan gives the impression that you have written me off. I have not given up on myself. Will you give up on me, without even a try?

"It seems that I deserve a better chance than this, and it seems that my chance is in your hands."

Finally, a phone call

Jim's lawyers told him it would be helpful for the settlement negotiations if they made a video that showed how his life had changed since the accident. The video was shot just before Christmas, a year since he lost his legs.

The video shows Jim from the moment he wakes. He pulls on his shorts by rolling back and forth on his bed. Then, still sitting on the bed, he pulls the sheets taut.

"When your bed is in the living room, you want to keep it neat," he says.

The video cuts back and forth between Jim in action and scenes of him sitting in his scooter, elbows propped casually on the armrests. In these scenes, the sun is streaming through the picture windows of his living room. Jim talks philosophically but plainly about the aftermath of the accident.

When the accident happened, Jim says, "I figured I had 12 to 14 good years left. Really, I have seven. Everything takes twice as long as it used to. The rest of my life is going down the drain going to the bathroom, taking a shower, making a cup of coffee.

"What pretty girl would find me sexually attractive? It works down from there. Employers don't want me."

At the end of the video, he talks about why getting out of the chair is important.

"My daughter was coming to think of me as the man with wheels, and I don't want her to do that. I would rather she know me as the guy without legs than the guy with wheels.

"There will come a time when I have to take her to the prom and she will think, 'Oh, boy, how are they going to react to Dad?' And I'm not looking forward to that."

* * *

In January, Ertl's assistant called with a firm date for the surgery: Feb. 17.

"It's real," Jim wrote in an e-mail to his friends. "They are going to overhaul these useless stumps so I can wear prostheses -- maybe. Yahoo!"

"I remind myself," Jim continued, "that after a wasted year the odds to walk are a lot longer. I am angry about the wasted time above all, and I will use that anger to help me prove wrong all those who said, 'What's your hurry?' May they all rot."

Privately, Jim had doubts. Somebody had shown him a triumphant video of a bilateral amputee learning to walk. But he found out that the man later developed sores on the ends of his stumps and couldn't wear prosthetics anymore. That scared Jim to death.

On the day that he was to fly to Sacramento, Jim woke up well before dawn. His throat was scratchy, his nose was runny. The pain in the stumps of his legs was tolerable.

His first thought was the cold would scotch the operation. I'm not going to get the surgery after all this time, he thought.

Nervous and unable to sleep, he hopped out of bed onto his scooter. He showered, made a pot of coffee and took a double-dose of an herbal antidepressant that didn't do anything for his cold or his leg pain but made him feel more cheerful in general. Still in his underwear, he pulled his scooter up to his computer. He began an e-mail to Ivonne.

I'm leaving for Sacramento this afternoon, he wrote. The surgery is scheduled for Saturday morning. You have the phone numbers. If anything happens, you know where I keep the checkbook and money. Jim didn't mention it in the e-mail, but he told me he was hurt she hadn't called to wish him happy birthday.

At noon, Jim hoisted himself into the driver's seat, put the car in reverse and punched the gas with his hand.

* * *

In clogs, Dr. Jan Ertl was well over 6 feet tall. His beefy shoulders filled the loose-cut sleeves of his hospital scrubs. His welcome, delivered in a deep, casual voice, seemed to get caught in the corner of his mustache.

He took a seat on a rolling stool and held the X-rays of Jim's legs up to the light.

In the two-tone images, the bone growths on the ends of Jim's femurs looked like smoke seeping from factory stacks. Really they were solid, arrowheadlike masses jutting into the surrounding soft tissue.

"This is impressive," Ertl said. He grasped Jim's stumps like he was palming a small ball. He pressed his thumb on the underside of the leg.

"Does this hurt?"

"No. . . . Yes," Jim said, wincing.

"That's your sciatic nerve," Ertl said. "It's stuck in the scar tissue."

The pain Jim felt was the result of that nerve being agitated, he said.

"We won't do a revision on you," Ertl said. "We'll do a reconstruction."

For the first time, Jim knew that the surgery was going to happen.

"Excellent," he said, smiling broadly.

Ertl said he would need four to five hours to do both legs. Be prepared for pain, he said. I'll be taking off about a half-inch of bone and working over the muscles some.

"Do you have any questions for me?"

Instead of a question, Jim rattled off everything he knew about the mechanics of the surgery. Then, assuming the role of an advocate for better health care, he asked why Ertl's technique was "invisible to the world."

"Not the world," Ertl said.

"Is it because it's such a long procedure that all the doctors are not doing it?"

"Find me somebody that's interested," Ertl said.

"You pass that off really casually," Jim said. "Why did it take me eight months to find out about it?"

"It's taken me much longer," Ertl said. "It's taken me much longer to get here than for you to sit here only a year out. You understand?" he said.

Ertl paused, then continued.

"I've presented my work. People know it's out there. I've been in practice 15 years. It's taken me a long time to get people to listen to me. You can't change people's thinking overnight, especially when they're so adamantly opposed.

"Why? I don't know," Ertl said. "They've never done it. They're afraid to do it."

"It's just that I have watched other people do the same battle I have to get here and lose," Jim said. "They were left broken and hopeless. I would like to help them have a little better idea what their options are if I can."

Their exchange wound down quickly, like an airplane propeller, until they had returned to a place of static cordiality.

See you at 9 a.m., Ertl said.

He's good, Jim said later as he replayed the meeting, but he's got that surgeon's arrogance.

* * *

Jim had been here before.

The nurse started the IV drip at 11:17 a.m.

Then he was on his back on the gurney, being wheeled into surgery.

He saw only ceiling tiles, a water stain or two.

His horizon was gone again.

A little groggy from the drugs, he told the nurse about the hallucination he had after the first operation. He'd been kidnapped by terrorists and held for ransom. "You're making a big mistake," he told the terrorists. "I'm broke."

At 11:25 a.m. he was unconscious.

A nurse taped his eyes shut.

The series

TODAY

DECIDING TO GO

After losing his legs in a violent accident, Jim Miller vows to walk again. He begins an odyssey he never imagined.

MONDAY

THE WAY THERE

Jim has much-needed surgery and slowly reconnects with his family. But conflicts within himself and with others stall his efforts to walk.

TUESDAY

WHEN YOU ARRIVE

After a lonely but productive time in France, Jim returns home and discovers what he needs to move forward in his life.

MISSED PART OF THE STORY?

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