Jim Miller believed only walking would give him back his life. To walk he was willing to endure the pain of more surgery. But the real challenge would come after.
By BILL DURYEA
© St. Petersburg Times, published July 15, 2002
The way there
The surgeon drew a scalpel along the scar at the end of Jim Miller's left leg. A thin red seam unfolded in an oval field of umber antiseptic.
The operating room was frigid. The nurses wore extra gowns for warmth. Dr. Jan Ertl, in short sleeves, was flushed with concentration.
Jim's body, everything except for the stump of one leg, was concealed under a tent of pale blue sheets. It was as if all Jim had ever been or might ever be was located in this exposed patch of skin and bone.
After the first surgery, in December 1999, Jim had developed bone spurs on the ends of his legs that needed to be removed before he could walk without pain. Generally, patients who need follow-up surgery get it from the same doctor. Jim knew the first doctor had saved his life, but now, more than a year after the accident, he was depending on Ertl to help him walk. In effect, Jim was about to be amputated for the second time.
The procedure was known as the Ertl Osteomyoplastic Lower Extremity Amputation Reconstruction. Ertl had learned it from his father, John W. Ertl. He had learned it from his father, Janos Ertl Sr., who had developed the method in Hungary in 1920 to help veterans who lost limbs in World War I.
Many surgeons remained unconvinced Ertl's longer, costlier procedure was necessary. But prosthetists, who saw the work of different surgeons every day, believed it improved the odds their patients would walk. Bill Copeland, the man who would fit Jim with artificial legs, had flown to Sacramento at Jim's expense to learn more about Ertl's technique. He stood over the doctor's shoulder as he worked.
A nurse put a Van Halen compact disc in the CD player as Ertl used a hot-tipped electric scalpel to burn through tissue -- pebbly yellow fat and hard white scar. The faint smell of seared flesh rose into the overhead lights on tiny wisps of smoke.
Probing inside the leg with his fingers, Ertl found one of the strongest muscles in the body, the one that runs along the interior of the thigh. The muscle was slack, like a broken guitar string.
"This is about the way it's usually done," Ertl said, assessing the work of the original surgeon. "Most people do it straight out of the book."
Ertl continued to poke inside Jim's thigh, searching for the sciatic nerve, a neural trunk line running the length of the leg. After several minutes he withdrew his gloved hand, the fat white nerve looped around his blood-slicked forefinger. Jim's sciatic had embedded its severed end in the scar tissue of his stump. Every time something pressed on that area of his leg, Jim felt jabbing pain.
Ertl pulled the nerve taut from the end of the leg. He cut off about 41/2 inches and allowed it to snap back deep into the thigh. This way it wouldn't bind into the new scar tissue.
Gradually, Ertl separated the muscles and other soft tissue, revealing the bone spur. It looked like the head of a small pickax.
A nurse handed Ertl a chisel with his name branded on the wood handle. Ertl cut into the periosteum, the sturdy membrane of connective tissue that surrounds all healthy bone.
"Oh, no," he said.
Peeling back the periosteum, he discovered that the hole at the end of the femur had been capped with a wad of surgical wax. The instinct to close the end of the bone was a good one, Ertl said, but wax would never work as well as a natural substance such as the periosteum. He quickly scraped away the wax.
With a pneumatic chisel, Ertl removed a little less than half an inch of bone -- enough to get rid of the spur without significantly shortening Jim's leg. Ertl sewed the periosteum back over the opening of the femur.
Then he separated the thigh muscles into four sections -- front, back and sides. He sewed the medialis to the periosteum. He sewed the lateralis to the medialis. Then he sutured the hamstring to the lateralis and, finally, the quadriceps to the hamstring. When he was done, the muscles looked like the neatly wrapped end of a Christmas present.
Closing the wound, Ertl trimmed the skin like a dressmaker. He wanted to avoid the "dog ears" of leftover skin that poke out at the corners of the incision when surgeons rush. Any irregularity on the skin would prevent a tight fit of the prosthetic leg.
Four and a half hours after he began, with Bon Jovi's Lay Your Hands On Me echoing in the room, Ertl tugged the last stitch tight. He inserted two pieces of soft surgical tubing into the corners of the incision to drain fluid from inside. They looked like whiskers on a catfish.
Jim was still unconscious when the anesthesia nurse leaned over and whispered in his ear, "Time to wake up, honey."
In the recovery room, Jim pushed through the fog of the anesthesia. He smiled when he saw Bill standing next to the bed. Bill clasped his hand.
"Did you learn anything?" Jim said.
"You bet," Bill said.
Jim smiled and gave him a thumbs up.
When Jim woke the next morning, the nurses told him that his wife had called Ertl's office several times while he was in surgery.
Ivonne hadn't forgotten him. He forgave her for not telephoning before he left Florida. Then he called.
"I love you," Jim said into the receiver. "I just thought I'd mention that."
Ertl walked through the open door as Jim was hanging up. Jim turned, beaming, toward the doctor.
"You look really good," Ertl said. "You feel a difference?"
"For the first time since the accident, I really feel as though I can do this," Jim said. "The legs feel like they belong to me again. They used to feel like something was broken inside."
Jim was experiencing a great deal of pain -- a throbbing, nonspecific ache and electric shocks from his overly agitated nerve endings. But intense as the pain was, Jim could accept it because he knew it meant he was getting better.
Ertl explained what he had done during the operation. His words described the difference between solving an immediate medical problem and helping the patient live a more functional life after the surgery.
"This is the oldest operation in the world," Ertl said. "But I don't think we prepare people enough for the change we're creating. Sure, we saved your life, but now you have to deal with a whole new set of circumstances."
Ertl, as it turned out, planned to be in Sarasota for a medical conference at the end of March, six weeks away. If everything went according to plan, Jim might be wearing his first prosthetic legs by then.
Maybe we can get together, Ertl said.
As Ertl left, Jim opened a bottle of French red wine he had on his nightstand. Sipping from a foam cup, Jim thumbed the button on the morphine drip like a boy with a video game. On the muted television Dale Earnhardt crashed into the wall and died on the last lap of the Daytona 500.
Jim's thoughts drifted on a warm tide of morphine and wine. He remembered a bottle of $175 cabernet sauvignon that he and Ivonne once shared. He was touched that Ivonne had tried so hard to reach him. Yes, they were getting a divorce, but love -- even under such strained circumstances -- was far better than being alone.
While he was in the hospital, his lawyers in St. Petersburg called to say they'd settled his suit against the two drivers who caused the accident. After paying off Bayfront Medical Center, the lawyers, and setting aside $101,457 for an annuity for his daughter, Giselle, Jim was left with $1,403,603.90. Whatever lay ahead for him physically, money would not be the reason he would not walk again.
To calculate the size of Jim's settlement, his attorneys had used actuarial tables to determine his life expectancy. Before the accident, a healthy Jim Miller might have had about 20 years to live. The lawyers estimated Jim had half that much time left. Another perhaps more frightening statistic showed amputees have a higher rate of suicide. One study from Finland in 1969 indicated amputees were 300 percent more likely to kill themselves than non-amputees of the same age.
Jim had emerged from the other side of the surgery only to discover a disquieting irony -- he was moving forward, but losing time.
In the beginning, Jim had dreaded not getting the chance to walk. Now, more than a year since the accident in December 1999, he worried that relearning to walk might monopolize whatever time he had left.
Metaphorically, Jim had restarted the clock on his recuperation. He was back at the beginning with freshly amputated legs. Without question, the surgery had been necessary, if only to alleviate the pain caused by the bone spurs. But the surgery, as Jim knew, would not by itself make him walk.
"I have realistic expectations and great determination," he had written to Ertl months before.
But in the months ahead, Jim would discover that nothing would control his destiny as surely as the battle between what he wanted and what he was capable of.
Coming home from the hospital was different this time. Ivonne flew to Sacramento to help Jim on the plane flights back. She agreed to stay with him in St. Petersburg, at least for a night, to make sure he was comfortably settled.
On the drive back to Jim's house from the airport, they stopped at the Garden restaurant for a couple of glasses of red wine. It was nearing midnight and Jim was worn out, but mellow. Ivonne had a serenity about her that seemed to rub off on Jim. He leaned across the table and embraced her.
This was the first time I had seen Jim and Ivonne together. They didn't seem like people who were days away from becoming officially divorced. If anything, they appeared to be drawing closer. Everything Ivonne said expressed her concern for his recovery or her amazement at his perseverance. Jim was grateful for her encouragement. He needed every bit of it.
"I don't know if I'll ever get the nerve to go back to L'Avenir," he said, referring to the restaurant next door to their old apartment in Paris.
"If you can walk up the street, maybe you will."
"If I can walk."
Later, Ivonne told me that although she supported Jim's effort to walk, she was not convinced that Jim needed to succeed to regain his sense of himself. The things that gave Jim pleasure -- writing and flying, for example -- were still available to him. Strange to say, but in some ways the accident had improved Jim, Ivonne said. He had become less dictatorial, she said, because he was forced to rely on others for help. He couldn't pace around nervously like he used to, relentlessly amending his list of projects. He had to move slower now, which made him calmer.
The biggest change, she believed, was that he had become more tolerant of people, especially those he had to rely on for help.
With Ivonne living two hours away in Orlando, Jim spent most days at Albert Whitted Airport, fixing his hangar and trying to find someone who could install the hand controls he needed to fly alone. Progress on the plane was frustratingly slow, but he enjoyed hanging around at the airport far more than staring at the walls in his house.
At Albert Whitted one afternoon, Jim began to get the first twinges of phantom pain. At first it felt like ants crawling over his toes. When his feet began to feel fiery hot, he reached into the satchel slung over the back of his motorized scooter. He pawed through the contents but could not find his pills.
He had no choice but to ride home. A mile and a half. Every crack in the sidewalk shook his legs until he wanted to scream.
At home he swallowed a Percocet. He lay down. The day faded away in a vapor.
When he awoke later that night, the phantom pain hadn't disappeared. He felt a crushing ache in the arches of his feet as surely as if they were still there. The doctor had prescribed Valium for these episodes.
But Jim was confused. He forgot about the Valium and he couldn't remember how much of thepainkillers he had taken. He was afraid of overdosing. Well after midnight, he called Ivonne.
Help me, he said. I'm scared.
She talked him through breathing exercises and reminded him about the Valium.
In the morning the pain had ebbed, but Jim was shaken. Once again, drugs were dulling his mental edge. Just like after the accident, Jim feared the drugs were getting in the way of walking.
Jim doubted he would be healed enough to wear prosthetic legs in time for Ertl's visit at the end of March. Bill Copeland was determined, though. He scheduled Jim for an appointment only days before Ertl was to arrive. Bill was confident he could make the legs in time.
"I've been dreading this and longing for this for a long time," Jim said.
He was sitting in his wheelchair in Bill's Tampa office at the end of March 2001, sipping a cup of coffee and hoping his pain medication would last the day.
The walls were full of pictures of patients Bill has worked with over 20 years. One picture showed a young man who had won a gold medal in the 800-meter run at the Paralympics in Sydney. His left leg was a slender carbon bow that started below his knee and curved into a running shoe.
Nearly six weeks had passed since the surgery. Jim's legs had healed enough that the pain was manageable. But he had not tested them yet. He had not walked on them. His ambivalence was clear in everything he said.
"I'm ready," he said as Bill wrapped his stumps in moist plaster bandages to make molds for the prosthetic legs. "I think this is going to work."
"There are times when I'm on the edge of blowing this off," he said as Bill poured plaster into the molds.
"But any person with any guts would never forgive himself if he didn't at least give it a shot," Jim said as Bill shaped the hardened plaster with a rasp.
The workshop in Bill's office was long and narrow. At one end was an oven that had once cooked chicken in a Kenny Rogers Roasters restaurant. It was perfect for the task of heating the thick sheets of heavy-gauge plastic from which Bill made test sockets.
Bill placed the plaster forms on a vise next to the oven. He heated the clear, silicone-based plastic until he could see it slump inside the oven. Then he draped the plastic sheet over the form and used a vacuum to suck the material tightly to the plaster. This would be the flexible sleeve that would fit snugly around Jim's stumps.
Bill repeated the process with harder plastic. This would serve as the rigid shell within which the soft sleeve would sit. It was the same clear, bulletproof material used for cashier windows. The clear plastic made the sockets look like flower vases. Bill made them see-through so he could spot white pressure points on the skin that would indicate a bad fit.
By the middle of the afternoon, Bill had made the sockets for both legs. He drilled small holes near the bottoms for the air valves that would create enough suction to keep the sockets on Jim's legs.
Next, Bill took the "feet" off Jim's old sockets, the ones Jim couldn't wear because of his bone spurs. Bill screwed the feet to the bottoms of the new sockets, making what looked like a leg without shins. The feet were rectangular with hard foam soles. They faced to the rear to give Jim extra balance.
"The tendency for someone without knees is to fall backward," Bill said.
Seven hours after he started, Bill carried the legs out of his workshop into a room with a set of parallel bars bolted to the floor.
Jim, sitting in his underwear, slathered lubricant on his stumps and lined the inside of the sockets. With the legs standing in front of his wheelchair, he slid slowly off the edge of the seat, letting his weight push down inside the sockets. The air escaping from the bottom valves made a flatulent sound.
Grasping the parallel bars, Jim pulled himself upright. Then he let go.
He was standing.
"Right now I have no pain," Jim said. "Thank you Dr. Ertl. Thank you, Mr. Copeland.
"This is going to work, buddy."
Two days later, Jim and Bill drove to Sarasota to see Ertl.
In a meeting room off the hotel lobby, Ertl watched as Bill pulled the legs out of a large gym bag and handed them to Jim.
"Let's take a peek," Ertl said, rolling his chair toward Jim. Jim pounded on the ends of his stumps.
"No pain," he said.
Then Jim slid into the sockets for the second time.
Jim toddled across the floor like a child, arms waving at his sides for balance. As he got closer to Ertl he stretched his arms toward him, smiling.
"Hey, dude," Jim said.
Ertl smiled so hard he blushed. "Oh, fantastic," he said. "This is beyond my expectations."
"How do you feel, Jim?" Ertl asked.
"I'm scared shitless," he said.
"What are you scared of?"
"I had an excuse before. I saw the pictures you took of those bone spurs. Now I have no excuse at all."
Two schools of thought exist on how a bilateral above-the-knee amputee should learn to walk again.
Some prosthetists believe in returning patients to their full height immediately. They make sockets that fit, they attach artificial knees and feet. The rest is physical therapy and gait training, weeks of learning how to walk inside parallel bars and beyond.
The other method is to fit the patient with a steady progression of incrementally taller legs until he is just shy of his original height; sometimes patients ask to be made taller than they were before, but prosthetists know that makes balancing more difficult. The patient might spend a couple of weeks or more at each stage before gaining enough balance and walking strength to move up. Given Jim's age, Bill guessed that the slower approach would be safest.
But with either method, it is a virtual certainty that the prosthetist will make numerous adjustments to the legs.
Making sockets that fit is largely trial and error. But it is complicated by the way an amputee's stumps change shape. If a patient is dehydrated, for example, the stumps shrink. Put too much salt on your fries and the stumps will swell. The more an amputee walks, the more toned the muscles become and that changes the fit of the sockets, too. A bad fit might create a pressure point, which could lead to an abrasion, which could turn quickly into an open sore that would stop the whole process.
New variables are introduced when the prosthetist attaches the sockets to the rest of the leg. The alignment of the socket to the knee and the knee to the shin have profound effects on an amputee's balance.
Set the legs too far back behind the person's center of gravity and he has to compensate by thrusting his stomach forward, a terrible position for the lower back. Put the legs too far forward and the person feels like leaning back, thereby collapsing the knees unexpectedly. A seemingly slight adjustment, such as turning the feet a couple of degrees to the outside, can mean the difference between walking and falling.
Bill had all this in his mind when he began working with Jim. He had been making limbs for people for so many years that he just knew what came after what, why one method might work better for a young person than an older one. Jim never asked for a contract or a written timeline. Everything was done with a smile and a handshake.
Jim wanted to walk and Bill wanted to help him. What more needed to be said?
Two weeks after the visit with Ertl, Jim returned to Bill's office for a routine adjustment. The left socket was giving him some pain. He said it was uncomfortable enough that he had avoided wearing it every day as he was supposed to.
Bill's solution was to heat the liner and stretch it out. When Jim put the sockets on again, it was the right one that hurt.
Jim was frustrated.
"I doubt all my perceptions," he said.
Looking at Jim's legs inside the sockets, Bill could see no white pressure points. He wasn't sure what the problem was. He wasn't sure there was one.
Maybe it's the position of the feet, Jim said.
Bill shook his head. "If I move the feet forward, you'd fall right over," he said.
Bill decided to change the feet to show Jim where his balance point was. Off came the backward-pointing rectangles and on went the forward-facing feet. Then Bill threw in a twist. He added 8 inches of aluminum pipe to give Jim some height.
Apprehensively, Jim tried them on. He was unstable, like a newborn colt. He became more frustrated and angrier with every step.
"There is no balance now," Jim said.
All the wobbling broke the suction seal on the legs and Jim couldn't control them enough to walk forward. The insides of the sockets were cutting into his groin.
"These are going to slice my balls off," he told Bill. "I can see why people quit. Because this is absurd. This is impossible. This is just a stunt."
Bill left to take a call from another patient. If I have to go through this every day, Jim thought, I won't do it. I can't live my life like this.
"Sorry, this maybe wasn't the best thing to do to you today," Bill said, returning.
The damage had been done. Jim's confidence had suffered a serious blow.
Bill took Jim's legs back into the shop to put the original feet back on and removed the 8-inch shins.
Sitting alone in the therapy room, something made Jim think about Paris. He had a story he wanted to tell of a special restaurant, but he couldn't remember its name or the street it was on. He burst into tears. He'd never felt as at home anywhere else in the world and now Paris was slipping away from him street by street.
By the time Bill returned with the old legs, Jim was so despondent it wasn't clear he would try them on. But he did, and moments later was smiling again. "I can do this," he said.
Jim went to Orlando to see Ivonne for Easter weekend. He didn't wear his legs once.
Jim had come to think of the legs, which he left propped in a corner of his kitchen, with the same distaste as paying his bills every month.
His outlook was not improved by the drugs he was taking, in particular one called Neurontin. It was an anticonvulsant usually prescribed for epileptics, but Jim's doctor had put him on it to ease his phantom pain.
When Ertl heard that Jim was still taking Neurontin, he urged him to quit. But Jim had doubled his dosage in the few months since the operation in Sacramento. He was showing many of the well-documented side effects: irritability, depression, memory loss, mood swings and stomach cramps.
Even though it was still early in the fitting, Jim had almost convinced himself the artificial legs were a waste of time. Too much effort for too little gain.
He demanded that somebody provide him with names of other similar amputees who could tell him what to expect.
"Everything falls on a bell curve," Jim said. "I want to know where I am on that curve. I want to know whether my chance of walking is so passingly remote that it would be quixotic to even attempt."
But when he was given the phone number of a man in Port Richey, the sanitation worker Jim had met months before at Bayfront, Jim didn't call.
Someone suggested he contact local amputee support groups. Jim scoffed. He called them nonsupport groups. He believed they would destroy his morale.
Jim's mood worsened with the realization that if he were to return to Paris, he would do so alone. He had always hoped to bring his family with him if he returned, but Jim's burgeoning relationship with Ivonne was not enough to overcome the ties she felt to her family in Orlando. He did not want to live by himself. Even in Paris.
Even in the midst of this profound doubt and depression, Jim never quit. Each time he put on his legs, he did it a little quicker. Each time, he could stand in them a little longer. Each time, his balance was a little surer.
In May, Bill added a few inches of height to the legs, this time with Jim's approval.
He spent three hours in the legs one afternoon. Because it was easier to walk on tile than carpeting, Jim preferred to stay in his kitchen. He baked to fill the time. Buckwheat muffins. By the dozen. He couldn't eat them all, so he stuffed bags of them in his freezer.
Something about moving forward seemed to unnerve Jim. He said he feared that a monomaniacal quest to walk would alienate him from his young daughter.
The few times that Giselle had seen him wearing the legs, Jim had detected fear on her face. You don't look like her father when you're wearing the legs, he thought to himself. You look almost human, and that is as bad as being a monster.
Ivonne didn't think Giselle was bothered at all. Giselle, who was only a little more than 3 years old, liked riding on Jim's lap in his wheelchair. His missing legs didn't upset her. In fact, Giselle was pretty sure that if she poured enough water on them, they would grow back.
On a day in early June 2001, a day that hinted at the stifling heat to come, Ivonne and Giselle came back to St. Petersburg with Jim. He had spent the previous 10 days in Orlando helping Ivonne shop for a new house.
At lunch in the courtyard of the Garden, Jim couldn't remember a time since the accident when he had been happier. Jim and Ivonne had continued to draw closer after he returned from Sacramento. Divorced though they were, Jim still called Ivonne his wife. As they held hands across the table, they looked very much like a married couple.
Being divorced is the key to a good relationship, Jim thought. The paradox amused Ivonne, too. But neither of them wanted to look too deeply into why they were getting along so well now.
Time with his family, however, had come at the expense of time in his legs. Jim didn't wear them the entire 10 days he was in Orlando.
Though Jim had just sent Bill a check for $14,000 to cover the cost of new legs with knees, he didn't think he was ready for them. He thought that all of his progress of the past two months had drained away.
Ivonne had promised him that Jim's legs would be the No. 1 priority of the family now that her new house was in order. They agreed that after lunch they would go back to Jim's house so he could spend some time practicing.
After Giselle went down for her nap, Ivonne left to get her son Adrian from his day camp.
But Jim didn't put on his legs. He stayed in the living room.
He thought about how unfair it was of Ivonne to leave him alone at the house with a young child and two kittens and expect that he would be able to practice walking. If my walking were a priority, she wouldn't have done that to me, he thought.
Later, when Ivonne returned with Adrian, Jim was sitting in the same spot she had left him.
"Can I have a hug?" he asked.
Jim wore shoes for the first time since the accident on the same day in July that Bill gave him knees. The shoes were light beige Rockports -- ProWalkers. Jim had bought them just before the accident. They were so new they hardly had any dirt on the soles.
He needed the shoes now because the new legs came with realistic looking feet that were angled at the ankle to accommodate the slight lift of a shoe heel.
"I'm really excited," he told Bill as he laced the shoes onto the rubber feet. He didn't have to bend over to do this -- the feet were attached to legs he had propped in his lap. "You try not to expect too much, but I'm really excited."
Getting into the legs was harder than Jim expected. With the old straight legs, Jim would perch on the edge of his chair and force his weight into the socket. But Jim couldn't keep the same pressure on the bendable legs without the knees giving way. It took him three tries to get one leg on. He gave up on the second one.
"I hate these sockets," Jim said.
After several more attempts, and a lot of sweat and swearing, Jim managed to get both legs on firmly.
Holding on to the parallel bars, Jim walked across the room. His gait was awkward. He rolled his hips to keep his feet from catching on the floor. But his knees bent a little with nearly every step.
"You're looking good," Bill told Jim.
But Jim didn't smile like he had in March when he first got up on the short legs.
"It doesn't look doable from a practical standpoint," Jim said. Without parallel bars at home, he wondered how he would put the legs on by himself.
"And we've got to get sockets that fit," he said.
So Bill took them back to the workshop to reshape them. While he was gone, Jim stewed about the new legs. The knees were not identical. Close, but not identical. They were used, to boot. He and Bill had agreed to go with the used ones to keep the cost down, but now that he had seen them, Jim thought Bill was making money twice on the same hardware.
Who knows how much these knees cost, Jim said to himself. Bill could say $50,000 apiece and I wouldn't know any better. Jim was convinced that this would not be happening in Europe. This is what happens in a profit-driven system.
Bill tried to boost Jim's morale when he returned with the reshaped sockets. Again, Jim put them on and again he walked between the parallel bars.
"You're doing it," Bill said. "All these other things are little things that can all be worked out."
Jim wasn't convinced.
He confronted Bill about the costs. Bill showed him the prices that he typically submits to insurers such as Medicare. Jim said he didn't understand the insurance codes.
He made Bill reattach his old feet and straight legs to the sockets. There was no point in taking the new legs if he couldn't put them on at home. Jim left the knees sitting on Bill's workshop table.
Three days later a letter from Jim arrived at Bill's office.
In it, Jim accused Bill of ingratitude and incompetence. The letter sounded a lot like the one Jim had sent to Ertl back in December -- a personal and professional broadside.
Jim said he had made Bill "an interest-free loan" of $10,000 to start his business. "A word of thanks would have been nice," he wrote.
He mentioned a mix-up over an appointment Bill had forgotten to schedule in early July. "You blew it. If I had driven over, a whole day would have been wasted," Jim wrote.
Then he got into the bill. The accounting he had given Jim for the legs was incomprehensible, written in insurance-speak, Jim wrote.
The sockets didn't fit, the knees didn't match and the feet were the cheapest available, Jim wrote.
"This is a shabby way to treat a friend and a customer and you know it," he went on. "I do not have time to waste on this nonsense. I will be your customer, your friend, but not your patsy."
Jim demanded an explanation of the bill for the new set of legs with knees. He wanted a pair of sockets that satisfied him. He wanted Bill to devise a way for him to get into the legs at home.
"If this is unacceptable let me know, I'll seek other professional help and I'll turn this letter over to my attorneys," Jim wrote in closing.
Bill was stunned. He told me he hadn't seen any of this coming.
That $10,000 wasn't a loan, Bill said. Bill had made Jim two pairs of legs for that price -- the ones that didn't fit because of Jim's bone spurs (which Bill had helped diagnose) and the second set after Ertl's surgery. Every office visit -- be it 10 or 100 -- was included in the flat fee. Other prosthetists told me that what Bill was charging Jim was so low that they didn't think he could possibly make a profit on his work.
Jim makes everything so difficult, so negative, Bill said to me. He's always finding an excuse. That's what he wants. He's trying to find an excuse to quit.
A few days after the letter arrived, Bill went to Jim's house after work to clear the air.
"If you don't feel I have your best interest at heart," Bill said, "we need to end this right here."
He reminded Jim of the chores he had done for him around his house, of how he had called the doctor in Sacramento after Jim's surgery, worried that Jim sounded incoherent on the phone. Bill explained that there are only so many ways to put on prosthetic legs, and said he'd keep experimenting until he found one that worked for Jim.
He did make one concession. He agreed to give Jim a new set of knees, hydraulic instead of pneumatic, for no extra charge.
After two and a half hours, they agreed to keep going.
The next morning, Bill spent a few hours widening the sockets at the top of the thigh and shrinking them at the bottom. After each adjustment, Jim said they felt better.
But the problem of how to put on the legs remained. A colleague Bill had consulted reminded him of a donning method in which the lightweight socket liner is put on first and the socket frame and leg go on after that. Bill mentioned the idea to Jim.
"You've known this all along," Jim said. "Why didn't you tell me?"
"We hadn't gotten there yet," Bill said.
No matter, Jim said to himself, now the information is here and we can move forward.
Jim wasn't sure he really believed this.
He told Bill he was satisfied with his effort, but he was making plans to consult a prosthetist in Michigan who had worked for many years with the Ertls' patients.
Jim wasn't really sure he wanted to do that either.
Even as he said he would fly to Michigan, Jim was bemoaning the stress that his efforts to walk were placing on his family. Giselle wasn't eating properly and he needed to pay attention to that. Ivonne was exhausted caring for two children and him, too. Everyone was being pulled into his vortex.
Still, he didn't want to stop trying to walk either.
He worried that his family was paying an emotional price, but he was constitutionally incapable of quitting. If he were a quitter, he told himself, he would never have finished building his 46-foot sailboat years ago.
He wondered though if this was all worth it.
As far as he could see, walking was an excruciatingly painful chore that offered little advantage over his wheelchair.
Nothing would change, Jim decided. At least not for the next two years or so. That's how long he estimated it would take to learn to walk. Until then, this was always going to be a labor-intensive, expensive, life-consuming chore.
He didn't go to Michigan. Nor did he stay in Orlando to be with his family.
He came up with an entirely new plan.
At the end of July, Jim packed his legs in a carry-on bag and, once again, flew to Paris.
DECIDING TO GO
After losing his legs in a violent accident, Jim Miller vows to walk again. He begins an odyssey he never imagined.
THE WAY THERE
Jim Miller has much-needed surgery and slowly reconnects with his family. But conflicts with himself and with others stall his efforts to walk.
WHEN YOU ARRIVE
After a lonely but productive time in France, Jim Miller returns home and discovers what he must do to move forward in his life.
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-- Times staff writer Bill Duryea can be reached at (727) 893-8457 or firstname.lastname@example.org.