Mettle to Bone

TRAPHILL - Now and then, in that hazy world between sleep and wakefulness, Tamara Westfall reaches to push the covers down with her foot, only to remember that her foot is no longer there.

She lost the bottom of her right leg five months ago in a car crash, a horrible event in its own right but just one of many she has faced in her short, hard life.

Westfall is 18. She has never known what it's like to have a comfortable, secure home, with two mature, responsible parents to guide her safely through life's pitfalls. Her parents were not married, and they split up when she was 2. Her mother was an alcoholic. In the various households in Oklahoma where Westfall grew up, there was never enough money to go around.

She is tough, stubborn and resilient, traits she mastered growing up fast. Maybe too fast. In some ways, she still isn't all the way there. She fights to get her life on track, then makes mistakes. In September, she made a big one, and it cost her a leg.

The night before Labor Day, Westfall spent the night drinking, and she was still drunk when she walked home to the mobile home that she shares with her fiance, Dennis Watkins, and her mother, Tammy Johnson. They want something better. But they can't catch up on back rent, and the bills keep piling up.

"Every time we start getting back on our feet, something happens," Westfall said.

On Labor Day, the three of them headed to Gristle Tail, a swimming hole also known as "the rock" near Stone Mountain. Westfall often sought refuge at this peaceful spot, where she could sit in the clear, shallow stream and listen to the rush of water pouring over rocks and feel it pound her back.

Westfall didn't drink anymore that day, she said. Too many people had gotten in trouble for drinking at the swimming hole, and she didn't want to be one of them. But she had drunk so heavily the night before that she still had enough alcohol in her blood to exceed the legal limit for driving.

The three of them were making their way across slippery rocks to get to the swimming spot when Watkins slipped, fell and hit his head, opening a gash that would require 10 staples to close.

Blood gushed. Whenever he tried to stand, dizziness overtook him, and he fell back.

Westfall, the only one with a valid driver's license, panicked and drove off to the Traphill Volunteer Fire Department to get help.

"I asked her not to take off," Watkins said. He thought that he would eventually be able to make it back to his car so that Westfall could take him to the hospital.

While the rescue workers gathered their gear, Westfall sped back toward the swimming hole, crying. Driving 70 miles an hour on Austin Traphill Road, where the speed limit is 55, she lost control of Watkins' 1993 Nissan and crashed into the concrete steps of a Boy Scout hut.

She said that a maroon car came into her lane and sideswiped her, but Kyle P. Barker, the trooper who investigated the accident, found no evidence of another car. He cited her for driving while impaired and exceeding a safe speed. Her blood-alcohol level, tests later showed, was .12, .04 over the legal limit.

The car hit the steps with a force powerful enough to shove the engine almost into Westfall's lap. She had locked her right foot onto the brake. When the car hit the steps, her foot took the full brunt of the impact.

"It (her foot) wasn't going to give, and that concrete wasn't going to give," she said.

The car caught fire.

Passing cars stopped, and people raced to help. One person kicked in the door of the Boy Scout hut, found fire extinguishers and put out the fire. Westfall remained conscious, but she remembers just bits and pieces of her rescue.

"I kept telling them, 'I'm OK. I'm OK. Go to the rock. Dennis fell.'"

She doesn't remember feeling pain.

That came later.

The firefighters, who were following Westfall, arrived a few minutes later and sent word to the Wilkes Rescue Squad that they needed help. The rescue squad used the "jaws of life" to free her. She went by AirCare helicopter to Wake Forest University Baptist Medical Center.

In the emergency room, doctors evaluated her injuries - small punctures of her lungs, a bruised liver, a severe cut on her right knee, a broken rib, a cracked pelvis and two broken bones in her spinal column.

Her most serious injuries, however, were to her right leg.

"Her heel was just crushed, almost like a bomb went off, and it just exploded," said Dr. Bob Teasdall, the orthopedic surgeon who took over Westfall's care the day after her accident. Bone jutted from her skin. An artery and the nerve that runs along the inside of her ankle had been severed.

"Always the question, when you're faced with this, is what is the best thing to do, to try and salvage the foot or do an amputation?" Teasdall said. Doctors sometimes have no choice but to amputate when a limb is infected or the bleeding can't be controlled. Westfall's damaged leg was not bleeding profusely, and it had not become infected, although her risk for infection was high.

Amputation would not be any cheaper than trying to save the leg, Teasdall said.

"When you have someone this young, when you consider she will need prostheses for the rest of her life, it ends up about the same."

Trying to salvage the foot would have meant many surgeries spread out over more than a year, with no guarantee of success. Infection would be a constant danger. And Westfall would still have been left with a foot that probably would never work the way it should.

"Most people, when they react to an amputation, it's like the worst possibility," Teasdall said. But he sees it differently.

"I look at it as the first step to rehabilitation. There's very little someone with a below-knee amputation can't do," he said.

An outdoorsy girl

Westfall had always been an active, outdoorsy girl. She ran track in high school and anchored a relay team. She loved to swim and hike, and she once talked Johnson and Watkins into climbing to the top of Stone Mountain with her.

Places like Gristle Tail have provided Westfall with peaceful respites from the chaos of her life. When she entered her teens, she realized that her mother didn't just drink, but she also took drugs.

"I got into the wrong crowd," Johnson said. "I was messed up, and it cost me my family, my marriage." Johnson, now 39, said that she didn't have much of a childhood.

"I waited until a little down the road to try to have a child's kind of life. I didn't know better at the time, I guess."

Westfall lived with her mother and her stepfather. "Then she (her mother) wasn't there. She came a few times a week." Westfall had problems with her stepfather.

At 13, she ran away. She bounced from a shelter to her grandmother's house to her father's house.

For several years, Westfall lived with her father, Michael Westfall. Her mother would come and go.

Westfall wanted to hurry and grow up so she could go to college, she said. She wanted to get her life on track - unlike her parents. Neither of them finished high school. Westfall played the viola, practiced her cooking skills and thought about going to culinary school.

Reality kept getting in the way.

In 2002, Johnson's half-brother murdered her mother and stepfather. In the summer of 2004, Johnson left Tulsa and moved to North Carolina to start over and look after her grandmother.

Johnson had straightened herself out after going through rehab. She is working on regaining the driver's license that she lost four years ago, when she was charged in Oklahoma with driving while impaired.

"She's pulled through it. I'm proud of her," Westfall said.

"I wish I could have made a better example years ago," Johnson said. "But she knows right from wrong, and I know she forgives me."

Several opinions

Westfall took the news about her leg hard at first.

"I never thought it was going to happen to me," Westfall said. "I was a little afraid I was ruined forever."

Tony Saia, an owner of Bio-Tech Prosthetics & Orthotics in Winston-Salem, talked to Westfall and her family while they were trying to decide what to do.

"At first, there was a ton of fear, fear of everything." he said. "Because of their lack of knowledge of prosthetics, there was fear that she would be on crutches or in a wheelchair."

Johnson said that they sought opinions from several doctors.

"All gave us the same news," she said. "It took a lot of praying and a lot of tears to come up with the right decision."

Westfall had the final say.

"I told them to go ahead and amputate it," she said. "Get it out of the way and move on."