A Step at a Time

TRAPHILL - For a week after her lower right leg was mangled in a car wreck, Tamara Westfall lay in a hospital bed, the fate of her leg uncertain.

Doctors advised amputation. Her parents - her mother, who stayed by her side, and her father back in Oklahoma - desperately wanted doctors to save the leg. Westfall tried to appear strong to keep others from breaking down, but she worried about what life would be like with a prosthetic leg.

Would she be able to drive? Could she wear sandals? Would she have toenails that she could paint? Would people stare at her when she went swimming and removed the prosthesis? Would her fiance, Dennis Watkins, still love her?

But once she faced reality - multiple surgeries, a lot of pain, no guarantee of success- she decided to go ahead.

Dr. Bob Teasdall amputated the leg about eight inches below the knee. Two days later, Philip Rock, an orthopedics supervisor, removed the bandages from her right leg and she saw it for the first time.

"It looked weird," she said. She didn't cry. She sat, stoic, while Rock wrapped the leg in a protective cast made from nylon gauze laced with Fiberglas resin. He cautioned her about phantom pains and itching that seem to come from a severed limb.

"When it happens, reach down and scratch where it used to be," he told her. "It will go away."

She went home that day, her 10th in the hospital.

Instead of walking up the stairs of the mobile home that she shares with her mother and fiance, Westfall rolled up a ramp that Watkins and a relative built. A bedside toilet sat in the living room. Her wheelchair wouldn't fit through her bedroom door, so she camped out in a nest of pillows on the living-room sofa. Her mother, Tammy Johnson, slept on the other sofa, and Watkins slept on a pallet on the floor. Her dad, Michael Westfall, kept tabs on her progress through calls from his home in Tulsa, where he had to stay to care for his mother.

As the days passed, Westfall fought to regain her mobility. She lifted her leg, cast and all, and moved it in circles for exercise.

She stayed active. She visited relatives. She accompanied her mother to work. She swept and mopped the kitchen floor from her wheelchair. She hopped on her left leg and held onto furniture and the wall to make her way into her bedroom.

Much of the time, though, she stayed on the couch, watching TV and reading. The painkillers she took dulled the twitching and throbbing of her leg but couldn't stop it. Her other wounds ached.

The family struggled to maintain a normal routine. The Nissan that Westfall wrecked was the only car, and she was the only licensed driver. She sometimes showed up late or had to cancel medical appointments because she couldn't get a ride.

But her leg began to heal, and Westfall started looking toward the future.

A month after the accident, she made her first visit to Bio-Tech Prosthetics & Orthotics in Winston-Salem and Tony Saia, one of the company's owners, replaced her cast with a shrinker sock, a tight elastic band that would help reduce the swelling in her leg.

He reminded her of what he had told her in the hospital about dealing with amputation.

"Where are the battles lost and won?"

"Between your ears," she replied.

"Massage your leg," he said. "Scrub your leg with a washcloth." The more she handled the leg, he told her, the less sensitive it would become. He told her to make a conscious effort to tighten the muscles and extend her leg.

"A lot of this stuff is in your control. You have to do it," he said.

When she left Bio-Tech, she felt insecure without her cast.

"On the way back home, I was scared to put my leg down," she said. "When I touched something with the end of the leg, I was afraid I would hurt it."

But soon she was pushing herself to be more mobile.

A cousin bought her a walker, and she quickly mastered it. One day, she used the walker to make her way around the salvage yard where the car she wrecked had been taken so she could dig through the wreckage for her belongings.

Her mother went back to work shortly after Westfall left the hospital, and Watkins started a new job at a restaurant/service station. On the first morning that Westfall spent by herself, she managed to keep her balance and make coffee while her kitten curled around her foot.

By early November - a little more than two months after the accident - Westfall was back at Bio-Tech, ready to be fitted for a temporary socket for a prosthetic leg.

Saia first showed her a gel liner, which would protect her leg and suspend the prosthesis from a pin at its bottom. Then he slid the socket mold on.

"You see how you feel resistance?" he asked. "If it slides on easily, you need socks." Prosthetic socks, which come in different thicknesses, go over the gel liner and give the prosthesis a snug fit. Depending on her activity, Westfall's leg will shrink and swell in the course of a day for at least several years.

"Anytime you have surgery, the normal flow of blood is interrupted," Saia said. "Fluids don't efficiently flow out of the leg." When an amputee walks on a prosthesis, it acts like a giant pump and helps promote circulation. The leg shrinks. At rest, the leg swells again.

Watkins took photos as Westfall gripped a set of parallel bars and stood with her right leg, encased in a test socket, propped on a stool. Her eyes never left Saia's as he instructed her to slowly shift her weight.

"I can feel my bone, my shin bone," she said. They experimented with socks, and he told her that most amputees first think that their sockets feel too tight. "It's like cowboy boots," he said. "Once your body gets used to it, you actually like it when it's good and firm and tight."

She felt pain as she shifted her weight, but she downplayed it. "It don't hurt that bad," she said. "I want to walk."

He adjusted the socket to ease pressure on a tight spot and then had her try again.

"This feels pretty good," she said.

At her next appointment, Saia said, her new temporary leg would be ready.

She would walk.

Saia hugged her and warned her against trying any stunts that could injure her still-healing leg.

Eight days later, she returned, nervous and excited. Saia worked on the fit of the leg, then she stood and walked, holding onto the bars with both hands. Saia watched her gait.

"People use the leg like a crutch," he said. "I want you to get to use it like a leg." Using a walker had put her in the habit of balancing her body over her left leg.

"You're going to try to do that," he said. "That's become normal. Look at yourself in the mirror." He adjusted the height of the leg and trimmed the socket. Her mother watched, smiling, as she continued to practice.

Saia gave her more instructions, then said, "Tell me what you're thinking."

"I hope I don't fall," she replied.

He took her outside and had her practice going up and down steps. Then he told her to go home.

She burst into tears.

"Why are you crying?" he asked.

"It's over," she replied.

Walking with ease

More than five months have passed since Westfall lost her leg.

Her neck still hurts sometimes. Her intact left leg and the toes on that foot ache when it's cold. Phantom pain from her severed foot makes her feel as if her lost toes are curling. She stopped taking painkillers in December.

She walks on her temporary prosthesis with ease and confidence. She has filed for Medicaid so she can pay for a permanent prosthesis with a flexible carbon foot that will allow her to be as active as she wants to be. Even with her temporary prosthesis, she can climb over trees and run after her puppy. Her new foot will have a cosmetic cover with toenails that she can paint.

But she faces reminders of her accident every day. Each morning, before she can leave her bed, she reaches for a gel liner and slides it onto her right leg. Next, she slips her leg into a socket and pushes until she hears a click. Then, she can get up.

That's the routine. But nothing else about her life is routine.

She recently found out that she is pregnant. When her baby cries during the night, she won't be able to just roll out of bed and walk to the nursery.

Her life has been changed forever.

"I'm only 18," she said. "These are years when you want to go, 'Look at me! Look at me!'" She realizes now, she said, that life is not all about how people look.

But she constantly asks Watkins if he can tell by her gait that she walks on an artificial leg.

She has also learned her lesson, she said, about drinking. She was once a heavy drinker. Since the wreck, she said, she has consumed no more than a six pack of beer and one or two wine coolers.

And what about drinking since she became pregnant?

"Oh, God, no!" she said.

She talks about her dreams and her future with youthful optimism and indecisiveness. She loves art. She loves math and science. She loves secretarial work.

And now there's a baby on the way.

"She really wasn't ready for it," her mother said. "She wanted to wait."

Earlier this month, her court case from the wreck came to trial. She pleaded no contest to charges of driving while impaired and exceeding a safe speed. The judge convicted her of a level 5 DWI, the lowest level. Her sentence includes suspension of her driver's license, 24 months of unsupervised probation and a fine of $100 plus court costs.

After turning over her license, she got into a car and drove away.

She worries about things that many young women her age never think about. Catching up on back rent. Finding an affordable place to live where the floor isn't worn nearly through and cold air doesn't steal in around the windows. Stemming the tide of medical bills that won't stop.

So far, the bills for Westfall's care have run about $70,000. She has no insurance. Watkins and Johnson together make about $1,500 a month.

The policy at N.C. Baptist Hospital is to try to help patients work through the process of finding money to pay for their bills through Medicaid or other programs. A hospital fund is also available to pay some or all of the bills for a limited number of patients. If all other avenues have been exhausted and a balance remains, the hospital can offer extended-payment plans.

Westfall tries to discourage Watkins when he talks about wanting expensive things, such as cable and a big-screen TV. She reminds him that they need to pay for electricity and food first.

She gets tired of dealing with the red tape and scrounging for help from various agencies so she can get the medical care and financial support that she needs. One day, she cried for an hour and a half. But she bounces back.

"I'm happy," she said. "I worry about achieving. I'm going to go ahead and finish my credits and stuff. I'm going to get a temporary job until I absolutely can't work (because of the pregnancy).

"I ain't going to give up," she said. "I'll do what I have to do."