I Received Blown Up in Iraq. Years Later, Amputating My Leg Set Me Free.

All I have is flashes of memory when I was hit in a roadside bombing near Balad, Iraq on October 4th, 2005. I saw the concerned driver shake me awake, but at the time I couldn't remember who he was. As panic grew, I realized that I couldn't remember the name of my interpreter or what information I needed to get from my source that got me out on my 12th convoy in 12 days. I had worked with an infantry team made up of US and Iraqi troops for months, but suddenly their faces were no longer recognizable. Something was wrong.

When I got out of the truck, the sun was too bright through my sunglasses, the noises too loud, but indistinguishable in my bleeding ears. A searing jolt shot into my right leg with every step. I fell a little down a hill and felt my ankle give way, even though it was wrapped up and my laces were pulled as tight as possible.

Two weeks earlier, I was on a long-range mission to gather information on an oil field in a collision that killed three Iraqis and injured several others, including four of us in an armored truck. The impact had thrown me forward with such force that my right shoe slammed into the M16 rifle holder on the back of the Humvee's passenger seat, caught the tip, and twisted as we bounced across the street. The paramedics at the nearest base didn't have imaging equipment, so we called it a sprain, and I went back on my way. I was a news collector and investigator and I couldn't let my leg distract me from my work.

What I did not know at the time was that the injuries I sustained in these two incidents had inflicted such complex and significant damage on my body that they ended my military career and left me in almost constant and sometimes excruciating pain. My daily life and personal relationships have been overtaken by my injuries and the new ones they repeatedly caused.

Back in the United States after my assignment in Iraq, an ankle examination revealed that I had torn ligaments and a chip that had broken off the bone. The injury would require rigorous treatment to heal properly. Physical therapy. Steroid injections. Heat and ultrasound therapy. Rinse and repeat. Military doctors tried to repair this ankle for over a year, but they did not take into account the brain injury I suffered from the bomb explosion as the bleeding I suffered was not found for about another year. By 2008, the blinding migraines, impaired vision, and altered perception finally granted me an emergency trip to Walter Reed Army Medical Center to remove the mass that had coagulated in my brain.

I traded leg treatments for physical, professional, language, cognitive, and visual therapy for four years. Balance boards and drills with strange flashing lights. I've improved enough to qualify for and transfer to an elite unit and move on as a human intelligence worker. I re-entered and planned to stay in the army 13 or 14 years and make it a full career. I volunteered for another assignment – and then I was told that the complications from my leg and head injuries made me unsuitable and unsuitable for the candidate school for warrant officers. I was now a first class sergeant with no prospect of promotion. The army gave me medical retirement in 2012.

I have torn at least one piece of soft tissue in my right ankle every year since the accident. But I accepted it as it would be and went through all of the therapies at V.A. Hospitals. I lived with pain that no doctor could do about.

Over time, the muscles in my ankle atrophied from the nerve damage caused by the brain injury. No matter what I did, I couldn't get any stronger. I couldn't sleep, I couldn't get off a curb without feeling like my leg was about to snap. Hiking, mountaineering, rock climbing, and even walking around town brought pain.

Because I was always hurt and in constant pain, I thought I was a burden to those who were important to me. I withdrew from going to visit friends or participate in anything that would keep me on my feet too long. I relied heavily on a handful of people I was happy to confide in, but that didn't ease the guilt that weighed on me for asking so much and offering so little in return. I had already been diagnosed with post-traumatic stress disorder and my depression steadily worsened until sometimes I no longer cared whether I was alive or dead.

In 2019, I recovered from reconstructive surgery on my left foot that, after more than a decade of favoring my right side, was weakened when I took a wrong step and suffered from what the M.R.I. Report described as "internal incident". I couldn't walk again. At the time I was living in New York City and starting my own small business. I was constantly active – still climbing and hiking, walking around town as much as possible between inevitable injuries that were more common.

The damage was now so great that an operation was inevitable. Most doctors advised me to try a full joint-foot fusion, but I hesitated. It would only be a partial solution and nothing would eliminate the neuropathic pain as it was coming from my battered brain.

On my 39th birthday, I met Dr. S. Robert Rozbruch, a limb reconstruction and replacement surgeon at Weill Cornell Medical Center and the Hospital for Special Surgery in New York. He first listed treatment options that were similar to those I'd heard before, but then presented me with a new choice: a drastic option, he admitted, but one that he believed would improve my quality of life. Osseointegration, a procedure originally developed for the implantation of teeth, was developed in Sweden for prostheses and used on a larger scale in Australia. A limited number of American surgeons were now qualified to perform. Rozbruch was such a surgeon. He recommended amputating my right leg in the middle of the calf.

In traditional amputations, the limb is removed and then the stump is inserted into a socket prosthesis, which can lead to problems such as poor fit and lack of control over the prosthesis. Osseointegration involves amputating the limb and then inserting a titanium rod into the bone with a knot extending a few inches below the stump. From that node, in my case, I could screw on attachments for walking, kayaking, diving, and climbing.

Since 2001, around 2,180 US soldiers have suffered severe amputations, according to the Army Surgeon General's office. Of that number, at least 158 ​​were amputated a year or more after their injury – likely people who had injuries that needed stabilization before the amputation or who chose to amputate after other treatments failed. But very few people in the United States had undergone osseointegration, and only about half a dozen had the procedure for a leg injury below the knee. I would be one of the first to pursue it. The risk of the operation failing was small, but was I really ready to cut off part of my leg?

When everything is going right and one part of the body is doing its job, we don't have to think about it. We have the luxury of taking it for granted. But for the last 14 years I have had headaches every day. I hated the burden it placed on me and the burden I then placed on others. I hated the feeling of having to monitor my every step because I knew that a simple misstep could and often would end in a hospital visit. I hated feeling weak, hated, realizing it was holding me back.

I have been weighing my options for over a month: more cycles of surgery, physical therapy, injections, all without the promise of pain relief; or endure several months of intense recovery and wear a denture for the rest of my life. I consulted with my parents, friend Paul, and my therapist, but my diving, climbing, and mountaineering gear was piled up in the corner of a closet that made my decision: I planned the operation for August 5, 2019.

In the operating room, Rozbruch hammered the rod into my newly exposed tibia, and the plastic surgeon carefully reattached the severed nerves to the bottom of my remaining calf muscle. It only took me four hours to get bionic. When I got to, I had a cocktail of pain killers and anesthesia, but I was clear and feeling good enough to be starved. Strange as it sounds, for the first time in a long, long time, I stopped thinking about my leg.

After five days, I was released from the hospital into the care of Paul and my cats. I hopped off the couch to the fridge for water, food, and ice packs, generally cursing the slow pace of bone growth. Once, when Paul wasn't home, my pen got stuck in the little folding stool I used to balance in the shower. I pushed and pulled, but the peg didn't move, and I pondered for a moment if I should spend the rest of my life with a 9-inch black step stool that adorns the bottom of my calf like a plastic crinoline. I was finally able to pull out my pen with a little bruise and some blood.

I hate asking for help: as a woman in the military, showing weakness was not an option. But my new foot wouldn't be ready for a couple of months and until then I needed support to do everything from going to the doctor to having dinner. Paul's parents took me to and from the hospital almost weekly while Paul did what he could to make me feel comfortable at home. He cleaned, he cooked, he shoveled kitty litter, he made sure everything I needed for the day was within reach before going to work in the morning. The feeling of being a burden, of burdening these relationships, weighed on me. I made a promise to myself that if I could, I would make it up to me.

The surgery slowly subsided the pain and in September I experienced my first few hours in more than a decade without any discomfort. I went to the office knowing this was going to end my chronic leg problems, and this particular procedure was supposed to relieve phantom leg pain as well, but it had been done so rarely that I hadn't had to ask anyone about the end results beforehand. Although I was still on the couch and didn't even have a prosthesis for showering, I felt freer than I had in years.

It's been a little over 12 months since my surgery, and I've been happier with Peggy (the name I gave the new leg) than I have been with my natural foot in many years. I can't run yet, but I can step off a curb without my ankle rolling under my weight. I still work on stairs, but going uphill is so much easier without pain needles shooting up my leg. Although my balance is still affected by the brain injury, it has improved to the point that I have been upright for more than twice as long as when I did my pre-op tests. I still have headaches and dizziness, even though they no longer end with me tearing myself apart because of a fall.

Most importantly, I live mostly pain free and have finally been able to get back on a rock face. My climbing foot is about a third the size of my real foot to reduce torque, and it's not flexible. I had to change techniques that I had been practicing for 25 years because I don't know exactly what part of the prosthesis is on the rock and I can't shift the weight from the heel to the toes. But I am learning; I even built a bouldering wall in my yard to practice.

The years of relying on others challenged some of my relationships as I had always feared. Paul moved out and some friends disappeared as I took the time to regain my strength and balance before I could get back to the things we all enjoyed, like boating and diving. Heartbreaking as these losses are, I have no regrets about losing my foot. Without the pain, I focus more on what to do and what to do next. I can make music and dance in my apartment while I am making dinner or go for a walk while I take calls. I'm about to get a webbed foot in time for late-season beach trips, and I even have a running foot in the drafting phase. The choice I made was tough, and there are still tough days. But giving up my leg meant gaining the rest of my life back.

Elana Duffy is a Purple Heart veteran with 10 years of service in the U.S. Army. She also founded the artificial intelligence company www.pathfinder.vet to help service members and veterans connect with local benefits and resources.

Philip Montgomery is a photographer whose current work chronicles the broken state of America. For the magazine, he recently recorded the country's coronavirus outbreak by going to public hospitals in New York City, a funeral home in the Bronx, and shuttered shops.

Archival photography via Elana Duffy.

Design and production by Shannon Lin.