The phone rings in the amputee clinic and it is one of Darcy’s patients. He is on a ski trip sponsored by Disabled Sports USA and wants to tell Darcy that he just went down the ski slope on a mono- ski (seated ski). It’s his first trip away from the hospital since an improvised explosive device (IED) in Iraq blew his legs away four months ago.

His exhilaration is reflected in Darcy’s face. She downplays it when she hangs up the phone, but I can tell she’s secretly thrilled. Getting these phone calls, hearing these stories, are huge victories. It is what we live for as physical therapists— whether it’s seeing a patient head back to the ski slope, or, because we work for the U. S. Army, back to combat. It’s what makes the long hours and the physicality of our work worth it.

“Wasn’t that sweet?” she says to me. “That was Joe Davie calling to tell me how much fun he was having skiing.”

It was spring 2009 and I was a physical therapist in the most famous military hospital in the world: Walter Reed Army Medical Center. I’d been there for four years, and I’d go on to work there till its preplanned closing in 2011— part of a congressional budget base realignment and closure (BRAC) decision.

In the amputee section where I worked, there were ten physical therapists and, in the course of the day, more than a hundred patients. We were squeezed into a disproportionately small, glassed‑in gym on the top floor of Walter Reed’s Military Advanced Training Center. It was a strange idea, putting us under glass. On display for the rest of the world, but otherwise leaving us to our business. The glass wall allowed the tour groups to walk by without disrupting the patients. Three to six groups came by every day, often with celebrities in tow. But nothing distracted a patient more than looking up to see Angelina Jolie or an openly weeping congressman staring at him through the glass. My coworkers and the patients would joke that this must be how it felt to be an animal at the zoo.

I spent most of my evening hours swimming, so to me our facility felt like an aquarium. We were fish in a bowl. That day began like any other— at 0700. We gathered in the Fishbowl to go over the medevac list with our supervisor, Major Tavner.

Maj. Tavner looked over the list of new patients and then asked, “Okay, guys, who’s  ready for a new one?”

The other PTs and I skimmed the names as fast as we could, clamoring to see over her shoulder. Some of my colleagues wanted the big, complicated cases. They’d gone to graduate school specifically for this purpose— to serve as physical therapists to the nation’s war  wounded— and no challenge was too great for them: triple amputees, open abdominal wounds, fractured spines, broken pelvises. No problem.

Some wanted the prizes—the Special Forces patients, the West Point officers—patients who had been overachievers before and, they hoped, would carry that motivation through their upcoming rehab.

And some of my colleagues wanted a certain type of amputation. “I’ll take the double AK!” my friend and co‑conspirator Darcy passionately volunteered. When she saw that I’d burst out laughing, she added for emphasis: “I love double AKs. They just can’t cheat.”

A “double AK” is a person whose legs have both been amputated above the knee. They can’t “cheat” because they literally don’t have another leg to stand on. And because both of their legs are amputated at the thigh, they won’t have an easier amputation on the other side like a BK (below- knee amputation) to favor. Darcy had worked with these challenges many times before and considered herself something of a specialist. I made fun of her for it, but to a certain extent, we all played favorites, especially in our morning sports medicine sick call clinic. “Oh, I got an elbow. I hate the elbow! What’d you get, an ankle? I’ll trade you.”

Darcy is tall and thin and, no matter what the situation, always looks like she is about to dissolve into uncontrolled laughter. Her mission every minute of the day is to uncover the hilarity in random scenarios. Once, when the colonel who was in charge of the PT department held a long staff meeting on finding functional goals for our patients to achieve before discharge, Darcy had suggested with perfect comedic timing that they try to cross Georgia Avenue, a busy four- lane road outside the hospital. This was a preposterous suggestion, as just the week before, a Walter Reed nurse had been hospitalized after getting hit by a car while trying to cross Georgia Avenue.

The only person who heard Darcy’s comment was me. This had been deliberate on Darcy’s part, as she knew I would fall completely to pieces. Usually, though, Darcy can’t keep a serious look on her face to save her life, and her laughter is completely infectious. I knew for a fact that an AK/ BK (above- knee and below-knee amputee) is Darcy’s least favorite type of amputation. I teased Darcy that I was going to pick out an AK/ BK for her.  “Don’t you dare!” Darcy said dramatically, before exploding into laughter in spite of herself. “They are such cheaters.”

As for me? I just wanted someone easy. My dream patient, the one I crossed my fingers for, would have just one leg neatly blown off by a rocket- propelled grenade. No shrapnel injuries to the other side. No brain trauma from a huge explosion.

Unlike some of my colleagues, I’d never felt it was my calling to be here in Walter Reed. I’d put myself through physical therapy school after several depressing rounds of unemployment. My ambitions were fairly modest. I just wanted a straight job, a job with regular hours, and nights and weekends off. And I wanted a Ford Mustang. I thought after PT school I would have it made: decent pay, a steady paycheck. But student loans were expensive. I never got that Mustang. But I lucked into a cheap apartment, a basement apartment, on Alaska Avenue. Walter Reed was across the street, so I sent in my résumé.

Convenience: that was my calling.

Every day for the past few years, I’d pretended to be ambitious at these intake meetings, scanning the list and supposedly looking for a challenging patient, when in reality I was so paralyzed with indecision that I just picked out the patient with the most interesting name in the group. It was the same reason I ate oatmeal every morning in the hospital cafeteria, after first doing my usual inspection of the eggs, bacon, and waffles. I couldn’t make a decision to save my life. If I wasn’t so worried about my coworkers figuring out my secret, I would have selected new patients in alphabetical order. Luckily I had my system. I’d find the most unusual name, shout it out, and hope for the best when it came to his injuries. Lately, however, there really hadn’t been any “bests.”

Thanks to ever deadlier IEDs in Afghanistan and Iraq, the soldiers were coming in looking worse and worse. We’d admitted our first quadruple amputee in 2009, and four more had followed in quick succession.

I was still laughing with Darcy when I realized that everyone but me had picked a patient. Bright red, I turned back to the list. Injuries, ages, and ranks jumbled together in my head: They were all severe, all complicated. It was a miracle that any of these men had survived— indeed, a testament to their strength, as well as recent advances in combat medicine— but all of their roads would be long and trying from here.

That’s when I caught sight of my unusual name: Cosmo. In addition to losing a leg above the knee, Cosmo had multiple spinal fractures, a dislocated elbow, a femur broken in two places, and a smashed tibia. Terrible, I thought, but just another typical Walter Reed patient. You’ll be fine.

Our new patients usually arrive from combat to Walter Reed within seventy-Two hours. They are able to survive devastating injuries that would have otherwise killed them because they carry tourniquets into battle, and because they have access to immediate and aggressive medical and surgical care. Each soldier carries two tourniquets and is trained in applying them to their comrades and, in many situations, to themselves. In addition to tourniquets, the medics carry special blood-clotting powder and blood-cauterizing gauze bandages that can be packed into open wounds to quickly stop the bleeding. The injured are swiftly transported from battleground to combat support hospitals (CSHs) located close to the front lines, where they are stabilized and prepped for flight back to the United States on huge cargo planes that function as flying surgical hospitals. It sometimes happens that the flight nurses and surgeons are strapped to the stretchers as the plane is coming in for a landing so they can continue working on an unstable patient.

They land at Landstuhl Regional Medical Center in Germany for continued medical and surgical care and to prepare for a long air evacuation to Walter Reed. From Germany, an email is sent to Walter Reed listing the number of incoming wounded and their injuries. Walter Reed preps the operating room suites and gets hospital beds ready. Landing at Andrews Air Force Base in Maryland, the patients are loaded into army ambulance buses for a lights- and- siren- screaming ride around the Beltway to Walter Reed.

Awaiting their arrival, a lone figure stands in front of the hospital. The chaplain. Behind the hospital doors a small army of medics holding stretchers are standing ready to carry the wounded off the ambulance buses, the last leg of their long trip, into the receiving arms of the hospital. The bus pulls into the loading dock, and the medics explode through the hospital doors, whisking the patients off the buses, rushing them past the chaplain and waiting family members, and straight into the operating rooms.

It’s the first of at least a dozen surgeries for these soldiers. Explosions are dirty and blow infectious residue deep into the body. Once at Walter Reed, the patients spend their first month on a dizzying surgical schedule, getting rotated in and out of the operating room as frequently as every other day to clean the infection and dirt out of their wounds.

Physical therapy begins immediately and continues daily.

My work with Cosmo began with a physical therapy consult from the physician managing his case— a short note in the electronic medical chart titled “PT Consult.” I replied electronically that I had read the consult and then I scanned through the rest of Cosmo’s chart. In his case, as was common in our patients, his amputated leg was the least of his injuries. There was also the dislocated elbow, the spinal fractures, and his remaining mangled leg. With at least six fractures, a sciatic nerve injury, and big chunks of soft tissue loss, I knew that remaining leg was going to be a real problem.

No combat details were presented in the chart, with the exception of noting that Cosmo was an “AD 22 yo M OEF 11B s/ p dismounted IED.”

Translated, Cosmo was a twenty-two-year-old male, active duty 11 Bravo (infantry) soldier with injuries sustained in Operation Enduring Freedom from an improvised explosive device.

A device he had triggered by walking across it.