Life and Limb

How far would you go to preserve your life as a runner? Would you cut off your own left leg? That's exactly what Tom White did. This is his story.

October 29, 2008
Media: Life and Limb

On the day he decided to pay a man to cut off his leg with a power saw, Tom White woke up with a powerful yearning to run. It was last October, early morning. The girls were still asleep. White rolled over and found an empty bed. His wife, Tammy, had already pulled on her shoes and set off on a five-mile run on the streets of Buena Vista, Colorado. Without him. Again.

The Whites are well-known in Buena Vista, a farm town on the sunny central Colorado plain between the Arkansas River and the 14,000-foot Collegiate Peaks. Tom, a 47-year-old country doctor, has delivered many of the kids in town. He's a trim, compact fellow with an unflaggingly sunny outlook-kind of a one-man optimist's club. It's not uncommon for a woman to stop him in the produce section of the City Market, put his hand on her pregnant belly, and ask, "Is that a contraction?" Tammy, 46, is a physical therapist whose patients sometimes drop by the family's house on Main Street for treatment right there in the living room. The sight of Tom and Tammy running together was a part of daily life in Buena Vista. Tom was a nationally ranked cross-country runner in college, and Tammy completed a marathon about once a month. For ten years they'd paced each other along the river trails and up the high ridges outside of town. But by early 2007, the townsfolk didn't see Dr. Tom running so much anymore. A degenerative condition in his left leg, the result of a motorcycle accident in his 20s, was giving him pain. That summer the pain worsened. By autumn, Tammy was running alone. For Tom, the injury was more than a disappointment. It was maddening. Running was an integral part of his life, his identity, it was how he moved when he felt most completely himself. And it had been taken away from him once before, after the crash. He'd spent years teaching himself how to run on a badly wounded leg. Now he was losing it all over again.

It was a school day, so he had to get the show on the road. He showered, dressed, and woke the girls. Eight-year-old Whitney and her 4-year-old sister, Jasmine, both wearing Hannah Montana T-shirts, picked their way through matching bowls of Kix cereal. "Jassy, you want some oatmeal?" Tom asked. She made a face and shook her head. He mixed some Spanish coffee--hot milk, instant coffee, two teaspoons of sugar-and handed Tammy a mug as she came in the back door, flushed and damp with sweat.

Tammy drove Jasmine to preschool, and Tom walked Whitney a mile down the road to Avery-Parsons Elementary. This was their morning custom. Whitney kicked a soccer ball as she and her dad chatted about possible Halloween costumes. Tom quietly endured the pain shooting through his leg. On the walk home, he wrestled with his frustrations.

The previous weekend he'd taken the Buena Vista Demons to the state cross-country championships. In their spare time, Tom and Tammy coached the high school girls cross-country team, and it was a tradition for them to join the runners on a 5-K warmup. But last weekend, the pain was too much to bear.

"Coach!" the girls called. "You running with us?"

Tom's heart sank. "I can't," he said. "You go on without me."

He watched his squad head off. Next year, he thought, I'm going to be telling my own daughters I can't walk to school with them.

Over the years he'd joked about getting his gimpy leg cut off. "When this thing doesn't serve me anymore," he'd tell Tammy, "I'm going to get it amputated. Get a prosthesis."

Now it didn't seem like such a joke. Three years earlier, at the New York City Marathon, he heard about the Achilles Track Club's Freedom Team, a group of disabled Iraq and Afghanistan war veterans racing on prostheses. At that race, he met Sarah Reinertsen, a triathlete who runs on a hydraulic knee and a Flex-Run foot, a variation of the carbon-fiber Cheetah foot used by Paralympic athletes. Reinertsen had lost a leg to a congenital condition and still outpaced many able-bodied runners.

Back at home, White slipped into the garage to get his bike. He walked past a corkboard pinned with finishing medals and a rack of running shoes custom-designed for his unorthodox gait. Because it didn't pound his leg, bicycling was one activity he could still enjoy without pain. He rode the mile to his office, where Rhoda Boucher, his nurse, handed him a full schedule of patients. Tom saw a little bit of everything at Mountain Medical Clinic, the practice he ran with two partners: broken bones, newborn checkups, injured river guides, obese patients with heart failure. His oldest patient was 95; his youngest born last night.

The work took his mind off his own decision for a few hours. As a medical procedure, amputation goes back 2,500 years, but the human fear of limb loss hearkens back even further, to something primal. It's a horror-movie cliche and for good reason. The psychological toll-the self ripped apart, the disfigurement, the revulsion in the eyes of others-arguably dwarfs the pain. Amputation has always been an act forced upon a body. It's the last resort, the corner where gangrene traps the limb.

For Tom White it was a different story. The choice he faced wasn't life or death. It was life or better life. With his natural leg, he faced a future without running or hiking-the pursuits that animated his physical self. He felt fully alive, he was who he was, when his heart was pumping and his lungs were bellowing. Now he was considering cutting off a part of himself to retain that core identity. For Tom, amputation didn't look like a loss. It looked like a life regained-if everything went well.

That afternoon, he went through a stack of charts, dealt with prescription refills, and locked up the office. As he rode home, he recalled hitting a rut a few days earlier, and how it made his shin creak. Now a dull, familiar pain crept up his leg. Aw, man, he thought. Even the bike's giving me trouble now.

That night, lying in bed next to Tammy, he let his thoughts slip across the pillow. "You know," he said, "I think it's time to amputate my left foot."

Tammy's eyes freaked. Holy cow! I can't believe he's telling me this right when we're falling asleep, she thought.

Her reaction surprised him. "Cool!" she said. She missed him as a running partner. But more than that, Tammy wanted to grow old with Tom-with- him. So much of their joy in life came from running and hiking. Vicarious pleasure sucked. She wanted Tom to feel the endorphin rush, too.

The next morning she chased Tom around the kitchen with a date book. "Let's schedule it next month," she said.

"Whoa!" he said. Second thoughts kicked in. He was still talking theory. She was pressing for fact.

Hours later, the 2007 Runner's World Heroes of Running issue came in the mail. Tammy flipped open a piece on Amy Palmiero-Winters. She'd run a 3:04 in the Chicago Marathon on a prosthesis. "Tom!" Tammy called. "Do you believe in fate? Look at her."

She held out a photo of Palmiero-Winters, looking powerful and confident on her mechanical setup. Tom took a good long gaze. He didn't see a disabled person. He saw an elite marathoner pushing to qualify for the Olympic Trials. He smiled.

"That's it," he told Tammy. "That's what I want."

Tom White decided to cut off his leg at a time when there had never been a better time to do such a thing. In the past few years, a profound change has swept through American society and the global sports culture. Seemingly overnight, amputees have morphed from pity magnets to competitors. What once was handicapped is now bionic. A generation ago, disabled activists fought to pass the Americans with Disabilities Act. Today, the International Association of Athletics Federations (IAAF), track and field's world governing body, wrestles with the implications of South African sprinter Oscar Pistorius, who uses prosthetic legs, beating able-bodied runners in elite competition.

New technology has certainly made an impact. Devices like the Cheetah foot and the C-leg (a biomechanical prosthesis that uses a computer chip to run a hydraulic knee) allow amputees a more natural range of motion. But the gear-which has been widely available for nearly a decade-is only part of the story.

The real change has come in public awareness and attitude. It has something to do with Iraq War amputees proudly wearing prostheses emblazoned with Harley-Davidson logos and American flags. It has something to do with athletes like Pistorius making a leap from Paralympic champion to Olympic hopeful. It has something to do with amputees like Reinertsen flashing her high-tech leg in glossy ads for Lincoln sedans. These athletes raise the visibility of prostheses at a time when the melding of man and machine seems not only possible but inevitable. Tech fanatics are talking about mobile-phone implants. Skin-deep microchips help owners locate lost pets. Pistorius and Reinertsen are no longer human tragedies. They're the future. And they look damn cool.

In fact, the perception of athletes using prosthetic limbs has changed so quickly that some are now howling about the perceived advantage of prostheses users. Lawyers spent much of the past year dueling over Pistorius's right to run in the Beijing Olympics. (When Pistorius failed to post a qualifying time, he ended the controversy over Beijing. But the issue-whether prostheses give him an unfair advantage-is far from settled.)

Last fall, as the issue of prosthetics in sports made headlines around the world, Tom White chose to undergo one of the most radical transformations any runner will ever face: from two-legged to one. Tom's choice raised profound questions about identity, athletics, and the human body. How far would you go to sustain your running life? Would you sacrifice money, career opportunities, relationships? Would you give up your left leg?

I followed Tom through the entire process, from decision to surgery and on through months of grueling rehabilitation. Though Oscar Pistorius and Sarah Reinertsen make it look easy, running on a prosthetic limb-heck, walking on one-is hardly easy. It's a struggle. It takes grit and determination. When you lose a leg, it's a long, hard road back to running.

A week after making his decision, Tom sat in the exam room of Dr. David Hahn, a Denver orthopedic surgeon. Dr. Hahn, 59, had seen a lot of legs in his career. White's was a piece of medical history. Twenty-five years earlier a motorcycle accident had nearly severed the limb four inches above the ankle. Reattachment surgery, pioneering for its time, saved the lower leg and foot. It was heroic work back then, but the bone had never fully healed. Now it was cracked beyond repair. For 25 years, Tom had run on the human equivalent of a patched tire. He'd finally worn it out.

"You know, my first job is usually to tell people all the ways they can keep their leg," Dr. Hahn told Tom. "But it looks like you've already done that."

Three weeks later, on November 27, Tom and Tammy and the girls made the two-hour drive from Buena Vista to Denver's Presbyterian/St. Luke's Medical Center. Along the way they tallied mountains Tom's foot had climbed. "Mount Princeton! Mount Yale!" A few days earlier, Tom and Tammy had told the girls what was going to happen. "My foot hurts me, and once the doctors take it off, it won't hurt me anymore," Tom said.

Whitney began to cry. Tammy wondered if the amputation scared her. But that wasn't it. "I'm sad because Daddy was hurting and we didn't know," Whitney said.

That afternoon, Tom sat in a hospital gown on a gurney, prepped for surgery. A saline drip line draped from his right arm. For a man about to lose a limb, he looked calm. "I don't have any fear about the surgery," he said. "I'm excited to get this going." Asked what he planned to do with the foot, he answered, "You know, it would make great practical joke material." He laughed. "Tammy wants it cremated and spread someplace. But no. I think I'll just let them toss it out as medical waste."

Tom understood the risks. He'd seen men his age die in routine surgery. Things can happen-bleeding, infection, embolisms, hospital screwups. You didn't have to tell him that doctors and nurses were human. He also knew there was no guarantee he'd run again. If the amputated leg got infected, they'd have to cut again, above the knee. And who knew how he'd take to a mechanical leg? Chris Jones, the prosthetics expert he'd be working with, had warned him: "These things don't walk themselves."

He took those risks and fears and stuffed them in a locker in a far corner of his mind. If he was going to get through this, he had to stay up, focus on the positive. "I just need to get through rehab and then I'll be good," he said.

Late in the afternoon, a nurse wheeled him to the operating room. Tammy held his hand, told him she loved him, then let go. She turned and walked away. Once she was out of Tom's sight, she let herself wipe away a tear.

The anesthesiologist poked an epidural catheter into his spine. For years, Tom had advised pregnant patients not to fear the epidural. "It's just a little sting, like having blood drawn," he told them. But he never knew for sure. Now, as he nodded out, his last thought was this: I'm happy I was telling them the truth?

It took 22 minutes to lose the lower leg. Working behind a plastic face shield, Dr. Hahn used a scalpel to peel away muscle and tissue, exposing Tom's tibia (shinbone) and fibula, the beam-and-stud of the lower leg. The bones were small and thin, like the remnants of an order of pork ribs. A nurse handed Dr. Hahn a small reciprocating power saw, the kind of thing you'd use for small jobs around the house. Zip-tibia gone. Zip-fibula gone. Or rather, almost gone. In a maneuver known as an Ertl procedure, Dr. Hahn used a leftover bit of the fibula to form a bridge between the two bones, locking them in place with screws. The bridge would allow Tom to put more weight on the residual limb below the knee. With the bones secured, the surgeon clamped off Tom's blood vessels with tiny metal clips, then used flaps of skin hanging below the bone bridge to wrap the stump. (Residual limb is the medical term; stump is the word many amputees use.) Dr. Hahn sewed the works closed with surgical thread.

Then it was over. A nurse dressed the stump in bandages and wheeled Tom to a recovery room to let the anesthesia wear off.

The next morning, Tom sat up and stared at a spot 10 inches below his bandaged stump. "Phantom pain is real," he told Tammy. "It feels like my left heel is sitting on the bed, like someone is pressing down on it. And there's a slight pain in my arch." There was, of course, no heel, no arch. Ninety percent of recent amputees get phantom sensations (not always pain) that are triggered by brain neurons wired to receive signals from nerves in the amputated limb. Over time those neurons reprogram themselves to respond to adjacent body regions, and the sensations subside.

A nurse stopped by. She had experience with fresh amputees. "That's nothing," she said. "Wait till your toes start itching."

Tom was in an ebullient mood, helped along by drugs that kept both his legs numb. Friends and family kept the phone jangling. "Listen dude, I just dropped five pounds in surgery, and I'm back at my college weight," Tom told one caller. "I'm going to be kicking your butt soon enough." He hung up. "That was Tim Terrill," he said. "He's an old Vigilante. They put an item about my amputation up on the green line, and now all the old runners are calling me."

The green line was an e-mail list connecting alumni of the cross-country team at Adams State College, a small liberal arts school in Alamosa, Colorado, about 50 miles north of the New Mexico border. They called themselves Vigilantes (pronounced Vee-hill-an-tez) after their legendary coach Joe Vigil. Vigil is to cross-country running what John Wooden is to basketball. During his stint at Adams State from 1965 to 1993, Vigil's teams won 15 national titles. He produced 425 All-Americans and 89 individual champions in various running disciplines. Since then, he has coached Deena Kastor, Meb Keflezighi, and other elites.

News of Tom's amputation set the green line abuzz. Of course, over the years Vigil had produced runners who were faster than the Buena Vista doctor, but none more beloved. The tales told about White were passed down from generation to generation at Adams State, part of a storied program's cultural lore. They were tales of promise and misfortune, courage and fortitude. They were stories of the time he lost his left leg-the first time.

As a teenager, Tom ran along lonely ribbons of road outside Albuquerque. A poster of Steve Prefontaine hung on his bedroom wall. He was the only white kid on his high school cross-country team. "We were half Navajo, half Hispanic, and me," he once recalled. The legacy of that team lives on in his hard-to-place accent. When he speaks, what escapes his throat is the ghost of a studious white boy navigating between the barrio and the rez.

Coach Vigil recruited him after Tom won the New Mexico cross-country state championship in 1977. Despite Adams State's small size and remote location, Vigil built a powerhouse program by combining effective motivational techniques-the man has world-class charm and magnetism-with cutting-edge scientific training methods. "We ran a bold style," said Tom. "We went out hard, got to the front, and stayed there. And if another team had a strong runner, Coach Vigil would specifically assign a couple of our guys to key on him. Didn't matter where they finished in the race; they just had to beat their man."

His first year at Adams State, the team finished third at the NAIA national championships. Tom took fifth in the individual race. The next two years, Tom and his squad claimed the team title. By the spring of his junior year, Tom had run a 4:02 mile and looked to vie for the individual title in the national cross-country championships the next fall.

Then came the accident. The summer before his senior season, Tom and two teammates, Randy Cooper and Pat Porter, found work as beekeepers in Rifle, Colorado, about 180 miles west of Denver. They lived in a tree house to save money. Porter would go on to dominate the U.S. cross-country scene in the 1980s, competing in two Olympics and posting a record eight straight national titles, but at that point he and Cooper and Tom were just three college kids trying to raise cash for tuition.

One night when Tom was making his way back to the tree house from Rifle, a drunk driver in a pickup swerved in front of Tom, who was riding a motorcycle. The truck's bumper caught Tom's left foot and tore it almost completely off his leg. He went down, skidded on the road, and came to a stop on his back. He lifted his left leg and watched his foot droop like a grotesque flag. All that kept it attached were his Achilles tendon and a flap of skin.

Thinking quickly, Tom applied his own tourniquet and then asked a passerby to compress a pressure point in his groin area, which prevented him from bleeding to death. A helicopter flew him to St. Mary's Hospital in Grand Junction, Colorado. When a doctor there saw him, Tom, still conscious, begged him not to amputate. "Doc, I'm a runner!" he said. "Save my foot. Please save my foot!"

As it happened, Dr. Richard Janson had just arrived at St. Mary's. Only two weeks before White's accident, Dr. Janson and a nurse wrote the hospital's first protocols for transporting amputated extremities. By coincidence, that nurse was on the chopper that flew Tom to St. Mary's. Dr. Janson hadn't been on call that day, but staffers called him anyway to see if he could help.

Dr. Janson reattached Tom's foot, but he didn't have enough skin to work with. After a temporary graft was performed by Dr. Janson five days later, White was flown to an Albuquerque hospital for a far more complex-and torturous-graft. Surgeons there peeled a patch from Tom's thigh and grafted it onto his leg. The skin wasn't just lifted and planted like a piece of sod. White's legs were pinned in a way that forced him to sit completely still for three weeks with his left leg bent cross-legged so it met his right thigh. Skin from the thigh was peeled back slowly, like the lid of a sardine tin, and grafted bit by bit to the left leg-while the skin was still attached to the right thigh. "You could tell he was in pain," recalled Vigil, who often visited White in the hospital. "His leg had atrophied to just skin and bones."

Though Dr. Janson saved Tom's foot, his racing days were over. He joined Vigil's staff as an assistant to finish his senior year, but all the rehab in the world couldn't bring back a 4:02 mile. For two years he lived on crutches. When he finally set them down and walked again, the crutches bowed like wishbones.

For seven years, there was no running. Then Tom met Tammy. They fell in love and married. Tom went to the University of California, Davis for med school. There in Davis, Tammy joined a running club called the Buffalo Chips. She'd leave on Saturday mornings and return with tales of runs through redwood groves, up the crest of the Sierra, or down to the Pacific. Tom felt like a hungry man hearing his wife describe a banquet.

He felt himself jonesing for a run. One day after watching Tammy finish a half-marathon, Tom acted on the impulse.

"Tammy, let's run to the car!" he said.


"I want to run to the car!"

They ran to the car. "You couldn't really call it running," she later recalled. "It was a sorry sight. He looked like Quasimodo."

The next morning, Tom began teaching himself to run again. He made his way in a sort of stumble-hop around the block. The next morning he did a block and a half. Then two blocks. "It was ugly, but every day I went a little farther," he said. It took him a while to figure out how to adapt his gait. But eventually he started joining Tammy on her runs. His pronation was so extreme that he destroyed a new pair of running shoes every couple of months, until finally he found a custom shoemaker who designed an angled sole built to withstand his distinct pounding.

He started to enter races but encountered a unique problem. His limp was so pronounced that race officials would jump onto the course and pull him off. They thought he'd broken his leg. "Hey!" he'd shout. "I'm not done yet!"

The pain never went away Every step hurt. But Tom trained himself to ignore it, to make it white noise. He built up his distance. One year he ran a marathon. Then a 50-K. He posted a 3:45 in the London Marathon. He tried the Leadville Trail 100 five times. He ran 50 miles several years, once making it to mile 72.

The race that made White a legend at Adams State wasn't a 100-miler, though. Every year a group of alumni return to Alamosa to challenge the current team in a five-mile race. It's not a typical take-it-easy-on-the-old-guys match. Though the Grizzlies are perennial national champion contenders, the alums often include Olympic-caliber talent. In 1991, 10 years after Tom's motorcycle accident, Tammy called up Joe Vigil. "Coach," she said, "don't tell anyone, but Tom's coming to run the alumni meet." Pat Porter won the race, but Tom White won the day. "He hobbled through the entire five miles," recalled Vigil. "People were lined up and down the last mile just to watch Tommy finish the race. Everybody was cheering like crazy and crying."

Context is everything. When doctors warned him about the tough rehab and psychological adjustments he'd face after amputation, White just smiled. "Usually an amputation is a trauma," he said. "But I went through that trauma 26 years ago."

He was more concerned with the difficulties his daughters might face in seeing a stump-legged father. "For children, a missing limb is the most traumatic thing," he said. "You can't see diabetes or a heart attack, but this you can see. It's a jarring sight."

But when Whitney and Jasmine visited him the day after surgery, they seemed more spooked by the strangers in the hospital room than by their dad's missing limb.

"My operation went real well," said Tom. "I don't hurt at all."

"Yay!" said Whitney.

"What did they do with the other part?" Jasmine asked.

"I told 'em to just get rid of it," Tom said. "I'm done with it."

The girls were also there a few days later when Dr. Hahn arrived to unveil his handiwork. "Okay, girls, you know, it might look a little different, but it's really okay," Tom said. When Dr. Hahn removed the cast, he revealed what looked like a rounded slab of bacon-a stump marbled white and red with skin and blood. Dr. Hahn liked what he saw. When he left the room, Whitney and Jasmine brought out a treat they'd saved for their father: gingerbread-man cookies. The girls bit the left legs off their cookies and held them up. "Daddy cookies!" they said.

When a limb is severed from the body, the vertebrates of the world-creatures with spinal columns-face one of two fates. If they are salamanders, their bodies will grow new limbs. For everyone else, it's stumpville. Scientists are studying limb regeneration in salamanders, but until they come up with a way to transfer the amphibian's unique ability to other species, humans and others will have to be satisfied with a less-miraculous form of healing. After amputation, the sewed-up skin starts to form scar tissue to seal itself up. Broken capillaries near the amputation site leak blood and serum into surrounding tissue, causing the leg to swell. The ends of the tibia and fibula begin to grow new bone tissue that connects to the Ertl bridge, turning the saw-and-screw job into an organic structure.

For that biological process to happen, though, Tom White had to do one thing: rest. That was tough.

"I'm planning to head back to work on Tuesday," he told Dr. Hahn a few days after surgery. "I'll start slow, just a half day."

Dr. Hahn's eyes narrowed. He urged Tom to rest. "You know how easily a half day can turn into a full day," the surgeon said.

Back in Buena Vista, Tom quickly slipped into a routine. He worked half days at Mountain Medical, using crutches to move between exam rooms. His patients were happy to see him back. But at night, he had trouble sleeping. The phantom pain kept him up. Sometimes it was like getting hit with a charley horse. Other times his missing foot ached or burned. Sometimes it itched, or felt squeezed, or seemed like electric shocks were running through it. "One time I felt my left toes dragging on the floor, clear as day," he said. "I felt them move."

Tammy worried about Tom's schedule. "You're working too much," she told him.

He brushed her off. "Ahh, you don't know what you're talking about." He was a doctor. He could read his body's signals. Everything was a go. Tom felt so good, he made a pact with Andrew Miller, a bike-racing friend. They'd do the Leadville Trail 100 Race Across the Sky, a 100-mile mountain-bike race, later that summer. It seemed like a reasonable goal.

One month after the amputation, though, Dr. Hahn told White to knock it off. "You're working too much," he said, and it was affecting the recovery. Before Tom could get fitted for a prosthetic leg, the swelling in his stump had to subside. That wouldn't happen until he stopped hopping around the clinic every day.

So Tom cut back to three half-days a week. After lunch he'd come home and catch up on paperwork, or sit in a recliner and page through a prosthetics catalog, daydreaming about his shiny new leg. Through the living-room window he saw the snow pile up, and guiltily watched his wife deal with it. Tammy hated clearing snow. That was usually Tom's job. And, of course, this winter had to be the one with record dumps. "You stay in that chair and rest, mister," Tammy told him. "The faster you recover and get your new leg, the sooner you can get out there and shovel."

On a freezing January morning, two months after the amputation, White crutched his way into the clinic of Denver prosthetist Christopher Jones. It was time for his first leg fitting, and Tom was psyched. He wore running shorts and a "Vigilantes" T-shirt. He didn't really think he was going to tear into a 10-K that afternoon, but if it happened, he was damn sure going to be ready.

A prosthetist acts as a kind of pharmacist and physical therapist for amputees, designing and fabricating the right artificial limb, and then helping train patients to use the device. Jones was one of the best. His most famous patient, Capt. David Rozelle, has become a powerful symbol of the Iraq War amputee. In 2003, Rozelle lost his right foot and lower leg to an antitank mine. Working with Jones, Rozelle got himself back up and running within months. Less than two years after his injury, Rozelle returned to active duty in Iraq, becoming the first amputee in recent military history to resume command in a combat zone.

Tom unwrapped his residual limb. "Looks like it's healed well," Jones said.

"Yeah, the swelling's gone and now it's atrophied," Tom said. "My left thigh is half the size of my right."

Jones wrapped the stump with a silicone liner, then layered wet plastered bandages on it to form a cast. From the cast, Jones would be able to make a socket for the prosthetic leg.

While the model hardened, Tom and Tammy wandered around Jones's office, which is part clinic, part woodworking shop, part museum. Today's new prostheses are high-tech wonders (with fancy price tags, between $15,000 and $35,000), but when it comes to the socket that binds them to the stump, there's old-fashioned drilling, grinding, filing, and sandpapering involved.

"Tom, did you see this?" Tammy said. She pointed to Jones's collection of antique prosthetic legs. They progressed from a wooden hand-whittled job, worn by a Civil War veteran, through World War I models, 1950s-era legs, to today's cutting edge: the C-leg, a prosthesis for above-the-knee amputees that uses computer-controlled hydraulics to mimic the actions of a biological knee.

Until recently, prosthetics was largely a mom-and-pop industry. Innovations usually came from amputees who were so frustrated with old equipment that they went into their garage and created something better. But in the past 20 years, prosthetics has become a booming business. It's not because of war wounds. Too many Americans are fat, out of shape, and smoking-and it's costing them their limbs. About 3,500 amputations are performed in the United States every week. A little more than half result from vascular disease (blood circulation problems, usually caused by diabetes or smoking). Trauma and cancer account for 46 percent of amputations. The population of U.S. veterans of Iraq and Afghanistan requiring amputations tops 750, but they make up a small fraction of the nation's estimated 1.7 million amputees. Analysts say the market for prosthetic legs has been growing about four percent annually, and industry officials expect Americans' unhealthy lifestyles to double the amputee population by 2050. "It's the baby boom generation," says Jones. "As they age, vascular disease, diabetes, and smoking will lead to limb loss."

It's not just a demographic game, though. The increased visibility of Iraq War amputees has helped normalize the use of prostheses, and marketing has played a role. For nearly a century, the German company Otto Bock, founded to serve World War I amputees, dominated the market. Bock was a staid, established institution with little competition. Then about 10 years ago Ossur, an Icelandic upstart, began buying the mom-and-pop shops (including the company that made the Cheetah) and ginned up an aggressive marketing campaign. The company sponsored athletes like Oscar Pistorius, Sarah Reinertsen, Brian Frasure, and Casey Tibbs on "Team Ossur," picturing them in ads as bold risk-takers who embodied Ossur's motto, "Life without limitations." Ossur wanted to make prosthetics cool-and it did. Today's prosthetics industry is highly competitive, but it's still dominated by two players, with Ossur playing Pepsi to Otto Bock's Coke.

"Let's give this a try," said Jones. He appeared from a back room holding Tom's new foot, an Ossur carbon-fiber model called the Talux. Attaching the hardware to the limb has always been tricky with prostheses. Thirty years ago, an artificial leg was strapped on with buckles; today's designs use a ratcheting coupling, suspension sleeves, and various suction systems. Jones rolled a silicone-based sleeve, with a nonskid surface that felt like neoprene, over Tom's stump. Jones handed Tom the prosthesis. "Okay, now slowly fit yourself into the socket," Jones said.

Tom pushed his leg into the Talux. For the first time in months, he looked nervous.

"You hear that click?" said Jones. "That means you're connected. But you can get it tighter. If you can get to five or six clicks, you're solid. That's what you want."

Tom pushed harder. Four, five clicks. "That's it," Tom said.

"Take a few steps," said Jones.

Steps? Tom thought. Heck, it's amazing to just stand up. Instantly, he gained an inch of height. All those years of limping had induced a stoop. The new leg gave him perfect posture. For the first time in his life, he stood and looked at his wife eye to eye.

Tammy stepped back to give him space to move. Tom took three tentative steps across the room, turned, and walked back. His face drew into a rictus of concern and fear. This isn't exactly the glove of comfort, he thought. It was all wrong. He didn't feel like marathoner Sarah Reinertsen. He didn't feel like sprinter Oscar Pistorius. He felt like a man with a clunky hunk of metal on his leg. A hunk of metal that pinched and hurt. His head was aboil with misgiving. Uh-oh, he thought. This may not go as planned.

"Everything's going to feel heavy at first," Jones said. "Remember, you've been moving around for two months without any weight on that leg, and it used to have a five-pound foot attached to it." This prosthesis, a sort of training leg, weighed two and a half pounds. His final leg would weigh a little bit less.

"Yeah," Tom said. "Okay." He tried to put on a good face. He couldn't. His expression was that of a man whose doctor just told him he had cancer. "Let's adjust it, and I'll walk a little more."

Tom described where it pinched. Jones took the foot into his shop, where he used a router to grind away the socket. "Yeah, that's a little better," Tom said as he ambled, slowly, down the hall. Still, it wasn't great. He expected it to feel like his stump was hitting a cushy sofa. Instead he got a wooden chair.

For the better part of an hour, he worked with Tammy and the prosthetist, breaking down the mechanics of his new gait. He had to figure out the right hip motion and stride length. He had to learn how to strike the ground with his new carbon-fiber heel, roll and flex and push off without ankle muscles and tendons there to do the pushing. He had to find optimal mechanical efficiency in his gait, and he had to find it now. Any bad habits formed this early would be hard to break, and a slight flaw in his mechanics would waste huge amounts of energy. Researchers have found that below-the-knee amputees like Tom White require 20 to 25 percent more energy than nonamputees just to walk around. (Above-the-knee amputees use up to 60 percent more.) As a distance runner, Tom was used to training his body to move with exquisite efficiency, to think like a machine that turned calories into endurance and speed. Now he had to apply such thinking to every moment of his waking life.

The next day, Tom and Tammy drove back to Buena Vista with Tom's new leg. They went straight to their daughter Whitney's elementary school, where the teacher was expecting them. Whitney gave Tom a big hug, and the kids buzzed around his new leg. They made him take it off, put it on, take it off again. They passed it around, felt it, banged it on a desk, tried it on themselves.

"Is it made of titanium?" one boy asked.

"Yes," Tom said proudly. "Yes, it is."

By the end of the school day, word had spread through the playground grapevine. Whitney's dad had a robot leg. It wasn't weird or scary. It was cool.

He couldn't wear it all the time at first. He walked on the new leg in the mornings, then took it off in the afternoon and got around on crutches. His stump was sensitive, and putting pressure on it made it ache and swell a little. Every few days he'd call and check in with his old coach, Joe Vigil. They'd talk about life and running, coaching techniques, and Tom's progress.

"I had knee replacement, Tom, and I can tell you this: It's really going to affect your gait," Vigil told him.

"I know, Coach," Tom said. "It's like I'm learning to walk for the third time in my life. First as a baby, then after the accident, and now this. I'm going to get it right this time."

That was easier said than done. He worked at it, on his own and with Tammy. Had to perfect his leg swing. Get his hips balanced. Sometimes he'd walk past a store window on Main Street and watch what his right leg was doing, and then mimic the motion with his left. Tammy gave him feedback, but sometimes she bit her tongue. "It's great to live with a physical therapist," Tom said, laughing, "but sometimes it's hard, too. They're always watching how you walk, and the professional in them wants to correct it."

For three months he worked on getting used to the leg. It was never easy. Sometimes the prosthesis pinched or his stump ached. One day at work, he had to take off the leg and use crutches. While standing in the hall between an elderly couple using walkers, looking at himself on crutches, he thought, Oh my God. I'm in the lunch line at the nursing home. Back in November, he'd set a goal. He wanted to be running on his prosthetic leg six months after surgery. Now that looked like a pipe dream. He couldn't imagine the carbon-fiber contraption ever feeling like a natural part of his body. "I don't see how I'm ever going to run on this," he told Tammy. The idea of riding the Leadville 100 seemed ludicrous. He had to call up his friend Andrew and back out of the race.

In the midst of his discouragement, he talked to Amy Palmiero-Winters. She knew what Tom was going through. Eleven years earlier, at age 24, she lost her lower left leg (due to injuries suffered in a motorcycle accident that had occurred three years earlier). Now, at 35, she lived the life of an elite athlete. PowerBar featured her in magazine ads. She had nearly broken three hours in the marathon on a prosthetic leg. Tom wanted to know if she was doing all that while suffering as much as he was. Maybe he just had to suck it up and get used to the pain.

"Amy, is your leg uncomfortable?" he asked. "Does it hurt at all?"

"No," she said. "It's comfortable. I wear it all day long."

"How long was it before it started to feel comfortable?"

Palmiero-Winters couldn't remember. Tom took that as a good sign. "At least it wasn't a horrible period that was burned into her memory," he said. She passed on a few tricks: Detach the leg when you're sitting down to take a little pressure off. Don't bend your knee all the way or the socket puts pressure behind your knee.

Not long after that, he achieved a tiny bit of success. Christopher Jones cast a new socket for him. Tom's muscles had atrophied so much that the old one made his stump feel like a clapper in a bell. Then one day a stranger stopped him in a hallway. "Are you an amputee?" the man asked. Yes, said Tom, who was wearing pants. "I saw you earlier today, and I didn't even notice," said the stranger.

Yes! thought Tom. Finally he was walking well enough to fool somebody.

Despite the increased visibility of amputees, a certain amount of social stigma still comes with the territory. Even for Tom, who treated bodily deformities every day, it wasn't easy to endure the stares of strangers. Or the imagined stares. "Oh, get over it," Tammy told him. "Nobody's looking. Nobody cares." Easy for her to say, Tom thought. She wasn't the one shocking people every time she hiked up her pant leg.

Then Tom went to Boston and got schooled in the art of getting over it.

He and Tammy flew there in April for the marathon and the Women's Olympic Marathon Trials. Tammy planned to run in Monday's marathon, and daughter Whitney came to compete in the Newton Heartbreak Hill International Youth Race, a kids' fun run up the course's notorious rise. For Tom, it was a running reunion. He kept bumping into Adams State friends, including Coach Vigil. At the race expo the evening before the Olympic Trials, Tom finally met Amy Palmiero-Winters in person. She was walking around on her Flex-Run foot, a drink in one hand and a spare leg in the other.

"Wow, look at your leg!" Tom exclaimed.

"Have a look yourself," Palmiero-Winters said. She snapped the leg off, handed it to Tom, and stood on her remaining limb, perfectly balanced. "I give her back the leg," Tom said later in describing the scene, "and she just goes click-click and she's in. I'm cracking a sweat just putting my liner on!"

Officials at USA Track & Field had told Palmiero-Winters she could run in the Olympic Trials if she posted a qualifying time, but her personal best of 3:04 came up 22 minutes short. She came to the race anyway to cheer on the hopeful Olympians.

At the expo that night, she analyzed Tom's setup like a NASCAR mechanic working over an engine. "The first thing you need to do," she told him, "is get yourself a knee brace and pull it over the socket. There's a CVS around the corner. They're probably open late. Go."

Tom smiled and mumbled something about picking up the brace in the morning.

"No," she said. "Go now."

So he did. When he pulled the brace over his knee, the contraption seemed to pull together. His walking improved at once. "Holy Toledo!" he told Tammy. "I had no idea!"

The next day, Palmiero-Winters joined Tom, Tammy, and Whitney to watch the Olympic Trials. Unlike the point-to-point Boston Marathon course, the Trials layout featured a loop that the runners lapped four times. Tom's gang found a spot where they could watch Deena Kastor, Magdalena Lewy Boulet, and other frontrunners pass by on one side of the course. Then, if they hustled, they could cross the Charles River and watch the runners pass on the other side of the loop. It was hot, sweaty work. Tom did his best to keep up, walking and jogging in a kind of gimpy hop. By the halfway point, sweat had turned his prosthetic liner into a sopping wet mess. His leg began to slip.

"You're not walking so well," observed Palmiero-Winters. "What's going on?"

"I sweat through my liner, " he said. " I need to take it off and let it dry."

"Go ahead," she said.

Tom nervously eyed the crowd. Tens of thousands of people lined the course that day. "I'll wait until the crowd moves on, then I'll do it discreetly," he said. "A little bit of privacy, you know."

Tammy watched the whole thing go down. She often fought this battle with Tom and often lost. But Palmiero-Winters didn't back down. She'd been there, done that. If Tom was too shy to change his socket liner in public, at some point he would hurt himself-if not today, somewhere down the line. "Do it now," she told him.

Tom held firm. "I don't want to do it in front of all these people."

"Oh my God, just change it," she said. "Suck it up and do it!" She stood in front of him, hands on her hips, resolute. She wasn't going to let him off the hook.

"Arrgh!" Tom parked his butt on the grass and snapped off his leg. He unrolled the wet liners, let them dry, and then put them back on. Nobody in the crowd gave him a second glance. They were busy watching Kastor overtake Boulet for the lead.

At that moment, White realized that living with the leg was going to demand different kinds of courage. There was the courage to get up and walk on the thing-and eventually, maybe, run. And then there was the courage to snap it off at a party in a room full of strangers.

"Amy has this attitude like, 'Nothing wrong with me. I'm just gonna do my thing,'" he later said. "She taught me plenty of technical stuff, but nothing so important as that attitude. I don't have her command or her presence yet. But I'm working on it."

The end of spring drew closer, and with it the realization that nearly six months had passed since his amputation and Tom still seemed miles away from his two main goals. He hadn't yet walked Whitney to school, and he still couldn't run. Tom's frustration mounted.

"Well, of course you're not running on that thing!" Palmiero-Winters told him in Boston. White was still walking on his training leg, which wasn't really built for the pounding of roadwork. She pointed out her custom-made model, which had a socket that flared up higher near her knee to give her much better stability. So when he got back home to Colorado, Tom met with Chris Jones and designed a new leg based on Palmiero-Winters's model.

By the middle of May, the Colorado snowpack was fast disappearing. Sandbags were stacked around Buena Vista, ready to stave off the meltwater floods. Tom checked the mail every day, and then finally it arrive-his new leg, boxed and packed in Styrofoam peanuts. He threw off his old model and started snapping on the new one. He felt some trepidation. What if this one wasn't any better? But ohh, it felt good. Stable. Snug. He walked out the door, and the new leg felt better with every step.

The next day he walked Whitney to school. The whole family went, and they walked all the way: one mile to school, one mile back. Tom and Tammy talked about the upcoming cross-country season. They'd been trying to talk a friend into coaching a sixth-grade girls team. In the off-season Tom and Tammy organized a fitness and running club for elementary school kids, the Speed Demons, and recently Tom had begun coaching some local masters runners who met at the high school track Wednesday mornings at 5 a.m. The Whites were doing in Buena Vista what Joe Vigil had done at Adams State: building a running culture from the ground up. "Start them early, get them excited about it," Tom said. "The main thing is to get them out there doing some physical activity they enjoy." As a doctor, the toughest patients for Tom, emotionally, were those with heart disease, diabetes, obesity, or other ailments that stemmed from inactivity. "That's part of the reason I'm doing this," he said. "So I can say to my patients, 'Hey look at me, I've only got one good leg and I'm out there running, biking, staying active. You can do this.'"

"How's your leg feel?" Tammy asked on the way back home.

"Good," Tom said. "Like a combination stilt and pogo stick. It feels like I'm mastering a new sport. I have good steps and bad steps."

That Saturday, he tried something new. In between his daughters' soccer games, he snuck off to a quiet corner of the park, and he ran. Just for two minutes. But it wasn't walking. And it didn't hurt. And he couldn't keep the words from racing through his head: I can run!

He kept on running. He started at two minutes and added 30 seconds every day. "I'm realizing I need to get my ultrarunner's step back," he said. "It's kind of a slow shuffling gait, no high knees, stay low, conserve energy while moving forward." After several months of struggle, the path ahead was beginning to open up. Somewhere in the future he could see himself doing 10-Ks with his daughters, maybe even run a marathon with Tammy.

He smiled. "I feel like my third running life is just getting started."

The major advances in prosthetics have almost always been made by amputees themselves. Van Phillips, the engineer who created the Flex-Foot, lost his lower left leg in a waterskiing accident at age 21. Hugh Herr, director of biomechatronics at MIT's Media Lab, is pushing prosthetics into the bionics age with joints that use microprocessors, integrated sensors, and advanced actuators to mimic natural motion. He lost both legs below the knee at age 17 after being trapped in a blizzard on Mt. Washington.

There's a reason for this: It's almost impossible to know how a prosthesis works-or doesn't work-until you wear one yourself. As a doctor, Tom looked to medical professionals for advice in the early months of his recovery. After a while, he discovered that the best info often came from the amputee grapevine. Amy Palmiero-Winters showed him how to brace his knee. A technician in Chris Jones's practice, an amputee himself, gave Tom crucial advice on cleaning his liner and minimizing sweat. ("Roll a little antiperspirant on your stump," the guy said-and he was right.) At a marathon in San Diego, Tom spent an hour talking with Sarah Reinertsen. She told him to give himself a break. "You've only been on your leg for a few months," she said. "It takes about a year before you really realize what you can do."

By mid-June, Tom was running for 14 minutes at a stretch. Then, almost overnight, his stump lost a huge amount of sensitivity-as if his nerves had been set to volume 8, then turned down to 3. The hard wooden chair wasn't so hard anymore.

When Tom, Tammy, and the girls flew to France at the end of that month, Tom kept a secret notion in the back of his head. They were going over to watch Tammy run in the Marathon du Mont-Blanc, a spectacular race held in the streets of Chamonix and the foothills of the French Alps. When they arrived, Tom signed up for a 10-K held the day before the marathon. "I'll take it easy, see how far I can get," he told Tammy. "Run a kilometer, then walk, run, walk. See how it goes."

At the starting line, his leg caused no commotion at all. The other runners were preoccupied with their own prerace rituals. Anxiety crept into Tom's head just before the gun went off. Man, maybe I should have signed up for the 5-K, he thought.

A 12-minute-mile pace put him at the back of the pack. At 2-K, he felt good. Maybe he'd stop at 5-K and take a rest. But then things started humming. He picked up the pace. Passed a few people. Then a few more. The course turned onto a hiking path and snaked into the hills. That worked to his advantage-Tom could really crank on the leg when he motored uphill. At the 5-K water stop, he didn't pause. Just kept on running.

By 7-K, sweat was soaking his liner. He could feel his stump sloshing. The voice of Amy Palmiero-Winters came into his head. Do it now. White stopped, snapped off his leg, wrung the sweat out of the liner, rolled it back on, and snapped on his leg. Right there in front of God and the Alps and the nation of France.

He continued on. His ears became his coach. Since he couldn't feel his foot strike the ground, Tom had to listen for the sound. When he tired, his footfall made a sliding sound. For the last three kilometers, he concentrated on making good strikes, good sounds. And that's when he felt it-a little bit of that old rhythm. When he was a kid, before the motorcycle accident, the rhythm of running was his biological clock. Back in those days, if he ran long enough, with proper mind frame and respect, he could slip into the rhythm and transform his body's movement into a mystical experience. It was like a scent from childhood, a sense-memory of which he caught just a trace up there among the edelweiss. That's what he missed the most, all those years. That's what he gave his left leg to get back again.

And then the finish was upon him. Tammy, Whitney, and Jasmine screamed his name. The girls dashed onto the course and ran the final 50 yards alongside him.

He hugged the girls and felt them crinkle his race bib. Around him, runners caught their breath and checked their times. Tammy offered a smile. He savored the world opening up around him and the feeling, once again, of being whole.