The day I first heard about Captain David Berling was like many others. I was called and asked if I could take care of the orthopaedic injuries on a military service member who was involved in a plane crash and currently in the intensive care unit in a prominent trauma hospital in the Los Angeles area. Like always, my answer was, "I would be happy to take care of him!"
My confidence came from working at a great military hospital with a wonderful medical staff. Naval Medical Center San Diego served as the West Coast amputee treatment center. And during my 25+ year military career including three deployments to the Middle East, I was exposed to a significant amount of war trauma, including amputations. This experience, combined with my background in orthopaedic oncology, allowed me to tackle nearly any injury that came my way and gave me a strong appreciation of amputation surgery and the care of patients with amputation. Although some surgeons approach amputation as a treatment failure, I believe it is just another reconstructive option for the traumatized extremity to be undertaken with the same care and precision as any other reconstructive surgery.
When Captain Berling arrived at our Intensive Care Unit, he was sedated and intubated with a breathing tube. He was already missing both of his legs, which had been amputated through his knee joints, and his right arm was broken. I was told his lower legs were connected to his body by just threads of tissue when they were removed at Harbor-UCLA Medical Center. His three broken limbs were heavily bandaged, so I had little idea of what I had to work with. I received his X-rays, which showed significant breaks in both of his femurs, or thigh bones, in his remaining legs. I knew my team and I were in for a real challenge.
David was taken to the operating room where I cleaned his wounds and stabilized his femurs. I saw the true extent of injury to both legs. They were severely injured almost all the way to his hips. I prepared for a difficult talk with David's family.
After that initial surgery, I spoke with David's family and was immediately struck by the overwhelming love and support he had. They relayed that the doctors at the last hospital had considered amputating both of his legs through the hips. They also told me how important it was for David to maximize his possibility of walking again. They were very concerned about his future opportunity to use prostheses.
Trying not to remove all hope, I explained some of the grim facts:
A patient with one leg amputated above the knee needs to use 65% more energy to walk than someone with two intact legs.
A patient with two legs amputated above the knee uses 280% more energy.
As an example, someone walking at two miles per hour with two above-knee amputations expends the same amount of energy as a person with two intact legs jogging at about five miles per hour. Because of the extreme effort required to walk, many patients with two above knee amputations end up using a wheelchair as their primary means of moving about.
Several days later, after David was awake and his breathing tube was removed, I discussed with him the severity of his injuries. I explained the most reliable and predictable plan would be to proceed with the plan outlined by the other hospital—amputating both legs at the hip. In just a couple surgeries, we could get his wounds healed and have him recovered, but he would have virtually no chance of walking again.
I discussed a second option of shortening both legs up to the level of his broken femurs, leaving him with short above-knee amputations. I told him this may require a few more surgeries, but would allow him to use prostheses and probably walk intermittently.
The third option I discussed with him was trying to keep his legs as long as possible, fix his fractures, and revise his amputations to include injured tissue, which is typically not recommended for amputation surgery. I explained this third option was intriguing because it left his legs as long as possible and gave him the best chance of walking. This option was unpredictable and could require numerous surgeries. I also informed him that ultimately, after multiple surgeries, we might have to revert to one of the first two options.
For David, there was no hesitation and no other option; he wanted the option that would give him the best chance to walk again. Many of my fellow surgeons and doctors suggested the absurdity of attempting to preserve such severely injured limbs because this would provide challenges in surgery, during David’s medical care, prosthetic fitting, and rehabilitation. We both began a journey that would span twenty-one surgeries over eight months.
Along the way, there were multiple complications but David never wavered from his goal of walking. David was willing to endure operation after operation as my team painstakingly worked to save his limb length. Even on the eve of reverting back to option two, David and his family implored me to try anything, no matter how extreme, to save his residual limbs.
However, this is not a story of miracle surgeries and amazing medical breakthroughs. This is a story of overwhelming determination and hard work by a man with an incredibly loving and supportive family. While there were innumerable setbacks, obstacles, and opportunities to give up or quit, David and his family never did! This is a great story of one man’s struggle to beat the odds.
Captain (retired) Scott Helmers, MD, has been an orthopaedic surgeon for the last seventeen years and retired from the United States Navy on July 1, 2011, after twenty-five years of service. While in the military, he deployed five times, including Iraq, Kuwait, Japan, and the Philippines, to perform life-saving operations on hundreds of severely injured service members. Dr. Helmers is currently an Orthopaedic Oncologist at Kaiser Permanente in San Diego, California.
By Chaplain, Lt Col (retired), Warren "Chappy" Watties
I was called into service when news of David's accident spread across Los Angeles Air Force Base. As Base Chaplain, the welfare of each soul is my responsibility and David's was barely staying within his body. Additionally, I am a focal point for the support groups on base and David's family was going to need their help.
My first contact with David's family was escorting his wife Melissa from the airport to the hospital. Soon after, I met David's mother and father. I reached out to each of them by taking them for a walk-n-talk. Each of them told me stories that showed their love for David. I have never seen or met a family with such selfless love and commitment to each other.
As Chaplain, I was one of very few non-family members, other than medical personnel, to see David at Harbor-UCLA. I prayed at his bedside. He was a terrible sight with medical equipment appearing to randomly sprout out of his swollen body. I thought it would take a miracle to save this young man.
Throughout my thirty-three years of ministry, I have heard of many wonderful and spectacular recoveries where people, on the brink of death, make it back to life again; stories that border on the miraculous. David was my first opportunity to be an eyewitness of a miracle.
Through the walk-n-talks with David's family, I learned about David and the relationships they have with him. I believe David's story will demonstrate how his family used their love for him to make the decisions that brought about the miracle of David's physical and mental recovery. His life and family have truly changed my life and I pray they will do the same for you.
Chaplain, Lt Col (retired), Warren "Chappy" Watties has served in full-time ministry for over thirty-three years, with almost twenty years of that time spent serving in the United States Air Force. While in the military, he deployed on five occasions to the Middle East and has baptized and won to the Lord, hundreds of deployed warfighters.
By Captain (retired), Dr. Scott Helmers, Orthopaedic Surgeon