After years of caring for amputees, she became one herself. How her life’s work led her to inspiring Alex Smith's NFL comeback and landing a spot in the Paralympic triathlon.
One particular job at one particular place in one particular city called to Kelly Elmlinger, back in 2011, for reasons she did not yet understand. She felt a “burning desire” to care for wounded warriors, her fellow veterans, who were returning from the same battlefields, only with the kinds of severe injuries she herself had managed to avoid.
She even knew where she could make the greatest impact: the Center for the Intrepid in San Antonio, a world-class rehabilitation facility that mostly treated soldiers weighing limb salvage vs. amputation, along with burn victims. She landed a job there, the one she needed, for reasons that did not become any clearer, not at first.
She would ask her patients, the ones fighting desperately to save legs or arms, “Why are you hanging onto it?” She wanted to understand the psychology behind their choices, and they often bared their souls. They desired to feel whole, complete, like when they went to war, because they wanted to go back. But not everyone felt that way. Some told her, “F--- it, I’m done,” and she took that to mean they didn’t want to weigh something that heavy anymore, that it was time to move on, to amputate.
This was during the height of two U.S. wars, in Iraq and Afghanistan, which meant no shortage of patients. Elmlinger, now 41, cared for double- and triple-amputees, like one man who had lost both legs to an IED blast that also fractured his back and his pelvis. He wanted to salvage both arms. She can still recall the dizzying number of machines and tubes hooked up to him, plus all the trips to the emergency room, his life at stake each time. Sometimes, she took the extra step of sleeping in his room, just in case he needed anything overnight.
Eventually, two important, related notions bubbled higher in her subconscious: The soldiers needed teams like this to care for them and, with the right team in place, they could return to lives that, even if different than before, fulfilled them. “[The patient] made it; he persevered,” she says. “It really gives you a moment to say, Hey, I’m fortunate. And it humbles you to say, I don’t care what you ask of me, I’m here for you.”
As the years went by, Elmlinger empathized with patients through their shared experiences. She had enlisted in the Army, as a medic, on Veteran’s Day in 1998, then spent 10 years serving in the 82nd Airborne Division’s Combat Aviation Unit. From 2002 to ’05, she was deployed three times overseas, and while in war, in those same places, she noticed that physician assistants like herself went with their units. Nurses, however, did not. She started taking online classes and got pregnant with a daughter, Jayden. She attended North Carolina to study nursing and graduated in ’10, right around when she felt called to San Antonio.
Elmlinger often told patients the same thing. She could not relate to their injuries but she could connect to where they’d come from. “You’re just plucked out of this environment, this brotherhood, and now you’re here,” she would say. “You’re pissed off, and you’re angry, so you need to throw some f-bombs around. I came from that. I get that.”
The resilience shown by the soldiers in those moments … that was her inspiration. Many learned how to walk again; were fitted with prosthetics; endured painful operations, complications and infections; confronted depression and anxiety. Some returned to battle. Others went on to new careers. So many achieved milestones previously thought to be impossible, thanks to advances in technology, centers like the one she worked at and people like her, their jobs at once inspiring and heartbreaking.
Often, at night, she wondered the same things: If I were the one lying in that bed, what would I want? How would I handle that?
Nobuo Yano/Getty Images
Elmlinger was one of those people. She loved running, from the minute she could run. While growing up in Ohio, every time she headed out the door and jogged down the block, she started to make sense of—and bring order to—her world. Miles meant peace and solitude. Sure, she participated in other sports, like starring on the basketball court. But by the time she went to nearby Tiffin University to run in college and study criminal justice, “It had become more than a sport to me,” she says. “More like a way of life.”
By her sophomore year, though, Elmlinger realized she had gone to college for the wrong primary reason: because she did not want to give up sports and couldn’t fathom her life without them. She struggled more with the academic part, with the classes that didn’t interest her and all the sitting around, stuck at a desk in some sterile lecture hall. So she dropped out and enlisted. She went on special missions to recover downed aircrafts. She jumped out of airplanes, falling into rescue zones, saving more than a few lives. She also saw the worst of war, the soldiers whose body bags she zipped up, the names of relatives she wrote on the outside. “Your perspective on hardship and suffering changes in those moments,” she says.
At the Center for the Intrepid, she asked for placement on the orthopedics floor, because that was the toughest assignment, because she wanted to care for soldiers returning with multiple wounds and nearly catastrophic injuries. The gravity of that work made her feel the way that running once did, which is to say, alive. She continued to jog, combining three passions—parent, nurse, athlete—that made for a fulfilled life.
Her own injuries didn’t seem like much at first. After all, she had spent 14 years on active duty. She had run for most of her life, had jumped out of those planes. Of course her legs hurt.
The pain persisted, though, and one perk of Elmlinger’s new gig was access to advanced MRI machines. She went in for additional tests, which revealed what doctors believed to be a mass of blood vessels intertwining in her left leg. Initially, they stopped the blood flow to keep the mass from growing. But the discomfort only increased. She tried various medications. She tried resting. She tried not running. But soon, she could hardly walk.
At that point, Elmlinger thought back to her early 20s, right before the deployments started. She had noticed something funny about that left leg in particular. It looked the same as her right, but sometimes, when she touched one specific area, near her left shin, it ached so bad right there that “you could be running down the street with a knife, and I could not get up.” She would need to regroup before resuming her training. That was the weird part: She could sprint, jump and complete marathons. But she could not touch that specific spot without invoking stop-everything-and-rest pain.
Combining that information with the scans led to an unexpected—and unexpectedly brutal—discovery. The nurse who cared for injured soldiers, who sought out the hardest tasks and slept in patients’ rooms, had a tumor in her leg that had lain dormant for over a decade but was by that point growing fast. Had it been discovered earlier, she would not have lasted that long in the military, would not have worked with those patients at that center. “I was supposed to be in San Antonio,” she says.
The same doctors she operated with performed what’s called exploratory surgery. When she came to, the surgeon told her his diagnosis, but it didn’t register through the haze of medications. A nurse she knew drew the connection she had missed. “Kelly, I’m so sorry,” her friend said. “It’s cancer.”
Officially, Elmlinger had synovial sarcoma, a form of soft-tissue cancer that’s both extremely rare and sinister. Col. Joseph Alderete, the CFI medical director, sat down as she wiped away her tears. He told Elmlinger that had she been diagnosed even a few years earlier, she would have lost her leg. But not there, not then. “What do you want to do?” he asked.
At that moment, the severity hit. She wasn’t the nurse anymore. No, she thought, she knew, “I’m one of them.”
She had to make the same choice as her patients: limb salvage? Or amputation?
“This is why I’m supposed to be here,” she said.
Without running, Elmlinger felt like a GPS satellite that no longer worked. She went to the Mayo Clinic for a second opinion that confirmed her diagnosis. She started radiation. But the clarity her cancer brought only made her more lost.
She chose limb salvage and tried wheelchair racing, a sport she struggled with at first but came to respect over time. She nabbed a haul of gold medals at the Invictus Games in 2016, winning the 100, 200, 400 and 1,500 meters for her disability category, then picking up three bronzes in separate swim events. She competed on Team Army for something called the Department of Defense Warrior Games. She finished the Los Angeles Marathon in a wheelchair, then completed the Boston version, in honor of her grandmother, Mildred, who had passed down the tenacity gene but died a few months before the race. She wanted to quit throughout but heard Mildred in her ear, saying, “Never quit, Kelly. Never quit.”
This wasn’t running. But it could have been worse. After all, she still had her left leg, and Alderete had been right about the advances in tech for people with injuries like hers. The braces she could affix there to walk and run and jump were miracles of science. If she didn’t wear them, the leg throbbed, until, she admits, “I felt like a grandma, saying, give me a second, I need to sit on this bench.”
Elmlinger began assembling her own team, adding people like John Fergason, CFI’s chief prosthetist. He had never before heard of someone who treated limb loss later being treated for limb loss. But that comfort level meant advantages, because Elmlinger understood the language and the science. He fashioned braces for cycling, running, lifting and walking around, tweaking as they went per her instructions. She never balked at trying something new.
After all, she knew more than most about limb salvage recovery, how uneven it can be, how months of progress can be undone in a day, the trajectory altered by one wrong step or a thousand of them. She had nine surgeries performed on that leg alone. Many took place on the same floor where she once had treated soldiers; some were to remove damaged tissue, others to place in a rod to stabilize her bones, which the radiation had whittled away. Sometimes, she endured painful infections that forced her to head immediately to emergency rooms. She started to develop stress fractures simply from walking, from the weight she placed on the limb. Doctors even took skin and tissue from her left foreman to graft over the gaping wound in the lower half of her damaged leg.
Still, something about Elmlinger stood out to Fergason, something like drive, her will. Whenever she discarded a piece of equipment, he held onto it. Why? “Because I knew she was going somewhere,” he says.
This never ended, the cycle between infections and complications and recovery. It took an emotional toll, absolutely, but it also did structural damage to what remained of the limb that Elmlinger was trying so hard to keep. She often felt as if she was “dragging” it around. She also went back to treating patients at the center, but now, with deep bonds reinforced by her own experience that helped Elmlinger sympathize with patients and relate to her fellow nurses. She thought she had better odds than the soldiers whose injuries came from war—at least, until she realized, she was just like them.
Eventually, she met with Alderete, her boss turned doctor, and spilled everything from how much it hurt to how she knew the choice she now needed to make.
“Let’s cut it off,” he said, and she cried again, but “happy” tears this time.
In August 2016, Elmlinger felt an unexpected calm as the surgery approached. She had been more nervous broaching the subject of amputation with her doctor than with actually amputating her left leg. Her progress and regressions had been too bumpy, too frustrating. She wanted to move forward, even if she would look different, even if her daughter begged her to keep trying limb salvage. It hurt like hell to tell Jayden, “I’m going to do this regardless of what you tell me. I’m going to be a new person and a better mother, and I’m not going to be so upset all the time because I can’t do what I want to do.”
Now, Elmlinger looks back at that surgery and sees not what she lost but what she gained.
“It’s really,” she says, “a day of hope.”
Elmlinger woke up from surgery in even more pain, with even more complications to address. She developed what’s called a neuroma, which meant her nerves bundled, the tissue around them thickening like a scar. Pain shot through the spot where doctors had amputated, right at the main nerve in that leg. For a year, she could hardly wear prosthetics. Alderete, weary of another surgery, still advised that they go back in and cut out the neuroma in early 2018. “It was like a blow torch in my leg,” she says. But surgery led to other revelations: She finally felt like an amputee! She could wear prosthetics! And, most important, she could resume running!
Alderete, Fergason and the rest of her CFI team showed Elmlinger the power of adaptation. Their creativity was endless, limited only by their collective imagination. She felt grateful, yes, but also determined to lean into her new identity, as an adaptive athlete. So she aimed upward, at a new goal, one that might have seemed impossible for another person, in another place.
“I wanted to enter a triathlon,” she says, like it’s that easy, just flip the mindset and take off.
She emailed the national program director for Paralympic triathletes, despite having spent only three weeks on her new, multipurpose prosthetic leg. She hadn’t run in five years. But she couldn’t “sit on the sideline” any longer. She ran. She swam. She biked. Of course it hurt, and yet, that one run competition changed her life, again. She even qualified for nationals, while finding something even more important: her new purpose.
Now a full-fledged Paralympic triathlete, she won a national championship in ’18 in only her second competition and was named USA Paratriathlon’s developmental athlete of the year. In ‘19, she nabbed a silver at the world championships, then won gold at the World Cup. She started to dream another improbable dream, hoping to qualify for the Paralympics even though she was not yet able to because of her qualification level. Elmlinger competes in Category 4 for Paralympic sports, which is the second-highest and means she’s the second-most able. But only Category 5 athletes were being considered for Tokyo.
Then, another setback. Excruciating pain. Elmlinger traveled to Florida for the Olympic Trials in 2020, still unaware that her left hip was broken. She worried she would not be able to finish. But the day before the race, the spread of COVID-19 prompted a cancellation. This devastated her at the time but allowed for the exact pause she needed.
Back in Texas, X-rays did not reveal any breaks. But by then, Elmlinger could hardly move. Rather than go home, she insisted on being taken upstairs at CFI, to her old floor, where an MRI revealed a fracture. They debated whether to embark on yet another surgery or let the damage heal naturally, and elected to go under once more. This time, when she came to, the surgeon told Elmlinger of her incredible fortune. “You have no idea how close you came to needing a full replacement,” he said, knowing that would have ended her Paralympic push. For now.
The delay and the scan allowed Kelly to heal and Team Elmlinger to resume their work. Then, more kismet. Officials changed the qualification requirements, saying that 4s could race with 5s. As long as they finished in the top nine, they could go to the Paralympics.
By that point, Alderete, the medical director, had started to use Elmlinger as a model for his other patients. He even told an NFL quarterback who would mount perhaps the greatest comeback in sports history to “be like Kelly.”
Simon Bruty/Sports Illustrated
Inside a conference room at CFI, Alex Smith and his wife, Liz, sat across from Elmlinger. The triathlete had been watching the Washington Football Team on television in November 2018, the fateful afternoon when Smith’s right leg bent below his kneecap and his bone broke through his skin. After months of surgeries, infections and complications, he had traveled to San Antonio, to meet with the only people who could understand what he was going through: soldiers choosing between limb salvage and amputation.
Smith couldn’t stop staring at Elmlinger’s leg. She owned her prosthetic, how different it looked, how different it made her, in a way he could not back then. She noticed but said nothing; instead, she told her story, the attempts to salvage, the amputation, the fateful choice to work at CFI and the team and technology that saved her. She wanted him to understand. “This is gnarly stuff,” she told him. “It’s not roses.” His face sunk, because Smith thought his progress would continue unabated. But now, after completing his comeback, he realizes that Elmlinger told him what he needed to hear. Seven months after that trip, he rebroke his leg. He would not have returned to pro football without the conversation that reset his expectations. Be like Kelly meant try like hell to play football again.
As Smith told his comeback story to the world, Elmlinger marveled at his reach and his willingness to use his platform to highlight the work of the team he had just met. Everyone who found him inspirational would see who they all were, everyone at CFI, from the soldiers to the athletes to the nurses and the doctors. “About damn time we shed some light on this,” she thought. Last season, when Smith jogged back onto the same field where his leg had snapped two years earlier, goosebumps rose on Elmlinger’s arm. “I’ve had that feeling before,” she says. “I’m back. I know I’m back.”
She understood, too, what it felt like to prove so many who doubted wrong. “He went in with middle fingers, like, I’m here, deal with it,” she says, adding a “hell yeah.”
This spring, Smith retired, having healed enough to walk away. He now considered himself an adaptive athlete, and felt immense pride in his new, transformative team. Elmlinger pushed on, inspired by the man she had inspired and the poetic symmetry involved. “So cool,” Smith says now. “It’s hard to put into words how much strength that gives people like me.”
In May, Elmlinger resumed her Paralympic push. She knew that she needed to chase points, completing several races in a short period of time, without prompting another injury that would ground her for the Paralympics, which start in Tokyo on Aug. 24. Her first competition back took place in Japan, on one of her favorite courses. Some of the Category 5 competitors were not there, meaning this marked perhaps her best chance to gain on them in qualifying. She hadn’t raced in almost a year and a half. But she won, registering a personal best.
In June, she triumphed again in England, winning gold in the World Triathlon Para Series. A few weeks later, she competed in Wisconsin. Again, she won her category. On July 6, her hopes became official: She was a Paralympian, headed to Tokyo, ready to shine an Alex Smith–sized spotlight on CFI, nine years—and nine lives—after her first shift.
Still, this is Kelly Elmlinger. She has met presidents, gone to war, performed rescue missions and helped NFL quarterbacks move forward. She will not be satisfied with a long trip to Japan. For the friends and family who all but shout their excitement, the triathlete says, “Tone it down. We’re not there yet.” She knows, better than most, the heartbreak that lurks around unseen corners, how complications for athlete amputees don’t care about upcoming competitions.
She wishes her daughter could come with her. The CFI team, too. But, she adds, “I’ve come too far not to win.” For the quarterback with the broken leg, for the most optimistic surgeon in the United States, for the colleagues who changed her life and for the patients who gave her purpose. They have carried her so that she can carry them.
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