Love In a Time of Trauma: One Man’s Struggle to Survive
Sam Paulos peered over the edge of the dock. The water looked deep enough. One of his cousins had just bought a cottage on Lake of the Woods in northwestern Ontario, near Kenora, and this was Paulos’s first visit. His first swim of the trip, too, and maybe the last of the season. It was Labour Day 2011, and Paulos, a 45-year-old account executive in Toronto, would soon be back home, bracing for winter.
Paulos plunged roughly three metres down, then winced. His left foot had hit the lake’s rocky bottom, and a dull ache spread up his leg, the sort of diffuse pain that comes from jumping out of a tree from too high.
When he surfaced, another cousin, who was standing on the dock, appeared concerned. “Sam, I think you’re bleeding,” he said. Paulos swam to shore and they took a look: a jagged Zorro slash, less than five centimetres long, ran between his left arch and heel. The cousin, a dentist, found some bandages and gauze and cleaned and wrapped the wound, but the laceration suggested stitches, so they headed to the hospital 10 minutes away.
A few years earlier, Paulos had been in a nasty car accident, suffering whiplash and bruised ribs. When he was in his 20s, he’d endured third-degree burns on his hand after a cooking incident. The resilient type, Paulos stayed calm, though the pain had worsened. He was concerned, and annoyed, too, but he wasn’t about to panic.
The triage nurse handed him a form, changed his bandage and told him he would have to wait to see a doctor. Paulos took a seat near a guy with afishing hook through his thumb and passed the time texting his new girlfriend, Gayle , a 41-year-old sales and marketing consultant.
Paulos and Kosokowsky had been introduced six months earlier by a mutual friend. The attraction was instantaneous. Paulos thought Kosokowsky’s freckles and double-dimpled cheeks were adorable, and he loved how she was always smiling. Kosokowsky later gushed to her friends about the tall, handsome guy who was “just really, really nice.” The next day, they went on a date. Soon, they were a couple.
Kosokowsky was just heading out when Paulos texted: “Cut foot. Going to hospital.“ She could sense irritation in his brevity. He was visiting his family for only three days and wouldn‘t want to spend any length of it in a waiting room. But Kosokowsky didn’t take the news too seriously. Paulos was a kid in many ways-an adventurous, fearless guy who loved riding his motorcycle. A little cut wasn’t cause for alarm. “Aw, really? Little boys in the woods,” she typed back.
Dr. Jim Brunton, an infectious diseases specialist, examined blood cultures to determine which bacteria had caused the infection, so he could narrow down the list of antibiotics Golan had administered. Eventually, tests revealed a strong presence of Aeromonas veronii biovar sobria, found in lakes and streams, and Clostridium bifermentans, found in lake sediment, soil and sewage.
Six of Paulos’s closest friends and one cousin huddled together in the waiting room, but despite the company, Kosokowsky felt isolated. She was acquainted with everyone, but not well, and was in shock over the events of the past few days. Later, when she overheard someone refer to her as “the girl,” she nearly burst into tears.
Golan monitored Paulos through the night for significant signs of improvement. None came. In the morning, four days after the swim, he still required the same life-support as before the debridement, a sign that bacteria were still present. A doctor from the orthopaedic surgery team came to inform the family that the leg needed to be amputated. If they waited, the bacteria could travel into his groin. Kosokowsky escaped to the picnic table outside and sobbed.
The news of the amputation came just before Paulos’s mom, Maria, arrived. Her daughter, Paulos’s older sister, had died from melanoma in 1999, so everyone wanted the news to be good on her arrival. It wasn’t. When she heard that her son would lose his leg, she wept.
The doctors cut off Paulos’s leg just above the knee. Paulos’s abdomen was swollen-a complication called abdominal compartment syndrome-and ventilating him had become difficult. While Paulos normally weighed 165 pounds, he had ballooned to more than 200. Golan couldn’t wait any longer. He brought in two teams of surgeons-general and vascular-to operate on Paulos. They searched for signs of necrotizing fasciitis in the abdomen but luckily found none. The bacteria hadn‘t spread, and the swelling and infection were under control. There was nothing more the doctors could do. It was up to Paulos to survive.
Not everyone was charmed. One of Paulos’s close friends cornered Kosokowsky in a hospital hallway. He had always looked out for Paulos and told Kosokowsky that if Paulos was lucky enough to recover from the surgery, he should be spared a broken heart. Kosokowsky stood her ground. “I’m not going anywhere,” she told him. “Sam lost his leg; he didn’t change as a person.”
Paulos awoke on September 12, six days after being put on life-support. He was heavily drugged and unable to talk, but when Kosokowsky walked into the room, he turned toward her and smiled.
Paulos and Kosokowsky had loved to go out for dinner, explore the Queen West neighbourhood and stroll in silence through the Art Gallery of Ontario. Once Paulos had recovered enough to talk, he decided it was time for an important discussion.
“We won’t be able to do that anymore, at least not in the same way,” he said. If she wanted to leave him, he’d understand. Kosokowsky refused to consider it.
After 20 days in the ICU and four more in the orthopaedics ward, Paulos was released. Being in public was a crushing return to everyday existence. He hadn’t had time to adjust to his new reality: the stump where his leg had been, the scar stretching up his stomach, his diminished 136-pound frame. He was transferred to West Park Healthcare Centre, where Kosokowsky visited almost every day of his month-long stay. The process of learning to walk again was agonizing, and phantom pains made his foot feel as if it were trapped in a slowly tightening vise. Kosokowsky’s presence eased the loneliness of recovery. After he was discharged, Paulos moved into her place.
Over the next six months, he progressed from walking between railings to a walker, two canes, one cane, and then fully unsupported. With the help of insurance and family members, Paulos bought an $80,000 state-of-the-art prosthetic called the Genium. The leg featured a microprocessor knee, an accelerometer, a gyroscope and “stumble recovery” capabilities, all of which made walking much easier.
“The whole ordeal strengthened our emotional bond and definitely brought us closer together. I’m committed to Gayle fully, and forever,” says Paulos. Today, they’re not engaged, and that won’t change-Kosokowsky was married twice and has sworn off the practice-but they are in every other way bound to each other.
Paulos has had to adapt to a slower pace. He can’t jump out of bed in the night to get a glass of water. He must sit in a chair to shower and can’t run or drive standard. Simple tasks like screwing in a light bulb require more time than you might think, and he’s mindful of his other leg, which bears about 30 per cent more load than it did before the accident. He’s had to come to terms with relying on Gayle for certain chores, like shovelling heavy snow and bringing home a Christmas tree. In other ways, however, it’s as if nothing has changed.
“Gayle doesn’t treat me any differently,” says Paulos. “In the beginning, when my mom was around, she was always fussing, moving stuff, staying close in case I tripped-which I did appreciate. Now she worries less. On her end, Gayle considers me perfectly capable of doing most stuff on my own. She doesn’t look at me like I’m disabled. She looks at me like I’m me.”