Looking back, the day Army Capt. Kelly Elmlinger requested a nursing assignment at Brooke Army Medical Center in San Antonio was the most pivotal of her life. The serendipity of that choice is impossible to ignore.
"I wanted to take care of wounded warriors," Elmlinger says. "I'd taken care of them at the time of injury during my deployments, and I wanted the opportunity to see them through their recovery."
Elmlinger was just 19 when, a few months into her sophomore year at Tiffin University in Ohio, she enlisted as an Army medic on Veteran's Day 1998. For the next decade, she served with the 82nd Airborne Division's Combat Aviation Unit at Fort Bragg, North Carolina. But after three back-to-back deployments to Afghanistan and Iraq between 2002 and 2005, she says she "needed to get out of the cycle" she saw devastating so many people around her. She accepted an assignment in a special missions unit and began taking online courses. Then, shortly after becoming pregnant with her now-7-year-old daughter, Jayden, she applied to the University of North Carolina's nursing program and was accepted. While deployed, she'd noticed that physician assistants deployed with their units; nurses did not. In December 2010, Elmlinger graduated with her nursing degree.
"It was a blessing in disguise to have asked to come down to San Antonio," she says.
When she arrived, Elmlinger began taking advantage of all Texas had to offer, both personally and professionally. A lifelong athlete and avid runner, she had traded running for CrossFit-style workouts while in North Carolina, but she began feeling the itch to return to her endurance roots. She trained for the San Antonio Rock 'n' Roll Marathon, which was held on Veteran's Day 2012, finished in less than four hours and came within striking distance of the qualifying time for the Boston Marathon. She and her father, an avid runner before having two back surgeries, had both dreamed of running that race.
Two months later, in January 2013, Elmlinger took a break from running to have her lower left leg examined at the hospital where she worked. Pain in her leg had bothered her for nearly a decade, but doctors consistently told her she had nothing to worry about. This time, her doctor admitted her for a simple procedure to treat a collection of blood vessels he believed was causing the pain. But when the pain persisted, she returned in March for another round of tests and an additional exploratory surgery.
"When I woke up, my surgeon told me what he'd found, but I was groggy and the term didn't ring a bell," Elmlinger says. "It wasn't until a nurse I knew said, 'Kelly, I'm so sorry it's cancer,' that I realized what I'd heard."
Elmlinger was diagnosed with synovial sarcoma, one of the rarest forms of soft-tissue cancer, and was faced with a decision she'd watched so many soldiers in her care make after returning home with an injury. "My orthopedic oncologist gave me an option," she says. "He said, 'A few years ago, we would have amputated. But I think we can save your leg.' He sent me to the Mayo Clinic for a second opinion, and when I returned, I started radiation and made the decision to attempt limb salvage."
Over the next two years, Elmlinger underwent numerous surgeries to remove the tumor and damaged tissue and to place a rod in her leg to protect her bones, which had grown brittle from radiation. She had additional surgeries to remove skin and tissue from her left forearm to graft to the open wound in her lower left leg and another to treat the graft site when complications from the original surgery caused painful neuromas in her arm.
It is never lost on Elmlinger that each time she arrives for a procedure, she does so on the same floor at the same hospital where she has worked since 2011. It does not go unnoticed that her physical therapy takes place at the Center for the Intrepid, a $60 million state-of-the-art facility where the brace most commonly used for limb salvage patients like Elmlinger was developed. "I had all the right people to take care of me," she says. "The best surgeon, the nurses I worked with, an incredible facility. Anywhere else, I don't think I would be this far along."
When she returned to the hospital as a nurse in June 2015, her experience as a patient made her more empathetic, strengthened her bond with the nurses who cared for her and with the men and women she once treated and now saw at therapy each day. But it also reminded her of the unyielding road she had chosen.
"I'd seen so many soldiers try limb salvage and fail for years before they finally had to amputate," she says. "But my injury wasn't combat-related. We weren't trying to put pieces back together. I thought I had better odds. With hindsight, if I had to do it over again, I would have chosen differently. I'm dragging something around that doesn't work. If I had a prosthetic, I'd be able to go out for a run. But I had to try."
That last statement defines Elmlinger's personal philosophy as clearly as any. It explains why she spent a year studying at Tiffin, even though she knew her heart wouldn't be in it. It is why she returned to work after her surgeries, despite the pain and limitations she now faced. It is why, after the realization that what remained of her left leg would no longer carry her on the runs she so loved, she began trying new sports through the adaptive sports program at BAMC.
"She's an incredible athlete and had the opportunity to be a really good paracyclist," says David Smith, Elmlinger's coach in the adaptive sports program at BAMC's Warrior Transition Battalion. "She took silver at her first nationals after just a few months of training. But I knew it wasn't meeting her full desire to compete."
Next she tried swimming. And rowing. But nothing was fulfilling the need running once did. Then Smith suggested wheelchair racing. It was not love at first ride.
"At first, I was like, 'This sucks.' If this is the alternate for running, screw this. It's not my thing," Elmlinger says. "But after a couple of months, at one practice, it just clicked. That day, it wasn't a struggle. It was a steep learning curve, but I'm glad I stuck with it. There are days when I miss running, but the chair fills that void. It's new and challenging and pushes me to be better at something I've not done before."
As she became stronger and her pushes longer, another coach suggested Elmlinger was ready to rekindle a precancer dream and give Boston another shot. At the 2015 Los Angeles Marathon, her first in a wheelchair, she finished in 2:14:37, 10 minutes faster than the qualifying time for Boston. "It's almost like it was meant to be," Smith says.
On Monday, April 18, Elmlinger lined up with the other wheelchair racers at the 2016 Boston Marathon. Her parents and siblings flew in from Ohio to cheer her on. Her best friend and roommate, retired Army Sgt. Aaron Stewart, remained in San Antonio to take care of Jayden. The two months leading up to the race were trying. Elmlinger's grandmother, the headstrong matriarch of the family, had died in March. Between training trips to El Paso, Elmlinger flew to Ohio to be with her family and attend the funeral. Two weeks before leaving for Boston, she and two other Invictus athletes were invited to the White House to dine with the president, vice president and first lady as their guests at the U.S. Department of Defense's Combatant Commanders' Dinner.
Throughout the night, she spoke with four-star generals about the benefit of adaptive sports programs in the military and took selfies with the president and VP. When she returned home, her leg ached, she was exhausted and Jayden was sick. Yet she never complained, never allowed herself to feel sorry for what she is missing or that she was unable to train as much as she wanted.
"I deployed three times and put many friends, and many people I didn't know, in body bags," Elmlinger says. "When you are the person who writes down your brother or sister's name, zips the body bag and helps load them on the medevac helicopter, your perspective on life, hardship and suffering changes."
Once she arrived in Boston, Elmlinger looked around at the other women in her division, women who'd qualified from around the world, whose stories and struggles were no more or less important than her own. She realized competing alongside them offered her another chance to learn and improve and she recognized that just being in Boston was an achievement. She'd arrived at another start line at which to reset.
"Kelly is a unicorn," Stewart says. "Her heart is so big and she gives 100 percent in everything all the time. She pushes herself to the breaking point every day. She's constantly exhausted but doesn't stop. Most people who have been through the things she has would say, 'I've had enough. This is too much pain. I have too much stress.' Instead, she adds more to her plate."
Elmlinger now looks ahead to her next starting line: the 2016 Invictus Games in Orlando, Florida, and has her long-term sights set on making the U.S. Paralympic team in 2020. She knows that's a long way off and perhaps a long shot. She struggles with fatigue and pain and still faces the very real possibility of having to amputate her lower left leg. She knows she is setting out down another long road. "I'm big on potential," Elmlinger says. "I know I have the potential and I have to act on it."
Elmlinger doesn't know if she will make the Paralympic team or win another gold medal in Orlando, but if she knows anything, she knows she has to try.