ENGLEWOOD, Colo. -- The woman on the mat bellows. The noise is her relief.
Her torso twists and sweat drips from her brow. Her new world is on the third floor of Craig Hospital outside of Denver, where she is one of dozens of patients recovering from spinal cord injuries. Her world is a bedroom and long hallways, examination rooms and a cafeteria, but it grows with every day, to her mother’s house, to a sailboat on a local reservoir, to the zoo.
The woman is tall, a fact easily overlooked when she’s folded into her wheelchair, and she is loud. Her hair is wrangled into a messy ponytail, her eyes ringed with a faint smudge of liner. She complains about the brace that sandwiches her torso, and she laughs when her shirt rides up as her physical therapist contorts her into positions she sees but cannot feel.
None of this makes the woman remarkable. There are other tall patients, others almost as loud, others who make an effort to look nice no matter the strain. She is not the only one who has choice words for her brace, one of many whose body has become the most frustrating kind of Play-Doh.
On June 24, the woman slid into a pool. It was a scheduled activity, a step in her rehabilitation. She strapped on her goggles, she let her physical therapist guide her movements, and she pulled herself up with the strength that’s been building in her upper body.
She felt free, she says, and wonderful, and then she announced that she would not swim again.
The woman is Amy Van Dyken-Rouen, the six-time Olympic gold medalist known for her powerful freestyle stroke and even more powerful personality. On June 6, she severely injured her spine in an ATV accident in Arizona, and she was airlifted to Craig Hospital outside of Denver on June 18. She remained there for nearly two months and was discharged on Aug. 14. She is still in the area and will return to the hospital for treatment as an outpatient for several weeks before she can return to her home in Scottsdale, Ariz.
At Craig, Van Dyken-Rouen spends her days in what seems like an extended therapy session, doing everything from occupational therapy to physical therapy to mat and wheelchair classes. As boisterous as she was before the injury, her approach to rehab is tireless. Just watching her is exhausting. She says no to nothing -- except swimming.
“As a swimmer, we always tried to take our legs out of the equation or take our arms out of the equation,” Van Dyken-Rouen says. “I got in there, and I was like, oh, this is like what I was doing at the training center. I felt bad saying it was easy.”
She felt bad, and she looked around at the men and women in the water beside her, who struggled and improved with every session. She saw the packed schedule for the pool, and she realized she was taking precious space. Even though she hadn’t swam for fitness since she won her last medal in 2000, Van Dyken-Rouen realized in that moment that she was still a swimmer, that her body, even paralyzed, was still its best self in the water.
And so she gave up her swimsuit and retreated to her mat. She wheeled herself back to her room, which bears a nameplate that reads simply, “Rouen.” There is no hint of what she was, the Olympian, the celebrity. That woman exists only in the water, and Van Dyken-Rouen’s fight now is on land, where as always, life is just a little bit harder.
When Van Dyken-Rouen was thrown from her ATV that June evening in the sleepy town of Show Low, Ariz., she flew over a curb and down a six-foot drop. Her husband, former Broncos punter Tom Rouen, discovered her facedown on the ground, and he waited by her side, fearing the worst, as emergency workers arrived. Van Dyken-Rouen was then airlifted to Scottsdale Healthcare Osborn Medical Center, where doctors delivered some terrible news: the former Olympian had fractured her back between her T11 and T12 vertebrae, causing paralysis from that spot downward. She also suffered two more minor fractures, one at her L4 vertebrae, the other at her T8.
Although most reports have described Van Dyken-Rouen’s injury as a severed spine, her physician at Craig Hospital, Dr. Mark Johansen, takes issue with that designation. “Severed really isn’t an accurate term,” he says. “Her spinal cord is severely damaged. Some of the nerves may have been separated, but there’s still architecture in there, so it’s not completely severed.”
Even after Van Dyken-Rouen was airlifted to the intensive care unit in Scottsdale, the loss of feeling in her torso continued to ascend. Soon after her arrival, doctors rushed her into emergency surgery to repair her damaged spine. It was a risky procedure in which she lay facedown on an operating table with her upper body tilted toward the floor for more than six hours, and one of her only memories of that day occurred just before she was wheeled into the operating room. That was when doctors told her to say goodbye to her husband, a moment she found more sobering than frightening.
“It was just a reality, I was living, and I had to live,” Van Dyken-Rouen recalls. “I couldn’t think of [the surgery] as being terrifying. I had to be in the moment and move on. If I did think outside of the moment, if I did think about my nieces and nephews and husband, I would have lost my stuff.”
After the surgery, in which there was a blood transfusion but no complications, Van Dyken-Rouen remained in Arizona for a week and a half as she, her doctors and her family worked out her treatment plan and waited for her to become stable enough to move. During that time, she was fitted for her brace (called a thoracolumbosacral orthosis, TLSO for short), which looks like a two-piece turtle shell and envelops her torso. During surgery, doctors fused her T11 and T12 vertebrae, but they deemed it unwise to fuse either of the other two fractures. The brace is used like a cast to keep her spine steady and the bones healing.
Van Dyken-Rouen hates it. She wants it off, now, and despite being ahead of schedule in much of her recovery, she cannot control this aspect. “While she is a special person,” Johansen says, “her bones are just bones.”
Van Dyken-Rouen hates the brace because it pinches at her armpits, because just when it doesn’t feel so bad, her physical therapist will notice that it’s riding too low or too loose, and he’ll push it up or cinch the Velcro. She hates it because it squeezes and digs into the only parts of her body she can feel, but most of all, she hates it because it is covered in butterflies.
Well, it was covered in butterflies, for a good six weeks, before a friend came to visit and upgraded the front with strips of skull print alternating with a Hello Kitty design. Van Dyken-Rouen doesn’t do butterflies, especially not these butterflies, which dotted the brace from top to bottom, in every color of the rainbow. She’s too tough for butterflies, which begs the question, why?
“It was my Dilaudid decision,” she explains, referring to the painkiller she was administered after surgery. She’d initially picked out a camouflage design, she thinks, but when she was asked again, heavily medicated, she changed her mind. “Oh my God, the butterflies are so pretty,” she says now in a singsong voice, mimicking her post-surgery self. She shrugs, and she points to the skull and crossbones she added to the back, by hand. She had to do something to toughen the thing up.
On a Friday morning in mid-July, Van Dyken-Rouen extends her left hand. It’s awkward, and she laughs, but she’s so sorry, she just happens to be sitting on her right, and it would be such a pain to extract it. She’s perched here, on this elevated mat the size of a large playpen, contorting herself, laughing about her swollen feet. She lies on her back and extends her right leg 90 degrees, then tries with the left, which doesn’t go up quite as far. A catheter bag dangles off her ankle.
Throughout it all, Van Dyken-Rouen narrates, a soundtrack of commentary and grunts. She tells anyone who cares to listen how limber her muscles are today, how she’s going to learn to self-catheter tomorrow. She rolls from side to side, and she rotates an exercise ball around her torso, huffing at the weight. She jokes about how hard this is, which is the saddest kind of joke, because it used to be so easy. “I’ve got 20 pounds here in my hands!” she exclaims, then looks down, looks up again and winks. Four pounds, the label on the ball reads.
Every time a therapist works her too hard, she admonishes him or her. “Be nice.” “Be gentle.” She doesn’t mean it. Van Dyken-Rouen may be nice, but she is anything but gentle, and she expects neither of these sentiments from the men and women working to make her self-sufficient in her wheelchair. She peppers them with questions, too, the questions of a woman whose job it was for years to know everything about her body and its inner workings. When a therapist tells her she needs to strengthen her hip flexor, she follows up by asking what part, and which exercises are best, and what other areas will that work on, and how long will it take? When she gets a free minute, in bed, in her chair -- and such minutes are few -- she makes an effort to stretch or to bend, to put a few more seconds into whatever tactic she’s mastering that day.
During this session, she’s working on transfers, sliding herself from the mat or the ground into her wheelchair. This is one of the most crucial skills she will master while in the hospital. At one point, she needed a board to help ease her from surface to surface, but now she takes just a bit of help from her therapist, and thump, she’s in her chair, ready to pop a wheelie and go. With every successful transfer comes applause and encouragement from Van Dyken-Rouen’s mother, Becky Van Dyken, who travels up from her home south of Denver to the hospital each day. Tom Rouen follows the same routine, and this week, Van Dyken-Rouen’s younger brother, David, has joined the cheering section. He’s up from Miami with his wife and seven-month-old daughter, spending his vacation within the walls of the hospital. That’s just how this family functions. They show up, as much now as they did in the immediate aftermath of the surgery, when Katie Van Dyken, the family’s middle child, donned an oversize T-shirt to hide that she was days away from her due date and hopped on a plane from Los Angeles to Phoenix.
There comes a time in the therapy session when Van Dyken-Rouen must sit up, face the edge of the mat and stretch her arms. Her niece, Brooklyn, has woken up from her nap, and she’s been sitting with her parents near the edge of the room. For a moment, the family’s attention veers from Van Dyken-Rouen to Brooklyn, who has at that very moment learned to wave. “She’s just the best baby in the world,” Becky coos, with all due respect to her other grandchildren, and then David takes Brooklyn on the mat opposite her aunt. Van Dyken-Rouen waves, and Brooklyn waves back, and why stop there? Whenever her aunt twists an arm, Brooklyn approximates the same movement, squealing and drooling as her grandmother melts with pride. It’s moments like these that make the therapy bearable, that make it seem like its not even therapy at all.
The routine can get tiring. Rehab has become Van Dyken-Rouen’s full-time job, from 8 a.m. to 4 p.m., Monday through Friday. She has the weekends to visit with her family -- and her dog, Kuma -- at her parents’ house, but during the week, her days are scheduled to the minute. Every day at 4 p.m., when her therapy sessions end, Van Dyken-Rouen is so exhausted that she returns to her room for a nap. A nurse comes in to help her take off her brace, revealing a shirt that is invariably drenched with sweat. She wouldn’t make it through dinner without that rest, and even so, she’s usually asleep by 10 p.m., ready for her 7 a.m. wakeup call and the arduous process of getting herself ready for the day.
“I’ll be asleep probably within five minutes,” Van Dyken-Rouen says. “I’m exhausted. It reminds me a lot of training for the Olympics.”
But this is training for life, and it’s the furthest thing from the glamor of Atlanta and Sydney. Here, Van Dyken-Rouen learns how to brush her hair, how to shower and how to control her bladder. She isn’t afraid to claim even the most mundane of victories, to talk in detail about everything from bladder control to withering muscles to sweaty undergarments, because these are as much a part of paralysis as wheelchairs and back braces.
“When you hear about paralysis, basically, you think about the paralysis,” Johansen says. “It’s not just the paralysis. It’s not just the sensory loss. Every organ system is basically affected. There’s nerve pain. People don’t think about the kind of pain people can experience from this. There’s the post-traumatic and post-surgical pain. There’s the neuropathic pain. There’s muscle spasticity. There’s bowel and bladder function, those things that the general public doesn’t think about how difficult an injury like this can be.”
And then, of course, there is the brain. Van Dyken-Rouen’s is as sharp as ever, but it’s taxed. “The mental side of it hurts, too, when you can’t feel your toes,” she explains, which is why sometimes, before a good laugh, she must cry. Sometimes she frowns, and sometimes a shouted expletive is not quite enough to buck a bad mood. Most of the time, though, that does the trick, because to be Amy Van Dyken-Rouen is to have priorities. Why let her mind hurt when that’s the one pain she can control?
“Staying upbeat helps with the pain, and it helps with getting through that moment I don’t think I can push my body through,” she says. “If you laugh and smile, it comes true, it happens.”
On June 12, Van Dyken-Rouen’s hip flexors began to flicker. She’s regained some movement and feeling in her adductors, and she has feeling in all of her abdominal muscles and obliques. She’s even beginning to wonder if a few of her gluteal muscles are starting to fire, but she can’t be sure.
Gaining feeling is a process that occurs overnight -- literally. Every morning, Van Dyken-Rouen gets a shot of blood-thinner, injected by a nurse to the same spot on her torso. For weeks she couldn’t feel the a prick as a needle punctured skin. Then, one day, she gasped. The shot stung. “That freaking hurt,” she told the nurse, who assured her that just the morning before, she’d pricked that same patch of skin, which had remained as numb as it had been since June 6.
During the last week of July, Van Dyken-Rouen began to ease out of the brace she had detested so much. She finally got rid of it by the beginning of August, and she’ll wear a corset-like apparatus for lumbar support for a few weeks longer. And though her rehab didn’t change dramatically the moment she was discharged, by moving out of a hospital room, she’s creeping that much closer to a normal life.
For Van Dyken-Rouen, the long-term goal is to be as self-sufficient as possible. As an outpatient, she will eventually learn a variation on walking in which her legs will be strapped in braces and she’ll use crutches and those firing hip flexors to push her along. It remains to be seen whether that or her wheelchair will be a more effective means of movement, although Johansen says he believes she’ll eventually employ some combination of both.
“If those hip flexors start kicking in a little bit stronger, then that will really help her to be able to participate in upright, over-ground kinds of activities,” Johansen says, “[but] probably not walking like she did before.”
And that’s the rub: Johansen refuses to say his patient will never walk again, but he’s not one to set outsized expectations, either. For injuries like Van Dyken-Rouen’s, he says, most of the recovery comes in the first six months, which means that time is still on her side. “You kind of prepare for the worst but hope for improvements over time,” Johansen says. “There’s a delicate balance between reality and hope. She is realistic in the day that she finds herself in, but I know that she still holds out hope for improvements over time. … We’re not going to take that away from her.”
Van Dyken-Rouen is realistic. “Will I ever walk under my own power again?” she asks. “I don’t know. I want to. But the chances are probably slim to none.”
Even so, she allows herself to occasionally dream out loud. “If I ever walk again …” she’ll begin, and then she’ll shift back to talking about therapy, about how she’s moved to the east side of the hospital, where nurses force her to do everything for herself. It can be difficult, but she loves it.
These days, Van Dyken-Rouen makes her own coffee each morning. She’s gone kayaking and to a Rockies game, to the zoo and to the grocery store. She’s learned how to navigate daily life from a new perspective, one where she must ask someone taller to reach for the salsa on the top shelf. That doesn’t stop her, though, from planning more adventures, from cooking her favorite Mexican chicken recipe for her family. “It was delicious,” Becky exclaims at the mention of that meal, and you get the sense that even if it had tasted like sawdust, she’d have asked for seconds. She’s just that proud of her daughter for making it.
Mexican chicken is just the beginning of what Van Dyken-Rouen has planned. She was about to host a luau pool party before her accident, and she’s going to finally throw it when she returns home. These are the goals the former Olympian sets: parties, playing with her dog, floating in her pool. But there are bigger ideas, too, and challenges, with the most amazing rationale behind them.
Before the accident, Van Dyken-Rouen was sometimes afraid to challenge herself athletically. Sure, she was in tip-top shape thanks to Crossfit and running, but she always worried about failing at physical endeavors. “When I’m able-bodied, and I go rock climb and I fail, that’s six-time gold medalist Amy Van Dyken,” she says. “She’s not very athletic. Now, as a paraplegic, if I go do the same thing, it’s oh … it’s understandable. I have more leeway.”
“I want to do everything.”
As Van Dyken-Rouen wraps up her therapy class, a middle-aged man wheels into the room, accompanied by his young son. The boy is thrilled to see Van Dyken-Rouen, to share that he’s been monitoring her media coverage, that newspapers in Eastern Europe seem especially interested in her recovery. The two agree that if the boy finds anyone in the press speaking negatively about her, they’ll team up to hunt the perpetrators down.
Once that plan has been hatched, the father interjects. He arrived here at Craig after Van Dyken-Rouen, and she’s watched him improve for weeks. What he’s about to tell her, though, will shake her. On the morning before his accident, he happened to turn on the news. There he saw the story of the Olympic swimmer and her ATV crash, of Van Dyken-Rouen struggling to hang on. And what happened next? While he was out on his ATV he suffered his own spinal cord injury.
“He kind of has my heart,” Van Dyken-Rouen says later, as she explains that her tragedy happened for a reason. She can’t bear to think of more people going through what she went through, and she’s decided to control her message, to beam to the world through her cell phone what it looks like to recover from a spinal cord injury. If the story of her accident alone doesn’t steer people toward safety, maybe her hundreds of social media posts will. If anything, they’ll show the world what it looks like to recover, to be wheelchair-bound, to live in spite of a handicap, not with one.
“There is a reason that you’re here,” she tells herself. “Be thankful. There’s a reason that the accident happened.”
Van Dyken-Rouen remembers very little from the hours immediately after the accident. Her husband is thankful. He’ll bear that burden. But there’s one thing that does stick in her mind, and whether it’s a memory, a dream or some strange misfiring of neurons as her body went haywire, she’s unsure.
“There was a time when Tom found me, and I was facedown and not breathing,” she says. “I do remember during that period, there was something. I was very enclosed into a tunnel. It was green, and I almost thought that it was trees and plants. It was very beautiful and serene. I just remember being very comfortable and very happy at that moment. What was that? I don’t know. Could it have been I just got hit in the head really hard, and the neurons were firing? Could have been.”
This is not a story she volunteers readily. It does not help anyone. It does not educate or empower. That’s what Van Dyken-Rouen values most, the voice she’s been given to talk about even the most gruesome aspects of her injury. And some strange recollection from a green tunnel, she can’t explain that. No one’s ever going to explain that. But it matters. It matters because now she wheels herself off to church at the hospital while her family raises a collective eyebrow. This is new. She was never spiritual, but at the root of her recovery and advocacy is a question. Van Dyken-Rouen is adamant that she shouldn’t be here. Her doctor admits that to see someone progress the way she has is rarer than rare. She calls it a miracle. Those who know her call it will. But still, the question lingers.
Why am I here? Not a day goes by that Van Dyken-Rouen doesn’t wonder, and with every stretch, every bead of sweat, every swear that she’ll get better, she begins to answer the question that is her life.