When August O’Niell, a member of an elite special forces group, woke up from routine surgery, it only took one look at his mother’s face to tell something went horribly wrong.

She was with the doctor. “Are you awake? Are you able to talk now?” the doctor asked. “I have woken you up halfway through the surgery. There was so much scar tissue …”

O’Niell had already endured 19 grueling surgeries in the three-and-a-half years since a rifle round mangled his leg while he was on deployment in Afghanistan. He woke up hoping this 20th surgery would finally allow him to have a functional knee. But he quickly learned his left leg would never fully function again.

The entire left side was mostly scar tissue. The skin, tendons and muscle were all adhered straight to the bone in one solid layer. Given the extent of the damage, a knee replacement was going to give him less than 14 degrees of movement.

“You will be in less pain, and I can put it in there if you tell me that’s what you want,” the doctor told him. “But I didn’t feel right putting that in there without telling you that it wasn’t going to be what we thought it was going to be at first.”

“There’s so much scar tissue in there, it’ll be impossible for you to have a functional knee.”

O’Niell was an Air Force pararescueman, a para-jumper or “PJ,” as they are known in the service. He was the elite of the elite, in charge of rescuing the most drastically injured troops, and even top special operators, in dire circumstances. He loved being a PJ, and wanted nothing more than to be back in the field, jumping out of helicopters and saving wounded comrades. The diagnosis he now faced was tough, but without missing a beat, he made up his mind.

“Don’t worry about it, I’m gonna have it amputated,” he said.

Dumbfounded, the doctor asked if he was sure. O’Niell was sure. After 20 surgeries and years of unsuccessful treatment, he was done with experiments.

He allowed himself what he called a “ten minute boo-hoo session.” It wasn’t so much about losing the leg, as it was learning this particular surgery was a fail. He had been looking forward to some relief from the constant pain of his injury.

But none of that mattered now. It was time to move on. He had seen troops with major amputations make remarkable progress on prosthetics in a little as six months while he was in rehab, and here he was after more than three years barely hopping along on crutches. He thought of the amputees he had seen running on prosthetic legs and had a moment of inspiration, and it occurred to him that if he could run again, he could be a PJ again.

That was all the motivation he needed to greenlight the removal of his leg.

A Faucet Of Blood

It happened when O’Niell was halfway through his deployment to Afghanistan on July 15, 2011. The U.S. had begun drawing down forces two days before, but the notoriously violent Sangin Valley was as deadly as ever. O’Niell and his team got a call that a group of Marines were under fire. Two were injured, one critically, after taking a shot in the chest. O’Niell’s team was headed back to base after working all day, but immediately turned around to rescue the injured Marines.

The PJs came onto the scene in two Pavehawk helicopters, one leading the other. They circled in shifts. One would provide watch and draw the enemy’s attention, while the other went into the zone to rescue the wounded.

As O’Neill’s helicopter was about to take a turn going in for the wounded, his team got word that another Marine had been hit. O’Niell was lead medic for the operation, and told his team leader to let the team in the helicopter behind them go into the zone, since it had three PJ medics on board, while they provided cover.

“So it’s better patient care, you know, one medic per patient,” O’Niell told the Daily Caller News Foundation.

O’Niell’s helicopter then flew over the zone, dropped smoke grenades and popped back up so the second helicopter knew where to land. The tactic has the dual purpose of attracting enemy fire, and was successful in doing so.

“It works like a charm,” O’Neill said. “We came up over the smoke and popped up and we caught all that fire. They started shooting up at our bird, and one of the rounds, when they shot up, bounced off the door where I was sitting in the left door. [It] bounced off the doorway and then went through both of my legs.”

O’Niell initially he thought a flare had bounced off the door and hit his knee. He looked over the edge of the chopper, and then the pain hit him.

“Ah, they shot me!” he yelled while grabbing the top of the Pavehawk to pull himself back. He saw a hole in the side of the leg of his pants where the bullet had entered. “It just looked like someone had turned a faucet on, it was pouring blood,” he said.

His team leader instinctively jumped towards him, putting one of O’Niell’s tourniquets on his legs. He was in critical condition, forcing the helicopter to return home. Fortunately, a second PJ team was deployed with Apache helicopters in tow when O’Niell returned. They were able to extract the Marines and take out the enemy forces in the area.

O’Niell was well known to the medical staff at the base. He and his fellow PJs would often help out with the injured between shifts in order to keep their medical skills sharp. The hospital pulled a surgeon to try to save O’Neill’s leg. He was woken up after the doctors fixed an artery, and informed he would be moved to Bagram air base.

“Not until I get my re-enlisting paperwork,” O’Niell said.

“Now that’s the type of dude we need!” a nearby officer said excitedly. O’Niell was told it was an Army general. The paperwork was there waiting for him when he got to Bagram. His brother, an Air Force officer who is now also a PJ, swore him back in while he was in Landstuhl, Germany for another round of surgeries.

“The Pipeline”

O’Niell wasn’t sure what he wanted to do when he joined the Air Force in 2005, but he was certain he didn’t want to be behind a desk. The Air Force occasionally gets chided as the “Chair Force” by the other services, and O’Niell knew he wanted to be doing something active. He became interested in the pararescue and combat controller jobs. A recruiter warned him that either would be tough, but assured him he wouldn’t see much of a desk.

The medical aspect of the PJs also appealed to O’Niell. His father, a retired Air Force major, had encouraged him to stay in college and become a doctor. He figured the PJs would keep him from a desk job and make his father happy.

“I just went with it,” O’Niell explained. “I joined it not really knowing anything about it except for we jump out of planes and do cool guy stuff.”

Most people have never heard of the PJs, even inside the special operations community. It’s a remarkably small force whose work is often overlooked.

They’re are a remarkable combination of expert shooters, skydivers and medics. A PJ can shoot with the top Marines, save lives like the best Navy medical corpsmen and jump out of planes like an Army Ranger. They even do their fair share of diving. This remarkable combination is why becoming a PJ is one of the hardest things you can do in the military.

“You need to be able to deal with all situations between the top of Mount Everest and 130 feet below the ocean — and in all environments, all weather conditions, all light conditions,” Nic McKinley, a former PJ, told TheDCNF. “And you need to be able to deal with them in a way that mitigates risk to the extent that you will live through those missions, because, you know, there is nobody to go get the PJs if the PJ’s gonna patrol.”

Training for the group, known as “The Pipeline,” has one of the highest attrition rates of any program in the armed forces. O’Niell started training in a class of 110. Nine would make it through. For McKinley, that was a big draw factor.

“I’m a big data guy,” he told TheDCNF. “I really like the numbers and the facts, and I don’t like your opinion.”

On the basis of data, McKinley found the PJs to be the toughest. “You know, they can get into arguments about why, or any of the subjective stuff, but the objective data shows that it’s harder,” he told TheDCNF.

Special operators often debate about who is the toughest, but one thing is clear: when the SEALs, Green Berets and Marines need saving in the worst conditions, they call the PJs.

The training puts a massive strain on your mental strength.

“You can’t just have a high level physical performance and ride on that, you also have to be able to think at a high level,” McKinley said. “Pararescue teams expect you to be able to do everything, and if you can’t do it at a high level, you need to go succeed elsewhere.”

The entire process takes between two and three years. After basic training, a would-be PJ starts “The Pipeline” with an indoctrination course at Lackland Air Force Base, which consists of ten weeks of intense physical training including obstacle courses, running and swimming.

“That’s where they test your mental and physical limits … push every button they can,” O’Niell told TheDCNF.

No aspect of indoctrination training so utterly punishes the mental toughness of a PJ than “The Pool.” Technically known as “water confidence training,” the Pool is known for chewing up even the most elite athletes in the program.

Would-be PJs are expected to swim laps under water, tie complex knots at the pool bottom, bob up and down with hands and ankles tied (an exercise known as “drown proofing”) and wrestle underwater with an instructor while not being allowed to fight back, according to former PJ Matt White. His solution? Just don’t breathe.

“When your fingers go number tying a knot, you can panic,” he wrote in a piece for Task and Purpose. “Or you can relax. When an instructor pushes you to the bottom of the pool and stands on your head, what can you do? You can quit. Or you can relax.”

PJs who survive indoctrination go on to a combat diver course in Panama City, Florida for six weeks, then to survival school in Spokane, Washington. Next they pay a visit to Army Airborne School, where they learn to jump out of planes, before heading to either Army or Navy free-fall skydiving school, located in Yuma, Arizona and San Diego, California respectively.

Once a PJ candidate is a honed warrior they attend 37 weeks of various medical courses. Trainees are expected to get their national paramedic certification within two months of medical training, a task which normally takes six months.

The Pararescue Recovery Specialist Course puts everything a PJ trainee has learned together in a 24-week course which includes shooting, jumping and full mock mission profiles. Upon completion, a PJ is given a maroon beret and assigned a team. A PJ is then expected to to do on the job training with his team to become mission qualified.

O’Niell deployed to Afghanistan with about 20 people rotating in six man teams. He recalled flying approximately eight missions per shift, all of them being worst case scenarios. He acknowledged that war is terrible, but said he loved Afghanistan because he got to do his job.

“It’s very satisfying when you have a guy [that] easily ten minutes later … would’ve been just dead, and you were able to get him, get pain meds onboard, get blood onboard, and see this guy who wasn’t even responding all of a sudden start blinking up at you and you’re like: ‘Hey man, you’re going to be good,'” said O’Niell. “And then you go and check with the hospital, they’re like ‘Yea, he’s on his way home,’ and it’s just awesome.”

When asked how many people he’s saved, O’Niell said he never kept count.

Road To Recovery

His job cost him a leg and years of pain and surgeries, but O’Niell is laser focused on returning to the fray. There was not a hint of regret or doubt in his voice when he recalled his harrowing experience to TheDCNF. He detailed his injury like the challenges presented by one of his missions, by focusing on solutions to problems.

Step one of O’Niell’s road back to the PJ teams was to get acquainted with his new prosthetic leg. Fortunately, the Center for the Intrepid fitted him with one of the most advanced models available.

“It’s an Ottobock X3, and it’s awesome,” he said.

The leg is completely waterproof, and comes with an app that lets O’Niell switch between four modes suited for various kinds of situations. He detailed it like a piece of high-tech military equipment.

“I’ve got a boxing mode, which basically doesn’t allow the knee bend more than 14 degrees, that way I can throw a punch and don’t have to worry about the knee buckling. And I can, you know, bob and weave on it,” O’Niell said. “I’ve got a running mode, I’ve got the basic walking mode which is just the everyday mode, and I’ve got a jump mode, which keeps the knee from bending past ninety degrees while I’m jumping so that way I can fly flat dumb and happy, as we say, and not worry about backsliding.”

WATCH:

His injury was not the least bit apparent when I met him for the first time in an Air Force office in Manhattan, except for the presence of his service dog, Kai. O’Niell walked through the door and shook hands much like he probably did before the injury.

Most amputees usually require approximately six weeks of walking on their new prosthetics before they take them home. But O’Niell was taking his home in only two. He noted that’s because most amputees have trouble trusting the devices to hold their weight.

“I attribute it to the fact that I’ve trusted my life on much sketchier pieces of equipment,” O’Niell joked. Falling to his knees due to a prosthetic is nothing when you’re used to jumping from planes with parachutes made by the lowest bidder.

O’Niell’s sense of relief after the amputation and prosthetic was practically immediate. Even before the prosthetic was fitted, he recalled his fellow PJs looking at him strangely after the amputation when they found him moving around his thigh. He hadn’t been able to move the leg for years before, so this was a victory.

“The pain I was living with was awful,” he said. “I don’t take pain meds so it became a normal way of life, just living with pain all the time and it’s miserable. It’s miserable. So yeah, it was definitely awesome waking up and immediately not feeling that pain.”

The next step to getting back to the job he loved was requalification. By November 2016, O’Niell had qualified in calisthenics, swimming, parachuting, ropes, alternative insertion, diving and was close to reaching the requisite run time. He has been working on mission profiles as well, in order to learn how to adjust to his new leg.

O’Niell’s fellow PJs have been extremely supportive during his recovery. They’ve kept him up to date on any new tech or kit that has been incorporated since his injury, and asked him when he is coming back to the teams. He even had training plan offers from five or six team chiefs. He noted he’s unsure about their motivations, but nevertheless, he remains focused on his goal.

Fellow injured airmen have also been a source of strength and friendship. Thanks to the Air Force Wounded Warrior Program, O’Niell has developed a close-knit group of friends who refer to themselves as “The Order of the Pineapple.” He noted the origin of the name is a long story, but that not a day goes by that they don’t talk to each other.

Additionally, his service dog Kai has served a crucial role in his recovery. K9 Soldiers in New Jersey gave him the German Shepherd on Veteran’s Day 2013, and he has relied on him ever since.

“Mentally, I was in a real crappy place when I started reaching out to get him, and then after getting him, he’s just made my outlook almost one-eighty,” explained O’Niell. “I’m inherently a really happy person anyway, so when I’m depressed, I’m very depressed … because a lot of things have happened to make me very depressed.”

Kai can sense when O’Niell is depressed or angry, and will come put his head on his lap or go for a walk with him, immediately putting O’Niell in a better mood. He also helps with bracing and stability and will block people from invading his personal space. Kai also can do smaller tasks, like getting O’Niell his phone and keys when he doesn’t have the prosthetic attached.

“He’s not a retriever and he absolutely hates doing it, but he will do it,” joked O’Niell.

Kai goes to work with O’Niell, and has become a big hit with the other PJs. He inspired a team in Alaska to buy their own dog so they can keep up morale abroad. O’Niell hopes to bring Kai on his next deployment. The German Shepherd won’t be tagging along on missions, but he would be waiting for him when he gets home.

The First Of His Kind

Other special operations forces have rejoined their units after an amputation, including members of the Army Special Forces, Marine Special Operations Command and Navy SEALs. Advances in medical science and prosthetics have allowed many troops to return to duty after amputations. More than 16 percent of amputees had returned to combat in the early 2000s, up from 2.3 percent in the 1980s. But O’Niell would be a first for the PJs and the Air Force.

He has every intention of getting back in, and he doesn’t plan to leave any time soon. He reenlisted in the beginning of 2015, and plans to do at least another five years after his contract runs out.

“The majority of people who want an amputation, they aren’t very crazy like I am, so they’re just kind of like ‘Yeah, I’m done,’ and rightfully so,” he said.

O’Niell’s remarkable story has also come with a great deal of unexpected fame. He has competed in both the Warrior Games and Invictus Games, the latter of which earned him a profile in ESPN. He also led the Atlanta Falcons onto the field during the Super Bowl, carrying an American flag as he ran in front of thousands on his prosthetic. And Paramount Pictures bought a pitch on O’Niell’s story in March, so a feature film could be in the works.

O’Niell told TheDCNF he’s “excited” for the press coverage to end, but he’s also pleased his story brings attention to PJs. “I don’t mind doing this type of stuff because it highlights the career field and that’s awesome,” he said.

For now, he is continuing strength training and Pararescue qualification training at Hurlburt Field Air Force Base in Florida, where he is expected to join a team sometime next year if all goes well.

has been sent to begin requalifications so he can join a team at Hurlburt Field AFB, hopefully sometime next year. Assessments with the teams have been positive, and aside from some issues with stress fractures, he has no complaints.

O’Niell hopes to be back to jumping out of planes and saving lives as early as the end of 2017.

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