Aimee Copeland, the Georgia student who lost her leg to a rare flesh-eating infection after a zip line injury, is smiling and laughing, according to her family. But the 24-year-old can't remember the events that landed her in critical condition, and faces an extreme psychological adjustment when she does.
"She will learn about the loss of her beautiful leg. She will discover that her hands lack the dexterity and tactile response she has known all her life," Copeland's father, Andy Copeland, wrote in a blog dedicated to his daughter's recovery. "How would you respond in such a situation? I think that moment will be one of horror and depression for Aimee."
Medications designed to keep Copeland calm have blurred her memory of the May 1 accident that cut open her calf, inviting the life-threatening infection that claimed her leg and threatens to take her fingers. But despite her remarkable physical recovery, the psychological wounds of realizing she lost a limb could be harder to heal.
"I want to ask everyone to pray for my child's psyche and for her self-awareness to not be focused on her physical being," Andy Copeland wrote. "Please pray that she will have understanding."
The ventilator pumping oxygen into her lungs makes it impossible to speak. But soon, the breathing tube will be removed, allowing Copeland to ask questions.
"As wonderful as that moment will be for us, it will also be the time that Aimee receives all the answers about her condition," Andy Copeland wrote.
For Copeland, an active and ambitious graduate student, news of the amputation could trigger grief rivaling the physical pain of the infection, according to Dr. Harsh Trivedi, chief-of-staff at Vanderbilt Psychiatric Hospital in Nashville, Tenn.
"For someone who was in good health to be in this situation all of a sudden, that's a pretty substantial loss," he said, alluding to the physical loss of a limb as well as the loss of opportunities in life. "There's almost a grieving process that needs to occur, and that can lead to feelings of depression over how different life is now compared to literally two weeks ago."
Remembering details from the zip line accident also raises the risk of post-traumatic stress disorder, a condition marked by haunting flashbacks, Trivedi said.
But much of how Copeland reacts to the news depends on how it's delivered.
"Some people like to be told flat-out. Some people like to hear a little at a time," Trivedi said, adding that Copeland's questions can help doctors gauge her readiness. "Some people are just happy to be alive."
The bacteria that triggered the infection, Aeromonas hydrophila, thrives in warm climates and fresh water like the river where Copeland was zip lining with friends. The common germ rarely causes flesh-eating disease. But when it does, the infection carries a fatality rate upward of 60 percent, according to 2010 report published in the journal Clinical Microbiology Reviews.
"The words I hear from the medical professionals to describe Aimee's continued recovery are 'astonishing,' 'incredible,' 'confounding,' 'mind boggling' and 'unbelievable,'" wrote Andy Copeland. "All those are fitting words. My favorite word is 'miracle.'"
While Copeland's physical recovery has astounded, her psychological recovery is hard to predict, according to Trivedi.
"A lot of it will have to do with what kind of progress she's making medically. Each time she has a complication it will make it more difficult to move on from the event," he said. "This is more of a marathon than a sprint, and there will be good days and bad days."
Copeland, who was completing her masters in psychology at West Georgia University before the accident, may be more resilient because of her background.
"The fact the she was studying psychology and was interested in helping others may give her a positive outlook in terms of what to do with these new challenges," he said. "But it's a lot easier to give advice to other people than it is to take it ourselves."
Trivedi said Copeland's family, too, will need support in the days and weeks to come.
"Parents have hopes and dreams for their kids," he said. "Once they get over initial fact that she has survived, they'll start thinking about what it means for her and the rest of her life. That's a sense of loss, too. And they're going to grieve as well."