This article contains graphic descriptions of injuries.
Kristen Kilpatrick could see the propeller blades flashing in front of her and feel her body being sucked in by the pontoon boat's powerful motor.
"Breathe," the teenager commanded after she hit the icy water and curled up in a ball. "I thought I was going to die."
It was around 6 a.m. a year ago in May when Kilpatrick and some college friends went to her parents' ranch near Hico to kick off the summer.
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Kilpatrick had been fishing off the nose of the boat when it lunged forward, sending her plunging into the water.
Suddenly, her friend Jamie Jennings felt a bump under the boat.
The impact broke the propeller and slammed Kilpatrick to the bottom of the man-made lake.
When she resurfaced, two friends tried to help her back into the boat.
Kilpatrick grabbed the rope ladder with her left hand, then tried to pull herself up.
"But when I went to lift up my right arm, there was nothing there," she said.
Her friend Taylor Hohmann called 911 without knowing how badly Kilpatrick was injured.
She soon found out.
The blade had sliced into Kilpatrick's arm below the elbow, leaving a mangled mess of tendons, muscle, arteries and bone.
"It looked like hamburger meat," Hohmann said. "It was all ground up."
Hohmann, 19, immediately tied a belt around Kilpatrick's shoulder and made a sling from her jacket. The pressure, along with the cold water of the lake, slowed the bleeding. As they headed to the shore, Kilpatrick asked whether her fingers were attached.
Hohmann's effort to apply a tourniquet was the first of what Kilpatrick considers a series of miracles that occurred that morning.
Although she's a nursing major, Hohmann said that didn't help a bit.
"All the credit goes to the Man above. He gave courage to do what we had to do," she said. "In the back of my mind, I was telling myself there's no way this girl will have an arm."
A mother's call
They were in a remote area and had traveled on dirt roads to get there. No one could tell the 911 operator exactly where to send help. It was amazing they were even able to pick up reception from their cellphones, Hohmann said.
When they got to the shore, the group packed Kilpatrick into an SUV and headed toward a road leading to Hico, where the 911 operator had told them an ambulance would meet them.
On the ride there, Kilpatrick remained conscious except for a moment when she slumped down and became silent.
Hohmann said she couldn't find a pulse but kept talking to Kilpatrick until she snapped back.
Once they moved Kilpatrick into the ambulance, Jennings insisted on riding with her as they headed to the helicopter for the 100-mile ride to Parkland Memorial Hospital in Dallas.
"The whole time going there, I could hear Kristen screaming," said Jennings, who had to sit in the front seat so paramedics could work on her friend.
But as Kilpatrick was being moved, a paramedic told Jennings that her friend was trying to tell her something.
"She was waving at me," Jennings said. "I knew then she was OK."
Back in Fort Worth, Betty Kilpatrick got a phone call that her daughter had been in a boating accident, but she knew little more. When she arrived at Parkland, she got her first inkling of how bad it was.
While waiting to see her daughter, a nurse approached her.
"As far as her life goes, she's going to live," the nurse said. "But as far as the arm goes, we don't know."
Kilpatrick came as close as anyone can to having a traumatic amputation, without the arm coming off, said Dr. Joseph Borrelli, chairman of orthopedic surgery at the University of Texas Southwestern Medical Center at Dallas.
"She easily could have bled to death from this injury," he said.
As he examined Kilpatrick's mangled arm, Borrelli determined what was salvageable and what was not.
"The radius -- a bone in the forearm -- was basically chopped up in six pieces," he said. "I suspect the propeller hit her more than once."
Pieces of the ulna, the bone that is responsible for strength in the forearm, were missing.
The arm was attached by some skin, tendon, nerve and artery.
Although Borrelli had recently been in Germany treating wounded American troops, Kilpatrick's arm was as bad as the worst battlefield injury, he said.
Reattaching muscle, tendon, bone and flesh would be like "sewing rope to chopped meat," he said.
But before he could do that, Borrelli had to remove debris, most likely collected when Kilpatrick hit the bottom of the lake.
In the past, high pressure water guns were used to remove contaminants and debris, but then it was discovered that the method drove bacteria deeper into tissue. Instead, Borrelli used a low-pressure irrigation system that allowed water to flow through the wound much like a faucet left running.
During the four-hour surgery, Borrelli used nearly two dozens screws and two plates to put her arm back together. It helped that she didn't lose much skin and the major nerves were stretched but not cut, he said.
Arm amputations are uncommon, with Borrelli treating three to five such upper-extremity injuries a year.
When Kilpatrick came out of the operating room, all her friends were waiting for her. As word spread, more students crammed into the waiting room.
Strangers who had heard about the accident prayed for her recovery.
"As horrible as it has been, such amazing good things have come out of it," Betty Kilpatrick said.
Two hours after she left the operating room, Kilpatrick was able to move her fingers.
Four days later, she went home.
At first, no one knew whether she would ever be able to cut up food or write with her right hand.
So as a show of support, her friends and family started using their left hands. When she came to dinner one night, everyone at the table had a fork in his or her left hand.
Although rehab helped her learn to use her left hand, Kilpatrick was determined to use her right arm again. She was driven by two great loves: horseback riding and painting. At Texas Christian University, she was a child development and art education major and had no intention of changing her degree plan.
Before the accident she had been a competitive rider and was determined to ride again.
Without her parents knowing, she slipped away to her family's ranch and one day got on her horse and rode around.
When the fall semester started, she insisted on moving into the Tri Delta sorority house, despite waves of pain and night terrors. Everything from blow drying her hair to carrying books was challenging.
"We would see her struggling to button her pants and try to help her," Hohmann said. " She would say 'I'm going to learn how to do things.'"
But there was one thing that she could not bring herself to do: look at her injured arm.
"My dad had photos of my arm, but I never looked," she said. "I'd see people's reactions, and that was enough."
Still, she fought back her fears and learned to accept the injury.
Her friend never imagined that she would come so far in less than a year.
"We were just grateful that she had her hand," Hohmann said. "But then we would see her drink a drink, or drive or do the things we take for granted."
With time, Kilpatrick regained her confidence. Slowly, things just came back to her.
A few months after the accident, she was sitting in class when she started to doodle.
"I looked down and the pen was in my right hand," she said.
She has been writing with it ever since.
JAN JARVIS, 817-390-7664