Legs strapped down, wires and tubes jutting from underneath her blankets, Amy Van Dyken-Rouen began to weep.
An accident on an all-terrain vehicle 12 days earlier left the decorated Olympic swimmer paralyzed and headed toward an uncertain future, yet these were not tears of sadness or anguish.
They were tears were of joy, for what she still has, not what she lost.
"Yes, this injury sucks and yes, things hurt, but I'm alive and I'm so thankful to be alive, so that's why I can be positive about it," Van Dyken-Rouen said. "It helps get me through the pain."
A six-time Olympic gold medallist, Van Dyken-Rouen was injured when the ATV she was driving hit a curb and sent her hurtling over an embankment near Show Low on June 6. The accident left her paralyzed just below the waist, in intensive care for more than a week and with an uncertain prognosis.
As someone who has been active all her life and an athlete who was among the best ever in her sport, the possibility of spending the rest of her life in a wheelchair could have been a devastating blow.
Instead, Van Dyken-Rouen attacked her new life with the same vigour she had as a world-class swimmer.
Smiling through gritted teeth as she fought through brutal pain and restless nights, she brightened the day of everyone around her at the hospital with her positive attitude and people around the world with her upbeat posts on social media.
Now, after nearly two weeks in a Scottsdale hospital, Van Dyken-Rouen is headed toward the next phase of her recovery.
The 41-year-old loaded onto a medical transport flight Wednesday to Colorado, where she will continue rehabilitation at Craig Hospital in her hometown of Denver.
"A severe spinal cord injury with a complete loss of motor and sensory is a very difficult challenge for any patient, however in the hours after her operation, she was smiling," said Dr. Luis Manuel Tumialan, Van Dyken-Rouen's neurosurgeon. "She wasn't smiling because it was easy. She was smiling because of the fortitude of her inner person, something I haven't seen in the 14 years I've been doing this.
"The past 12 days, she literally walked through hell with a smile on her face, the likes of which I have never seen."
Van Dyken-Rouen's injuries were devastating, nearly fatal.
When her husband, former Denver Broncos punter Tom Rouen, found her, Van Dyken-Rouen was lying face down and not breathing. She began to breathe again after Tom lifted her head and was airlifted to a Scottsdale hospital after being stabilized by emergency personnel.
Severed spinal cord
Once at the hospital, doctors discovered she had a fracture dislocation of the T11 vertebrae, which had subluxed almost entirely over the T12 vertebrae. The dislocated vertebrae also severed Van Dyken-Rouen's spinal cord and caused a spinal fluid leak.
Because of the severity of Van Dyken's injury, Dr. Tumialan told her to say goodbye to her husband because there was a chance she should not make it through surgery.
"It was one of those things where I looked at my husband and said, 'I love you, goodbye, please continue on with your life,"' Van Dyken said.
During more than six hours of surgery, Dr. Tumialan moved Van Dyken-Rouen's dislocated vertebrae back into place millimeters at a time to prevent a potentially-fatal rupture of her heart. He drilled screws into four vertebrae, inserted rods to stabilize her spine and patched the spinal fluid leak.
The surgery was designed to stabilize not restore function, and Van Dyken-Rouen said she is still unable to feel anything from about her pubic bone down.
She still faces an arduous road of rehabilitation and long odds for ever walking again, but will not back down whatever happens.
In the short term, Van Dyken-Rouen plans to buy the best wheelchair available, plaster it with skull-and-bones stickers, paint it purple and dye her hair to match.
Long term, she will do whatever it takes.
"It's almost like a rebirth," Van Dyken-Rouen said. "I get to learn how to do everything all over again and I'm anxious to do that. It's time to start so I can get back to Arizona and continue my life -- start my new life, I guess.”