The first time around, Clint Malarchuk did not want to die. The second time, 19 years later, he didn't give a damn.

"Look what you made me do," Malarchuk said to his fourth wife, Joanie, right after sending a .22-caliber bullet through his chin, tongue, several teeth, roof of his mouth and a nasal cavity where it came to rest just millimeters from his brain.

Joanie, who met her husband in San Antonio in 2004 when he worked as goalie coach of the AHL's Rampage, started the mental checklists of being a widow.

"It became almost like an out-of-body experience at that second," she said. "I don't really know how I was able to get on my phone and dial 911. I just went into instant shock when it happened. I thought I was witnessing my husband's death."

In Malarchuk's brain, one awash in booze and self-pity, that would have been fine. As an 11-year NHL veteran goaltender for three different teams, Malarchuk didn't care about another comeback.

On March 22, 1989, the Buffalo Sabres had a game that night at The Aud against the St. Louis Blues, and starting goalie Clint Malarchuk was feeling pretty good. He'd been the centerpiece of a trade-deadline deal between Buffalo and the Washington Capitals 16 days before, a guy the Sabres gave up a former first-round pick (Calle Johansson) to get.

Sure, he was still prone to obsessive thoughts about his career, about his relationships, about a lot of things.

This was the same person who spent a month in the hospital as a 12-year-old after experiencing bouts of extreme anxiety when his father had been locked out of the house by his mom following one too many drunken, violent outbursts. Young Clint remembers Mike Malarchuk trying to break back in using a hammer on a window. From that point on, the sound of shattering glass wouldn't leave his head.

But by this stage, Malarchuk thought he'd conquered that garbage. With nearly seven years already in the NHL and the promise of several more, life was good for the man whose 10-gallon hats and Wrangler jeans spawned his nickname—the Cowboy Goalie.

Everything about the night had been routine. Malarchuk warmed his reflexes throwing a rubber ball against the cement wall outside the Sabres dressing room, a trick he learned from Russian legend Vladislav Tretiak a few years before at a goalie camp. He spent the final few minutes before the puck dropped visualizing whatever might come, be it a wrist shot from Brett Hull or a deke move from Bernie Federko.

But a skate blade to the jugular vein on the right side of his neck? No, Malarchuk never saw that coming.

It happened with 4:43 left in the first period, the Sabres up 1-0. The Blues' Rick Meagher picked up a loose puck in the left corner of the Sabres zone, with numbers. He centered a pass to Steve Tuttle, charging the net with Buffalo defenseman Uwe Krupp trying to keep pace. Krupp had no choice but to try to muscle Tuttle, and at 6'6", 235 pounds, this was not hard to do against the 6'1" rookie.

Krupp leveraged Tuttle off his feet. Not a lot, but with Malarchuk dropping down to play the pass, Tuttle's right skate became perfectly horizontal with the right side of his neck. The carbon steel blade sliced clean through the soft, outer flesh and then through the jugular vein (footage of which is still circulating on the Internet).

With every pulse, fresh blood shot out from a six-inch open wound. Malarchuk reflexively took off his mask and clutched his throat.

"I thought, 'Well, this is it, this is how I'm going to go,'" Malarchuk said. "Then I thought, 'My mum [Jean] is watching,' because she had a satellite dish that got all the games, and I wanted to get off the ice as fast as I could because I didn't want her to see me die right there on TV."

The whole thing happened right in front of Sabres veteran Dave Andreychuk.

"People were throwing up in the stands," Andreychuk said. "It was traumatic for everybody. We heard not long after that he'd make it, so they continued the game. But that shouldn't have happened. His blood was still all over the ice. Nobody cared about playing anymore. Nobody cared that we lost the game."

In just a few seconds, a three-foot pool of blood formed in the crease. A Discovery Channel episode that re-enacted the incident showed it would have taken two minutes, 14 seconds for Malarchuk to bleed out completely. It took Buffalo trainer Jim Pizzutelli, a former combat engineer in the Vietnam War, just 14 seconds to get to Malarchuk and begin applying pressure to the severed jugular, to keep as much blood in his body as possible.

Malarchuk was put on a stretcher. As Pizzutelli cut off Malarchuk's pads and chest protector, one of the Sabres team doctors took over pressing on the wound. Another literal helping hand, that of Sabres equipment man Robert "Rip" Simonick, squeezed one of Malarchuk's, telling him to hang on. Malarchuk still thought it was all over.

"I asked Rip to call my mother and call over the team chaplain," Malarchuk said. "I figured I really needed him this time, but he had taken the night off."

At Buffalo General Hospital, doctors were able to thread 300 stitches into his neck and stanch the wound. The cut had stopped just short of the internal carotid artery. Had that been sliced, Malarchuk almost certainly would not have survived.

The next day—yes, the next day—Malarchuk sat for a press conference in the hospital, saying he hoped to be back in net as soon as possible.

"When you get knocked off the horse, you get back on," Malarchuk said, his neck heavily bandaged.

Two days after the accident, Malarchuk walked back into an empty Memorial Auditorum with Pizzutelli, right to the same crease. Ten days later, incredibly, Malarchuk was in the same crease for real against the Quebec Nordiques.

"I thought I could just go on like nothing ever happened, because that's who I was: the Cowboy Goalie, the tough guy," Malarchuk said. "I thought I could handle anything that came my way now.

"Not quite, it turned out."

On Oct. 7, 2008, Clint Malarchuk, a two-time NHL All-Star and then-goaltending coach for the Columbus Blue Jackets, was lost.

"I just wanted the mental torment to stop. Joanie had left me the night before, staying at a hotel because I had been on another bender and just impossible to deal with. I basically stayed up all night and into the next day, just drinking and feeling like my mind was spinning right out of my head," Malarchuk said.

"I was drunk, not in a good mental state at all, and a rifle was nearby. When she showed up to check on me, because I wasn't answering her calls, I just grabbed it, put it to my chin and pulled the trigger."

If he'd put in one of the regular .22-caliber bullets instead of the "shorties" that each sat beside his rifle, Joanie Malarchuk never would have seen him alive again. If her cellphone hadn't been latched to her belt; had the iffy cellular range been acting up around their rural Gardnerville, Nevada, ranch that early fall day in 2008; had the town's paramedics unit been on another call at the moment...well, that would have been it for the Cowboy Goalie.

A 1995 study determined that suicide attempts with long-barreled arms such as rifles and shotguns to the head had fatality rates of 99 percent. Malarchuk, who made $180,000 a year as an NHL netminder in the 1980s but blew through most of it, is a 1 percenter again, but of a more spiritual kind.

A 30-day stay in a rehabilitation facility following his suicide attempt was the first step, and it wasn't an easy one.

"Just another shrink who will try to fill my head full of touchy-feely bullcrap," Malarchuk thought at first of Tina Galordi, the psychiatrist assigned to him at the facility in San Rafael, California.

He'd been through this stuff before, starting when he was a kid. The shrinks back then would try to make him talk about his feelings, but Malarchuk rode a wave of denial out after a few visits. They gave him antidepressants, but he'd stop taking them after a while and go back to the liquor bottle. A few drinks always seemed to calm the mind down better than any prescription drug, and besides, only weaklings relied on that stuff, Malarchuk thought.

"I'll just do my time, get out and resume my life just like before," Malarchuk said. "I had a counselor, a guy, at first, but I didn't like him. So they put Tina on my case. I thought she would be a waste of time for me too. I was mad at Joanie, blaming her for me being in this place in the first place. I hated everything about the place. I thought it was a prison for me."

Malarchuk belittled Galordi's methods and even stormed out of the facility after she told Joanie he needed a longer stay than 30 days. But with no cash and no credit cards on him to get back to Nevada, and with Joanie playing the tough-love method her own therapist recommended from a stay at the Betty Ford Center in California, Malarchuk had no place to go but back to the facility.

Soon after, Galordi handed him a 1997 book by Peter A. Levine titled Waking the Tiger: Healing Trauma. Boiled to its essence, the book argues that any unreleased emotions from previous trauma will keep a person in its grip and that humans should look more toward wild animals for cues as to how they are able to live effectively in a world with no artificial means of taking care of themselves.

Malarchuk, an animal lover who still has a part-time practice in horse dentistry, could relate to Levine's words. Galordi theorized that Malarchuk was still holding in all the trauma of the skate-blade accident. She went so far as to say she believed he was suffering from post-traumatic stress disorder.

Malarchuk thought it was malarkey, but Galordi persisted. It was foolish, she told him, that he was never assigned any counseling by the NHL or NHL Players Association. Part of that was his own fault, maybe, but Galordi believed the night in Buffalo was still playing havoc in Malarchuk's mind and nothing was in practical use to stop it.

Finally, the tough-guy facade started to give.

"I broke down in her office and kept on crying for about three days," he said. "She helped me realize that I was sick, not crazy. I was mentally ill, not mentally weak. I realized that it was OK to cry a little. I didn't have to be the guy anymore who thought he couldn't let anyone see any pain.

"I started to finally deal with the things I'd kept so bottled up for so long. I got on the right medication. I started to work on a better relationship with God. It all started to come flooding out of me. I finally realized I didn't have to do it alone anymore."

After a six-month stay, Joanie picked Clint up for the four-hour ride back to Gardnerville.

"He was back to being the man I first fell in love with, only better," Joanie said. "It seemed like a miracle."

Everywhere he goes, in what is now a second career as a speaker on behalf of various mental health organizations, Malarchuk sees old versions of himself.

"The hardest thing for anybody is to be honest with themselves, but as men we're taught not to show any emotion, to tough it out in hard times," Malarchuk said. "But it's not about being tough; it's about being honest. And one of the things about being real honest is saying it's OK to ask for help.

"Men don't like to do that, and it's something I want to help try and change, but for women too, for anyone who feels like things are hopeless."

In 2014, Malarchuk wrote a book of his life story, A Matter of Inches: How I Survived in the Crease and Beyond, with the help of journalist Dan Robson. He was so honest in reliving everything that it triggered some anxieties again, and he suffered a brief relapse with alcohol. But with the continued help of Galordi and adjusted medication, he said he has remained sober since.

Steve Ludzik, a former NHL player and coach who goes back to the Buffalo days with Malarchuk and is one of his closer friends, used to worry every time a call came from him or Joanie. Now, the worry is gone.

"I'm so happy for him," Ludzik said. "He's a special man, what I call a 'foxhole guy.'

"He's going to be remembered as more than a hockey player now, more than a guy who had that freak accident happen to him. He says it all the time now, 'I was put here for a reason, to help people out.'"

Now 55, Malarchuk receives numerous emails from people, especially men in his age group, thanking him for telling his story. He has hugged and cried together with countless people after his talks, he said. He wants to do a lot more, to make a bigger difference. But he also wants to keep a foot in hockey, which is why he serves as a part-time, unpaid coach for a Nevada junior team, the Tahoe Icemen.

"I've always loved being a coach, and this has given me something that had been missing the last couple years, which is a role in hockey," Malarchuk said. "But they know I'm on the road a good deal in talking to people. The demons have given me something to speak about, that I've overcome.

"And I do work at it. I don't look at it like, 'I'm cured, everything's all fine now.' I'm going to continue to struggle and battle. But I feel great today. I feel I've come a long way as a person. And I'm so very lucky to have Joanie still in my life. She's the love of my life."

A man so full of anxiety, depression and outright rage that he once pulled off the road into a random gym to pick a fight with the two biggest guys he could find now meditates daily to relaxing rhythms of his own breath.

A man who once showed up to the morning skate as goalie coach of the Florida Panthers in a bloodied shirt from a fight-filled bender at a bar the night before now regularly attends AA meetings and hasn't had a drink, he says, in nearly two years.

"He's always been such a strong-willed person, but sometimes that was directed in the wrong areas before," Joanie said. "I think now it's directed in all the right areas. He knows he can't do everything on his own anymore. He asks for help now, and he never did that before."

His marriage, once marked by obsessive thoughts Joanie might leave for a former juice-head bodybuilder boyfriend, is now one of mutual trust. A man who says he never pictured himself as anything but "tortured in the head, flat-out crazy" now travels across North America speaking on behalf of mental health organizations.

Now, people come to Clint Malarchuk for help. That he's still around to give it amazes him more than anyone.

After escaping a seemingly sure ticket to the hereafter, Malarchuk is fully in the here and now.

"This time, I made better use of my second chance," he said. "I've got real purpose in my life now."

Adrian Dater covers the NHL for Bleacher Report. Follow him on Twitter at @adater.