War and Amputation (long)

[Wayne Renardson]

One fine day Rodger O asked:  

R> Think she'll send the next one to save me from a bunch of inept 
fumbling.  Even with the link I probably can't find the next article. 
Any idea when it will be published?  

Now. Here it comes......

Wayne Renardson
======================================

Moving Forward, One Step at a Time

By Tamara Jones and Anne Hull

A fat C-141 rumbles to a halt at Andrews Air Force Base. A gangplank 
is lowered from the belly of the plane, and the Army's latest 
casualties from Iraq hobble or are carried to a waiting white bus, 
their gear still covered with fine desert dust.   

These medevac flights are now so routine that no cameras, no VIPs, 
await the wounded. Their welcome home happens at Walter Reed Army 
Medical Center, the nation's biggest military hospital, where doctors 
and nurses in camouflage fatigues wait at the curb to whisk the 
newest patients to the large exam room on the second floor. Here the 
soldiers are triaged with swift precision:   

"I need 10 of morphine!" a doctor calls out.  

"Are you weak in your right hand?" another asks.  

"Where does it hurt you now?"  

A 20-year-old private moans. In Baghdad, he camped out in a bathroom 
of Saddam Hussein's palace, stacking his Chips Ahoy on the shelves 
above the gold-ingot faucets. Now he lies on a gurney with shrapnel 
in his belly, beneath a balloon that says, "You're the Best!"  

Upstairs on the orthopedics ward, the beds are already filled with 
recovering casualties from the war in Iraq. There are different 
battles being fought on Ward 57, more private struggles. It's not 
about victory, but coping. Not about war, but its aftermath.  

First Lt. John Fernandez is a veteran of Iraq and by now a veteran of 
Ward 57, too. He reports to an exam room early one morning for his 
twice-daily dressing change. The former West Point athlete is 25, a 
newlywed whose wife, Kristi, hasn't left his side since  he arrived 
at Walter Reed six weeks earlier. They had been married less than a 
month when John shipped out. His hospital room would become their 
first home together; the nurses looked the other way when Kristi, 22, 
moved a cot next to John's bed against hospital regulations.  

Their usual wisecracking is on mute this morning, their faces drawn. 
John hoists himself onto an exam table and the doctors begin 
scrutinizing what is left of his legs.  

"I felt sick yesterday," John announces. "My glands are swollen."  

"Any fever, chills?" Ken Taylor wants to know. The chief orthopedics 
resident swabs his patient's surgical wounds with iodine. John is 
missing his foot and ankle on one side, most of his lower leg on the 
other. He knows that any infection in his body might find its way to 
his legs, putting him at risk for higher amputations. He already has 
had  a dozen operations.  

Surgeon Donald Gajewski notices some redness and leakage around the 
sutures on the left stump and Taylor searches for a sterile pad so he 
can clean it. "They're in that cabinet," Kristi says, pointing. By 
now, she knows this exam room like her own kitchen.  

As the headlines shift from the war in Iraq to the rebuilding of 
Iraq, a similar theme emerges at Walter Reed. Joe Miller, the 
prosthetist who will craft John's artificial sockets, joins the 
doctors in the exam room to decide whether John is ready to be sized. 

"I think we can start the right side," Miller offers. John can barely 
manage a wan smile at this consolation prize. "My stupid foot hurts 
again," he mutters. The severed nerves in his legs are sending 
frantic signals to body parts no longer there. Phantom pain, it's 
called, but there is nothing imaginary about it. John is in constant 
agony. His nonexistent feet throb. His lost toes burn. "Like Fred 
Flintstone when he stubs his toe?" Kristi wants to know, imagining a 
red-hot pulse. "Exactly like that," John says. Painkillers are 
useless.  

Miller heads for the door, reminding John to come to the prosthetics 
lab first thing the next morning so he can make a plaster mold of his 
right leg. The doctors interrupt. They'll want to see him first. And 
don't eat anything the night before, Taylor and Gajewski advise. If 
that oozing doesn't clear up on the left side, they're going to have 
to operate again to check for infection.  

So there's a chance he'll have a new leg tomorrow.

And a chance he'll lose more of the other. An Impatient Soldier Garth 
Stewart is no favorite among the nursing staff of Ward 57. They bring 
Jell-O, he wants applesauce. But the  mortar gunner who lost part of 
his left leg to a land mine near Baghdad isn't trying to be the 
perfect patient. He just wants to be the perfect soldier. That means 
getting out of Walter Reed, his home for the past three weeks.  

"I hate this place," Garth, 20, said.  "I'm sick of being sick."  

Garth doesn't want to wait for the Army's bureaucracy to decide 
whether he's fit for combat. He's ready to buy his own plane ticket 
back to Iraq to rejoin the  3rd Infantry Division. Even the dullest 
moments of war -- playing chess in his armored vehicle on the convoy 
to the Euphrates -- were exhilarating. He was part of something 
larger than himself. Now he watches cartoons from his hospital bed.  

He's got  to make himself strong again. One morning he lowers himself 
into his wheelchair to go to a physical therapy appointment on the 
third floor.  For the wounded soldiers on 57, physical therapy is a 
confrontation with pain and humiliation. In their minds, the soldiers 
are still elite athletes capable of marching 15 miles with 40-pound 
rucksacks. PT is the hard truth, with three-pound dumbbells.  

Garth scans the room for Isatta Cooks, the  physical therapist who 
works with amputees. She smiles when she sees him. Cooks, 28, is the 
rare employee at Walter Reed who does not find Garth prickly. Not 
that their relationship has always been smooth. Cooks once innocently 
started, "When you were in the Army . . . "  

"I am in the Army," Garth snapped.

And yet he has earned her admiration. One of the tools she uses is a 
full-length mirror. It helps the soldiers see how their bodies are 
leaning as they get used to having only one leg or one arm. Some of 
the new amputees refuse to look.  

When Cooks led Garth to the mirror, he stared, as if trying to burn 
the image into his mind.  

Today, Cooks wants Garth to practice walking. Sweat has gathered on 
his forehead from doing a set of leg-lifts and push-ups. Cooks hands 
Garth a pair of crutches. He blows a puff of air from his cheeks and 
stands. Cooks buckles a harness around his waist so she can pull him 
upright if he loses his balance.  

Taking a step, Garth extends his stump as if he still had a leg and 
foot. "Good, Garth," Cooks says, walking alongside. Garth travels 30 
feet and then proceeds out the front door of the PT room. A man 
sitting in the lobby averts his gaze into a magazine, not lifting his 
eyes until Garth passes.  

Garth makes it back to the table and lies down, winded. Cooks touches 
his bandaged stump. Garth gasps. "Ow, ow, ow, what are you doing?" he 
asks, desperately. He exhales and stares at the ceiling. He can feel 
someone watching him. A girl with auburn hair has paused beside his 
table. She is struggling on her own crutches. Garth reaches out, 
placing his large hand on her small one. A Visit From Hulk A blast 
injury is like no other wound, a war unto itself. The tremendous 
force of a land mine shears soft tissue from bone, then reverberates 
through the skeleton with an energy that has nowhere to go but up. 
The brain bears the final insult, whiplashing inside the skull. 
Hitting the ground hard can also cause a blast victim's brain to 
swell, bleed or tear without any outward sign of a head wound. When a 
land mine or grenade or mortar detonates, the sound waves alone can 
cause concussion.  

Danny Roberts, 26, is wheeling himself to the Traumatic Brain Injury 
unit, one gleaming hall down from his room on Ward 57. "There's 
nothing wrong with me," he fumes. The slight reservist from Green 
Bay, Wis., had just been getting his life on track, tending bar part-
time and settling on a major -- education -- when his Army reserve 
unit, the 890th Transportation Division out of Hobart, Ind.,  was 
deployed. He went to war with paperback classics in his duffel bag, 
never fired his weapon, then  was blown sky-high by a land mine while 
just standing around talking to his buddies one afternoon. His left 
foot is gone.  

Now a neurologist will flip through a tablet of drawings: What's 
this, and this, and this? he asks. A bench, a tripod, a seahorse. 
Danny is usually so good-natured that nurses on Ward 57 drop by his 
room even on their breaks to chat. But today he's exasperated, his 
lips pressed tightly together. He is sure his nagging headaches are a 
side effect of his meds, that's all.  

Deborah Warden and her associates patiently explain to Danny that 
concussions can be mild; he may not even realize he has any symptoms. 
They cover his eyes and ask him to identify smells: coffee, oranges. 
They break a cotton swab in half and tap his palm with the cotton, 
then the stick. Which is soft, Danny? Which is sharp?  

A technician attaches electrodes to Danny's scalp. An 
electroencephalogram will chart any abnormal brain waves. Verbal and 
written tests will chart concentration and memory. Once  that's  
done, doctors have promised discharge. Goodbye, Walter Reed, after 24 
days.  

When the examiners take a break, Danny goes AWOL. He rolls back to 
his room. Hulk Hogan is coming to visit! "I'll be there for that," he 
says.  

Minutes later, Hulk barrels into Danny's room, all cartoon swagger.  
"We just wanna thank you guys for going over and protecting us," the 
wrestler booms. "We love you, brother."   

He glances at Danny's stump. "They'll fix that flat tire and get you 
runnin' again," he says.  

"Put me in a headlock," Danny begs. His mother has a camera ready.  

Hogan declines, but poses with his arm around him instead.  

Word comes that a medevac plane departing Andrews Air Force Base the 
next morning can ferry Danny and his mom to Wisconsin. The brain team 
will call him with their findings, and he can get an artificial foot 
at the Veterans Administration hospital in Milwaukee.  

When Taylor comes to say goodbye at dawn, the orthopedist finds his 
cheeriest patient in a tearful fury. The charge nurse is insisting 
that he cannot go because he needs valid military ID to board the 
plane. Danny's was shredded by the blast.  

"You have any other ID? Driver's license?" Taylor asks.  

Danny shakes his head. "They're saying it's my fault, that I 
should've taken the initiative! I can't walk up there."  He jerks his 
head toward the nurses' station. " It's their job."  

"You're absolutely right," Taylor soothes.  

He confronts the stubborn charge nurse: This is ridiculous, he says. 
Danny didn't need ID to be flown here and shouldn't need  it to 
leave. Just send him to Andrews, they'll let him on. "I doubt it," 
the nurse says. But she hands Danny a lunch sack filled with 
narcotics and his blue plastic hospital card. "Maybe that will work," 
she suggests. Nancy Roberts points out that her son has his dog tags 
tattooed on his chest -- what more ID could anyone want?  

Taylor and Danny exchange goodbyes, and Taylor studies him for a 
moment.  

"You're the most down you've been since you came here," he ventures.  

"I know. Just frustrated."  

"It's the system. All right, my friend . . . "  

Downstairs, they load Danny onto a litter and a couple of uniformed 
soldiers carry him through the lobby to the white shuttle bus idling 
outside. At Andrews, no one demands proof that Danny Roberts is a 
soldier. World Without Sleep Walter Reed, named after the Army major 
who proved that yellow fever was transmitted by mosquitoes, launched 
into operational tempo the day the war in Iraq started. The pace 
didn't slow when the war ended.  

Some soldiers have been patients of 57 for so long that they are 
treating the nurses' station like a concierge desk. They request 
Chinese take-out menus and the number for pizza delivery. "They think 
this is a hotel,"  one nurse says. "I keep tellin' them it's a 
hospital."  

Which no one really can forget. A team of Army psychiatrists visits 
the soldiers daily. They ask: Are you sleeping? Are you eating? Are 
you dreaming?  

Most of the soldiers swear the war left no psychological imprints, 
such as the  lieutenant who is such a charming cut-up that he invites 
his doctors home to Houston for margaritas. "Every day above ground 
for that guy is a celebration," comments a hospital staff member.  

Then why can't the soldier sleep at night? A psychiatrist teaches him 
hypnosis. Imagine you are on a beach, the doctor says. Breathe.  

Sleep is just as elusive for the nurses in the crush of overtime 
hours. They talk about sleep constantly. "I close the Venetian 
blinds, put on the siesta mask and earplugs; then the silence drives 
me crazy," one nurse tells another during dinner break.  

Taylor's pager goes off so frequently that his 4-year-old son knows 
what the sound means. "Are the soldiers hurt?" the boy asks. "Do they 
need you?"  

"Yeah, buddy, they do," Taylor answers before returning to Walter 
Reed for another numbing stretch.  

He considers the soldiers his brothers and sisters, "not just a 
payment on my boat."  

That sense of brotherhood overrides all sense of exhaustion on Ward 
57. Jim Mayer, a Vietnam veteran and double amputee, is known as 
Milkshake Man because he brings McDonald's milkshakes to the soldiers 
several times a week. Garth Stewart has become a buddy. He loves 
hearing about Vietnam.  

But one night, when Mayer walks into Garth's room, it's empty and 
smells of cleaning solvents. Garth has been discharged.  

Mayer feels his eyes welling up. Then he reminds himself: This is a 
good day. Holding Tight Gajewski unwraps the bandage from John's 
worrisome left stump. Kristi hovers protectively. The surgeon takes a 
 cotton-tipped swab and pokes beneath the black sutures. A thin red 
line of blood wells to the surface. Gajewski smiles.  

"That's what we wanna see. We want to see that skin edge healing. 
Dead, unhealthy tissue doesn't bleed. We just had a little skin-edge 
necrosis is all. I can't get the applicator in deep there, and that's 
a good sign."  

"You already had us in tears last night!" Kristi blurts out, 
relieved.  

"I was in tears!" the doctor counters.

The Fernandezes head for the hospital cafeteria. Standing in line for 
omelets, Kristi rubs the burred back of her husband's head, and he 
leans in to nuzzle her. She stoops to wheelchair-level, and they 
kiss. This isn't how they were supposed to start their life together. 
They had a five-year plan: She would finish school, get into public 
health administration. He would finish his Army tour in 2006, then 
put his degree in systems engineering to work in the civilian sector. 
They'd start a family.  

War fast-forwarded their lives. John decided to apply for medical 
retirement; he'll look for work as an engineer. Kristi will have to 
plunge into the job market.  Where they live will be a matter of 
accessibility; even the little choices, like who drives, are dictated 
by injury. They have to compromise their very closeness: John's 
relentless pain makes sharing a bed impossible for now.  

Yet they insist that they're coping just fine. Kristi hasn't fallen 
apart, not once. "I'm still waiting for it." No looking back is their 
attitude. "If this had to happen to anyone," Kristi says, "I'm glad 
it's us." Because they can handle it, she is sure.  

"All I see when I look at him is John."  

For his part, John speaks of what happened to him with an engineer's 
cool regard. He is a mathematical problem -- man, minus legs -- with 
a mechanical solution. Even though the explosion that killed three 
men beside him remains under investigation as a possible friendly-
fire accident, John is unwavering in his support of the war. "It 
could happen in any war," he says. "It's war. It's not a pretty 
thing."  

The hospital staff marvels at the resilience of John and Kristi 
Fernandez, at the tight net beneath their trapeze act. But among 
themselves, the doctors and nurses who have treated traumatic 
injuries for decades question whether the young lovers can bear the 
stress over the long term. "Is their relationship going to survive 
this?" Taylor wonders aloud.  

On the most important day of his new life so far, John nearly misses 
the appointment to get his first artificial limb when a fellow 
amputee -- a sixtyish stranger -- blocks his wheelchair in the hall 
and begins spouting advice. John and Kristi listen with polite 
impatience. The man is diabetic. Once he's out of earshot, they hurry 
to Miller's lab. "Nothing he said applied," John observes. "I know!" 
Kristi nearly shouts. "It wasn't vascular, it was a bomb!"  

Joe Miller greets them with the foot he ordered for John from a 
catalogue.  

"What exact type of foot is this?" John wants to know. "Is it 
flexible? How does it work? What about lateral distribution weight?"  

"This is a dynamic response foot," Miller says. "A special keel gives 
you ankle motion without having a true joint."  

John has brought a new sneaker for the new foot. Kristi pulls it out 
of her ever-expanding tote bag, which also contains sterile gauze, 
John's pills and lip gloss.  

A thick silicone stocking slips over John's stump. A brass pin on the 
bottom will screw into the plastic socket Miller has crafted, which 
in turn fastens onto the artificial foot. "Does it hurt?" Kristi 
wonders.  

"No, I'm all right," John assures her.  

"I forgot what you look like with legs!" she says happily.  

Miller leads the way to a practice walkway flanked by parallel 
railings. He warns John to take it easy, that he may feel dizzy.  

For the first time since he was wounded, John Fernandez stands.  

"I'm going to be a lot taller!" he discovers, laughing. The 
prosthesis has added two inches to his 5-foot-8 frame.  

"Oh, I like it when you stand up," Kristi says flirtatiously.  

The parallel bars shake from the force of John's grip, and Miller 
asks if he's okay, can he manage. And John answers the way he always 
does.  

"Yeah, I'm all right."

 Memories of War 

When Garth Stewart was in Iraq, he would lie under camouflage netting 
and listen to the plastic leaves rattling in the wind. He'd close his 
eyes and imagine he was at home in the woods in Minnesota.  

But back in Stillwater, all Garth can think about is Iraq. His mom 
works in the bakery at a  grocery store, so he has the apartment to 
himself most of the day. Fitted with a new prosthesis, he practices 
walking with his cane. He plays video games and reads Marcus 
Aurelius.  (Sorta like Geroge Boyer- ed.]

His friends throw a party in his honor. Garth holds everyone 
spellbound with his stories from Iraq. He removes his prosthesis to 
let people see. A guy drinks beer from the hollow socket.   

Garth keeps in touch with the Milkshake Man. Jim Mayer encourages 
Garth to visit Ward 57 someday to speak to new amputees. At first, 
Garth recoils. That hospital represents nothing but pain. But the 
idea starts to grow on him.  

Stillwater is green and  hot, cut in two by the majestic St. Croix 
River where Garth  swam as a kid. One afternoon, a friend picks him 
up and she drives him to the river. Garth limps as he makes his way 
toward the water. "It's not much farther," his friend says, looking 
back to make sure Garth is okay.  

The two of them lie on a rock in the sun, Garth's silver prosthetic 
ankle glinting in the sun. Canoeists  paddle by and birds fly 
overhead. "I came back here and people think the Iraqis just 
surrendered," Garth says. "The TV didn't show anything. I saw bodies. 
Melted bodies. Skulls. Bodies with the skin falling off. We got to 
Karbala and we started fighting the Republican Guard. Those guys 
don't want to take no for an answer."  

His feelings about the war remain mixed. But there is no doubt 
surrounding his desire to be a soldier again.  

Finally he gets the news he's been waiting for. Garth is told to 
report back to Fort Benning, Ga.,  home of the 3rd Infantry Division. 
A Future in Flux Danny Roberts is home alone in his new ground-floor 
rental outside Green Bay when the three boxes arrive from Iraq, 
emissaries from a distant dreamscape. Danny tears into them, dirt and 
sand spilling everywhere. My stuff ! All his Army gear, plus his CD 
player, the last disc he listened to still inside.  

In Wisconsin, Danny is unsettled, scattered. Waiting for a new foot, 
still unable to put weight on his other leg with its mangled heel, he 
can't reach the cupboards so his girlfriend has to put  dishes out 
for him each day before going  to work.  

For now, he spends hours watching TV or reading or playing video 
games. Doctors told him it would improve his concentration.  

Tests revealed mild brain trauma, after all. Which bums Danny out, 
despite assurances it will heal on its own within a few months. 
Sometimes he forgets where he put things, or who called or visited 
him that day.  

He joins a chapter of Purple Heart veterans, and they push his 
wheelchair in the Memorial Day parade.  

The Veterans Administration is trying to determine what kind of 
vocational training would suit him, but Danny is convinced they 
screwed up the test results. "You have no reading comprehension," he 
remembers the VA  lady telling him. He is still incredulous. "All I 
know how to do is read!" Does this mean they won't pay for him to get 
the English degree he wants? He sweet-talks the VA  lady into 
retesting him, and plans to re-enroll in college this fall. He's 
applying for a discharge from the Army.  

Maybe he won't teach, after all. Maybe he'll buy land in the Colorado 
Rockies. He knows a tiny town called Alma where they're always 
desperate to fill the lone policeman's job. He imagines himself the 
peacekeeper in that cool, quiet place.  

Jennifer Love Hewitt keeps calling. The actress kissed Danny's 
forehead when she visited Ward 57. Now she wants him to participate 
in an MTV documentary. Sure, he tells her.  

Danny is still trying to sort out what he thinks about this war. "I 
want the world to be a better place," he muses. "We gotta focus on 
homelessness, on education. We spend more money on guns and tobacco 
than we do on education."  

He records a new message on his answering machine. Danny's voice 
sounds rushed, like he's worried that time will run out. Well before 
the beep, he offers a hurried signoff.  

"Peace" is what he says. Reporting for Duty Fort Benning is just like 
Garth remembered: scrubby little sand hills and Georgia pines, with 
hot asphalt roads slashing the landscape of flat buildings. One thing 
is different: No one is here. Garth passes his barracks. The parking 
lot is empty. All 4,500 soldiers in the  3rd Brigade are still 
deployed.  

He knows it's up to the Army to decide his assignment, but Garth 
wants to convince the medical review board he can be a ground-pounder 
again.  

A cab drops him off and he walks into battalion headquarters. Behind 
a desk, the weekend duty sergeant is playing video games. Garth 
introduces himself. "I was wounded in Iraq," he says. "I need a place 
to stay tonight."  

The sergeant dials someone on the phone. "Hey, we got a WIA here," he 
says.  

"Hey," Garth says, pleased at the heroic-sounding acronym. "I guess I 
am a Wounded In Action."  

Three hours later, another sergeant arrives to welcome him back and 
announce that a room in the barracks awaits him. Instead of the 
fourth floor where he used to live, he's getting a spot on the first 
floor where the noncommissioned officers are housed.  

Garth's jaw drops. "No stairs!" he says.  

He arrives in his new barracks and sits down on the bed. After 16 
hours of wearing his prosthesis, his leg is throbbing. He lays his 
cane aside and looks around. There are fresh sheets on his bunk and 
the room has been stocked with toilet paper, bottled water and a few 
candy bars.  

"Outstanding," he says. Graduation Day John Fernandez returns to West 
Point at the invitation of Vice President Cheney. It is graduation 
day, and he is a guest of honor. Only 48 hours earlier, he was at 
Walter Reed getting his second foot attached.  

For the first time since the war, John is back in uniform, crisp in 
his Army dress blues, spit-shined shoes on plastic feet. He gazes 
from his wheelchair at the perfect rows of proud cadets; only two 
years have gone by since he was one, too. John begins steeling 
himself, a soldier with a mission. As the opening bars of "The Star-
Spangled Banner" fill the stadium, John rises from his wheelchair, up 
through the blinding pain. With Kristi holding him tight, he stands 
tall for just a few shaky minutes, and salutes his flag.  

The first part of this series, a gallery of photographs from Walter 
Reed by staff photographer Michael Lutzky and a video report on 
Marines recovering from their injuries at the National Naval Medical 
Center in Bethesda can be found at 

<www.washingtonpost.com/nation>