15 September 2006

Rehab Ward

I traveled through DC in the rain to meet up with Maria and Nick.

It was a somber day to be on the broken concrete and there were the usual commuter miscues at every key juncture; but naturally, that is not the story. It took nearly two hours to drive across town. Google would tell you it is a half hour trip, but Google does not know how they drive in Washington, in the rain.

The city is improving, and doing so rapidly. I counted sixteen construction cranes in a broad arc to the north and east of the Bus Depot the other morning, and places you would not have considered walking just a few years ago are becoming fashionable.

North of Howard University on Georgia Avenue that is not the case. Little has changed since the riots that killed the city, though some blocks of home retain a certain faded charm where the residents hunkered down and refused to flee the anarchy.

One of the long-time residents is the Old Soldiers Home, now a VA hospital and assisted living facility where Mr. Lincoln kept a cottage during his administration. Not far beyond that is the sprawling campus of the Walter Reed Army Medical Center. Parts of the establishment go back to the building of the Panama Canal, and the discovery of the link between the mosquito and yellow fever discovered by Major Walter Reed and his comrades. The original building is still in use as the Headquarters.

The signature structure is the massive gray bock of the 260-bed Central Army Hospital that dates to 1978, and was programmed when the Vietnam conflict still raged. Two vast floors of parking garage are buried beneath it, but there is no point in driving down there after nine o'clock in the morning. There will be no spots left, only patients driving slowly up and down the aisles in the dimness, the minute of their appointment coming and going as they seek a place to leave the car.

It is curious that a place so crowded could be considered surplus, but that is the fact. the recent Base Reallocations and Closure (BRAC) round put the hospital complex on the block for closure, and that is apparently what is going to happen. The functions of the WRAMC will be consolidated on the grounds of the National Naval Medical Center at Bethesda. It is going to cost a lot for them to do it, and I have no idea where they are going to put everything.

Maybe someone will come to their senses. There is no parking at Bethesda, either.

Perhaps it is because Bethesda is across the line in Maryland, and has two Senators and a few Congressional representatives. The District has none, of course. Perhaps it is something else. But I know that they are using WRAMC to full capacity, what with the war and the hoard of military retirees who depend on the DoD health care system.

I'm one of them, so I have an eye for these things. I have also had my time in WRAMC, since that is where the best hand surgeons in the Army practice, and that is where my older boy had his put back together after it was crushed in a Lacrosse accident.

You can say what you want about the Army, but at this moment in history, with insurance rates forcing good doctors out of practice in civilian life, the practitioners of military medicine have never been better. Nor, regrettably, have they been so experienced.

I was sitting in the glass outer lobby a few minutes before my appointment, and thankful to be there in one piece, with my car safely tucked into a parking place hidden behind a power transformer in a staff lot near the Emergency Room entrance.

Maria was getting Nick ready to travel when I called to confirm our meeting. They are staying at the Malone House, one of those out-patient facilities on the campus to accommodate the walking wounded, or those families there to provide long-term presence.

When I called Maria, she said they were just leaving their hotel room, which is what it best resembles. They have a bed and a television, a small refrigerator and a microwave oven. They also have a shuttle that runs a route around the campus, and brings them to therapy each morning just after ten o'clock.

I saw the van pull up, and a wheelchair was pushed to the hydraulic lift. A young sand-haired man was sitting in the chair, and part of him was missing. Part of him in addition to what was once his right leg. I can't tell you precisely what was taken from him in Iraq, but part of it is in the way that he looks passively from his chair. A very attractive young woman pushed him up to the sliding glass doors and into the lobby.

That was not who I was waiting for. The young women did not look around. I was glad.

The next chair looked like it might be the right people. A slight woman with reddish hair pushed the chair. A young man in a gray windbreaker sat in the seat. He wore running shorts. His left leg was bare, and ended in an athletic shoe with a low white sock. His right leg terminated in a tan stocking over the stump that ended just below the hem of his shorts.

"Maria?" I said hopefully, and the woman nodded. "Hi," I said. "I am the guy who looks like a walrus." I pointed at my drooping moustache. We all smiled. I introduced myself to nick, whose handshake was firm but guarded. I walked alongside as Maria pushed the chair into the lobby with the Dunkin Donuts and the Subway that have changed the mood of the vaulted ceiling and the high wood-paneled walls with the soldiers and retirees filling the waiting area. I could hear the voice calling out numbers for those waiting for prescriptions in the background as we rolled toward the elevator bank.

“Now Serving Number R325.” There were people sitting in chairs, old people and young ones in uniform. Some of them looked like they would be waiting a long time.

I heard the story of the attack twice, from her in snatches, and from him, once we were in the rehab ward. It was relentlessly cheerful and grimly military at the same time. Low beds formed islands along the middle of the room. Soldiers lay on them, waiting for evaluation, or doing exercises, or waiting for the steel cages bolted to ravaged limbs to be adjusted to the correct tension.

A black Labrador named Sgt. Rory, the Therapy Dog, brought a tennis ball to Nick, and rolled it onto his lap. He wanted to play, and it was clear that the dog loved the soldiers on his ward more than anything.

"This is it," said Nick. "This is how we spend our day. We throw the ball. They assess us. Exercises are at 1100. Then we work on walking."

Nick was hit at just after two in the morning, Traverse City time, on the second of July, 2006. It was morning in Iraq, and he was part of a convoy racing from operating base to operating base. What hit him was an improvised explosive device, or IED. But it was a particularly nasty one, the kind that are made by professionals in Iran and shipped to the Shia insurgents in Iraq. These are not the crude devices that detonate old artillery shells in holes along the side of the road. These come sideways, using hot gases to form shaped-charges that can penetrate the armor of Stryker or even an M1-A2 Abrams tank.

This blob of hot metal came through the side of Nick's truck. He did not know that he was hurt at first. A buddy in the seat behind him calmly announced that he had lost his feet, and Nick was trying to help him find them when he opened the door and discovered that his left leg was no longer fully attached to his body.

Gushing blood, he went into shock. Captain Houston, the forward operating base commander explained that Nick's calmness had helped to save him. Panic would have been fatal. But as Maria said, if there had not been a real medical doctor in the convoy with him, he would have been dead on the spot. He got a tourniquet almost immediately, but the wound was severe. As it was, only two pints of blood were left in his body by the time they got him to an aid station and began to pump more into him.

It was around 0830 in Traverse City when the call came. Maria had the kids there for the summer. She was preparing to take them back down to Clarksville, Tennessee. The call from the Army explained that Nick was badly wounded, and that he was being evacuated to the big hospital in Germany. That changed the world for Maria, and that is how she came to be here only days later.

Nick was pulling off the compression bandage on his stump as he told me that. He had been evaluated for swelling, and a long mirror placed along the side of his good leg for comparison. The reflection made it appear that he had two legs again, though of course that was an illusion.

Nick said it was sort of funny. He is a modest man, quiet spoken, though intense as we talked about recent reorganization in the battalion structure of the 101st Airborne Division of which he was a part. He told me that he had arrived in Germany without a stitch of clothing. They had cut everything off of him at the aid station and wrapped him in sheets. That is all he had when he was rolled into the ward in Germany, woozy on painkillers and disoriented beyond imagining.

Maria came back with the artificial limb that Nick is learning to use. There is a regular fraternity of young men who have no legs in the ward. Some of them are healed, and there to see friends who are still learning to cope. There was an older veteran who had lost his leg in Korea, and who came by each day with his wife, a former Army Nurse, to let the kids know that life was going to go on for them, and regardless of how hard it seemed, there was hope.



All the patients on the ward this day were male, but that is not the way that it is all the time. Several women have lost limbs in Iraq and Afghanistan, and that was one of the reasons she was there, to bear witness and listen.

There were Marines and Soldiers in the ward. Some of them still have the swagger. All of them have a look in their eyes. Some have learned to run again, on the strange spring-like athletic prostheses. Nick said the guy he know who was running again still had his knee. He said it with a certain longing.

Nick had lost his right leg high above the knee, but otherwise was pretty lucky. His right leg was peppered by shrapnel, but remained structurally sound. There were still pieces in the flesh, and I felt one there under the surface. They would work themselves out in time. Then there was the chunk of metal in his butt. Nick felt something there, and could not get comfortable resting on his back in the hospital bed in Germany. The nurses through it might be a bedsore, and were packing the wound when one of them thought she felt "metal-on-metal" rasping on her probe.

Sure enough, there was a chuck of what might have been his truck's door lodged in him, which Maria has kept as a souvenir. Other than that, he was in good shape. Nothing like the sandy-haired kid who looked out from his chair into the middle distance. Even Sgt Rory, the Therapy Dog, could not get him interested in throwing the ball.

Nick and Maria showed me the exercise regimen they have been taught to strengthen Nick's core body muscles. They work together, and Nick says Maria is a pretty tough taskmistress. There were crunches, and twisting motions. Maria helped lean into his side pretty hard to loosen the muscles over his pelvic girdle, which had lost strength and flexibility as he recuperated from the series of surgeries.



When he was loose enough, Nick made preparations to mount this new leg. It is a wonder of space-age construction, finished by a running shoe that is the mate to the one on his real left foot.

He slid the tan sock off his stump and showed me the job the surgeons had done. The end of the stump had once been the front of nick's thigh. The doctors had made a flap of the front, and folded it over the end of the bone that they cut back to fit. There was worry about infection. Nick said that the wound had begun to issue a thick pink fluid, and they rushed him to surgery once more. It had been touch and go against the dying of the skin. They tried to save as much as they could, and it was a near thing staving off the infection, and the flesh dying.

Just over ninety days from the moment that Nick's world changed, the skin around the thick sutures had a fresh look of health. It looked like the stump was going to stabilize, and depending on the swelling, would permit him to start walking on it.

The Army docs are about the best in the world in this line of work.

The mechanics of the new leg are interesting. Nick pulled a rubber sock up over his stump. It was slightly sticky to the touch, and formed a close seal on his flesh. At the bottom, at the point where the bone of Nick's femur was covered with the flesh of his thigh, there was a metal screw cap. A screw attached to a long nylon cord that is fed up through the knee of the artificial limb and screwed into the socket on the rubber sock. Nick then pushed him leg into the plastic cup at the top of the leg, which was molded to fit him like a rigid second skin. Maria then began to put pressure on the cord attached to the end of the sock, drawing Nick's stump down into the cup, and creating a strong bond between flesh and plastic, but with all the pressure on the sides of the stump, rather than on the pad of skin that covers the end of the bone.

It was quite remarkable the way it works. This was going to be a light day, said Nick, and he was pleased that the swelling seemed to be down from the day before.

He hopped into the chair and Maria pushed him across the ward, past the young men who were struggling with new limbs, or walking purposefully on them.

"Are they going to let you stay in the Army?" I asked Nick. "Do you want to?"

Nick looked up at me as he grasped the parallel bars and prepared to hoist himself up. Maria held the chair steady, but obviously intended for him to do the work, even if she was there with him every step of the way.

"I don't really know," he said. "I guess we will just have to see how the rehab goes, and what we can do once we get used to the new leg."

I took a picture of Nick coming down the path between the parallel bars, and Maria was right behind him. She helped him turn, and then they went back the other way. They were completely integrated in everything they did. They make quite a team.



I am not sure that is what either of them would have signed up for, but that is what life has given them.

As I prepared to go, I asked if they thought they might go home to Traverse City. Maria grimaced. “I don't know if I can take the winters any more.”

Nick nodded. “Spring and Fall are great, and the summer is wonderful. But I am not sure we can do the cold.”

None of us talked about the leg, not in that regard. But I have to say I agree with him.

Copyright 2006 Vic socotra
www.vicsocotra.com


Close Window