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Old 07-22-2003, 05:42 AM
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The Soldiers of Ward 57
Moving Forward, One Step at a Time
After Iraq, Wounded Soldiers Try Out New Limbs, New Lives

By Tamara Jones and Anne Hull
Washington Post Staff Writers
Monday, July 21, 2003; Page A01

Second of two articles

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.

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
? 2003 The Washington Post Company


SSgt. Roger A.
One Proud Marine
Once A Marine............Always A Marine.............
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