SAN ANTONIO – The five badly burned soldiers arrived around 11 p.m., sedated and swathed in bandages from head to foot – the screech of the plane's wheels on the tarmac and waiting ambulances marking the end of a 7,500-mile journey.
By Sharon Cohen
ASSOCIATED PRESS
July 15, 2007
Dr. Kevin Chung waited inside Brooke Army Medical Center as the ambulance convoy zipped through the gates. He knew the soldiers were coming from Germany after being evacuated from Iraq.
A three-continent marathon, and this was the finish line.
Now Chung and some 30 doctors, nurses and others took over.
They cut open the men's bandages and, using diagrams of the human body, mapped the soldiers' burns – shading in red for third-degree, blue for second-degree – to plan for surgery.
They called the soldiers' families. They needed permission to operate. Quickly.
The men had been injured days earlier when a roadside bomb turned their Bradley fighting vehicle into an inferno. One man who had escaped ran back to help a trapped comrade.
“This one's the hero,” Chung said as the first stretcher rolled in.
"They're all heroes,” a nurse replied.
Chung did a bronchoscopy to check the patient's lungs. He threaded a fiber-optic scope into the tube connecting the soldier to a ventilator. Tarlike soot deposits appeared on a monitor.
To Chung, it looked as though someone had smoked 100 packs of cigarettes in 10 minutes.
If this soldier – the one who had escaped – had so much lung damage, what about the men who had been trapped?
He examined them and answered his own question.
Their lungs were worse.
Brooke's burn center – the only one of its kind for the nation's military – has its own rhythms and rituals.
The center's 40 beds are tucked in a fourth-floor wing of the sand-colored hospital at Fort Sam Houston in San Antonio. In the halls and on the walls are constant reminders of war: the scarred young men, the clocks set to Iraq and Afghanistan time.
This is a place where patients celebrate every small step toward recovery and where a clenched-teeth grimace speaks more eloquently than words.
It's also a place with a quiet sense of urgency.
Doctors operate in womblike, 90-degree heat, sometimes six at once working on a soldier; nurses in boots, masks and long gowns sweat as they scrub down patients in steaming showers; families congregate, longing for the day loved ones will emerge from the cocoon of bandages.
In another era, another war, many patients probably would never have made it this far.
But troops today have better body armor, fast evacuation from the battlefield to war-zone hospitals, then state-of-the-art treatment in Germany and the United States.
Brooke has special teams that fly to Landstuhl Regional Medical Center in Germany to bring home the most severe cases on a C-17 transport, sometimes handling emergencies in the air.
A soldier burned in Iraq can be in a hospital bed in San Antonio within 72 hours, sometimes less. In the Persian Gulf War, it took nearly 12 days. In Vietnam, it was closer to 17 days.
Once patients arrive at Brooke, skin grafts are usually done within 24 hours to stave off infection, the major cause of death. Decades ago, doctors waited days or weeks to perform surgery.
“The faster you get the burn off the patient, the better off you're going to do,” says Dr. David Barillo, chief of the flight evacuation team.
Brooke's burn center also treats civilians. But these days there is a steady flow of wounded from Iraq and Afghanistan – more than 570 thus far, of which only about 6 percent have died. Many survivors, however, are permanently scarred. Some also suffer from blast-related wounds, such as head injuries or fractures. Others can't walk, cut their food or tie their shoes.
“We now have an entirely new population of burn survivors . . . with oftentimes lifelong and life-changing injuries,” says Dr. Evan Renz, a Brooke surgeon.
Some will recover. Others will learn new ways to become independent.
“You have to believe that you're doing the best thing for the patient by helping them survive,” Renz says. “You have to believe that in the end, when all is said and done, they will be glad they made it through.”
Chung woke from a quick nap on his office couch the morning after the five badly burned soldiers arrived and walked down the hall to check on them.
All were stable, but the news quickly turned grim.
One soldier went into shock. His heart, lungs and kidneys failed. He died without regaining consciousness.
With burns, Chung says, patients can rally, then suddenly take a turn for the worse – all the while dealing with excruciating pain.
“I can't think of a more devastating injury,” he says. “In the most tragic instances, a lot of us say to ourselves . . . sometimes life is worse than death.”
Of the five burn patients, one was transferred out of intensive care.
The soldier who had escaped was rebounding, too. Then an infection set in, and he died.
Within three weeks, four of the five were gone.
Chung had lost patients before, but each one, he says, leaves him shaken.
“You walk a tightrope,” he says. “I tell the family members that they need to be realistic. At the same time, I don't want to be the person to take away hope. How can you justify giving up on anybody?”
Chung always reminds himself of the most critically burned patient he helped treat who survived.
That would be Sgt. Merlin German.
German's survival is a story of numbers:
Burned over 97 percent of his body.
Nearly 17 months in the hospital.
More than 40 surgeries, and counting.
Practically everyone who has met the Marine describes him with one word: miracle.
Sitting in the therapy gym, sucking on a “fentanyl pop” – a plastic stick tipped with a morphinelike painkiller – he pulls a T-shirt of his own design from his gym bag.
On the front, it says: “Got 3 percent chance of surviving; What ya gonna do?” The back lists four options: “a. Fight Through. b. Stay Strong. c. Overcome Because I Am A Warrior. d. All Of The Above!” The last one is circled.
But living choice “d” isn't easy.
It means one surgery after another, learning to walk again with grafts and adjusting to a ripple-scarred face.
But more than two years after German, 21, nearly died from a roadside bomb, he has a steely resolve and a tremendously supportive family led by his mother, Yvonne.
Last December, after months of practice, he donned his Marine dress blues and hit the dance floor at Brooke's Holiday Ball.
He surprised his mother, taking her into his wounded arms and gliding across the room to a Rod Stewart song, “Have I Told You Lately That I Loved You?”
The crowd stood and applauded. And cried.
German's path to the dance floor began in the intensive care unit.
It's where Capt. Kristine Broger, an ICU nurse, thrives in heat and silence.
She's accustomed to rooms set at 80 degrees or higher to help those who can't control their body temperature after their burned skin has been removed.
And she's familiar with patients who can't speak – at least, at first – because they're sedated or hooked to ventilators.
Broger meets those patients by talking with loved ones and looking at photos they tack up on the walls, snapshots that remind everyone of the person beneath the bandages.
Seeing these “kids” month after month, “they become part of you and you get to know the family like your own,” says Broger, who at 27 is a veteran of Iraq.
She has a strategy for coping with the ICU's stresses.
“After the locker room, I try not to bring anything home with me. But some days,” she says, “it's more difficult than others.”
Chris Edwards is in Year 3 as a burn-center regular.
The Army staff sergeant was wounded when a 500-pound bomb exploded under his Bradley as he was crossing a bridge in Iraq. He was burned over 79 percent of his body.
Since then, he has endured 34 surgeries, including grafts over his entire body, eye operations and holes drilled through his lower right leg bones and heel and metal rods inserted to stabilize them.
“You start thinking, what did I do to deserve this?” says Edwards, 36, who also served in the Marines. “It really tests your faith. Not only that, you're really thinking: What did my family do to deserve this?”
Some days, he says, “I just . . . beg somehow for God to kill me and take away the pain and just let me die.”
Yet Edwards still looks for humor – as he has all his life.
“If you're a patient and you laugh for a second, that's one second more that you don't have to worry about how bad things hurt. . . . For that second, you're a regular person. I try to keep people laughing as much as I can.”
Sgt. Shane Elder patched up the wounded in Iraq and sent them home to be healed.
Now he's treating burn survivors at Brooke, gently massaging and stretching their scars so they don't shrink and turn fingers into claws.
Elder, a former medic, is an occupational therapist's assistant. Off duty, he's just one of the guys, hosting an occasional poker game for patients at his home or joining them for dinner or a movie.
“You don't work with these guys . . . and just talk about your burn scar,” he says. “They become your friends.”
One of his first patients was a severely burned Marine. The men shared the same dry wit and taste in rock music.
When the Marine was about to be discharged, Elder invited him over.
Elder prepared his older son, then 3, knowing he might be frightened by the Marine's disfigured face. Instead, the little boy was fascinated by his prosthetic arm and asked, “Are you a robot?”
“Sort of,” the Marine replied.
After that, Elder's son joyfully squealed the Marine's name every time he visited. Last fall, Elder was a groomsman at his wedding.
Elder helps burn patients face their fears. His advice is simple:
“You're not the same person you were before,” he tells them. “If anything, you're a stronger person. . . . Get back out there.”
Marine Cpl. Roy VanWey is plotting his path away from the burn center.
A year ago, a bomb turned VanWey's Humvee into a fireball, killing three Marines who were with him and leaving him with burns over 70 percent of his body.
Since then, he has been through 10 surgeries. He recently had one to hold his head straight. Slowly, he is regaining his independence. He can now spool pasta, draw and sign his name even though he lost most of the fingers on his right hand. But he still is adjusting to his changing face – pink, blotchy, raw.
He knows people stare when he goes to the mall, the movies or out to dinner.
“When I'm talking to people, I feel like the same person inside,” VanWey says. “But when I look in the mirror, I feel like I'm looking at a stranger.”
His wife, Cassi, offers a visitor a laminated Marine photo identification card showing a handsome man with bright eyes and a wide smile. Then she turns to her husband of 18 months and says: “I don't care what you look like. I love both faces the same.”
With her at his side, VanWey sorts out his life after Brooke, “mourning the death of the person I used to be,” he says, “and having to come to terms with who I'm going to be the rest of my life.”
Determinedly, he looks ahead.
“I've got to make the best of it,” he says. “At least I'm alive.”