With more than a million Americans injured in Iraq and Afghanistan, a physical therapist reflects on a decade of deferred dreams and rousing recovery at Walter Reed Army Medical Center.
It was spring 2009 and I was a physical therapist in the most famous military hospital in the world: Walter Reed Army Medical Center. I’d been there for four years, and I’d go on to work there until its preplanned closing in 2011, part of a congressional budget base realignment. In the amputee section where I worked, there were ten physical therapists and, in the course of the day, more than a hundred patients. We were squeezed into a disproportionately small, glassed-in gym on the top floor of Walter Reed’s Military Advanced Training Center (MATC).
It was a strange idea, putting us under glass — on display for the rest of the world, but otherwise leaving us to our business. The glass wall allowed tour groups to walk by without disrupting the patients. Three to six groups came by every day, often with celebrities in tow. But nothing distracted a patient more than looking up to see Angelina Jolie or an openly weeping congressman staring through the glass. My coworkers and the patients would joke that this must be how it felt to be an animal at the zoo.
I spent most of my evening hours swimming, so to me our facility felt like an aquarium. We were fish in a bowl.
Each morning, work started at 0700. Which meant you were expected to present for duty at 0645. Except for the enlisted, who had to be there at 0615. That’s fifteen minutes before 0645 to please the Colonel and an extra fifteen minutes to please the Staff Sergeant, who had gotten there at 0545 to beat the First Sergeant in. But since parking is an issue and traffic is always unpredictable, it wasn’t unusual for many of my coworkers to arrive at 0430.
I was one of the few outliers. I had my commute timed to the exact minute, so I could rocket into the clinic just seconds before the minute hand hit 0645. My drive in was pure adrenaline, with every cell in my body on high alert anticipating anything that could screw up my arrival time. A badly placed red light, a school bus, a missed turn.
To avoid the inconvenient possibility of a car search by the armed guards at the front gate, I’d leave my car on the street outside of Walter Reed and rush across base with a half-dozen other highly vexed coworkers at 0640. My coworkers and I could see each other out of our peripheral vision, but there was no time to stop and chat, or even wait up for each other. At this time in the morning, it was every man for himself. The lucky ones would scoot in the door with under a minute to spare, ducking past the Colonel who was standing in the hallway under the clock glaring at the minute hand.
No matter how bad you might appear after living through an explosion that killed your battle buddies, blew off your legs and opened you up like a can of tuna, inside the glass walls of our clinic it was all smiles and jokes and the occasional cheer. In fact, it was not unusual for a therapist or an entire room of therapists to stand up and applaud a patient the first time they came down to the MATC by themselves.
“Look at you!” my coworkers would say. “You are doing great!”
The tour groups saw it all without sound. And from inside the fishbowl, we saw them too, the looks on their faces reflecting something we didn’t consciously experience. They were seeing the devastating toll of war for the first time: young men and women walking stiffly on metal legs, or pushing their wheelchairs with the stumps of their amputated arms. Some of the patients had steel rods holding a broken pelvis together, or abdominal wounds still dressed in heavy gauze. The spectators stared. They couldn’t help it.
My coworkers and I were always outwardly happy. The MATC was our entire world. It was where we ate breakfast, lunch and sometimes dinner. It was where we met up on the weekends to catch up on paperwork and go on bike rides. And during the week, between 0700 and 1600, it was where we treated a hundred to a hundred and fifty new amputees.
We never talked about the staggering injuries we saw. Why? To us, it had faded into the background of day-to-day normality. We were cheerful because we were living our lives inside the crowded theater that was the amputee clinic, where we played the role of therapist and the soldier played the role of patient and we entered stage left and exited stage right.
It would be another five years before I heard the phrase “compassion fatigue.” While our patients distracted themselves through their long, sleepless nights by playing violent video games, my coworkers and I were in our homes outside the hospital gates, not answering our phones, and keeping those niggling thoughts at bay by watching mindless television, zooming in on anything that caught our funny bone. The dumber the better.
Physical therapy had appealed to me because the hours were good and because it was a career that would spare me the heart-wrenching details of some of the other medical professions, notably death and terminal illness. It was a job that, at the end of the day, I could leave behind at the office. But that’s not how it turned out at Walter Reed. Even when I had physically left the clinic, back at home, sitting on the couch in front of my TV, I couldn’t keep my thoughts from flickering back to work. No one was dying in our clinic. But everyone was struggling with how to live with devastating and permanent injuries.
Most of the patients in the amputee clinic were young men in their early twenties. They were usually from somewhere in Middle America, and Walter Reed was their very first time in a city. They were mostly soldiers and marines — almost always infantry. We also saw combat engineers, helicopter pilots and MPs caught short on a convoy. Once we had a finance officer — a mortar had randomly hit his personal trailer on the FOB (forward operating base). We had some women soldiers. They lost their limbs just like the men. But very rarely did a sailor or airman land in our clinic, unless they were a Navy SEAL or in the EOD (explosive ordinance detail).
The soldiers and marines who ended up in the amputee clinic were almost always enlisted, meaning they did not have the college degree required to be an officer. We also had a smattering of young officers, usually lieutenants right out of college, and every now and then a captain. But it was rare to get a high-ranking officer — a major or a colonel — unless they were really in the wrong place at the wrong time.
We had Coalition soldiers — Russians, Romanians, Georgians and Armenians. (The “Coalition of the Willing” was a term George W. Bush used to describe countries who supported the 2003 invasion of Iraq.) There was a scattering of international AP journalists; they got blown up, too. Unlike the American soldiers, these were men and women in their thirties, forties and fifties. We called them our “foreign exchange” patients.
Kai was from the Philippines, but he was not a journalist — just another young soldier. Joining the U.S. Army had put him on a fast track to U.S. citizenship. After losing an arm, an eye and his best friend in Iraq, Kai had indeed gone on to become an American citizen. He took a cab by himself to the Department of Immigration and, without fanfare or celebration, went through the citizenship ceremony alone.
Most of our patients were missing their legs. One false step walking on a trail in the Afghan mountains, and an IED planted by the Taliban will take off your legs. Kai had been riding in the back of an armored vehicle in Iraq when it hit an IED. Kai’s left arm was ripped away close to the shoulder, and he couldn’t see out of his left eye. His squad leader, a gentle man with an easygoing manner and a love of goofy jokes, took shrapnel to the head. But worst of all, Kai’s best friend, who had been sitting beside him, died instantly.
Kai had terrible phantom pain at exactly 1100 every morning, coinciding with the time he was blown up. As 1100 approached, Kai would get edgy. He’d bite his nails and avoid eye contact, all while keeping his eye on the clock. But otherwise, he was quiet and polite.
Most soldiers had a family member with them during their stay at Walter Reed. The military is very smart about this. To ensure that the soldiers have someone there for them one hundred percent of the time, they sign up a family member, spouse or friend of the soldier to be the paid non-medical attendant (NMA). The NMA gets a salary and, in addition to providing companionship, is expected to assist the soldier to and from appointments, help with meals, manage medications and facilitate the activities of daily living. They are considered an integral part of the care team.
But Kai’s family lived on a distant island on the other side of the world, and so the quiet and brooding soldier was at Walter Reed alone. Even though he didn’t need long-term physical therapy, I kept him on my schedule after he was discharged from the hospital just to make sure someone kept track of him until his discharge papers came through.
In the meantime, he was living at the Mologne House, a luxury hotel on Post that, during peacetime, had been used to board generals and colonels staying at Walter Reed for routine medical exams and joint replacement surgeries. Now its rooms were occupied by young soldiers and Marines who didn’t need to be in the hospital but still needed months or sometimes years of rehab in the fishbowl.
Kai celebrated his first week out of the hospital by going on a ten-day chocolate binge. Chocolate for breakfast, lunch, dinner and snacks in between. I discovered it only because he became more and more listless during his PT sessions.
“Did you eat breakfast?” I demanded one morning.
“A Hershey bar.”
“A Hershey bar? That’s not breakfast. What’d you have for dinner last night?”
“What about breakfast yesterday?”
Kai defended his choice in food with a shrug. “I never got to eat chocolate in Iraq.”
I sent Kai to see his doctor about his poor dietary choices, and she had him admitted to the psych ward.
I felt guilty for getting Kai stuck in the psych ward, so as an apology I brought him Hershey bars every day and signed him out for physical therapy. But instead of going to the fishbowl, we would sneak outside for a walk.
It was springtime, and Walter Reed was especially beautiful at that time of year. Kai and I would leave the building through a side door and cut across the wide green hospital lawn. The puffy pink cherry trees dotting the campus were at the peak of their bloom, while at their base, tulips with waxy red and yellow heads bowed gracefully in the breeze.
We would walk past the brick Old Red Cross Building, the original headquarters of the Red Cross “Gray Ladies,” and Delano Hall, an administrative building with tall marble columns, built after World War I as a dormitory for Army nurses. Kai and I would walk through fields of knobby crabapple trees weighed down with hard green apples and head over to Building One, with its sweeping white steps and high-pillared entrance looking as dramatic and beautiful as I imagine it did when it was first unveiled a hundred years before.
The hundred-year anniversary was on my mind. There were signs all over the hospital promoting the upcoming centennial celebration, which was going to feature local barbecue, performances by the Army Band and the dramatic arrival of the Army Parachute Team on the front lawn. Even the National Museum of Health and Medicine was in on the celebration, providing antique military outfits for the medical staff to wear on the day of the centennial.
In the rose garden across from Building One, I would examine the thorny buds of new roses as Kai talked. During World War I, the Red Cross Gray Ladies used to host picnics and dances for the injured soldiers in the rose garden. Eleanor Roosevelt and Mrs. Calvin Coolidge both attended Red Cross events there. But these days, Kai seemed to be the only soldier regularly spending time there.
Sharing a bag of Hershey’s chocolate miniatures and surrounded by flowers, Kai would tell me joyfully about his new eighteen-month-old niece or recall funny stories from high school. I had to remind myself that, like most soldiers — and unlike me — Kai was only one year removed from high school.
We talked about movies and he recommended one of his favorites. One night, I popped the movie eagerly into my DVD player when I got home from work, looking forward to something upbeat and humorous, the type of movie I thought Kai would recommend. Even the name sounded funny to me: “The Boy in the Striped Pajamas,” and I laughed a little in anticipation. Instead it turned out to be a movie about a young child dying in a concentration camp.
The next day, sitting in the rose garden, I was still slightly burned by the memory of the movie. “That wasn’t a funny movie at all,” I muttered to Kai, giving him a hard time. Kai leaned in and laughed, “I never told you it was a funny movie.” Then he added, “The first thing I saw after we hit that IED was my friend’s head sitting on the floor of the vehicle. That wasn’t funny then either.”
“Are you joking?”
“No. His head was still alive. His eyes were looking all around.”
I could smell the chocolate on Kai’s breath, intermingled with the sweet scent of roses. Looking at Kai’s sweet face, his round cheeks still imbued with the vestiges of childhood chubbiness, my mouth went dry and a wave of horror rose up inside of me. For a few seconds I couldn’t say anything. Then I asked, “Do you think he knew what had happened to him?”
“He knew. He seemed confused at first. Then he saw his body sitting in the seat next to me and he got this crazy look on his face. He looked over at me and we just looked at each other for a long time and then he died.”
I thought about how gentle Kai was — lover of chocolate and babies and men who made him laugh.
“He was lucky he could look at you before he died, Kai.”
Kai got out of the psych ward quickly and started eating a normal diet. His nerves and PTSD seemed to be under control, but mine sure were increasing. The casualties overseas were ramping up. My coworkers and I were all feeling the pressure. My rushed lunches of greasy cafeteria slop were not much healthier than pounding a few Hershey bars.
Around this time we also welcomed the arrival of our first surviving quadruple amputee. In another era, this would have shocked the staff, to see a patient who was missing all four of his limbs. But after seven years of war, we were as enthusiastic as usual, standing up and clapping as he was pushed into the clinic.
I was on the far end of the clinic with Kai. Since getting out of psych, Kai seemed happy and upbeat. He had a black-and-yellow carbon-fiber prosthetic arm in the colors of his favorite football team, the Steelers. And he had a new hand-painted artificial eye, which looked like the real thing. But this morning, the day of the hundred-year anniversary, something seemed to take Kai by surprise. While he stood in the doorway of the clinic, looking apprehensive, I automatically checked the clock: 0955. It wasn’t the time.
I walked quickly over to him. “Is it starting? Are you in pain?” Kai shook his head and pointed across the clinic to a new guy with a walker. The guy was lurching along in the stilted way badly brain-damaged people tend to do.
“That was my team leader,” Kai said.
He hadn’t seen him since the explosion, when they, the two survivors, were pulled out of their vehicle and placed on separate stretchers. Kai came here to Walter Reed, and his team leader initially went to a brain rehabilitation facility in Richmond, Virginia. Now he was wobbling past us unsteadily, with a dented head and his physical therapist in tow. He gave no indication of recognizing Kai.
Tears spilled over Kai’s bottom right eyelid, and I dragged him over to the other side of the clinic. Just then the door swung open, and the new amputee, the one who had lost all four of his limbs, was pushed into the clinic. My coworkers leapt to their feet with a cheer and began to clap. The new soldier smiled and held what was left of one of his arms aloft in a greeting.
That’s when Kai really started to cry.
Outside the windows of the fishbowl, attendees were gathering for the celebration. A drum and bugle corps marched by, and the crowd was staring up at the sky, trying to catch the first glimpse of the Army’s skydiving team. One of the members of the parachute team was a Walter Reed alum who had lost one leg at the thigh and the other below the knee. While all sorts of pandemonium was taking place in our clinic, he was circling ten thousand feet above us, getting ready to jump out of a plane.
In the hospital lobby, soldiers dressed in World War I uniforms were slicing up an extra-large sheet cake with a picture of the original hospital on it. All over Walter Reed, clinical staff members were in costume. Doctors and nurses went about their business as usual while dressed in medical and military uniforms from distant eras, covering every decade Walter Reed had experienced in its hundred years of continuous operation. There were phlebotomists from the ’70s, surgeons in tunics and tapered wool lace‑up pants over knee-high wool socks from World War I, and nurses in Korean War uniforms. The hospital had the festive and fun feeling of a costume party.
But inside the glassed-in clinic, none of us were in costume. Two staff members lifted our new quadruple amputee out of his wheelchair and placed him on a therapy mat. Kai stopped crying. My coworkers moved quickly from patient to patient while another tour group assembled in front of the windows. On the front lawn of the hospital, a cannon fired and a marching band began to play as the first of the parachutists gently landed.
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This excerpt is reprinted by arrangement with AVERY, a member of Penguin Group (USA) LLC, A Penguin Random House Company. Copyright © Adele Levine, 2014.
Adele Levine worked at Walter Reed Army Medical Center from 2005 until its closure in 2011. She was part of the clinical staff that was then transferred to the National Naval Medical Center (renamed Walter Reed National Military Medical Center), where she continued to rehabilitate war amputees for another two and a half years. She is now in private practice in Silver Spring, Maryland. Follow her on Twitter.
Ben Bertin is a cartoonist, designer, and organizer. He lives and works in Chicago.