On Ward 57, a new war waged

WASHINGTON — The taxicab pulls up to the curb of Walter Reed Army Medical Center, and Pfc. Garth Stewart slides into the back seat. A nurse stows his duffel bag in the trunk, offering her last advice: "Move your leg around on the flight," she says.

The American flag hangs slack on the flagpole. Stewart lays his crutches across his lap. The lanky 20-year-old from Minnesota rubs where his leg was amputated. The throbbing alternates with jolts that feel like electrical shocks. Two Percocets are in his pocket for the plane ride home.

The bed Stewart left behind on Ward 57 will be filled by day's end. Even though major combat operations in Iraq are over, the wounded keep arriving. Twice a week, transport planes land at Andrews Air Force Base, Md., bringing fresh casualties. Nearly 650 soldiers have passed through Walter Reed during Operation Iraqi Freedom, more than half since major combat was officially declared over.

Behind the black iron gates of Walter Reed, the nation's largest military hospital, the broad ambitions of global security are replaced by the singular mission of trying to save a leg.

Stewart was curled in a miserable ball of blue pajamas.

First Lt. John Fernandez, the West Point graduate, was beginning married life in a wheelchair.

Pfc. Danny Roberts was wishing for William Faulkner instead of a glossy guide about adapting to limb loss.

Their war was not over.

Walter Reed has treated wounded soldiers since the beginning of the 20th century, expanding and contracting with the rhythms of war. During World War I, the number of patient beds grew from 80 to 2,500 in months. Now, the patients arrive from Iraq, some so fresh from the battlefield they have dirt and blood beneath their fingernails.

Morning rounds

In Room 5714, Stewart is sleeping when three doctors arrive on morning rounds. One turns on the lights, and before Stewart can shield his eyes, his room is flash-blasted in white.

"Can we take a look at the leg?"

A doctor works quickly, unwrapping the bandage and then the white gauze. Stewart watches as they probe the black caterpillar of sutures on his bulbous stump. He moans. The stump begins to shake violently. "I'm gonna get sick," he says.

"You want your bucket?"

Stewart reaches for the container. "I can't do this much longer," he says, holding his hand over his eyes.

"We're almost finished," the doctor tells him.

"No," Stewart says, "not that, everything. I can't take it anymore."

They leave him in darkness, with his bucket. Four weeks earlier, he was a mortar man with the 1st Battalion of the 3rd Brigade, 3rd Infantry Division. "You get out of high school and you join the Army, or you get out of high school and live in your parents' basement," he says. He chose Fort Benning, Ga., over Stillwater, Minn.

He was eager for the fight in Iraq. But Iraq turned out to be messier than he thought. He saw charred bodies and a grotesque assemblage of dead Iraqi soldiers who had barreled their car into a U.S. tank.

On April 5, his unit was on the Karbala highway when some stopped for a picture by a sign that said "BAGHDAD." Stewart and a buddy inspected a bunker. A blast blew both of them down. Stewart's left boot was a wreck, and a chunk was missing from his lower leg. His other leg had a softball-size hole in the calf.

Now, the powerful painkiller Dilaudid drips through his intravenous line, along with so many other drugs that he is too sick to eat anything but crackers.

Scenes from the war drift through his head. In Iraq, an Army general told his company, "Man, we gotta stop Saddam. He boils little girls in acid." The statement struck Stewart as "hilarious propaganda."

But lying in bed, he can't stop remembering all the Iraqi people who came to shake the hands of the U.S. troops.

"Any beautiful and scornful poem you read about war, it's about the horrible randomality of war," he says. The same medic who treated Stewart and his buddy after they stepped on the mine was shot by a sniper two days later. That medic is on Ward 57, minus his right leg.

Ward 57 is filled to capacity. All day long, soldiers buzz the intercom at the nurse's station.

Yeah, when you get a chance, I just spilled something over me.

Yes, ma'am, I need a Percocet.

Yes, ma'am, I was using the urinal and ... I need a new pair of pants.

An unbearable decision

In his room, Pfc. Danny Roberts, 26, squints through eyeglasses that survived Iraq without a scratch. Reading helps break the boredom. The aspiring English teacher from Green Bay, Wis., props himself against the pillows and jots reminders in a green notebook: Call bank to replace the ATM card blown up in Iraq with his wallet; order tickets for the Red Hot Chili Peppers concert; get checked for anemia.

He was part of a supply convoy hauling food and water. There were wild dogs, searing white heat, enraged Iraqi boys who hurled bricks at the slow-moving convoy. One afternoon, he triggered a land mine.

At Walter Reed, surgeons operated four times just to clean out the wounds. Roberts' right heel had been torn off and was replaced with a metal plate. Two toes were missing on his left foot, and the others had to be amputated.

Doctors delivered more bad news: The explosive had destroyed tendons, causing the left foot to flop uselessly. He would never walk on it, and it would lose circulation and eventually have to come off. A prosthesis would give him far more mobility. It was up to him whether to amputate now or wait. Go ahead, Roberts told them and then wept alone in his room.

He is a model patient, chipper and polite. Thank you so much, he tells the nurse bringing pain medication. "Awesome work," he congratulates his surgeon. He urges bleary-eyed residents to get some sleep.

One morning, an intern unwraps his bandages, causing Roberts to grip the bedrails in pain. "Oh, Danny Boy," she begins to sing, trying to distract him. He manages an appreciative smile even as he winces.

Waiting for the breakdown

By the time he reached Walter Reed, 1st Lt. John Fernandez, 25, a West Point graduate, had made a vow. "I'm not going to feel sorry for myself," he swore. Not when three men around him, including the gunner he tried to save, came home in body bags. "I'm here and I'm alive and I'm going to walk out of this place."

His hospital room is the first home he and his wife, Kristi, 22, have shared as husband and wife. She has moved a cot in. His 13th Field Artillery unit was pushing toward Baghdad when an explosion blew Fernandez from his cot as he slept by his Humvee on April 3, less than 20 miles from the Iraqi capital.

"I woke up. My legs were numb," he recalls. "I took off the sleeping bag and I screamed." His feet were bloody pulp. The Humvee was in flames, spewing fuel. Patches of fire burned around wounded soldiers. "I crawled away, calling for my gunner. He called back. His legs were bad, pretty much blown off. So I threw my flak vest down on him, put my M-16 on his chest and started dragging him." Help arrived, and the gunner was carried off. Two more soldiers — just kids, Fernandez thought — appeared through the smoke. The Humvee exploded, throwing all of them to the ground. His rescuers began to panic.

"Calm down, it's OK," Fernandez remembers telling them. "Just grab my legs, not my feet." At the mobile Army hospital, a senior sergeant burst into tears. "Don't worry, " Fernandez heard himself saying. "I'm OK."

Arriving at Walter Reed, feet swathed in thick bandages, he figured he was in for serious reconstructive surgery. But the wounds were grievous, and infection set in.

Twelve surgeries later, Fernandez is a double amputee.

Surgeons sawed off one leg just below the knee, the other a couple of inches above the ankle. His wife of three months insists nothing has changed between them, and talks about dancing together at the big wedding postponed by war.

The surgeons agree: Anything is possible. People climb mountains, ski, run marathons on state-of-the-art artificial legs. Fernandez had always been an avid athlete: lacrosse, basketball, soccer, hunting, fishing, you name it.

Kristi Fernandez was at the curb when they unloaded her husband's stretcher at Walter Reed. 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 and then put his degree in systems engineering to work in the civilian sector. They'd start a family.

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

Yet they insist they're coping. Kristi Fernandez 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," she says, "I'm glad it's us." Because they can handle it, she is sure.

The honeymooners in Room 5711 quickly became the darlings of Ward 57. They crack jokes in their Long Island accents and beg visitors from home to bring fresh bagels. But among themselves, doctors and nurses question whether the young lovers can bear the stress over the long term.

The swelling is going down on Fernandez's stumps, and doctors hope to start fitting him for artificial limbs soon. The rehabilitation specialist, Jeffrey Gambel, says Fernandez should eventually be able to bear weight on the longer stump, so he won't have to put on both prostheses to get to the bathroom during the night. "It will be very hard to walk on," Gambel says, "like a cone."

"Like a pirate," Fernandez suggests. He and his wife burst into laughter, sharing the same ludicrous thought: "Halloween!" they hoot almost simultaneously. No need to worry about a costume this year.

The Mountain Dew 'cure'

Of all the specialists who puzzle over Garth Stewart, of all the expensive drugs dripping into his veins, nothing brings relief. The stomach cramps and constipation persist. He's getting worse. And then his magic bullet arrives.

The remedy comes from an unlikely deliverer known as the Milkshake Man. Jim Mayer is a veteran who lost both legs in Vietnam. Several times a week, he brings McDonald's milkshakes to the amputees on Ward 57. The visits are an excuse to talk and counsel. Mayer arrives this Saturday, but Stewart refuses the shake. Too rich. Any chance of a Mountain Dew, he asks. Mayer heads to the commissary.

The supercaffeinated soda does it. Caffeine! The next day, Stewart is sitting up. His blinds are open. "Mountain Dew saved my ... life," he says.

"So many people look at this as you are less of a man," Stewart says. "You should see the dignity of the guys who come in here to visit me. They roll up pants, and they are standing on plaster."

A day later, Walter Reed's highest commanders come to bestow military honors. After the VIPs leave, he sits in bed, a gold medal pinned to his pajama top and an empty delivery box beside him.

"Quite a day, man," he says. "Pizza and a Purple Heart."

Hoping for a return to Iraq

The next morning, Stewart is wide awake when the doctors arrive for rounds. Freshly barbered, he looks like a soldier. He has one question: "When can I get out?"

"I think a week is certainly feasible," Dr. Ken Taylor says, checking for signs that the skin flap is healing.

Stewart says how much he wants to rejoin his unit in Iraq. "This is something I'm really serious about, doc."

Taylor focuses on Stewart's stitches. "An amputation is not a death sentence as far as the Army's concerned," he says. "We've got two four-star generals with amputations. It's hard for me to say if you'd be a ground-pounder again, an infantryman, but I don't rule it out."

Stewart continues to press. "I mean, if someone came and got me, could the Army stop me from leaving?"

Taylor pauses, holding the gauze in his hand. The 37-year-old Army major is unshaven. He has worked all night, and his day in the operating room starts in 45 minutes. But he remains intent on Stewart. "You're itching to get out of here, and I'm itching to launch you," he says. "The fact that you're even saying that is fantastic. You were this guy curled up in a ball two days ago who didn't want the light turned on.

"You're on the fence right now. I can't pop your hood and look inside and tell you what's going on today to know what I have to do to get you out of here. The human condition is not like that. We're on your side. You buyin' what I'm sayin'?"

Stewart folds his hands behind his head. "Yeah."

When the doctor leaves, Stewart comes up with the idea to buy a plane ticket to Iraq. He can't stand the idea of the 3rd Infantry Division over there without him.

A brush with the real world

Danny Roberts' little green notebook is full of reminders. He and his girlfriend, Mindy, will need a new apartment, ground floor. And transportation; he sold his beater of a pickup truck before going to war. Will a wheelchair fit in Mindy's Kia?

In the haze of painkillers and too many different people trying to brief him on Army policy, the economics of being a disabled reservist confuse him. There are forms to complete, boards to convene, hearings to go through before the Army decides what his status will be and what kind of compensation he will get. The process can takes months. His head hurts. He thinks it must be the meds.

"I'm not one to gouge the system," he says, "but everyone's told me I already paid a big price and deserve what I can get."

His mother, Nancy, arrives from Green Bay, Wis., with Mindy, a blur of hugs and held-back tears. Nancy brings her son's favorite chocolate-chip cookies, homemade.

Mindy Bosse, 20, who is juggling two waitressing jobs and college, has final exams and can only stay the weekend. She'll hunt for a new place for them to live.

Roberts' convoy was exploring an abandoned Iraqi air base on April 9. He found souvenirs: an Iraqi beret emblazoned with an eagle, a gas mask, the blouse from an Iraqi uniform. Best of all, a hardcover book with an autographed photo of Saddam Hussein inside.

Wow, he thought, this is my lucky day.

Two hours later, he was having a cigarette with buddies. He kept bouncing the heel of one combat boot off the toe of his other boot, an old habit. He figures this mindless motion set off the land mine beneath him. Three others were hurt, none as seriously as Roberts. He can still see the speckles of blood on a buddy's shirt. "It was my fault," he would later sob to doctors, who noted the crying jags in his chart as they transferred him from Kuwait to Germany to Walter Reed.

Now he is getting a fresh cast on his shattered heel.

"Ankle up, ankle up, ankle up," the technician says.

"I'm trying," Roberts apologizes. The procedure causes pain not in the heel and the severed nerves that have gone haywire on the opposite stump, where his left foot was amputated above the ankle. He squeezes his eyes tight and grimaces but doesn't complain.

He massages his stump.

"Your body gets used to pain," the cast tech offers.

"I've definitely gotten used to pain," Roberts says

He scores a day pass, and he and his mother head to the nearest mall. But that first excursion leaves him depleted physically and emotionally. The wheelchair they give him was clearly intended for a large and husky man; Roberts is neither. Maneuvering through crowds and up and down inclines are a lot trickier than a hospital's wide, level halls. And there are the stares. The adults quickly avert their eyes, but the kids ask straight-out what happened to his foot. Accustomed to living in a ward full of amputees, Roberts didn't think to cover the raw red stump.

He returns to Walter Reed bone tired. In a small voice, he asks everyone — his mom, the social worker, the nurses — to leave him alone for a while.

It's too hard to concentrate, and these headaches won't go away. Worried doctors schedule him for tests.

A visit from family

Across the ward, John Fernandez is packing. His orthopedist, Donald Gajewski, is so pleased with the way Fernandez's wounds are healing and how well he has managed on his day passes, that he offers a deal: Discharge to Fisher House, a small inn on the hospital grounds for patients' families. But they need to return for daily dressing changes and physical therapy. The prosthetics lab will start casting Fernandez for artificial limbs once his swelling has gone down.

"Take it easy," Gajewski cautions, "you're still healing."

The nurses cluster around Fernandez and his wife leave.

At Fisher House, they are eating lunch when Fernandez's grandparents arrive from Long Island.

"Gramps!"

"Johnny! Johnny!" Frank Fernandez, 81, is a Navy man who survived the bombing of Pearl Harbor and had two torpedoed ships sink beneath him. He spent 33 hours in the water and won't go swimming to this day.

Mary Fernandez, 74, bustles in. "I brought cookies from New York!" She kisses her grandson. "How you feel? You're still pale."

He smiles. "Right now it still hurts," he tells them.

"Let it heal, John," his grandfather says. "Let it heal."

John and Kristi Fernandez excuse themselves for a nap. After they leave the room, his grandmother's smile begins to tremble. Tears slip down her face.

Nighttime on Ward 57. It's quiet except for the beep of morphine pumps and a lone TV.

Downstairs, the triage room is bracing for new casualties. An hour ago, another medevac plane landed at Andrews Air Force Base.