The coronavirus threatens those who need care the most and strains networks providing help
Andrew Smith has a vision. In January his brother is getting married. Smith imagines being able to walk up the church steps and down the sanctuary’s center aisle. After all, he is the best man.
This activity would be an after-thought for most 25-year-old men. But Smith is learning to walk all over again.
Last March while on patrol in Afghanistan, Smith stepped on a pressure plate, triggering an estimated 10-pound homemade bomb. The explosion hurled Smith into the air, took out his left leg below the knee and his right leg above the knee, and sent his life and that of his newlywed bride onto a path far from their original plans.
Now Smith just wants to walk a hundred feet down a church aisle in such a way that no one attending the wedding will realize that underneath his dress pants are two prosthetic legs. He doesn’t want to use a cane. “I don’t want to take any attention away from my brother,” he said.
This past summer Smith seemed a long way from reaching his goal. Recuperating at a military hospital outside of Washington, D.C., Smith couldn’t stand on his prosthetics for more than a few moments. “The longer I’m in them the more it hurts,” he winced.
Prosthetists worked to mold the artificial limbs into a better fit for what was left of Smith’s leg bones. While he waited on a comfortable adjustment, Smith depended on a wheelchair. He sometimes moved its wheels with his arms. At other times his wife, Tori, pushed him along.
Around him Smith sees plenty of evidence that his injuries do not condemn him to a life of confinement. Today a double amputee can do more than just stand.
One recent morning a pair of 20-something soldiers wearing black shorts and gray T-shirts with the word Army printed in black jogged beside a busy street near the entrance to the Walter Reed National Military Medical Center. As they ran past the line of cars and headed toward the military gate, the four prosthetic legs they wore matched each other stride for stride.
Since the start of the wars in Afghanistan and Iraq, over 17,000 Americans have been catastrophically wounded. As the United States honors war heroes on Veterans Day and readies for the end of war in Afghanistan, the saga for America’s wounded military personnel—particularly its amputees—will stretch not only over withdrawal timetables and political cycles but over their lifetimes.
The military has treated 1,559 amputee soldiers (of those, 272 lost an arm or hand). Such large numbers are due to advancements elsewhere. With modern body armor, better-protected vehicles, improved medic training and rapid evacuations, U.S. soldiers survive battlefield wounds nearly 90 percent of the time. Smith would have died if his injuries had occurred in Vietnam.
By 2010, a military study reported the highest amputee-per-wounded soldier and amputee-per-killed soldier rates in the nation’s history. In other words, more soldiers who would’ve been killed in the past are now wounded amputees.
That’s why portions of the 243-acre Walter Reed campus in Bethesda, Md., look like a village with two residency requirements: You must be well under the age of 30 and you must be missing one or more limbs. In addition to Walter Reed, the military has hospitals specializing in amputee care in San Antonio and San Diego. All three have opened within the last seven years.
With the rest of the amputees in this community, Smith attends physical therapy two hours each weekday.
The rubber-floored rehabilitation room contains items you would expect to see in an average gym: a rack of hand weights, multi-colored exercise balls, elastic resistance bands, and exercise machines. But there are also items you don’t see in a gym: cycles powered by hands instead of feet, an indoor track with an overhead support harness, and, in one corner, several dozen prosthetic legs stacked up like backstage props. Dominating the room’s center are rows of beds with white sheets and pillows. It’s as if a Gold’s Gym has merged with a hospital ward.
Most of the patients are double amputees. A few have lost three limbs. A couple of soldiers are missing just one leg. “We call a single below the knee a paper cut around here,” Smith says.
A soldier lost multiple limbs about once in every four combat amputations in 2009. Last year the ratio increased to almost one in two. Amputations hit an average high of 22.1 per month in 2011, according to a recent report by the Armed Forces Health Surveillance Center.
For decades leading up to 2001, most amputees treated by the military medical community involved older, inactive patients who suffered limb loss due to disease. But during the last 10 years the flood of young amputees requires treatments and devices to help them regain the active lifestyle they so suddenly lost. Seeing these soldiers as wounded athletes rather than patients, the military has modeled the recovery program after a sports medical clinic.
On one of the days I visited the clinic, two double amputees dribbled and passed a soccer ball. A third amputee threw a football over the hospital beds with a therapist. One patient sidestepped ankle high hurdles while another lifted his new legs over a row of rubber sports cones, tapping the tip of each small cone with his prosthetic foot before setting it down on the other side. Occasionally someone fell onto the red and blue rubber track. Always they got back up without asking for help.
The newest generation of artificial joints better approximates the human knee and ankle. A knee embedded with a battery-powered microprocessor carries angle sensors that adjust for walking up a flight of stairs, running down a hill, or jumping over a curb. This smart knee technology comes with a remote that allows its wearer to switch between modes for such activities as golfing and bicycling. Its battery charge lasts for up to five days.
I’m almost thankful about this injury. ... Now I get to spend every day with my wife, which is awesome.
During therapy as the soldiers learn to play with their new knees, young wives or girlfriends linger nearby. One stands right behind her husband and wipes sweat from his brow with a white towel as he slowly makes his way around the track holding a weighted exercise ball over his head. Two parents looking like someone has gut-punched them stand beside one of the beds as their son goes through stretching exercises to strengthen his core. The dad occasionally snaps a few pictures. The beds are the first phase of training for the new patients.
Smith graduated from the beds by July. But on this day he can only manage to slowly walk down a rubber mat with the help of waist high handlebars that run alongside the mat. After a couple of feet he calls for his wheelchair. He slumps down into it.
When Smith landed at the Kandahar airfield in Afghanistan in February 2012, the first thing he noticed was bullet holes covering the old terminal’s walls.
“This is real,” Smith said to himself. It had been a long journey.
The Sept. 11, 2001, terrorist attacks happened during his freshman year in high school in Chattanooga, Tenn. Smith spent the next four years yearning to join the military just as his grandfather had right after the start of World War II. He enlisted in 2010 not long after graduating from Tennessee’s Lee University. Smith found himself on the war’s center stage as a member of a brigade combat team in the 82nd Airborne Division.
In Afghanistan Smith got used to life inside tents the size of multiple basketball courts, sleeping on mattresses that looked like they had been there since the U.S. Army first arrived.
When an air raid siren went off while Smith and his unit took an orientation class on improvised explosive devices, some of the troops who’d been there awhile laughed it off, promising the fresh faces that any missiles launched couldn’t reach deep inside the base. But the sudden alert followed by the rush into the nearest concrete bunker was sobering to Smith.
“The Taliban is still here,” he thought.
Commanders assigned Smith’s company to a combat outpost in southwest Afghanistan near the Pakistan border. The soldiers passed rumors that Alexander the Great had once built a fortress there during his conquest of the area.
But there were no fortresses there in 2012. Smith’s squad of less than 20 soldiers took over a patrol base outpost south of the main outpost in the area. For protection they had a few tall sand-filled barriers, a couple of makeshift guard towers, concertina wire and a truck blocking the lone entrance. Baby wipes replaced showers. Canned soup and Gatorade bottles replaced hot meals.
The picket duty placed Smith’s squad near a hornet’s nest of Taliban fighters who trekked back and forth over the nearby desert from Pakistan bearing lethal supplies. Commanders tasked Smith’s squad with interdicting this smuggling. His part in the mission lasted only one patrol.
On the morning of March 8, Smith ventured outside the patrol base with about a dozen U.S soldiers and seven members of the local Afghan police. They moved along a dirt road near farmland with a few scattered buildings. Smith watched nervously as the Afghan police used twigs to poke at anything in the road that looked suspicious.
As the squad entered a field, the pop of bullets erupted from their left. Smith and the others hit the ground and held their fire. The soldiers couldn’t see where the fire was coming from, but that didn’t stop the Afghan police officers from firing blindly.
One of the Afghan police officers ran over to Smith and a few other Americans and motioned them to follow. The Americans hesitated.
“You guys are good,” Smith’s squad leader shouted. “He knows where the Taliban are. You guys follow him, and we will be right behind you.”
Smith hopped over a wall and landed inside a narrow ditch. Shots flew overhead. Smith was third in line, following the Afghan policeman and another American. Somehow the first two missed the pressure plate. Smith did not. When he crashed back down to the ground head first after the blast, Smith’s first thought was to push himself onto his back. Then he screamed.
“Help. Help. Help.”
Smith’s team leader held his hands as the unit’s medic slapped tourniquets and gauze onto Smith’s wounds. It was the medic’s first battlefield casualty. He was 20 years old.
“Jesus save me. Jesus save me. Jesus save me,” Smith shouted over and over. His screams were matched by the team’s radio operator yelling landing coordinates to a helicopter launched to take Smith off the battlefield.
Shoved into the helicopter, Smith continued to cry out for Jesus. As the helicopter took off, Smith’s screams stopped. He had blacked out.
The next time Smith woke up was inside a military hospital in Germany. It was March 10, two days after his injury and almost exactly one year since his March 11, 2011, graduation from basic training. He had only been deployed for 18 days. A Purple Heart, awarded to Smith while he was unconscious, sat inside a bag near his hospital bed.
After a recent morning therapy session at Walter Reed, Smith wheeled himself back to the outpatient apartment on base that he shares with his wife. A group of men in wheelchairs waited with their wives and mothers outside the hospital’s pharmacy. On the back of the wheelchairs are bumper stickers that say, “I served in Afghanistan.” Other amputees wear T-shirts that read, “I had a blast in Afghanistan” written alongside a cartoon drawing of an explosion.
“You have to have a sense of humor,” Smith explained.
Smith greeted a soldier from his own platoon who was wounded a month and a half after Smith. After a brief exchange, Smith noted that the fellow soldier was in the intensive care unit for a week. “I was in there for a month and a half,” he added.
Smith’s body got torn apart on a Thursday. By the following Tuesday he had arrived at Walter Reed.
Since the blast, doctors had kept Smith’s lower body covered in sheets and wrapped in bandages. But on Smith’s second day in the hospital’s intensive care unit, a doctor came in to examine him. Nurses removed the sheets and bandages. Smith looked down and did a double take. He tried to lift his lower body and couldn’t.
He looked up at his wife with a puzzled face and said, “I don’t have any legs.”
“Not all of them,” she replied. Tori Smith had prepared a big speech for this moment. But before she could begin, her husband had gone back to sleep.
When she got the call about her husband’s injury, Tori was in her second semester of law school at Michigan State. The military could not tell her whether Smith would be transported from Germany to a hospital in Maryland or Texas. But she didn’t want her husband to spend his first night back in the United States without her.
She got into a car with her mother-in-law and brother-in-law and headed toward Washington. Along the way they listened to worship music and prayed that they were going in the right direction. If the military called and told her Smith had been sent to Texas, then they planned to drive to the nearest airport and put Tori on a plane to San Antonio.
When Smith landed at Andrews Air Force Base, military personnel loaded him into an ambulance the size of a semitruck with six other wounded soldiers and headed for Walter Reed. Tori was already waiting.
Standing on the sidewalk near the hospital’s emergency unloading dock, Tori was warned by doctors it was as close as she could get. But when Smith arrived Tori went to him and held his hand for a brief second, kissed him, and told him she loved him. He gave the thumbs up sign before being whisked inside the hospital.
Tori has seen Smith every day since then. She slept in a chair during his stay in the intensive care unit even though doctors and nurses told her she was not supposed to be there. When Smith almost died at 3 a.m. one morning due to complications, Tori alerted the nurses. Soon four or five doctors surrounded Smith, his vital signs crashing. They wheeled him back into surgery.
Smith has had more to deal with than the loss of his legs. Shrapnel from the explosion ripped through his groin and slashed apart his abdomen. Infection almost killed him. He lost his abdominal muscles on his right side. Doctors performed 15 surgeries on his intestines.
More than once Smith would be discharged from the ICU only to be sent right back after vomiting up large amounts of blood or having a fever as high as 105 degrees or a heart rate hitting 200.
“Doctors would keep saying ‘this is interesting’ whenever they examined Andrew,” Tori explained. “In a hospital, you never want to be an interesting case.”
Released from the hospital in June, almost three months after Smith was hit by an IED, or Improvised Explosive Device, the Smiths’ new home is an apartment in Tranquility Hall, a 315,000-square-foot facility for amputees on campus that houses 153 two-bedroom suites. Smith says that every apartment is occupied.
Smith’s apartment on the fifth floor looks like a newly renovated three-star hotel room. Two framed picture collages hang on the wall. One before Smith’s injury includes wedding photos and a uniformed Smith surrounded by family at his basic training graduation, and one taken after the IED shows the Smiths at a Washington Nationals baseball game and at such D.C. monuments as the World War II Memorial.
In the den that separates the two bedrooms, Smith’s Purple Heart rests in a case on a ledge behind the couch. On the same shelf is a pair of pictures, one of Smith and the other of his grandfather who served in the Merchant Marine during World War II. They stand almost exactly alike, their feet spread slightly apart. Both are wearing their uniforms.
There’s a handicap-accessible kitchen where Smith, who only in recent weeks has been able to eat regular food, likes to prepare meals for his wife. His specialties include chicken and vegetables, steak and onions, or spaghetti. In the freezer of their apartment is a whole chicken that Smith is saving to roast for when his stomach heals. They spend their time when Smith is not seeing therapists or doctors watching baseball on television. Smith salivates at every pizza commercial.
“I’m almost thankful about this injury,” Smith says. “If I wasn’t injured I’d still be in Afghanistan right now, which would be fine, I’d be doing my job. But now I get to spend every day with my wife, which is awesome. It is kind of hard to think, ‘Man I wish I wasn’t injured so I could still be in Afghanistan sleeping on the ground and being shot at.’ It is just really cool being able to be with her every day.”
Ask physical therapist Kyla Dunlavey the secret behind Smith’s recovery, she gives a quick answer: “Tori.” Then she adds, “And their strong faith.”
Tori and Andrew were best friends in college. On the day Smith left for Army basic training in early November 2010, he turned to Tori before getting on the bus and said: “I love you.”
Tori didn’t know what he meant. She had to endure the mystery for several weeks because Smith couldn’t talk to anyone during boot camp.
When instructors gave him a two-minute phone call on Thanksgiving Day, Smith reached Tori. “I figured out then what he meant by ‘I love you,’” Tori said.
With Smith barred from using computers during basic training, they started dating the old-fashioned way: through letters. Tori, then working as a manager at a Target store in Cleveland, Tenn., wrote every day, including homemade crossword puzzles. They decided to hold “prayer dates” where every night at 9:00 they would both stop what they were doing and separately pray.
“We wanted to do something that reminded him to put God first no matter how much he got yelled at,” Tori said.
When Smith returned home for two weeks over Christmas, it marked the first time they had seen each other as a couple. They got engaged on Easter in 2011 and began planning a summer 2012 wedding.
But in the summer of 2011, Smith learned his unit would be deployed to Afghanistan in early 2012. When he told Tori she had one response: “You are not going anywhere without marrying this girl.”
Tori shopped for a wedding dress in less than 30 minutes, trying on two of the three dresses just to please her friends. She forgot to buy a veil until the morning before their Dec. 23, 2011, wedding. She was in her first year of law school and he was training to go to a combat zone. All they could do was Skype with one another.
“Now I see why God had different plans,” Tori said of their rushed wedding. “What would we have done if we weren’t married when all this happened?”
Today the couple talks often about the Book of Job—how God chose him to endure sufferings because He knew that Job would be a light for Him.
Part of God’s plan for the Smiths is already becoming clearer. They see their current community of wounded soldiers as a new ministry opportunity. Others on base see all the setbacks that Smith has been through and ask, “How do you get through that with such a good attitude?”
“When you are talking to nonbelievers that is like, cha-ching,” Tori said.
While Smith was unconscious in the hospital, Tori put headphones over his ears to play praise music. His head would sway back and forth. Tori wouldn’t let doctors wheel Smith away for any of his surgeries before praying.
A network of 2,000 family and friends who log onto teamandrewsmith.com spent months asking God to heal the holes in Smith’s intestines that prevented him from eating. A half dozen doctors told Smith that there was zero possibility that the holes would close without surgery. The doctors decided to wait until November or December to operate so Smith’s scar tissue from all the previous procedures could heal. But during an examination in late summer, the shocked physicians saw evidence that the fistulas had closed on their own.
“They were like, ‘Wow—just keep doing what you are doing,’” Tori said. “It’s such a testimony to the Lord.”
When Smith could return to a normal diet, he didn’t eat the roasted chicken saved in his freezer. The surgeons were so impressed with his miraculous progress that five of them insisted on taking him out to Ruth’s Chris Steak House. They said it was the first time they had done that for a patient.
Smith ordered a 12-ounce New York Strip, but he couldn’t finish it all. He brought it home and ate the rest of it the next day.
“We were talking to healers, and we were able to tell them that we knew the master healer,” Tori said. “What happened was a tragedy. It was terrible. But God has turned it into a blessing. To know that he is here because God spared him, it is hard to complain about anything.”
In the hallway of Tranquility Hall, information tables sometimes are set up offering internships for wounded warriors at government agencies like the FBI and Immigration and Customs Enforcement. But the Smiths are intent on returning to Tennessee. A local charity is raising funds to build a house for them. Once there they aren’t sure what they will do. Law school is on hold for Tori. Smith is studying for the GRE. They bought a Running a Restaurant For Dummies book. Smith said it wouldn’t be a fancy one. It would serve “a lot of nasty, greasy food. We’d name it ‘Heroes’.”
One morning in late October, Smith put on his new prosthetics that end with a pair of white and blue Nikes. He straightened up and began his stretching exercises.
“I feel like I’m 90,” he said. He grabbed a square shaped foam pad and began to drag it behind him around the track. “And he’s off,” said Dunlavey, his therapist.
Smith can make two laps around the track, dragging the extra weight. It’s his second day walking without a cane. Throughout the fall, Smith and Tori shared a saying: No cane by Christmas. Then the goal became: No cane by Halloween. It’s more than a week before Halloween.
Smith tosses a 4-pound weighted ball back and forth with Dunlavey. They soon advance to a 7-pound ball. Smith catches it with one hand without losing his balance.
Tori sits nearby talking with some of the other wives. When her husband grabs a basketball, Tori jumps up and starts filming with her cell phone camera.
What happened was a tragedy. It was terrible. But God has turned it into a blessing. To know that he is here because God spared him, it is hard to complain about anything.
Showing off his moves, Smith dribbles the basketball while walking around the track. He sends the ball between his prosthetic legs and around his back without breaking his dribble. He finishes by spinning the ball on his fingers.
“You are doing great, babe,” Tori says.
Smith is focusing on learning how to move without having to think about it. “I had no idea [of] all the mechanics involved in walking,” he says.
After receiving some instruction on the use of his hips, Smith walks toward a full-length mirror so he can study his movements.
Amputee patients at Walter Reed are usually walking by nine months and running by 13 months. When they leave Walter Reed after somewhere between nine and 18 months, the soldiers walk into a future with few limitations.
More than 300 amputees from Walter Reed have returned to active duty, including 53 who have gone back to serve in Iraq or Afghanistan. This summer an officer wounded in Iraq in 2007 became the first double amputee to assume the command of a major military installation.
Dunlavey says former patients return all the time boasting about their exploits: One ran a 10-mile race just 11 months after losing his legs. Others have climbed Mt. Kilimanjaro and Mt. McKinley.
“Maybe I could be the first amputee to do the Appalachian Trail. Has anyone done that?” Smith asks Dunlavey. “Two thousand miles of mountains. That would be perfect for me.”
But first Smith wants to hike from the therapy room to his apartment without his cane. It’s a 10-minute route that will take him over sidewalk curbs, around cars in a busy parking garage, and up a steep hill. He carries his cane but doesn’t use it. Instead he twirls it with one arm as if it’s a baton. Tori follows behind pushing his empty wheelchair.
“Another beautiful day,” Smith says as he marches up the hill. “You are doing great walking,” Tori responds. It’s two more months before his brother’s wedding.
Nine hundred runners dressed in track suits and spandex ran last month in a McLean, Va., 5K created to help provide wheelchair-accessible transitional housing to veterans recovering from their wounds. But I was particularly drawn to one of the 400 spectators who gathered to watch, encourage, and cheer the runners.
Larry Hughes, a muscular man with a white-tinged black beard and thick, rectangular glasses, was wearing a gold U.S. Marine Corps pin and sitting in a wheelchair because of shrapnel wounds suffered in the Vietnam War. Hughes trains wounded veterans in track and field events, including shot put, discus, and a “running bike” built for those with disabled legs.
Hughes’ injury helps him understand what the injured war veterans are going through. After his injury 44 years ago, he says he “had to find myself.” He realized that others perceived him as “other than us,” and that made him “question my integrity of being a citizen.” Overcoming his doubts, he went on to compete in the international Paralympic Games. In 1996, he won a gold medal for America in discus.
Hughes says, “To see someone with a disability running alongside, in front, and behind you in a race may make someone feel sorry for them and ask, ‘How can they do it?’” His answer: “They can do it like anyone else who has a desire to do it.” And he was right. More than 20 wounded vets were among those who crossed the finish line, some with a graceful stride, some with clenched teeth. —David Fisher