“What was it?” he heard one of the soldiers ask another.
“It was probably a command wire,” Frost called to them, all business, answering reflexively even though they weren’t speaking to him.
“What?”
“Yeah, it must have been a command wire. They hit us when we pulled up. And it was big. Maybe military ordnance. We get a lot of that here. A couple of 122s or 130s from ASP 3. But there is no frag, so maybe HME instead. From the size of the crater, it would have to be a ton, and—”
“Hey, man, don’t worry about that now,” his medic said. “The helo’s already on its way.”
So lucky, Frost thought, so lucky to be hit on a day that flights were not grounded, so lucky they had already radioed for a bird. Only thirty miles from the main theater hospital, but thirty miles of RPGs and surface-to-air missiles that often kept them on the deck.
Max was awake, and they were cinching down the tourniquets around his thighs since there was nothing lower. Branden Haunert had crumpled, he had crumbled fast, quiet, and his body armor was blown open and his chin was on his chest and the stumps of his legs had stopped dripping.
Thirty minutes or less or your pizza is free, and the helo arrived right on time. They loaded him on the bird but forgot his helmet. Too bad. It was his favorite one, and he wouldn’t get it back. Well, he’d never need it again anyway.
It was May 18, 2008, almost three years to the day before Fye lost his leg, three and half years before Matt died in a similar truck. Technical Sergeant Christopher Frost was on a medevac helo, a one-way ticket out of Iraq, and his war was over.
FROST’S FIRST STOP was a regional trauma center at FOB Speicher, a miserable moon dust–laden base in Saddam’s hometown of Tikrit. There the doctors declared Frost’s right foot to be unsalvageable—“soup in a boot” Frost would later call it—but they would try to save the left, so they knocked him out and sent him to the main military hospital at Balad Air Base, where he woke up the next day.
The hospitals at Balad and Kandahar were roughly analogous; both were on the second-largest base in their respective countries, both had world-class trauma capabilities, both had survival percentage rates in the high 90s. In personality and feel, however, they diverged. The Role 3 hospital at Kandahar was multicultural, run by a succession of branches of the US military and a variety of NATO countries cooperatively and with an integrated staff. The Level 1 Trauma Center and theater hospital at Balad, on the other hand, had been run by the Air Force alone from its inception and served as a vital deployment outlet for that service’s vast fleet of stateside doctors and nurses. The hospital was a focal point and source of pride for the Air Force, especially on a base known for its abundance of brass and comparatively cushy lifestyle. Kandahar was big but, compared to Kabul, still provincial. Balad, on the other hand, could feel like Baghdad’s safer exurb, and the eponymous base was a back-office logistical hub. Balad was an important airfield and warehouse and truck stop, but clogged with American-style traffic and fattening food and the most notorious poolside office pukes and rear-echelon motherfuckers and fobbits in country.
It is a testament to airmen generally, though, that many such desk dwellers appreciated their good fortune. After typing away at emails all day, many volunteered at the hospital evenings and overnights, as stretcher bearers and aides. Like a catch basin with a single drain, the hospital accumulated all of the lost blood of each day’s combat, conducted by helos and casevac Humvees and funneled through the small entrance known as the Hero’s Highway. Via that tiny walkway, a tent frame skinned in an American flag, administrative clerks and cooks bore each wounded soldier from the landing pad to a stainless steel table in a just-sprayed-down operating room, and so the hospital gathered a country’s worth of pain and suffering to itself through the labors of the dismissed and despised.
Frost woke up at Balad just long enough to acknowledge visitors; like a band of bearded candy stripers, the EOD brotherhood had gotten good at making hospital room calls. Soon, though, Frost was back in his drug haze, off to Germany for another round of surgeries, and then bound for the United States.
The armor of Frost’s truck failed spectacularly, but not directly under him, and so he was fortunate to avoid some of the worst effects of the detonation. Unlike Fye, he didn’t take frag from head to toe, or suffer a Traumatic Brain Injury. And unlike Matt, who absorbed the full vented explosive force and died four times, Frost had no organ damage or internal bleeding, only minor face trauma that would ultimately be repaired with a metal plate around his eye. No, the main damage was to his lower legs, and after years of explaining his mechanism of injury, he has found that the only guys who really understand it are old WWII Navy sailors who have been on a ship that has been torpedoed.
When an old Japanese Type 93 hit one of our floating steel tubs, it didn’t just leave a hole at the waterline. It threw the whole ship upward, the plating violently colliding with the boots of the men standing on each deck. It was not blast that crushed the feet and lower legs, then, but blunt trauma. The flooring of the armored truck beneath Frost’s seat reacted much the same way; he could have received the same damage by taking a heavy steel beam across the shins.
Surgeons at FOB Speicher amputated his right leg fairly high, right below the knee, because the tibia and fibula were pulverized into gritty oatmeal nearly to the joint. It would have been significantly worse at or through the knee, however, and the surgeon did Frost a lifetime favor by saving as much as he could.
The left leg was more complicated. Some combination of forces split his foot nearly in half, wrenching both his heel and toes upward and leaving his ankle bone exposed. His Achilles had retracted like a bungee cord and pulled his heel backward, but the toes randomly splayed forward and could probably have touched his knee before they were sewn back in. The surgeon folded back each layer of muscle and tendon and wired together the bones of the foot and installed a plate on the fibula with ten screws and then stapled it all closed in the correct general shape, but it only grossly resembled the foot it was. Frost’s lone shoe size grew from 10 Regular to 13 Wide.
Frost would spend the next two and half years trying to save that left foot, and he did it as a professional patient at Walter Reed Army Medical Center in Washington, DC, a hospital beset by scandal and in the process of shutting down.
CATHY HAD SEEN him at the bottom of the hill before, but she had never asked if he needed help. It’s rude, she knew, to assume the guy in the wheelchair needs someone to push him up the hill. But she had seen him around—on the porch reading in the sunshine, on the way to and from appointments—and she had been looking for an excuse to talk to him.
He is pretty gimptastic, she thought, but so are all these guys. And anyway, I’m pretty jacked up myself.
Cathy was a nineteen-year-old Army Private installing fiber optic cables for computer networks at Camp Victory in Iraq when she was told she had six months to live. She wasn’t injured in combat, and her abdominal pains weren’t due to bad food at the chow hall. No, the doctor told her it was pancreatic cancer, and she was rushed to Walter Reed for a Whipple surgery, the only treatment that offered a five-year survival rate out of the single digits.
Whipples were first performed in Europe in the nineteenth century, and the procedure retains a certain excessive thoroughness that characterized premodern medicine. During the operation, not only is the cancerous half of the pancreas removed but so are the gall bladder, bile duct, half the stomach, and two thirds of the small intestine. The remaining portion of the stomach is then plugged back into the end of the intestine, and a few juice ducts are rerouted so the right chemicals from the pancreas can still make it to ingested food. Months after the surgery Cathy was still recovering, and would be for some time. She would ultimately spend a year at Walter Reed as her remaining organs and the massive chop across her midsection healed.
Cathy was out for her regular walk, but when she saw him again at the bottom of the hill, she realized she fin
ally had an opening. His arms were full of boxes, and he couldn’t roll himself and hold them at the same time.
Ha, ha, I’ve got him now, she thought, and confidence filled her steps.
“Can I help you carry those?” she asked. He looked up at her. His head was clean-shaven, and cool-guy sunglasses hid bruising around his eyes.
“Sure,” he mumbled, and looked away, and handed over a few boxes. They were heavier than she thought.
“What is all this?” she asked.
“Donated books from the quilting group at church.”
“Do you read a lot?” She already knew the answer from watching him on the porch, but that started the conversation, about Terry Goodkind and Garth Nix, history and architecture, throw-away space operas and spy thrillers, and before long, Cathy and Frost had each found a partner to navigate the insular and utterly unique institutional culture of the Patient Mafia at a military hospital.
The military is full of mafias. The Air Force’s Bomber Mafia, propagated by men like General Curtis LeMay at Strategic Air Command, shaped policy for decades until the Fighter Mafia took control in the 1970s. The Corporal Mafias of the Army and Marine Corps are famous for breaking every rule—especially the ones that involve the lawful acquisition of supplies and materials—to outfit their units for missions. The Patient Mafia, particular to the hospital, more closely resembles the Corporal system and is the inevitable result when medical, military, and quasi-penitentiary cultures are combined.
The old Walter Reed Army Medical Center occupied the northernmost point of the District of Columbia, a compound surrounded by a wrought-iron fence and squeezed between a forested public park and the middle class suburb of Silver Spring, Maryland. Closed in the summer of 2011 to be redeveloped into a modern mix of apartments, offices, and shopping, the main hospital consisted of an old columned redbrick colonial structure built in 1909 with a sort-of 1970s concrete spaceship campus perched on top. Very few of the patients seen at Walter Reed occupied in-patient hospital beds, though, so surrounding the main structure were a mix of commandeered hotels and dormitories that housed the legions receiving outpatient physical therapy. In these buildings the Patient Mafia thrived.
Each of the four services imposed a separate command structure, to maintain control and combat the cliques that would naturally form among patients who received care together. The Army had daily 0900 formations of wheelchairs and crutches, every soldier in some sort of uniform. The Navy and Marine Corps had few patients at Walter Reed, but to Frost it seemed they assigned two or three staff members to watch over each one. The Air Force wanted its airmen, without irony, to answer daily emails.
The Patient Mafia existed to beat this system. Like a thousand Reds from Shawshank Redemption, it consisted of nothing but troops who knew how to get things. If a soldier missed formation, four contradictory alibis would be volunteered by his squadmates. If an airman wanted a new pain medication, he would receive advice on which doctor would prescribe it. If a sailor wanted a higher disability rating, she would learn what to say to her shrink. If a soldier wanted to go on a sponsored fishing trip, he would learn how to ask so he wasn’t saddled with fire watch on top of it. If you’re healthy enough to fish, you must be healthy enough to go back to work …
Cathy lived in Abrams Hall, the best Army barracks she had ever seen. Frost lived in the Mologne House, a former high-end hotel. They were lucky in their accommodations. The Department of Defense had put Walter Reed on the closure list in 2005, but the wounded from the war kept coming, and so even as the medical center tried to shut down, it operated at full capacity, swollen by the fallout of the Iraq Surge. This tension proved impossible to balance. A 2007 Washington Post investigation revealed a system of overwhelmed, shabby, and neglected facilities, especially the infamous Building 18. The Surge was producing more than five hundred injuries a month, and the soldiers needed to go somewhere. The Fisher House, similar to the one Jenny Schwartz would stay in three years later at Dover, tried to always keep a room or two open for incoming families. It was not always successful.
Six months into her stay, the Patient Mafia and overcrowding collided at Cathy’s front door. She was given a roommate and told to babysit. The girl had shot herself in the shoulder to leave Iraq. She screamed in her sleep. She lied and skipped every formation. She bought street drugs outside the hospital’s main gate and hosted a threesome fueled by oxy and crack in her barracks room. One of the guys OD’d and died. Cathy called her the Black Widow.
FROST AND CATHY became inseparable, and when not surviving the Walter Reed mafia, they helped each other heal.
The injuries to Fye and Frost were remarkably similar, only mirrored: one amputated leg healing quickly, the remaining leg stubborn. Frost did not suffer from the painful random bone growth of HO, but he did wear a Taylor Spatial Frame. The pins propped apart his ankle bones and gave his fibula time to heal, keeping his toes from flopping onto his knee again. He wore the frame for only four months because it was misinstalled. The securing bolts were wildly unstable, only ten degrees apart, so if he bumped the frame at all it would rotate and twist the bones internally.
“Can’t sue ’em!” Cathy would quip when Frost grew frustrated at the pain. She joked that the mistake was due to that fact that Walter Reed was not only a military hospital but a teaching one as well.
Once the frame was off, Frost’s ankle became the focus of repeated surgeries and procedures. It was dying from lack of blood supply, a condition known as avascular necrosis. Bones constant break down and are rejuvenated from normal use and circulation, but take that blood away and they grow brittle. Hidden away inside his bandaged foot, Frost’s ankle resembled the skeletal remains of some cattle carcass lying exposed in the desert sun.
As a first step, doctors attempted an experimental surgery. They removed one of the extensor digitorum brevis muscles—the little muscles in the top of the foot—and stuffed it into a hollowed-out section of his ankle bone and sealed it with plugs. Blood flowed to the starved bone, but the rest of his foot suffered. Less than a year later, complications arose, and Frost received a subtalar fusion, a procedure normally reserved for geriatric patients. Eight bones in his foot were drilled out and bolted back together. He was left with a mass of scar tissue and a foot stuck in one orientation, never to be flexed again.
“Worst. Idea. Ever,” said Cathy later, remembering the nightly massages to unbind the scar tissue, just so Frost could wiggle his toes. They were engaged by then and knew another fusing surgery would inevitably be required. During the day, when patients and staff innocently asked about the progress of his ankle, Frost provided inappropriately long and complaining answers. At night, during the foot massage, he and Cathy both asked whether they should consider other options.
Fifteen months after the blast, Frost was still trying new treatments, and he wondered why.
IN FROST’S OPINION, post-scandal Walter Reed Army Medical Center did not provide an ideal environment to rehabilitate and salvage his mangled left foot, so he sought to escape it nearly immediately. He successfully lobbied to be formally assigned to the EOD unit at nearby Andrews Air Force Base rather than the “patient squadron” at Walter Reed. He bought a condo in northern Virginia just to have an outside address. He reminded himself that his identity was not wrapped up in being a patient, and that, to use his words, he was “still an EOD superhero, just getting the tires changed on my car.”
Frost felt that the hospital struggled to find meaningful activities for his generation. The older patients, National Guard guys with heart attacks and the ailments of middle age, were content to go sit on a barstool at a baseball game. Meanwhile, the younger and otherwise healthy soldiers were stuck fighting over the few opportunities to go sailing or rock climbing. He saw too many grow frustrated and take to the wheelchair instead. Always analytical, Frost watched other patients in physical therapy and saw that the sooner he could get out of his own wheelchair, the healthier he would be.
“You’l
l die in the chair,” he realized.
So when a chance to get out of Walter Reed came, he took it. In the summer of 2010, two years after his injury and in the midst of recovering from the subtalar fusion, Chris Frost signed up for a cross-country bike ride.
The trip was sponsored by World TEAM Sports, an organization that plans trips for mixed groups of disabled and able-bodied. Frost had been a bit of a bike geek when he was younger, so he used the Patient Mafia to get all of his paperwork signed off and official permission to go. It was a second chance, a do-over, two months out of the hospital. He bought the stiffest shoes he could find and completed a few hundred-mile training days in preparation. He needed this.
The 3,500-mile ride attracted men and women of all backgrounds and abilities: veterans and not, support riders and college interns, guys paralyzed from the waist down using hand crank systems. Paul Bremer, the former head of the Coalition Provisional Authority in Iraq, rode along as the semiofficial grand marshal of the parade.
Frost completed the ride, but it was a misery, and he couldn’t walk at the end of each day. His ankle had no cartilage, and his foot was tearing itself apart from the inside. The bones held up, but the tendons and ligaments were failing; his toes acted like the end of a long lever, and the front of his foot was shearing off the back. He took six tabs of oxycodone a day, just enough to make him functional but not so much that he wasn’t lucid. Frost never liked pills, and he was afraid that if he took too many he’d forget to think or breathe.
On those long, painful days of riding, Frost spent a lot of time with a twenty-something kid named Chad Jukes. Jukes had a scruffy beard and flowing locks; Cathy called him Blond Jesus. In 2006, he nearly lost his leg in Iraq when his truck hit an IED. He too survived the Taylor Spatial Frame. He too had an ankle that died. But he quickly developed a severe infection, and the doctors said the leg should go. Jukes seemed unfazed.
All the Ways We Kill and Die Page 14