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washingtonpost.com: Hope Breathes Beneath Wounds

Hope Breathes Beneath Wounds
Bodies Ravaged by Terrorism, Survivors Savor the Small Steps
By Donna St. George Washington Post Staff Writer
Sunday, December 2, 2001; Page A01

It took 64 days for Louise Kurtz to see the sun again. She had not imagined, from her bed in intensive care, how sweet the moment would be. It came unexpectedly one day when she came upon a window in a hospital hallway. Outside, the leaves were flecks of red and yellow and brown, a brilliant patchwork on sunlit trees. It was warm, but autumn had come. "It's so beautiful," she whispered to her husband as he pressed his face next to hers.

Until then, the larger world had all but faded for Louise Kurtz – time virtually stopping the moment that she managed to escape the burning Pentagon, but not the harm and horror of its flames. When doctors examined her wounded body that day, they found that nearly 70 percent of it had been burned.

For Kurtz, the toll of Sept. 11 was unclear for a very long time.

It was much the same in the next room, and the next, and across the way, because all of those severely burned at the Pentagon ended up here at Washington Hospital Center, the region's long-established burn-treatment facility.

In all, they were just seven men and women, not the many dozens or hundreds that doctors had expected.

But for Washington, these scarred survivors became the truest living vision of the terror and torment suffered by so many on the day of the attacks.

They lost pieces of their skin, patches of their hair, parts of their ears. They lost the use of their lungs. They lost days – many, many days – when instead of eating dinner with friends or raking leaves in the yard, they lay in bed, attached to blinking monitors.

In this kind of netherworld, they have endured a combined 105 surgeries, with spouses sleeping in waiting rooms and children calling for missing parents and pastors clutching trembling hands to pray.

For many weeks, theirs was a fragile existence apart from the outside world – not dead, yet not fully saved.

The good times came when a patient spoke a first sentence. Took breaths without a ventilator. Walked from a room into a hallway. But there were setbacks that followed many bursts of progress – infections, pneumonia, even cardiac arrest.

So many chances to die, even after so much hope.

This was more real than they could bear on the September day that one of them slipped away, right in the intensive-care unit. Antoinette Sherman, 36, an Army budget analyst who had extensive smoke inhalation injuries, never made it through her second week.

The other families were heavy with grief.

For no one here forgets that so many at the Pentagon never even made it to a hospital. Close friends are dead, and bosses and co-workers, too.

The nation has, in many ways, begun to move on. Funerals have been held. War has been declared. Troops have gone to Afghanistan. Suspects are being pursued.

But in the hospital, life goes slower.

The day before Thanksgiving, Navy Lt. Kevin Shaeffer became the last of the Pentagon patients to move out of intensive care and get a room in the burn-rehabilitation wing. It was a big moment, a long-awaited sign of medical stability.

In another room, a few days earlier, Louise Kurtz appreciated the same change. With her husband and mother at her bedside, the 49-year-old civilian accountant took note that her new room in the rehab ward was outfitted with a window, large and prominent.

"You can tell," she said, "if it's night or day."

'By the Grace of God'

There is a purple Mylar balloon floating in the corner of Lt. Col. Brian Birdwell's hospital room. It says "Happy Birthday" in festive letters, a leftover from the November day he turned 40 – here, amid crisp, white sheets and sterile bandages.

That night, a buddy came to visit, and the two of them watched a college football game on television. His wife, Mel, was there; she is always there. Dinner was food he had been craving: a burrito supreme from Taco Bell.

This was not the big party his wife once imagined for him, but Birdwell had no complaints. "By the grace of God, I'm still here," he said, sitting stiffly in a chair, his bandaged arms propped on pillows and his forehead a band of scab-pocked temporary skin.

His wife does not mind saying that this skin came from a cadaver. It protects him from infection until his own skin can be grafted there. Amid the horrors Birdwell has endured, cadaver skin is nothing to wince at – a medical necessity, a wound dressing.

This is what Birdwell remembers of Sept. 11: He was surrounded by flames. There was no way out. He was on fire. Literally. He did something, he said, which was out of character: He gave up. He knew he would die. It hurt him to think of his wife and child.

"Jesus, I'm coming to see you," he called out.

But then, "when I finally collapsed on the floor," he said, "I collapsed under a sprinkler."

It has been a dark and painful course back toward the living. Birdwell's stay in intensive care lasted 26 days. His lungs were damaged by smoke. His face was terribly burned – as were his arms, his hands, his ears, his legs, his back.

He has gotten by, he said, with the help of his religious faith. Birdwell pointed to a quotation on an erasable bulletin board in his hospital room. He and his wife found it as they searched the Bible for help.

From 1 Peter 5:10, it says: "After you have suffered for a little while, the God of all grace who has called you to his eternal glory in Christ will himself perfect, confirm, strengthen and establish you."

He reflects: "First and foremost, I couldn't have gotten to where I am without Christ being in my life. And without Mel being my wife."

His wife kisses his tender head.

Birdwell knows he still has a long way to go.

His arm is in a cast one recent day. His eye is bandaged from surgery. His hair, growing in a soft patch straight up from his head, makes him look like Ernie on Sesame Street, he jokes.

"No, Bert," Mel Birdwell says with a laugh.

There are still good days and bad days. This one is good. Birdwell finds his naturally good humor, banters with his wife – and answers a telephone call, on a voice-activated phone, that begins with his son's easy greeting.

"Hey, Dad."

"Hey, buddy."

"Is Mom there?"

There is, in this exchange, a hint of life as it was, when Brian Birdwell lived in a town house in Lorton with his wife and son and golden retriever – and commuted 17 miles to a job in the Army's office of the assistant chief of staff for installation management.

Since then, so much has gone missing – like the days and weeks when Birdwell did not see his only child because the sight of his father broke the boy's heart and made him cry. And the 12-year-old insisted on not crying in front of his father.

He wanted to be strong for his father.

The Birdwells did not press the issue.

Now, Matthew comes more often; sometimes he plays video games on the television set in his father's room.

On Day 66, Matthew strolls into the room with the Birdwells' senior pastor, the Rev. Michael Easley, from Immanuel Bible Church in Springfield.

"Hey, Matthew, you made it," Birdwell says happily.

His son nods and sits on the edge of the bed.

On one wall of his hospital room hangs a family portrait from two years before. It shows Brian, with dark, neat hair, trim in his Army uniform, standing behind his smiling wife and red-haired son.

Their lives will never be the same.

But Birdwell takes comfort in the goodwill that has come his way, in the form of hundreds and hundreds of get-well cards, and gifts from members of his favorite NFL team, the Kansas City Chiefs, and daily meals from fellow members of his church.

One day, he was visited by Gen. Eric K. Shinseki, Army chief of staff, who awarded him the Purple Heart as he lie in bed just before an operation that would attach new skin to his arms.

Shinseki pinned the medal to Birdwell's pillow.

Just before he left, Shinseki said: "I have to see the president in an hour. Anything you want me to tell him?"

"Keep kicking Taliban butt," Birdwell said.

Not long after Sept. 11, Birdwell himself had met the president.

He was awake for Bush's visit, as it turned out – and aware enough to strain to return the salute the president had offered. He lifted his badly burned hand toward his injured forehead. When he could not quite reach it, he tried to bend his body toward his hand.

The president's eyes filled with tears.

Bush held firm until the wounded soldier let go.

Two and a half months later, on Thanksgiving Day, for the first time, Birdwell met the larger world on its own ground. He was allowed to leave the hospital and go back to Immanuel Bible Church for just one service.

At the service, the church leaders, who had not been sure that Birdwell would be able to attend, played a videotape they had taken of him at the hospital. Then, before 1,100 people, one of the pastors motioned toward a pew in the front.

"Would you do me the favor," he said, "of welcoming back Brian Birdwell, a good soldier of Christ, and his wife, Mel?"

The congregation rose to its feet and delivered its applause – long and passionate.

More Pain Along the Way

John Yates can tell his story. Once he could not. For weeks, he said nothing to anyone, not even Ellen, his wife. He could not watch the news. When after almost a month he finally saw a picture of the gaping gash in the Pentagon, he was stunned.

"I said, 'Oh, my God,' I was a basket case for a little bit," he said.

Now, more than two months have passed. His arms are still so red they look scalded. His hands are seized by shooting pains. His face is scarlet, and his head is raw and scabbed from bleeding. Nearly 32 percent of his body was burned.

But Yates has come a long way. He is the only patient in the group who was stable enough to go home to Fredericksburg. He is the only one who has set foot in the Pentagon again – with his grafted hands and protective body suiting.

Now, he has grown more comfortable with his story.

He remembers the thunder of the crash, the acrid smoke, the darkness. He remembers hearing people say that there was no way out. Yates told them yes, there was. As a civilian security manager in the Army's Office of the Deputy Chief of Staff for Personnel, he knew the office layout so well that he had dreamed about it.

His memory is fuzzy, but at some point, he said, he started to crawl toward voices.

When two Navy men found him in a corridor and led him toward a courtyard, he eyed himself numbly. "I could see the skin hanging off my hands," he recalls.

He lost the skin on the backs of both hands.

Now, on Day 65, a hospital therapist pours hot wax on the recently grafted skin that has replaced the burned layers. The therapists say that the heat helps loosen his joints so they can recover a wider range of motion, and the rich wax softens his skin.

His face tightens during a 20-minute period while tightly wrapped bandages constrain his wax-covered hands.

His foot tap-tap-taps through long minutes of pain.

"I come here every day and they hurt me," he jokes.

There is a hint of truth in his words. The severely burned learn quickly that there is no recovery without more pain.

First, doctors must remove the burned skin. Then they shave off some portion of healthy skin – .012 of an inch deep – to get the material they need for repairing the burned area. The healthy skin gets grafted to the wound.

Once the surgery is done – and each patient has had many surgeries – long days and weeks of therapy begin so the new skin can one day stretch like the old skin.

"You hear the phrase, 'No pain, no gain.' If you don't force it beyond what you did yesterday, you don't get anywhere," Yates says.

Recovery has many other difficulties.

"The hardest thing for me is asking why me – why did this have to happen to me, and why am I still here when people standing on three feet of either side of me are not?"

He reflects, "Every morning, I wake up and say 'Thank you.'‚" His voice catches. "The lady an arm's-length away," he says softly, "they still haven't found her body."

In all, Yates can count more than 20 dead colleagues and friends.

"I have a lot to do in the next few months. I have letters to write. I have graves to go visit," he said.

Yates is not sure how or when life will feel normal.

He can't cook. He can't get his burn garments on. To unlock a door with a key has become a multistep process. His therapy will go on for a year.

He and his wife, Ellen, once had plans to travel, to enjoy the tropical sun and faraway beaches. On Sept. 11, they had been married just 16 months – a second for each of them, in a ceremony in the Bahamas. They envisioned good years stretching out long before them.

Yates had turned 50 on July Fourth.

Whatever the future brings, he said: "I look forward to each day now. I'm just grateful to still be here."

Determination of the Young

It took 63 days for Blanca Shaeffer to hear the sound of her husband's voice. When she did, Kevin sounded strangely froggy. He was speaking through a tracheotomy. The pitch was not the same. Not that it mattered to Blanca.

She listened instead to what he said: Tootsabella. She chuckled. It was his nickname for her – and a small joy amid weeks of worry and heartache.

Kevin Shaeffer, a Navy lieutenant, was not only severely burned at the Pentagon – on 42 percent of his body – but he also inhaled aerosolized jet fuel, the doctors said. The nature of his lung injuries was different than the other patients'.

His recovery, his wife said, has been "up and down, up and down, up and really down."

Shaeffer, like the others, had to fend off infections, which can be deadly for burn victims. But his gallbladder also started failing, and it needed to be removed. He developed pneumonia. Twice on one terrible day – Oct. 4 – he completely crashed and nearly died.

Shaeffer awoke the next morning with no memory of the trouble. "What happened?" he asked.

What he had going for him was youth. At 29, he was the youngest of the Pentagon seven. His wife, his sweetheart at the Naval Academy in Annapolis and also a Navy lieutenant, says the other great resource has been a natural optimism.

"He has had an incredible spirit and an incredible strength through this," she said.

Kevin Shaeffer said he understands how narrowly he averted death.

After the hijacked jetliner crashed, he called out to his colleagues in the Navy Command Center and got no answer at all. It was eerie and silent and pitch black.

He escaped through a crater in the wall.

Later, as he was attended by doctors at another hospital, he thought he heard someone say that he had a 50 percent chance of dying. He grabbed the nurse nearest him.

"You don't understand," he insisted. "I'm alive. I'm going to live."

In one of his first lucid moments in intensive care, he asked his wife about his co-workers. "It was hard to tell him, but I couldn't lie," she said.

Everyone else in his office that day had died.

So there was grief mingled with his own struggle to survive. It was a fragile time. And for a time, when news started spreading about anthrax spores, the Shaeffers put aside their mail. But like many horrors during the past several months, they ultimately accepted that one, too. One day, Blanca Shaeffer looked at her husband and said, "I think we need to stop being scared."

They resumed reading the stacks of cards they have gotten from schoolchildren and strangers and military families. On down days, the mail has made a big difference, Kevin Shaeffer said.

"It helps me keep my focus on the bigger picture, on how fortunate I am to be here," he said.

As her husband has slowly improved, Blanca started writing down the achievements. His first word. Their first hug. His first breath without a ventilator. One day, she held out his hands as he sat up in bed. Kevin swung his feet. She had the CD player on.

They swayed – their first dance.

For so long, all that has mattered has been the effect of Sept. 11.

"Our whole world has been turned upside down," she said. "It's like we're in this time warp right now where everything is temporary and once we get home it'll be permanent again."

What the future holds for Kevin is not entirely clear. Just last week, the Shaeffers learned that Kevin may be discharged this week. He will then spend two weeks in the hospital hotel so he will be close to his daily therapy, then go home to Fredericksburg.

"We're hoping to be home for Christmas," Blanca Shaeffer said. And Kevin is hoping for a game of golf by summer.

Still, the recovery process is long, they know.

"The life that he used to have, it's not the same anymore," Blanca said.

From Strangers to Friends

Every morning before physical therapy, John Yates stops to see Brian Birdwell. They did not know each other before Sept. 11. Now they are good friends, a rare pleasure that has arisen from the heartache.

One recent morning, Yates walks into Brian's room, and as they talk about therapy – and pain – Yates notices that his friend's left arm, in a cast, is not well-supported.

Yates finds pillows and tucks them under the arm.

"Thanks, big guy," Birdwell says.

The friendship has developed in spite of the limits they faced for so long, with surgeries and woozy recovery periods and occasional setbacks.

"It's like joining the Army," John Yates says. "You don't know all these people. But you're thrown together and you form friendships."

In hallways and waiting rooms, similar bonds have developed between family members. In the first weeks and months, they were centered around the intensive-care unit, on the fourth floor. Now their lives converge in the rehabilitation wing, its pastel-pink walls adorned with crayon-colored get-well wishes from classes across the country.

In the burn center, nurses and doctors have worked long hours since Sept. 11. Although they have seen others in the past who were as injured as the Pentagon seven, the center's director, Marion H. Jordan, said there have never been so many at once. Along with the seven patients who started in intensive care, two others with less severe injuries were treated in the rehabilitation ward for several weeks.

Here, Pentagon families have come to know each other intimately.

"We hug each other," said Ellen Yates. "We kiss each other all the time. We see each other's relatives and we immediately do the same. . . .‚I feel as close to these people as I do to my close friends."

She added: "I have cried on everyone's shoulder at one time or another."

Her husband and other patients point out that the trauma has been unduly hard on their spouses – living at a hospital for weeks on end, watching them suffer, trying to help, worrying about the future.

Most of the intensive-care patients have had spouses around constantly. At first, they slept in waiting rooms; later, many got rooms at the hospital's hotel with the help of the American Red Cross. Only recently have most spouses gone back to work.

Family members understand the natural emotional overload. At times, they feel like breaking.

"Someone could give you a dirty look, or you could think they did, and you just lose it," Ellen Yates said.

Mel Birdwell remembered how even on the first horrible day – as she anguished in a hospital waiting room – the family of Antoinette Sherman reached out to her.

When the Sherman family's pastor arrived and ushered relatives into a side room to pray, the family "grabbed my hand and drew me in there with them," she said.

Just a week later, Mike Kurtz remembers getting off the elevator and feeling hurt as he saw the solemn faces and heard the news that Sherman had passed away.

"I died for a minute there," said Kurtz, who added he feels strongly that "seven friends met on the 11th of September."

"We all thought that God, having brought them this far, would save them all."

The families predict that their friendships will outlast their time in the hospital. Said Mel Birdwell: "We will know each other's grandchildren."

Little Comforts

Mike Kurtz holds a photo from 1970. It shows a baby-faced couple, at 19 and 18, shortly before their marriage. The young woman is Louise. The marriage is now in its 31st year.

For weeks, Kurtz feared losing his wife. He was at her bedside day and night – talking, reading cards and letters to her, comforting, watching. For weeks, she talked very little. He felt helpless. He found himself asking her four questions again and again.

Are you breathing OK?

Are you in pain?

Are you hot?

Are you cold?

"I ask those four questions because I can do something about those things. Those are the only things I could control for her," said Kurtz, a beefy retired Air Force master sergeant who works for the Justice Department.

His wife, he said, had just been hired at the Pentagon. Sept. 11 was just her second day on the job.

That day, Mike Kurtz walked into the hospital and noticed a bed with a body wrapped in bandages.

"I wonder if that person was hurt in the Pentagon," he said to his son.

It was Louise, he soon discovered – petite, precise, loyal Louise. Louise, who is a size 8 and loves pink carnations and the color blue and Nora Roberts books. Louise, who crochets and once ripped out a nearly complete blanket and started over because she found a mistake in the middle of it.

The Kurtzes live in a town house and have two car payments and two grown children. When they eat out, it is at Pizza Hut or Lone Star Steakhouse. Last May, they took a cruise to Alaska, their first vacation in 30 years.

They are raising a granddaughter, Brittany, who had her 14th birthday while Louise was in the hospital. But it was not the same without Louise.

"This was my wife for 31 years, my soulmate," Mike Kurtz said.

In 2½ months, Louise endured surgery after surgery – 30 in all – as doctors worked to graft skin on her face, her arms, her legs. She not only lost most of her skin, but also all of her fingers. Recently, portions of both outer ears, which had been blackened, crumbled and fell away.

"I hurt to see her hurt," her husband said in a tough moment the next day. "She was robbed."

Louise's medical setbacks, as it turned out, came not in the early going, but in Week 8. Suddenly her breathing was no longer stable. She was back on a ventilator.

During Week 10, while she was still in intensive care, her husband was still cautious: "We're getting through the woods, but we're not through the woods yet. . . .‚You can't let your guard down. It's not over."

Most of the time, Kurtz tries to think of how to make Louise's changed future come together. He bought a Nautilus exercise machine with two seats for workouts. He is thinking about changing the doorknobs so Louise will be better able to use them.

He tells her: "When we get home, baby, you're going to drop things, and I'm going to pick them up for you. It will take time."

But he worries. Will she be able to do a load of wash? Bake a cake? Care for herself? If she cannot do those things, he knows she will suffer even more.

"Louise is very independent," he said.

Jordan, the chief of the burn unit, said he believes that in three to nine months, "virtually everybody has a very good possibility" of being able to care for themselves, including Louise.

The Kurtzes are hoping for as much normalcy as possible.

For now, Mike Kurtz is with his wife from 6:30 a.m. until 3 p.m. every weekday, and then he makes the 60-minute drive home to Stafford to be with Brittany. He stays late on surgery days and weekends.

Just before Louise goes to sleep, he phones her one last time. He was surprised last week at her answer when he said, "How are you doing, honey?"

Louise told him: "I'm watching 'The West Wing.'"

The teasing banter between Louise and Mike Kurtz is picking up where it seems to have left off Sept. 11. She still has not talked much about what happened that day. She has not asked about the turn of world events.

But for all the dark and pain-filled times, the small improvements can be exhilarating.

Just Friday, Louise Kurtz walked, completely on her own, from her room in one part of the burn-rehabilitation wing to the physical therapy room down the hall. It was one of the first times she had walked without help.

Her legs carried her steadily, step after step. Her feet were flat on the floor. Her husband walked beside her, and Jordan and several nurses looked on, smiling. For a moment, it seemed that the hallway was brighter.

As Louise finally approached the therapy room, she looked into her husband's happy face and asked, "Wouldn't you say it's a great day to be alive?"