Quotes of the Day

"You like chocolate milk shakes?" Sitting on the toilet in my room, I thought I was hearing voices. "Strawberry?" I looked up and saw a middle-aged man with brown hair and pasty complexion sticking his head into a partially open doorway. He introduced himself as Jim Mayer, better known as the "Milk Shake Man."

I had heard about Jim, who apparently delivered McDonald's shakes and burgers several times a week. He was one of the angels of Ward 57, a special breed of patrons who brightened up a day otherwise filled with surgery, needles, bad food and pain. The angels usually arrived in the quiet times. Doctors weren't making the rounds. Metal meal wagons had stopped clanking, the traffic of institutional do-gooders from the Red Cross and veterans' groups temporarily halted.

As I would quickly learn, Jim had a feel for combat amputees no doctor could match. He was one of us, having lost both legs to a land mine in Vietnam. He had lived through every stage of recovery and knew what we were enduring beyond the pain: identity crises, loss of self-confidence, and fears about supporting ourselves and attracting the opposite sex. Jim passed along biofeedback tips — he called the process "mind f---" — for combating the jumble of severed nerve endings called phantom pain. He coached families on the need to validate their loved ones' suffering, pulling them into the hallway for a piece of advice: never tell amputees they should feel lucky to be alive.

He believed in the curing power of humor, especially slapstick. One of his favorite routines was mimicking awkward hospital volunteers who invariably said the wrong thing. When a leg amputee was convulsing in so much pain he couldn't talk, Jim handed him a chocolate shake and a three-by-five-inch index card with a scribbled message: "That will be $5. Bless you." But he mainly used treats to break the ice. After a couple of shakes, amputees were asking questions of the man who walked on two fake legs and worked for the U.S. Department of Veteran Affairs. He was living proof there was life after Ward 57.

By the time I arrived, Jim was delivering a dozen shakes three times a week, a cost he absorbed for months until a group of VA colleagues chipped in for McDonald's gift certificates just before the holidays. About the same time, Jim had befriended a Vietnam vet and Washington restaurateur named Hal Koster, who offered to host Walter Reed patients at his Fran O'Brien's Stadium Steakhouse, located in the basement of the downtown Capital Hilton. Jim rounded up transportation and circulated the invitation on 57. Before long, Friday nights at Fran's became a tradition. Koster drew a big enough crowd a few days before Christmas to fill up four tables, amputees wielding steak knives in their hooks and hobbling to the bar on prosthetic legs.

For visitors who were less familiar than Jim Mayer, the ward had a gatekeeper, an odd little man known as Mr. Nick. Sporting silver loops in both ears and wrapping his salt-and-pepper braids into a bun behind his head, 56-year-old James Melvin Nicholas stood out in the crew-cut, uniformed staff. The breast of his white lab coat was smothered in goodwill medals given to him by VIP guests. His accent was effeminate and Mississippian. He held the lowly title of medical support technician. But from behind the nurse's station, where he worked, everyone knew who was in charge.

Mr. Nick's outpost bridged the H-shaped corridor at the ward's entrance. No one passed it without his review. He could serve as kindly crossing guard for those with appointments or as rough bouncer for those without. He transcribed the daily histories of 57 on patient charts and on the whiteboard out front. He knew the private numbers of every doctor and how to reach them quickly.

New arrivals often did a double take when the mustachioed African American sashayed in for the first time. But they quickly learned the benefits of staying on Mr. Nick's good side. He'd boycott the room of anyone who gave him lip. For those who didn't, such as a badly injured 19-year-old, there was nothing he wouldn't do. The soldier was so depressed he could barely speak, until Mr. Nick persuaded him to confess that he was homesick for his parents, who couldn't afford the trip to Washington. Mr. Nick immediately left the room, returning a few minutes later with a form for government assistance. He helped the patient fill it out and walked it back to the right office. "Let Uncle Sam deal with it," Mr. Nick advised. The parents arrived a few days later.

A 16-year veteran of the ward, Mr. Nick was its sage and institutional memory. Nurses came to rely on his judgment. Above all, he advised that they keep their emotions in check around patients. These days that was a particularly tall order. For all but the past nine months, the staff had worked primarily with retirees recovering from orthopedic problems; they rarely stayed more than a few days, and the pace had been relaxed. Only 14 amputees had been treated at Walter Reed during the brief Gulf War of 1991, and they had been scattered around the hospital. Although nurses had been warned to expect a large influx of amputees from Iraq this time, no one was prepared psychologically for the relentless, wrenching sight. Bombs left the body looking very different than a surgical amputation. Blast wounds were dirty and gory, usually accompanied by the ravage of shrapnel — BBs, nails, and metal shards. Just six weeks into the war, the patriotism and professionalism that drove the ward's workers began to crumble. It wasn't just the carnage — the patients were difficult to comfort. The endless cycle of surgery led to endless pain, usually accompanied by anger, amplified by relatives who squatted like gypsies, and directed at those who were held responsible for easing it. Media and VIP visits made for a tense, fishbowl atmosphere.

Even head nurse Tammy LaFrançois , a 14-year veteran of army hospitals, wasn't immune to the strain. She went home many nights in tears, and was particularly struck by the plight of a 26-year-old sergeant who had arrived in early August with both hands missing. Months later, his wounds had healed; his pain was managed. But he continued to live on 57 because he couldn't take care of himself. One autumn day he approached LaFrançois at the front desk. He seemed so normal to her until he asked her to tie his shoes. LaFrançois waited until that night before she broke down. "You can't believe the things we see," she told her husband.

When many of LaFrançois's 20 nurses complained of burnout and threatened to quit, she took the problem to hospital commanders, who called in the hospital psychiatry department. Already overburdened with patients, therapists let the nurses vent and recommended ways of coping. First lesson: Remember the patient has suffered a life-altering loss. Second: Don't personalize the emotional aftermath.

It took novel strategies to persevere. Mr. Nick swallowed the sadness until he left work, then unwound by listening to classical music at home or window-shopping at malls. My day nurse, Tami Barr, had her own game plan. One of the civilians hired to replace army nurses deployed to Iraq, Tami was overwhelmed her first day on the job: the responsibility of caring for young men who had fought for her principles was daunting. Pulling herself together, she decided that she would take it day by day, shift by shift, sizing up each patient's individual needs, then striving to meet each one of them. Armed with her checklist, she was careful not to remove the bedsheet of a soldier who was unusually self-conscious of his deformity or fail to administer anesthesia when changing the dressing of a patient in extreme pain.

Tami was a full-figured 40-year-old with blond hair, blue eyes and a firm idea of what I and her other patients should be doing on her watch. Basically, she ran my life. The day after my final surgery, she decreed that I had lost too much sleep socializing, and blocked all visitors and calls to my room. She disciplined my rambunctious son, who ran down the halls demanding to see the gun of everyone in uniform. She helped me decide to euthanize my 15-year-old cat. I had been informed by the vet that he was dying of kidney trouble, and the question was whether to attempt a heroic procedure. "Putting a suffering animal to sleep is the last great act of love you can do for him," said Tami, who had a houseful of felines herself. I made the call and bawled in her arms.

Even Tami had her emotional limits, though. Down the hall, a 22-year-old specialist named James Fair wouldn't accept the loss of his two hands. He had also lost both eyes when a bomb he tried to defuse exploded, and nerve sensations tricked him into thinking he still had hands. He kept asking Tami to pass him objects. "James, you don't have any hands," she'd reply. He'd refuse to believe her, demanding next that she hold one of his stumps.

Some caretakers intentionally kept their distance from the soldiers to maintain their morale. Captain Kathleen Yancosek couldn't get close enough. A rehabilitation specialist known by everyone simply as "Captain Katie," she was a razor-thin blonde who almost dissolved into tears when she visited her first patient on the ward, a teenage soldier who had lost a leg in Iraq. He was crying from the pain. His mother was hysterical. The 27-year-old therapist braced herself, realizing that she was supposed to be the one whom they had confidence in to help him get better.

The best way to toughen up, Katie decided, was to look past the grievous injuries and to treat her patients as friends, not as amputees. She got to know them as intimately as they would permit, moving quickly beyond their hobbies and children's names. With her soft touch and sisterly concern, she often picked up more information than the hospital psychologists. Captain Katie knew if a soldier was checking out Internet dating services, fighting with a spouse, fretting about bills, or struggling to knot a tie with one hand. She made a habit of staying up at night to acquaint herself with their personal stories and continuously updating them. In mid-November, she walked in on Sergeant Heath Calhoun on his first day on the ward. He was sobbing in the arms of his wife and questioning how he could survive after both of his legs had been blown off by a rocket-propelled grenade. Though uncomfortable at first, Katie stuck around to console the 24-year-old Ranger, and from that day on followed each phase of his recovery. When he was on furlough and had to bounce on his butt up a flight of stairs to check on his crying son, Katie commiserated. When his young wife seemed overcome by the burden of a handicapped husband, Katie fretted for their marriage. After he went snowboarding on an amputee outing to Colorado, Katie brimmed with compliments.

Aside from a limb, the biggest loss to patients was their dignity. We were half-naked, helpless, fed from tubes, drugged, and constantly poked and prodded. Tami and Katie specialized in personal care, hoping to remind the wounded they were more than medical specimens. Jim Mayer made milk shakes his calling card because they were the last thing you'd find in a hospital; they established a personal bond, like a pitcher of beer. Jim learned everyone's favorite flavor as if he were an old drinking buddy who had bought a round at the neighborhood tavern.

Most of 57's workers could have pulled up a stool. They treated us like family members, warm and sensitive. I never would have imagined such a focus on individual needs in an institution that emphasizes group uniformity. But in a season of giving, they held nothing back.

From the forthcoming book BLOOD BROTHERS: Among the Soldiers of Ward 57, by Michael Weisskopf. (copyright) 2006 by Michael Weisskopf. Reprinted by arrangement with Henry Holt and Co.