Terminal Device - blr.med.nyu.edu · She smiles at that, ... miles. Above the waist Kelly is another person, ... the terry cloth towel clutched in the terminal device, her

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Terminal Device

Jennifer Lee

Physical therapy is in the basement of the hospital, and they send them down in wheelchairs right after surgery. It hurts, and people are always telling me what they can’t do—like I’m their sister and this is some confidence they share—but it’s best to get them moving as soon as possible. This morning one of the orthopedic surgeons came down early. “I’m sending you a new patient today, a young woman just home from Brookes. She tore the lateral exterior ligament of her right knee in an explosion. She has more serious injuries—burns to the face and neck, two trans-radial amputations—but all you’ll need to deal with is the knee.” He smacked his clipboard with his knuckle and said, “I thought you should have a heads-up.” I’ve seen some of these kids coming back from Iraq, and I’m grateful for the heads up. Last October one of the vascular surgeons spent two weeks of his vacation as a volunteer in Landstuhl, Germany. He came back with a laptop full of photographs. There were pictures of an amputation, the brown hairs of a thigh growing wavy and clean right up to the knob of what used to be a knee. There were pictures of debridements, gloved hands scrubbing away necrotic flesh. He showed us the mobile ICUs, how they shipped kids home like expensive meat, their abdomens open, packed with gauze and wrapped in plastic, a bin of blood product next to the gurney, both bolted to the floor. The patient’s name is Kelly Graham, and she arrives ten minutes early, her wheelchair pushed by a big man with a silver-gray crew cut and blue eyes. Probably he’s retired military, had his own wretched war and got lucky, came home whole. “I’m Mike Graham, Kelly’s dad,” he says, and we shake hands. He has a way of blinking his eyes that draws attention. I can’t tell if it’s a nervous tic or something he does, almost unconsciously,

to keep from crying. He kisses his daughter goodbye, tenderly, on the cheek. She has a beautiful mouth, untouched by the burns. Her eyebrows are growing back, stubby and white, and her eyes are blue, like her father’s. “I’m Jamie Faust,” I say, realizing I don’t know what to do with my hands. Kelly is missing both of hers. Her arms end in stumps just below the elbows. “Let’s get you up on the table. Let me know if anything hurts.” I hold Kelly just above her elbow, help her balance as she levers her weight up on the one good leg. She towers over me. Even in this condition I can sense her strength. “They’re not as sensitive as they look,” she says. “The stumps, I mean. They said they’ll stay red and puffy for a while, but I’ve already been fitted with the prostheses. Once I start walking again, I’ll start wearing them. One thing at a time, you know?” She tries to laugh, but I can hear her throat closing up. Remaining cheerful and upbeat is a physical therapist’s best option, so I say, “You might not make spring skiing, but I think we’ll have you up and running by the time the slopes reopen in November.” She smiles at that, lays back on the table with her arms close to her sides as I lift her leg and get started, finding the limits of her range, how much pressure she can take.

When I get home it is still light outside, but in Colorado, evening comes down cold and fast. The house is empty, and I turn my back on it. There is always this moment before I open the door and turn on the light when I am filled with a quiet dread. I stand on the porch and watch the sky as it turns a pale blue before sunset, and then darkens, a hint of turquoise in the west. I watch, standing in the cold, blowing on my hands, and listen to the trucks far off on the highway. Night arrives and at last I turn the key in the lock and go inside. Twilight reminds me of the ranch we had when I was growing up. I was an only child, and I rode the county bus an hour to school where I’d sit warm and sleepy under fluorescent lights until it was time to leave. Filling the stock tank and throwing hay to the dairy

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cows in the evening were chores I did after my long ride home, and it was usually dark by the time I finished. I loved it. On weekends I spent as much time as possible outdoors, holding the hens and petting their stiff, smooth feathers, running a stick against the rails of fences. If I wasn’t outdoors I was expected to help my mother in the house. We were poor enough that we still washed our laundry through an old wringer. My hands got so red and cold hauling the sopping jeans and flannel shirts through the wheels. It was the thing I hated most, and my mother always asked me to help her. She had arthritis, and her hands would swell so bad sometimes she could barely hold a potato. “Jamie,” she’d say. “This is no kind of life.” One or the other of them, my parents, were always telling me that.

When I have a patient in physical therapy, a brief and sudden intimacy forms. Kelly Graham is coming in five days a week, and I’m seeing more of her than any other person I know. Her knee will heal, and then our relationship will end. The only question is how long it will take. This girl is going to get back on her feet again. She’s determined, sets goals; she is thinking of training for the Washington, D.C. Marine Corps Marathon in October. Her father, Mike, brings her in every day. He could use some therapy on his knees too, the way he shuffles around. But he isn’t paying any attention except to Kelly. “How’s she doing?” he asks. He asks me that every time. I can tell she is all he has. “She’s amazing,” I tell him. It’s what he needs to hear, but it’s also the truth. I’ve never seen anyone try so hard. It puts me to shame. And I vow, in any way that counts, to be more like her. A couple weeks pass before I summon the courage to ask Kelly about her injuries. I can guess, but something about talking to a girl with a burnt face and no hands and not asking what happened—something about that seems like the heart of cowardice. Kelly is sitting in a raised chair doing quad lifts. Weights are strapped to her ankle, and I am watching closely to make sure she doesn’t cheat or overdo it.

“How long were you in Iraq?” I ask. “Ten months. Long enough to feel at home, I guess.” “You must have been close to the people on your team. That’s what I’ve heard about the military—that there is such camaraderie.” “Yeah, that’s true. My unit—we defused mines—we’d ride around in an armored truck all day looking for explosives. Work like that does lead to close bonds.” Kelly is staring with fierce concentration at her foot, lifting and lowering it in a slow, rhythmic motion. Neither of us is enjoying this conversation, but we’re in too deep to back out now. “Is that how you ended up here,” I ask, “defusing a bomb?” She sighs, letting her muscles rest at the end of the set. “If I’d defused it, the mine wouldn’t have blown up in my face, ripping my hands off. But, yeah, that’s pretty much how it happened.” Soon she’s walking without a brace. She’s wearing her prostheses too. The artificial limbs strap across her back and chest and respond to the muscles of her upper arms and shoulders. Her arms end in pincer-like metal claws called terminal devices. They rest in a closed position, and Kelly’s face is a grimace of concentration when she struggles to grasp a doorknob, or a water bottle, or a towel. She has mastered moving pins on the weight machines, tapping in codes on the electric pad of the elliptic. She can use the water fountain or a touch-tone phone. The fine points of touch and pressure are relatively easy; it’s grasping and holding on that are hard. She works out on the treadmill. She started with power walking, but in no time she was running the hell out of that machine. From the waist down she looks like a college-age jock, pretty legs someone else shaves for her pounding out eight-minute miles. Above the waist Kelly is another person, her arms pumping along handless or strapped into the claws, depending on her mood. The scars on her face are bright red from exercise, and her short blonde hair lies plastered to her head with sweat. I cheer her on; her marathon dream is for real. There is a high school kid in therapy, healing from a ski accident. He’s come in a handful of times, a nice kid, but this is the first time

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his schedule has overlapped with Kelly’s. He can’t take his eyes off her. I want to smack him, smack that look of sick fascination off his face, but Mike is here so I pretend not to notice. I sail around the room with my chin high, trying to smile. At the end of her workout Kelly is drying off in the locker room, the terry cloth towel clutched in the terminal device, her movements jerking and unpracticed. Her face, especially the burn scars, is flaming red. She catches my eye, her lips pursed white, and says, “I used to be pretty.”

I have an old cigar box of pictures from when I was young. In it there is a picture of my mother in a pretty print dress, reaching up to pin a shirt to the laundry line. She doesn’t seem to know that someone is taking her picture, her head tilted upward in profile, her arm a graceful curve. It is shocking how beautiful she was, and I guess the picture was taken when I was a baby or before I was born. I don’t remember her so lovely. There are only a few photographs in the box. When my parents passed away, their scant possessions became mine. They left little behind. I don’t know why there are so few photographs, if it’s because no other pictures were taken, or because all the rest were destroyed. When I was seven years old I had a pony named Duck, a black and white piebald with a shaggy mane that fell from his crest like grass, hiding his neck. I’d put a bridle on him and clutch the braided reins and handfuls of mane and ride bare-back over the fields, pretending I was a medicine man on a secret mission for my tribe. There is a photograph of me and Duck in the cigar box. Duck is saddled and I have on a red cowboy hat and fancy boots. I don’t know how my parents ever afforded a pony. Most likely Duck was a hand-me-down from a neighbor, complete with saddle and bridle. In those days my parents would have been hard pressed to afford the red cowboy hat. They were small-town people, my parents. My mother knew how to keep house and keep a budget. My father could work land and mend machinery. There is an old snapshot of them standing on a porch, their arms around one another and squinting into the sun. I

suppose at one time they had dreamed of a little farm together. But as I remember it, that dream must have soured on them. Neither one of them noticed anything but hard work and poor returns. My father was always looking at the ground, lumbering about as he moved equipment, put up feed. He didn’t talk much, and he wasn’t easy to approach. He hired drifters from time to time, usually in summer or fall when there was the most work to be done. There was a little room off of the dairy barn, warm and sweet smelling like the cows, where the hired hand lived. We never had more than one fellow at a time; there was work enough, but no money. I don’t know what became of Duck when my parents finally gave up on ranching. They passed away years ago, and there’s no asking the questions that have stayed with me from all those early years. We moved to town before I was ten. My dad worked in auto repair and I walked to school. There are no pictures in the box from that time.

I am sitting one day with the calendar out in front of me, ready to schedule Kelly’s sessions for the coming month. I’m nervous because I know Kelly doesn’t need to be in rehab anymore, and probably it is unethical for me to keep her on the books. She’s well enough to stop physical therapy for her knee. She could have stopped weeks ago. Kelly is looking restless across the desk from me. She has something to say, and I am afraid it is good-bye. Instead, she says, “Jamie, I want to ask you something.” I look at Kelly and give her my most encouraging therapist smile, pencil poised above the calendar. “Sure,” I say, “what is it?” “I want to ask if you’ll help me train for the marathon. Outside of here, I mean.” “Okay,” I say slowly. I don’t really understand what she means. “I want to start running outdoors,” she explains, “but I need a partner. I don’t feel ready to be on my own yet. My dad would do it, but his knees are crap. I know it’s a lot to ask, and I’ll understand if you don’t want to.” I’m surprised. I’m not someone people often turn to when they seek companionship. My colleagues tell me I don’t smile enough.

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I’ve never minded being a loner, but Kelly is different. I nod my head, trying not to look too happy or relieved. “I want to,” I tell her. “Yes, I’ll help you train outdoors.” As the weather gets warmer, we run together more and more. We stop often because the prosthetics chafe Kelly’s skin. Sweat runs down her neck and shoulders and gets under the straps and the cups. I’m secretly grateful for the chafing; Kelly can run me into the ground on her worst days, and as I help her readjust the prostheses, reapplying Vaseline to the raw spots, I get a chance to catch my breath. Kelly likes to do for herself. As much as possible she manages the readjustments of her clothes and equipment. Her goal is complete independence. I’ve no doubt she’ll get there. The hardest thing I’ve watched her do is tie her shoes. It can take a quarter of an hour for her to get them done, and when she stands up from it, her face is flushed and sweating. “Why don’t you get Velcro shoes?” I ask her. “Because I need the practice,” she says, pulling evenly on the laces, trying to get the tension right. She shakes out her arms, tired from the exertion. “When I get good at this, then I’ll switch to Velcro.” As our runs get longer and the weather gets hotter, Kelly and I both start wearing Camelbaks, small, close-fitting backpacks filled with water that hug the spine between the shoulder blades. On the day we finish our first thirteen-mile run—half a marathon—Kelly turns to me and says, “Well?” I am bent over at the waist, trembling with exhaustion. “Well, what?” I say. “Well, are you going to run the marathon with me or not?” I shake my head, laughing, surprised that I hadn’t considered this. I can’t imagine giving up my runs with Kelly, even though she’s confident now and doesn’t need me anymore. Rather, I am the one who needs something. I realize I’m prepared to go all the way, all twenty-six miles. I smile at her and say, “I’ve come this far, haven’t I?”

Runners hate to carry extra weight, even their clothes and shoes are scrutinized for extra ounces. No one races with a Camelbak. We practice the water station behind Kelly’s house. It’s a beautiful place with fields and a stand of aspen on a low hill, the Rocky Mountains behind. It is situated a little like my childhood ranch. Kelly’s dad still farms a bit, raising hay for his neighbors, and he’s got an old John Deere in the barn and a great roll of hay that has lasted over the winter off in a field near the fence line. My throat tightens when I see this; it’s as if Mike is some version of my own father, one not beaten down by adversity, only humbled by it. Mike hobbles around on his bad knees, happy to have Kelly home. He and I set up a card table with paper cups filled with water and try to hand one to Kelly as she runs past. But every time, Kelly has to walk to take the water, and often enough the cup slips from the claw or is crushed in the grip before she can get a drink. Her dad says, “Honey, I think you’re going to have to wear that Camel thing.” Kelly nods, finally giving up on the water cups. About thirty of them lie crumpled in the grass at the foot of the table. Kelly will be carrying a lot of weight in the race. In addition to the Camelbak, she’s going to wear the prostheses, and each of those is close to two pounds. But Kelly is a soldier at heart and knows how to train; the extra weight will hardly slow her down.

One of the hired hands that stayed with us a while was a man named Tom Fallen. He had served in Vietnam, came home with a bullet wound in his leg. He hadn’t been back in the States long when my father found him hanging around the hardware store, looking for work. My father had served in WWII and went out of his way for the vets. One of the few things he talked much about was how badly they were treated. There would be a piece on the news about protests and insults toward the soldiers, and he’d start to fume. “People have no shame,” he’d say. “Those boys are serving their country. Folks should go over and see what it feels like, walking through a jungle and getting shot at. Then let them come home and do their spitting.”

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We had more than one vet come through, work on our land as he got his life back together. I don’t remember the others well, but I guess they were like Tom. He had a scowling face and worked hard. When he wasn’t working, he was sitting on the worn-out sofa in the dairy barn room, his feet up on the chipped coffee table, drinking a beer. I had a crush on Tom and would follow him around as he dug post holes, mended wire. My attention seemed the only thing that could make him smile, and I imagine that’s why I liked him so much. He would give me slow rides on the front of his motorcycle, up and down the dirt roads. And he was good for rough play, keeping me at bay easily with one large hand when I charged him over and over again. Or he would throw me into piles of hay, then chase me up the bales of it. The only thing about Tom that was scary was a sensitivity he had about being touched on the face. He had warned me straight away when we became friends. “Don’t touch my nose,” he said. “I mean it, I’m not kidding. If you touch my nose, I’ll get a nose bleed. I’ll beat your butt if you don’t listen to what I’m saying.” Once in wild play, I swiped his nose by accident, and his face twisted in fury. He picked me up by the collar of my coat, shook me like a trout and threw me on the ground. I was wearing a thick down coat but it didn’t keep me from feeling the ruts in the frozen earth. I spent all the time I could with Tom. In the evening before supper I would sit with him on the sofa, watching television and eating pretzels. I had red sneakers then, and they barely reached the coffee table as I propped my feet up beside his. My parents were used to me acting this way. I was alone on the ranch, so it was normal that I would pester the fellows hired on for the season. “Just send her home when you get tired of her,” my mother told Tom. My father would tell me, “Let him get on with his work. Stop bothering the man.”

By the time of the marathon, Kelly is wearing shoes with Velcro closures. I’ve come to hate my own shoes, which are not Velcro,

blaming them for all the pain. Kelly laughs at me when I complain, holds an open-clawed terminal device to her forehead and says, “Loser!” Washington is beautiful in mid-October, not as far advanced in season as Colorado, and green leaves still cover the trees. Sharp-cut Marines in organizer T-shirts manage the crowds, direct everything with a smile. There is a huge enlistment booth covered in red balloons, and young men and women stop to listen. From fifty yards away I can read a poster in block letters offering a $25,000 signing bonus. “Can you believe that?” I say to Kelly. She nods, but her eyes are focused in the distance. Because she is tall, her gaze passes over the shoulders of many, and I wonder what she is looking at, what she is thinking. Mike is beside her, and his expression is a mirror of hers. For the first time I wonder about his war, and I am sure it was Vietnam. I am also sure that, despite appearances, he did not come home unscathed.

I wonder what happened to Tom Fallen. One morning, the summer before I started second grade, we were watching cartoons. There was a heat wave on, and a window fan sucking the hot air from the room was all there was to relieve the temperature. I was wearing my bathing suit and rolling a cold can of Coke across my forehead. Tom was stripped down to a pair of navy blue boxer shorts. He was coming out of the bathroom when my father opened the door to the apartment. My dad reacted the way I suppose a lot of fathers would. He took one look at Tom in his underwear, muttered ‘son of a bitch’ under his breath, and hammered a fist into the other man’s face. Tom flew backward into the TV set, blood spurting from his nose. That was the last time I saw him. My father marched me out of the barn and back to the house, his grip so tight on my arm that he left bruised fingerprints. While I got dressed, my hands shaking, in jeans and a T-shirt, I heard my parents yelling at each other below.

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I stayed in my room, not knowing what I was supposed to do. I heard the sound of Tom’s motorcycle, listened to it fade away as he drove off.

By the thirteenth mile I hope I never run another marathon. Marathons are for people who have something to prove, or something to work out. I’ve never wanted to count myself among this tribe, but what else can explain it? It’s no surprise that most marathon runners are over forty, right about the time that people come smack up against the reality that life is a mess. By the twenty-second mile I realize that running a marathon is a form of self-induced trauma. I imagine in the months to come that the very sight of my running shoes will trigger PTSD, post-traumatic stress disorder. I think of Kelly’s hands, and I think of the ranch. My parents never talked to me about what happened. It was just something I carried along. My father never hired another hand, and I stayed away from the dairy barn room. In another year, we had left the ranch and lived in town, where I kept to myself. I finish my race. Kelly and her dad are here to greet me. Mike grins and hands me a fresh water bottle and a towel. Kelly is rested and cool from having crossed the line long before. I let myself collapse against her, crying, my slimy, anabolic sweat sticky against her dry skin. She holds me up with her broad shoulders and greater height and wraps her arms around me. Her laughter is synchronized with my sobs of relief, and I feel the light, almost absent touch of her mechanical hands, the curved claws resting against my back.

Bellevue nurses in 1876

The striped uniform had not been adopted yet, but the caps were in use as a hygienic measure. These Bellevue nurses were given the honor of participating in the 1876 US Centennial Celebration held in Philadelphia. The accomplishments of the school of nursing were considered amongst the foremost achievements in the first hundred years of the nation.

Graduation photo of Bellevue nurses in 1885

The director of the school is the woman in the center wearing black. These student nurses are younger than the initial students in the 1870s. When the nursing school opened, it sought older women and widows. Over the years, younger women applied in greater numbers and shifted the demographics.

Photos courtesy of Bellevue Hospital Center Archives