Something worth fighting for

By Army Staff Sgt. Pat Caldwell

103rd Sustainment Command (Expeditionary)

JOINT BASE BALAD, Iraq (3/22/11) - In Iraq, there is often the known and the unknown and sometimes the two merge and overlap so that even the clearest scene is marred, obscured like sand pushed over a road by a hard, hot wind.

Ten-year-old Ahmed’s tale, though, is straightforward and horribly simple.

One day in November, Ahmed’s father bought a car. He asked a man to take the car to fill it with gas. Ahmed wanted to go along. So his father said go ahead.

Somehow gasoline spilled over Ahmed. No one, not even Ahmed, is sure how he came to be soaked in gasoline.

When the man tried to start the car there was a spark. The car erupted and caught fire. Ahmed was engulfed in flames.

Ahmed said he can remember crawling out of the vehicle and running. Running on fire, and, of course, he recalls the pain as his skin became ash.

Two nearby men grabbed Ahmed. One covered him with a shirt; another man pulled his coat over Ahmed’s scorched body, and took him home.

His family traveled to Baghdad to seek help. At a local hospital the doctors were firm with the family. Ahmed was burned too badly, and there was nothing they could do.

The family took Ahmed home to his village northeast of Baghdad, and there, in a farmhouse with no electricity, Ahmed began to die. A local nurse arrived and treated Ahmed as best she could, but offered an option as final hope – take him to the Americans. So the family packed Ahmed up and drove from his village north, through central Iraq toward Joint Base Balad.

Hard decisions prove easy

When Ahmed was admitted to the hospital he suffered third-degree burns over more than 54 percent of his body.

“He was the most seriously burned kid to ever survive coming through an Air Force Theater hospital,” said Air Force Maj. Todd Bafus, surgeon.

One thing was crystal clear when he came into the hospital: He was dying. Not slowly, but all at once.

“He was black. He was knocking on death’s door,” said Air Force Staff Sgt. Frances Robinson, a critical care technician at the hospital.

Ahmed’s chest, back, arms, face and portions of each leg were scorched. He was placed on a ventilator.

“We thought he was going to die,” intensive care unit nurse, Air Force Capt. Lani Cuebas said.

Hard decisions had to be made. To keep the boy or send him home. There were other issues to address. The priority was always wounded American servicemembers. Going back home for Ahmed, would mean death.

“We thought, ‘how could we make this kid get better? We got to try,’” Cuebas said.

So Ahmed stayed, and then the real fight for his life began.

A hard battle

A team of surgeons, nurses and technicians worked to save Ahmed during a three-month period. Some were members of the Air Force; some were assigned to the Army.

Right from the beginning, it was apparent Ahmed’s condition presented an intricate series of nearly overwhelming challenges. He needed skin grafts. He needed surgeries.

Ahmed was wrapped in bandages and lived in the little room just off of the ICU on a ventilator. Several times a day a team of nurses and technicians changed his bandages and his bedding. It was not an easy task, either for Ahmed or the medical personnel.

“His sheets were soaked in body fluid,” Robinson said.

Doctors kicked off a series of operations to replace the skin burned away. Eventually Ahmed was placed in a full-body cast. And every day the medical personnel battled unseen bacteria and viruses, working to get ahead of any infection.

For the first six weeks, Ahmed required skin grafts every three days. He was on a breathing tube for six weeks. Gradually, though, the medical personnel began to sense, if not victory, then hope.

“I thought if he didn’t get an infection ...” Cuebas said.

But he did get one. First a lung was compromised by microbes, and then Ahmed acquired a blood infection.

A song of hope

Every night, Cuebas would tend to Ahmed inside the gloom of the darkened room off the ICU ward and hold his hand and whisper to him. Then she would sing.

She would huddle next to the bed and squeeze his little hand and sing songs she’d heard as a young girl growing up in Olympia, Wash. Songs she knew. The words didn’t matter. Only the sound, so the little boy could hear. Could know he was alive. That he was going to make it. She sang, “Amazing Grace” and “God Bless America.”

She sang softly to the shadows and to the walls and most of all she sang to the little Iraqi boy who was burned over 54 percent of his body and no one was really sure would live.

His face was swollen shut; he had a tube down his throat. She squeezed his hand as she sang. He squeezed her hand back.

“He couldn’t talk. I figured he missed his mom,” Cuebas said.

Cuebas saw victory on the horizon. Almost close enough to touch.

“I guess I bonded with him. He became like my little brother,” she said.

Sometimes Ahmed cried for his mom. Cuebas sat with him then, held his hand, told him it was going to be all right, because despite everything weighing against him, she knew he was going to make it.

She knew.

When little things are huge

Ahmed improved enough in December to move out of the ICU room and onto the main, intensive care ward.

Air Force Registered Nurse 1st Lt. Stephanie Allen began to care for Ahmed, right after she reached the Iraq Theater.

Allen said Ahmed’s progress was steady, but not without challenges.

“It was a process. By the time I got him, I knew he’d make it. What my focus was on was we needed to rehab him to improve his functions,” she said.

Ahmed’s improvement hinged around a series of milestones. His feeding tube was removed. His tracheotomy was repaired. Then his body cast was discarded.

Even something as seemingly small as a smile was considered real progress.

The hard work, the rehab effort, though was just beginning. That is where assistant physical therapist, Airman Carolina Marin-Soto, came in.

“It was a challenge,” Marin-Soto admitted. “He couldn’t stand on his own.”

So Marin-Soto found a soccer ball.

“We started working on his legs. We’d sit him up and he would slowly kick the ball. His main goal has always been to play soccer,” she said.

Rehab also meant more operations. Ahmed endured surgeries through December and January. Still, progress was measured with small victories.

“The little things were huge. When we first started, I had to carry him to his chair. It was a big challenge and I can’t say it was easy.”

If Ahmed could walk from his bed to a chair, that was a victory. Then, if he could go from the chair to the door, that was a victory. Then from the bed to the door to outside was another win. Eventually Marin-Soto and the rest of the medical staff built, and then capitalized, on those victories.

And he began to speak, finally, after months of living with a feeding tube and a tracheotomy, Ahmed began to talk with the nurses, especially Cuebas.

“He’s come such a long, long way. He’s been so strong,” Cuebas said.

What hath God wrought?

Marin-Soto considers Ahmed to be a miracle.

So does Ahmed.

“I’m lucky, yes,” he said through an interpreter. “But not just lucky. God is watching over me.”

By February, Ahmed improved enough that he could walk, play soccer and eat on his own.

While medical technology had improved Ahmed’s chances – had, in fact, pushed him back from death – his body will be forever disfigured. As the skin grafts healed, the skin tightened, forcing his arms into an embrace.

That meant more work for Marin-Soto, who worked with Ahmed twice a day, every day.

Sometimes they practiced writing numbers. Sometimes they practiced turning the pages of a book, or stacked cups, or placed paperclips, one by one, into a cup.

“Every day I saw him progress. From the first time I saw him kick the ball, to the first time I saw him get dressed,” Marin-Soto said.

Going home

Then the operations were over. Ahmed’s time at the hospital evaporated. While some agreed there was more that could be done for Ahmed, the reality was his care could only go so far in an American hospital.

“With Ahmed, you do the best you can do and hope for the best,” Allen said.

The day before he was to leave, the medical staff held a small party for Ahmed. There was a sense of satisfaction and a feeling of victory and also sorrow. The little boy who had lived in the hospital for four months was going home the next day.

“He needs to be in his own home. He’s been away from his siblings long enough,” Allen said.

Marin-Soto said she was sad he was leaving. “Do I wish I had more time with him? Yes,” she said.

That night, back on the ICU ward, as Ahmed prepared to go home, Cuebas summed up her past four months with the Iraqi boy. “You can’t put a price on life. We’ve definitely made an impact on his family. Before this, probably Ahmed’s only interaction with us was raids and the war,” she said.

Then she glanced down the ward at the little boy who was ready to go home. Cuebas nodded as she looked down the ward at Ahmed.

She smiled slightly.

“There is one less kid who will grow up to be a terrorist,” she said.

Maybe, in the end, that isn’t much.

Maybe all that really matters is a group of American medical personnel did what they were trained to do. They went the distance and saved a little boy from death.

For a brief moment in a country ravaged by war on a base far from home, a small group of Americans made a difference.