For the Wounded, No Miracle Is Small

BETHESDA, Md. —  The Ryan family stood vigil, gathered around a hospital bed in Building 10, Ward Five East -- a surgical ward at the National Naval Medical Center. Before them lay Marine Cpl. Eddie Ryan, silent and pale, a grievous bullet wound in his brain and a feeding tube in his belly, straight through the “N” in a blue tattoo that spelled “RYAN.”

Angela Ryan stroked her son’s fine hair. Christopher Ryan squeezed his boy’s hand. Felicia Ryan, 19, looked into her brother’s eyes, her hand on a Bible resting against his left leg.

The news was not good.

Eddie’s neurosurgeon, Robert Rosenbaum, had told the family that the young Marine’s frontal lobes had been terribly damaged by a bullet that tore into his skull during a firefight in western Iraq on April 13. It was quite possible that Eddie, 21, would never fully regain consciousness or recover what the doctor called “full cognitive activity.”

Christopher stared at his son’s smooth face and spoke: “We need a miracle. Eddie’s going to be our miracle Marine. We’re praying that God gives us this miracle because my son is a great American.”

Across the hall the same day this month, Marine Cpl. Bryan Trusty sat up in bed, wolfing down a chicken dinner on a hospital tray. His father, Steve, sat at his bedside, amazed that his son was eating and talking, and even laughing.

On April 3, a hot shard of shrapnel ripped a hole beneath Bryan’s left eye, pierced the length of his brain and lodged against his brain stem. He survived emergency surgery in Baghdad, but went into cardiac arrest on the medevac flight to the U.S. on April 7. His doctors did not expect him to live.

Now Bryan, who turned 21 in the intensive care unit four weeks earlier, was about to be discharged for outpatient therapy, with shrapnel still in his brain and his arm, and a distinct memory of all that had befallen him. He is able to walk and speak normally.

“I call him my miracle child,” his father said, watching him eat.

The number of service members wounded in Iraq has surged past 12,000, half of them injured so badly that they cannot return to duty. Many of the most critical cases end up here at the National Naval Medical Center, established in the early days of World War II.

On the worst nights at the Bethesda hospital complex, ambulances and casualty buses deliver up to 100 wounded Marines and sailors from Iraq. Since the invasion of Iraq in March 2003, more than 1,700 have arrived, most of them young and suffering from the devastating damage inflicted on human tissue by explosives, bullets and shrapnel.

Some, like Bryan Trusty, stay only a few weeks. Others, like Eddie Ryan, stay longer. The soldiers are surrounded by attentive nurses and skilled surgeons, and by loved ones who cling to hope and share an ordeal that can be both traumatic and uplifting, their lives in turmoil and forever altered.

If not for Eddie’s tattoos, Angela Ryan would not have recognized her son after she and her husband flew to see him at a military hospital in Germany. His face and body were grotesquely swollen. Before he was wounded, Eddie was lean and fit, 6 feet tall and 195 pounds. He had ballooned to 250 pounds because of severe swelling and fluid accumulation caused by injuries.

Eddie is a sniper, one of the Marine Corps’ elite. He signed up straight out of high school and was sent to Iraq. He was on his second tour there when an enemy bullet pierced his brain.

Since he arrived here last month, his mother has not left his side. She sleeps in his room or down the hall in the visitors’ lounge. His father and sister have left the hospital once, to drive Eddie’s beloved black Toyota Tacoma pickup from a friend’s house in Virginia to the family home in Ellenville, N.Y.

The Ryans have taken leaves from their jobs -- Christopher, 43, as a heavy equipment operator and Angela, 46, as a school lunchroom monitor. Felicia has left community college and a job at an outdoor supply store.

“Wherever Eddie is, that’s our life now,” Felicia said.

The Bible resting on the hospital bed contained a photo of Eddie in his Marine dress uniform, looking handsome and fearless. Placed between his feet were an embroidered Marine Corps logo and a photo of Eddie and his family the day they picked him up at Camp Lejeune, N.C., when he returned safely from his first tour in Iraq.

Much of the time, Eddie’s eyes were open. He breathed on his own, but he did not speak. He was shirtless, and his tattoos were on display. His parents had not approved of them; for a while, Eddie wore long-sleeved shirts to hide them. But now the Ryans found comfort and inspiration in the body markings.

On Eddie’s abdomen is the RYAN tattoo. On his right arm is a tattoo of hands in prayer and the Marine Corps logo. On his left arm is an American flag and the words “Land of the free because of the brave.”

His parents read to him from the Bible, squeezing his hands as they prayed. His father read him a favorite passage, Psalm 50, Verse 15: “And call upon me in the day of trouble. I will deliver thee and thou shall glorify me.... “

“Eddie’s faith is very important to him,” Angela said, careful, as always, to speak of her son in the present tense.

In the evenings, she sang to him. He loved being sung to at night as a boy, she said, and often he would fall asleep to “Jesus Loves Me, This I Know.” She sang him the hymn, softly.

Sometimes Angela sang a favorite song titled “Show Me Your Ways,” which includes the lines, “Show me your ways that I may talk with you

“That’s my prayer,” she said, “to walk with him and talk with him again.”

Rosenbaum, the neurosurgeon, was candid with the Ryans about their son’s prospects: “From the beginning, I made it very clear to Eddie’s mom and dad that if we were successful in keeping him alive after the initial swelling, they’d be taking home a human form, but I did not think they’d be able to take home Eddie as they remembered him. He will not remember his dog or his best friend or his room at home. If a miracle of miracles happens and he wakes up and begins to interact, they’ll have a person they’ve never met before.

“And, unfortunately, that is the extreme best scenario.”

The bullet or bullet fragments that penetrated Eddie’s brain created a percussive wave that produced a temporary cavity and caused severe bilateral frontal lobe injuries, Rosenbaum said. Portions of his skull were destroyed on impact; others were removed by surgeons in Iraq to relieve brain swelling.

“The doctor told us that Eddie lost two-thirds of his frontal lobes,” Christopher said. “And the frontal lobes are what makes Eddie, Eddie.”

However, Rosenbaum said, Eddie’s youth and superb physical condition can improve his degree of recovery. He’s a fitness fanatic and an amateur boxer. On home leave, he would jog in his combat boots, lugging a backpack loaded with rocks.

Twice a day, Rosenbaum checked Eddie for a response to a stimulus -- a pinch, the squeeze of a hand. He said this month that he had not detected anything more than purely reflexive responses, but he promised the Ryans that he would devote “200% effort” to their son.

“Not only Eddie, but Eddie’s parents have made the sacrifices that the country asked of them,” Rosenbaum said. “It’s the responsibility of those of us here to do our very best for them.”

In Eddie’s room, Felicia tried gently to get her brother to arm wrestle; they roughhoused often as kids.

“I was holding his hand down and I was like: Come on, let’s arm wrestle -- and he pushed my hand down,” she said. “So I pushed back and I was like: Are you going to let me win? And he pushed my hand back down. That’s Eddie -- he’s very competitive.”

Every day, Felicia held family snapshots in front of Eddie, and his eyes seemed to fix on them. She pointed out friends and relatives, describing the circumstances behind each image.

The family showed Eddie cards and letters from the hundreds sent by friends and strangers. Packages of fruit, flowers and food arrived daily from the Ryans’ relatives, co-workers and church members. The family heard that their hometown plans to dedicate this weekend’s Memorial Day parade to Cpl. Edward Joseph Ryan II.

Marines dropped by regularly, most of whom had never met Eddie but wanted to show solidarity. Marine commanders have visited, along with retired Marine snipers. They were upbeat and encouraging.

“It’s important that these boys see a positive attitude,” Angela said of her son and the two dozen other wounded Marines on the ward. “We need to give them hope. If you’re over their bed crying all the time, they’ll know you’re doing badly.

“Eddie always told me: ‘Don’t worry about me, Mom, I’ll be OK.’ ”

In his room, Bryan Trusty was up and walking, preparing to go home. His doctors had anticipated a stay of several months, but he was being discharged after a few weeks.

“You should have seen this boy,” his father said. “He looked like he’d been shot in the face with a shotgun. He went into cardiac arrest on the plane ride home. He had no brain waves. Now look at him.”

Bryan shrugged and smiled. Slender and fair-haired, he speaks with a slight Midwestern twang. He said he remembered little of the plane flight, but every detail of the firefight in which he was wounded. It happened during an insurgent attack on Abu Ghraib prison, when he rushed to a guard tower to help fellow Marines.

A rocket-propelled grenade exploded inside the tower, injuring Bryan and five other Marines. In all, 44 Americans were wounded during the battle.

“I didn’t see the RPG come in, but I saw it explode,” Bryan said. “I caught a piece of shrapnel in the frontal lobe and another piece went back to the brain stem.” His right arm was broken.

A Navy corpsman, Benjamin Graves, dragged him to safety, Bryan said. Graves suffered severe wounds and ended up down the hall at Bethesda, where he and Bryan were reunited with another Marine injured in the tower.

“When Graves got discharged, his mother told us: ‘Trusty, it’s time for you to get up out of bed and get out of here too,’ ” Steve Trusty said.

There is a long red scar on Bryan’s scalp from surgery in Baghdad to remove shrapnel, and a tiny spot beneath his left eye where the shrapnel penetrated, shattering his spectacles. Surgeons decided to leave the shrapnel lodged against his brain stem because of the risk involved in removing it.

Bryan’s swift recovery is highly unusual, “just an absolute tremendous turnaround,” said James R. Dunne, the first surgeon to treat him when he arrived at Bethesda.

There is no single reason, he said. “Just the luck of the draw, really. It depends on the path of the fragment, the extent of the damage -- a lot of factors.

“But these young guys have very plastic brains and can overcome some really serious injuries,” Dunne said.

Bryan felt strong enough on Mother’s Day to take his mother, Deborah Hall, to dinner at a restaurant. The following week, he was sent to a Veterans Affairs hospital in Louisville, Ky., near the family home in Corydon, Ind., for therapy to help improve his short-term memory. He wants to return to school to study computer science. He built his first computer as a high school sophomore.

Bryan and Eddie joined the Marines in response to the Sept. 11 attacks and were based at Camp Lejeune, but they had never met. Even so, before Bryan left the hospital, he sought out Christopher Ryan.

“I told him to just be patient, Eddie will get better,” he said. “I said it may look bad right now, but they need to keep the faith and everything will be OK.”

Bryan’s mother told Angela: “We’ve seen amazing things happen here, and so can you.”

In Eddie’s room, Christopher looked down at his son, who seemed to gaze back. “Look into his face and you’ll see he’s a good boy who helps people,” the father said. “He’s a selfless person. He was more concerned about his country and his fellow Marines and his family than he was about himself.

“He knew he was fighting for us here at home. Fighting is what got Eddie in here, and fighting is what’s going to get him out.”

“That -- and prayer,” Angela said.

As they monitored Eddie’s vital signs, the nurses fussed over him and spoke gently to him. The food tube gurgled and Eddie coughed. His mother and his father held his shoulders to comfort him, and another quiet afternoon passed as the Ryan family awaited a miracle.

Last week, they got it -- or at least an early installment. Eddie was stable enough to be transferred to a VA hospital in Richmond, Va., for rehabilitation therapy.

He is now able to move his hands and to hold up two fingers on command, his father said Thursday night. He no longer needs a feeding tube, and he recognizes friends and family members. He is alert and responsive. He has smiled for the first time since he was wounded.

Four days ago, Christopher said, his son managed to speak his first word: “Mom.”