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thedrifter
12-17-06, 09:29 AM
Posted on Sun, Dec. 17, 2006 <br />
FRANK’S FIGHT: FINAL OF FIVE PARTS <br />
Coming home <br />
<br />
By Mark Emmons <br />
Mercury News <br />
<br />
YUMA, Ariz. - Lunch diners at the bustling Mexican restaurant...

thedrifter
12-17-06, 09:41 AM
Posted on Sun, Dec. 17, 2006

Roadside bomb turns soldier's world upside down
Road to recovery from traumatic brain injury has become emotional roller coaster for Army corporal
By Mark Emmons
MEDIANEWS STAFF


Who had Frank Sandoval become?

Where was the tough soldier who wouldn't quit?

Michelle Sandoval broke down in tears, her brave front shattered as she tried to describe the man her husband had been before that awful day.

Frankie was someone who never gave up. He wouldn't make excuses and didn't accept them. He always encouraged the couple's young daughter by saying: I don't want to hear you say, "I can't." Just do it.

Now, she was watching him cry and plead those haunting words: I can't.

Frankie never would have done that before.

It was late January, and they had just arrived at the Veterans Affairs hospital in Palo Alto. Frank could sit up in his wheelchair for only a few minutes. He couldn't feel or control much of his left side. His speech was nearly unintelligible.

And there was the more obvious evidence of his terrible wound: The right side of his head was sunken like a deflated basketball.

Frank now was a face of the modern war casualty. He had suffered a traumatic brain injury -- the emblematic wound of the fighting in Iraq and Afghanistan. These devastating injuries have forever altered the lives of hundreds of U.S. soldiers and Marines, leaving their futures uncertain.

Like Frank's.

It wasn't his physical impairments that upset her most, a tearful Michelle told Harriet Zeiner, a VA neuropsychologist. It was that Frankie did not seem to remember who he really was.

That, Zeiner said, could be the cruelest part of a brain injury. Losing a sense of who you are.

'Stay with us, Frank'

No one knows how the journey of Frank Sandoval will end. But this is how it began.

He joined the Army in the aftermath of the Sept. 11, 2001, terrorist attacks. Part of it was patriotism. But he also wanted more for his new family than a job managing a pizza parlor in Yuma, Ariz., could provide. A former high school wrestling team captain and a big fan of Superman, Frank saw the military as a springboard to college and a career in law enforcement.

Those goals were the only things that could pull him away from the two lights of his life: Michelle and their daughter, Joelena.

That's how, on Nov. 28, 2005, Cpl. Sandoval came to be on a stretch of hilly, barren terrain in northern Iraq that baked under the midday sun. He manned the .50-caliber machine gun on a Humvee.

When Lt. Maurio Smith received the assignment to train Iraqi soldiers, he handpicked 12 men from his artillery battery to accompany him. Sandoval, 25, was his first choice. That's why he was atop Smith's lead vehicle. When you went down a dark alley, you wanted Sandoval covering your back.

And now, on an unfamiliar road in the middle of nowhere, as their small convoy slowed to cross a narrow bridge, everyone sensed danger.

Cpl. Randy Radant, in the last vehicle, had been counting holes in the road -- ominous evidence of the deadly improvised explosive devices used by insurgents. In the second Humvee, Sgt. Nardello Keith heard Smith's warning over the radio to be ready for anything. Keith saw Sandoval turn and give a thumbs-up sign, indicating that the way looked clear.

Then there was a flash and a loud bang, followed by a mushroom cloud of dust and debris. A roadside bomb had ripped through the lead Humvee.

The three men inside the vehicle -- Smith, driver Cpl. Jeff Neville and an Iraqi interpreter -- were left stunned by the explosion. As Smith and Neville regained their senses, they called up to Sandoval, who had been standing in the gunner's hatch, his upper body exposed to the blast. He didn't respond. After racing up the road to safety, Neville scrambled on top of the Humvee to Sandoval, who was slumped back and unconscious.

He was bleeding, but Neville couldn't find the source -- until he removed Sandoval's Kevlar helmet. Shrapnel, blown upward in the blast, had torn into his skull, just below the helmet's rim.

At the top of a hill, where the soldiers had driven to call for a rescue helicopter, they formed a protective cocoon around Sandoval. The minutes felt like years as they waited for the Black Hawk. Sandoval, a muscular man who could bench-press 300 pounds, roiled with seizures. Neville, Radant and Keith struggled to calm him.

Keith remembered sharing a sandwich with Sandoval at lunch just an hour earlier. Now he was fighting back tears, cradling Sandoval's bloody head in his lap, cleaning vomit from his friend's face, not daring to look under the bandage.

"Stay with us, Frank. Help is on the way. Think about your family. You're gonna make it."

Smith wasn't so sure. Neither was Radant, who had seen a ball bearing lodged in Sandoval's exposed and broken skull.

Back at the battery's home base in Mosul, 120 miles north, Capt. Tom Caldwell looked on as reports came into the operations center that one of his men had been wounded. Not Sandoval, he thought. Caldwell always believed that with a unit full of Sandovals, he could take over a small island.

Caldwell gathered some of his soldiers. They began to pray.

Frantic flight

In Arizona, 12 hours later and 8,000 miles away, Michelle Sandoval was picking up her younger sister from school. Her cell phone had kept ringing during her shift at a coffee shop, but every time she answered, the call would drop.

Michelle's mother had told her someone from the military had called at home, but that he would talk only to Frank Sandoval's wife. Michelle, increasingly anxious, had expected something bad.

It was.

Your husband suffered a serious head injury. He is out of surgery and will be transferred to Baghdad for the flight to a military hospital in Germany.

Michelle went numb. The only words she could focus on were: He's alive.

Back at her parents' home, Michelle had become so frantic that she was scaring 3-year-old Joelena. After telling her father what had happened to Frank -- the only boyfriend her dad had ever liked -- Michelle disintegrated. She locked herself in the bathroom and sobbed for 15 minutes.

And then, she was done. Michelle decided there could be no more crying, no more negative thoughts. She would get through whatever came next.

By 7 the next morning, Michelle was in Phoenix, where she had rushed to get a copy of the birth certificate she needed for an emergency passport. Her phone rang again. This time it was a doctor at Landstuhl Regional Medical Center.

"If you're not here within 24 hours, Mrs. Sandoval, you might be too late."

She traveled to Germany on commercial flights with Frank's parents, Bea and Ricky. Ten days earlier, Bea had dreamt that Frank, the third of their four children, had been hurt. The premonition so unnerved her that she had e-mailed Frank, who was in his second deployment in Iraq, to make sure he was safe.

Don't worry, he responded.

Now, she was living that nightmare.

Ricky, a Homeland Security official along the California-Mexico border, had used his contacts to arrange for someone to sit with Frank, someone to whisper that they were coming.

He didn't want his son to die alone.

Bedside vigil

When Michelle first saw him, Frank appeared to be sleeping peacefully. He had no cuts or bruises -- only the bandage wrapped around his head. But it hid the severe injury that has become the signature wound of the war.

In clinical terms, he had suffered a penetrating brain injury that required a right decompressive craniectomy with a partial temporal and parietal lobectomy.

In layman's terms, surgeons had removed a section of his skull bigger than a softball -- both bone destroyed by shrapnel and undamaged bone to relieve the pressure caused by massive swelling of his brain. In addition to brain tissue lost in the operation, both of his frontal lobes had been traumatized by the powerful blast, and he was suffering from aspiration pneumonia because he had inhaled vomit into his lungs.

When Frank arrived at Landstuhl, the doctors initially believed he would die. Instead, as the hours passed, his condition stabilized. Still, he was critical, and even if he did survive, he might be blind and partially paralyzed. Or he could remain in a vegetative state for the rest of his life.

Yet although Frank was in a coma, tears trickled down his face as Michelle and his parents spoke to him and held his hand.

The following weeks melted into one long vigil at Frank's side. Just four days after he was wounded, Frank, Michelle, Ricky and Bea flew on a transport plane that served as an airborne intensive-care unit to Andrews Air Force Base outside Washington. He was taken to the National Naval Medical Center in Bethesda, Md., where Michelle, after talking to an optimistic doctor, became convinced that Frank would survive.

But he remained a very sick man. He developed other infections. Frank was kept heavily sedated because he was on a ventilator, yet he still would become agitated and disoriented. He had to be restrained so he wouldn't hurt himself. Ricky thought his son's mind was still on the battlefield.

Even after he was transferred to Walter Reed Army Medical Center in Washington in mid-December, Ricky, Bea and Michelle barely ate or slept.

But slowly, Frank improved. He became more alert. On Christmas Eve, he left intensive care. A general came to award him a Purple Heart -- the same honor his late grandfather, also named Frank Sandoval, had earned in the Korean War.

Although he was plagued by severe headaches, dizziness and nausea, doctors decided a few weeks later that he was ready to begin more extensive rehabilitation. On Jan. 23, he and Michelle arrived in Palo Alto, home to one of the VA's four polytrauma centers that treat traumatic brain injury, or TBI.

He had no memory of what happened to him and didn't seem to understand why he was in a VA hospital in Northern California.

Painful struggle

Frank's temporary home was a room in Acute Care Ward 7D. Military rank had no place here. All patients were equal and shared the same plight. Everyone was trying to reclaim his or her life.

This was how that process started for Frank: He sat in a wheelchair, struggling to hold his head up for a few minutes of physical therapy.

He could barely do it.

Frank wanted to go back to bed. But Beth Pittman, a physical therapist, reminded him of his goal. If he wanted to walk again, he needed to regain his endurance and strength. That meant fighting through the fatigue.

Wearing a T-shirt, pajama bottoms and a protective helmet that made him look like a hockey player, Frank pounded his right fist on the wheelchair armrest. His face contorted into a look of sheer anguish -- the way a young child appears in that silent moment before unleashing a scream of pain. What emerged from Frank's mouth was a whimper.

A photo on the wall, taken in Iraq, showed the brawny, intense-looking soldier he had been two months earlier. The man crying in the wheelchair had now lost more than 40 pounds and shared only a passing resemblance to the one in the picture.

His left arm and hand hung limp in his lap. He could move his left leg and foot only fractions of an inch.

He understood what was being said to him, but Frank's short-term memory lapses meant VA staff members had to repeat things like their names and the day of the week to him, over and over.

A weakened tongue and muscles of the mouth made swallowing difficult, so he tended to drool. His diet was limited to pureed food and thickened liquids. Because he ate so little, Frank had a feeding tube for nutritional supplements, 12 vitamins and medications -- everything from an anti-seizure drug to Ritalin, which kept him calm.

His words were so difficult to comprehend that even speech pathologist Karen Kapolnek had trouble understanding what he said.

Except for one thing. Whenever his wife was not in the room, Frank repeatedly asked a question that everyone understood.

"Where's Michelle?"

Hidden feelings

She no longer saw his disfiguring wound. All she saw was her Frankie.

Michelle seemed older than someone who was a few months shy of 22. She and Frank always had been an inseparable couple. Now, Michelle had moved into a nearby hotel and was living in a strange city, far from their daughter, who stayed with grandparents in Yuma.

She settled into a routine. Michelle arrived at the VA hospital most days at midmorning, always taking care to look her best, and she wouldn't leave until early evening. Michelle accompanied Frank to his therapy sessions, absorbing everything the VA staff said. And often they addressed her, not Frank.

Since her breakdown in the bathroom, Michelle had resolved to be strong for both of them. This would be the low point of their lives. Someday, they could look back and say: Can you believe how far we've come?

But she also was consumed with anxiety and doubt -- feelings she didn't dare to display in front of Frank. That's what came tumbling out of her in a flood of emotion the day that Zeiner, the ward's chief neuropsychologist, asked about her husband's personality and who his therapists were trying to recapture. Michelle feared Frankie never would be the same.

Zeiner had worked with brain injury patients for nearly 30 years. But since the fighting in Iraq and Afghanistan had begun, the ward was seeing an influx of more young wounded, along with their often-distraught loved ones. Improved body armor and life-saving techniques meant these soldiers had survived grievous wounds. Now Frank, like every other patient who came to the polytrauma center, faced the struggle of trying to rebuild his life.

Zeiner said Frank's condition was fairly typical for someone who had just suffered such a severe wound.

His crying wasn't the result of depression. It was the only way he could express himself when he was tired, frustrated or overwhelmed. And sensory overload was common in TBI patients. Zeiner used this old-fashioned analogy: His mind was operating at 45 RPMs in a 78 RPM world.

His damaged brain would begin rewiring itself and create new connections to his body. Most of his improvement would occur within two years. How quickly he emerged from the fog of post-traumatic amnesia -- this period when he was confused because his brain was unable to store or process new information -- would be an indicator of how much he could be expected to recover.

Nothing, though, was guaranteed. No matter how hard a patient worked, sometimes there was just too much damage. As of Oct. 31, 1,652 American soldiers and Marines in Iraq and Afghanistan had been treated for brain trauma, ranging from mild to severe, according to the Defense and Veterans Brain Injury Center. Of those, it's estimated at least 250 are in assisted-living facilities, unable to care for themselves.

All Zeiner could promise was that she and the staff would help Frank return to the highest level of function possible.

"You can't have the life you had before because you don't have the brain you had before," Zeiner said later. "But the trick is you can still have a meaningful life. Our job is to make sure hope stays alive."

Mental struggle

It would be weeks after their arrival in Palo Alto before Frank first asked Michelle about that day in November.

By then he had endured hours of physical, cognitive and emotional therapy -- each session a painful ordeal. Some days were good, when therapists pushed his fragile body and mind to do just a little more than he thought possible. Other days, he mostly cried and begged to return to bed.

Nothing came easily. A simple tongue exercise -- sucking on a LifeSaver that Kapolnek attached to a string to prevent choking -- left Frank exhausted. Even basic memory drills, such as reciting the alphabet and counting backward from 20, inevitably resulted in a headache because just thinking drained his limited energy.

But he also had begun to propel his wheelchair around the ward for short distances. Occasionally, when Michelle was close by, his stoic demeanor -- usually devoid of any expression -- brightened.

"We know it's going to be a long path," Michelle said one afternoon, sitting next to Frank's bed. "It will be slow, but we'll get there."

It had been a few days earlier, during a trip around the VA grounds as Michelle pushed his wheelchair, when Frank finally wanted to know what had happened.

Michelle told him what she knew. About how he had been given only hours to live and how she refused to believe it.

He became quiet and looked sad.

Michelle was sad, too.

She knew she probably would have to repeat this story to him many more times. He wouldn't remember.

Reach Mark Emmons of the San Jose Mercury News at 408-920-5745 or memmons@sanjosemercurynews.com.