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MELISSA BLOCK, host:

The Pentagon has just one burn center to treat the hundreds of service men and women who've been badly burned in the wars in Iraq and Afghanistan. Yesterday on the program we met some of the doctors and nurses who work at that burn unit at Brooke Army Medical Center, or BAMC, in San Antonio.

Today we are going to met one of their success stories, a patient who's made it through. Sergeant Joe Fowler is going through his daily two hour course of physical therapy at BAMC with therapist Vicki Barrera. She is trying to rotate his shoulder.

Sergeant JOE FOWLER (Army Sergeant): It doesn't rotate.

Ms. VICKI BARRERA (Brooke Army Medical Center): It rotates up here.

Sergeant FOWLER: Well, that does.

Ms. BARRERA: Yes, right here.

BLOCK: He's an outpatient now after spending four months in the hospital.

Ms. BARRERA: Hurting?

Sergeant FOWLER: Yes.

Ms. BARRERA: How bad? One to ten.

Sergeant FOWLER: Eight.

BLOCK: Joe Fowler and his wife, Leslie, know they have a long road ahead of them.

Sergeant FOWLER: It's not something you say, hey, well he'll be fine in six weeks - like if you broke a bone. It's like hey he'll be fine in six weeks, it's just, only time tells.

Mrs. LESLIE FOWLER: A minimum of two years is what we've been told, just for the general healing process. It will probably be more like five years as far as like continued surgeries and things like that. So, it's not something unfortunately that can be healed tomorrow, but he's doing wonderfully.

BLOCK: Joe Fowler was a dog handler assigned to the army's Tenth Mountain Division. On December 11th of last year he was in a convey going out to a warehouse to search trucks coming in with ballots just before the Iraqi elections. His Humvee hit a, anti-tank mine - and Joe remembers everything.

Sergeant FOWLER: From the first initial explosion that we hit the actual anti-tank mine, looking down and seeing like the flash of the red. I remember getting up across actually on the other side of the road - I was ejected, I was sitting on the passengers side. And then just getting up and opening your eyes and seeing like the orange and the red of the flames.

BLOCK: Was the Humvee armored?

Sergeant FOWLER: Yes it was armored, and basically there was nothing left of the truck, just a big heap of metal. So -

BLOCK: One of the soldiers in the Humvee died. Joe also lost his partner, his dog, Dak, a Belgian Tervuren, who he says is like his best friend. And Joe says that's been worse then dealing with his own injuries, which are extensive. His face and arms are laced with red scars and a patchwork of skin graphs. He can't straighten his arms. His elbows stay bent. Joe Fowler's blue eyes are bright. He's had three surgeries to replace his eyelids so they can close and so his eyes can be saved.

Sergeant FOWLER: I was burned 54 percent of my body. My right arm was broken at the wrist and the bone was dislocated from the elbow. My right ankle was broken as well. At the time, it was like adrenaline is going through you so, I didn't know any of that was actually broken because I was able to walk from the first explosion, I was able to put all the flames out.

BLOCK: You were able to put the flames out on your own body?

Sergeant FOWLER: Yes.

BLOCK: His wife Leslie has moved to San Antonio with their son Shane, who is now 10-months old. Shane has pretty much grown up in this hospital and the state dotes on him.

(Soundbite of baby Shane)

Mrs. FOWLER: Baby Shane

BLOCK: Vicki Barrera, the therapist, stretches Joe's hands. They're stiff and wrapped in gauze dressing up to his forearms to cover his wounds. She sets him to work. He has to grasp colored clothes pins and try to move them from wire bar to another. His focus is intense.

Ms. BARRERA: First to the second, alright?

BLOCK: Joe's hands tremble as he tries to squeeze and the pins clatter down to the table.

Ms. BARRERA: Which one are you using mainly?

Sergeant FOWLER: Middle finger.

Ms. BARRERA: Middle finger? That's okay. Long as you are trying to grip and release.

BLOCK: Between exercises, Vicki Barrera talks with Joe and Leslie about their daily frustrations.

Ms. BARRERA: It's frustrating when you can't do something for yourself.

Sergeant FOWLER: Yes.

Ms. BARRERA: It's you know, especially if you have an itch, and you have to call somebody over to -

Sergeant FOWLER: It's just like little things.

Ms. BARRERA: Give me an example.

Sergeant FOWLER: Like being able to like actually kind of open the fridge, grab something out. Just anything. Like when you're hungry being able to make something.

Ms. BARRERA: Are you able to open your Coke?

Sergeant FOWLER: No.

Ms. BARRERA: Or chips.

Sergeant FOWLER: Nope.

Ms. BARRERA: Microwave?

Sergeant FOWLER: No.

Mrs. FOWLER: Eating chips and salsa that's the most annoying.

Ms. BARRERA: Eating chips and salsa?

Sergeant FOWLER: Yes.

Mrs. FOWLER: Cause he can't eat it.

Ms. BARRERA: Pick it up and scoop it up?

Mrs. FOLWER: Yeah.

BLOCK: When we sit down to talk, Joe and Leslie both sound remarkably upbeat. No, he's not 100 percent of what he was. But they both take pride in what Leslie calls the baby steps Joe is making.

Sergeant FOWLER: One of the things, you got to back and heal up for the family. Make sure you're there for them.

Mrs. FOWLER: Our logic is just one day at a time. He'll get well. That's the important part and he's here. You know, my son gets to see his dad and gets to have a dad. That's the most important part. All of this is just, you know - I hate to say that it's just superficial, but it is. I mean the most important part is that he's still breathing. So we're very fortunate in that respect and even with the extinct of this injuries, you always know that there's somebody here that's worse, and that's something to think about, there are a lot of guys that are either worse injured that has been here for longer than he has but have never even made it out of the hospital yet. And then there's the ones that haven't made it that have fought and fought and didn't make it, and so we think of them and their families and understand that, okay so we're having a bad day, but not nearly as bad as their having.

BLOCK: Is that how you feel about it too?

Sergeant FOWLER: Yes, and then the family's kind of, they can kind of see me I guess, and they're like, he's up out and about. And then I go and talk to the other people that been burned as well to kind of help them through the process of getting healed and going, yeah, it sucks. It hurts, but you go to do it. You just got to try fight through the pain and heal up as quick as you can.

BLOCK: And sometimes what might seem like a small success can make all the difference.

Major Ian Black is chief of anesthesia at the Burn Center.

Dr. IAN BLACK (Brooke Army Medical Center): These are incredibly stoic guys. They, I mean, they just want to be functional. I mean the difference between having all their fingers cut off or amputated and having a little bit of a nubbin so that they're able to button their shirt and go to the bathroom is enough - that's what they're worried about. To be functional enough that they can take care of themselves.

BLOCK: For now, much of Joe's care falls to his wife, Leslie. She's had to leave her job with the Girl Scouts to devote herself to helping Joe.

Mrs. FOWLER: I have to do his, help him with his showers and do his dressing changes. I have to give him injections twice a day. I regulate his medications, applying the creams, and if we're eating something that he can't stab at, I feed him. And you know, getting him into the car. Simple things like buckling his seatbelt. He doesn't have enough motion in his hands to buckle a seatbelt. He can't get out of bed without having his legs wrapped. Getting him out of bed is a 45-minute process to get his legs wrapped and to get him up and dressed and things like that, because he can't dress himself at this point. And things like that. So I mean it's a full-care job. He likes to joke that we have two babies now.

BLOCK: Joe Fowler says he works through the pain with humor as much as he can. When it gets really bad, he says, he'll zone out, just get quiet, and he'll think about those things that he misses.

Sergeant FOWLER: Miss mountain biking. Loved to mountain bike. I can't really jump on a bike right now and go charging down the hills. I can't really go fishing a lot either. Love to fish. Can't really make your own food. So it's like, got to ask for help from everybody. It's just, ask here and there. Yeah, can you help me out? So it's, the hardest thing now is not being able to do what I used to do.

BLOCK: But that's coming back, isn't it?

Sergeant FOWLER: Yeah. It's all coming back. Working on getting my hands back and hopefully be able to go out and jump on a bike and go mountain biking. So I set goals for myself. But I know that if doesn't happen then it's okay. I make progress every day.

BLOCK: The next day, we run into Joe and Leslie at the hospital just before he goes in for his latest eyelid surgery. They're standing in the hallway talking to Captain Kerry Kingsley Smith, a registered nurse, who's holding some brand new parts for Joe's bike. Turns out the nurse had been talking with his mother-in-law about Joe Fowler. She wrote to the bicycle company Trek, and pretty soon Trek called to say, what do you need and where can we send it?

Captain KERRY KINGSLEY SMITH (Brooke Army Medical Center): This is adaptive equipment. It's got hydraulic disc brakes, which are real expensive for a wheel. And Trek decided to go ahead and cough that up. All he talked about when we were doing wound care on him for hours at a time is riding his mountain bike in Colorado.

Sergeant FOWLER: Just get me out there and go riding.

Captain SMITH: We'll get you back up real soon.

Sergeant FOWLER: Appreciate it, sir.

Captain SMITH: Yeah. No problem.

BLOCK: Joe Fowler has set this goal: he wants to have enough grip strength in his hands to get up on that bike by the end of the year. Meantime, there's been another breakthrough. Last Sunday, he was able to brush his teeth by himself for the first time in seven months.

You can hear the first part in our series about the Burn Center at Brooke Army Medical Center on our website, NPR.org.

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