On the rain-slicked apron at Hanscom Field, almost everything seemed gray: the sky, the walker folded in J.P. Norden’s lap, his sweatpants and hoodie and T-shirt underneath. What wasn’t gray was black: his wheelchair, the asphalt, the 10 steps leading to the Gulfstream’s cabin door.
Norden, with one leg blown off at the Marathon and the other scarred and throbbing in pain, gripped the handrails. He thought about pushing up and hopping, but his body merely twitched.
He looked up at his doctor and slackened, and the doctor, E.J. Caterson, did something they do not teach in medical school. He laced an arm under Norden’s, clasped his back, and hoisted him gently, one step at a time, one minute to the top.
They had known each other across nine weeks and 11 surgeries, but it was the third week when Caterson started planning this trip. A rampant bacterial infection had sent Norden from recovery back to the ICU, plunging him into depression.
So the doctor reached out to friends at the Walter Reed military hospital, where more than 1,000 young men had been treated for injuries like Norden’s. They had learned to thrive. Being with them for a day might be what Norden needed.
The plane taxied and took off, soaring above a still-empty Route 128 early Wednesday. Norden stared into the gray, then turned to his doctor.
“What’s the game plan when we get there?” he asked.
“This trip is therapy, mental recovery,” Caterson said. “You’ll see something very powerful today.”
The blast had torn off Norden’s right leg below the knee, seared his skin, punctured his eardrums, and pelted his body with shrapnel, unexploded gunpowder, and debris. When the dust cleared, he shouted for his brother Paul, but Paul did not respond. He was staring at his own severed leg, wondering if he should pick it up.
For two weeks Norden went into surgery almost every other day at Brigham and Women’s so doctors could remove more debris from his wounds, before closing and covering them with skin grafts. In the third week he relapsed, bacteria ravaging his wounds and requiring aggressive surgery and frequent dressing changes.
The pain was so intense he could feel it even after a spinal epidural. When they removed his dressings and he looked down at the legs he used to push off of as a Stoneham High School hockey player, all he saw were cuts of meat and bone that reminded him of a butcher shop. He began to despair, wondering if he would ever leave the hospital, if he would ever walk again.
Caterson, a plastic and reconstructive surgeon, thought about Norden away from the hospital. He wasn’t one of those patients who decided to reach into a lawnmower or dart across highway traffic. A 33-year-old construction worker who liked to golf and fish, his life changed because he went to cheer a friend at the Marathon.
Caterson also thought about the weeks he had spent operating at Walter Reed a few years ago; what stayed with him was not the OR but the glimpses of the gym, men about Norden’s age attacking the weights and clambering up rock walls on prosthetic limbs, recovering from bomb blasts.
Even after Norden healed enough to go to the rehab hospital and move back home with his mother, awaiting a prosthetic, surgeon and patient stayed in regular touch. “Everyone’s old,” Norden had sighed about rehab. “Not everybody works hard.” He needed this trip as much as ever, Caterson thought.
They were going to fly commercial until Brigham donors John and Cyndy Fish heard about it, offering their jet. Caterson, 38, had performed five face transplants but had never seen anything like this, a jet with cashmere pillows and a ceiling covered in glove leather. Their own flight attendant brought parfait and hot towels.
“J.P., can you pass the Grey Poupon?” Caterson joked.
Norden laughed a little. But he was subdued, kneading the painful knot of bone that had formed in the muscle of his left thigh, a condition that also afflicted the surviving limbs of scores of Iraq and Afghanistan amputees.
That was another reason for the trip, so Caterson could consult with military surgeons about when to cut it out, and whether the stump on Norden’s other leg would benefit from a grafted tissue flap from his back to cushion a future prosthetic.
Landing at Dulles, a Mercedes van met their plane at the stairs. “Wow, you must be some guy,” Norden said to Caterson, marveling. They crossed the Potomac on the Beltway when a dump truck in front of them towing a backhoe began to fishtail, the trailer swinging wildly before the truck ran off onto the grass.
They exhaled. “That’s all I need,” Norden said.
“We go down here and you get a backhoe through your forehead,” Caterson said, chuckling nervously.
“Yeah,” Norden said. “My mother would love you.”
In the lobby of the America Building at Walter Reed National Military Medical Center, a senior surgeon and a therapist welcomed Norden and mapped out his day. They told him about all the amputees who reclaimed independence, including a few hundred who returned to active duty, through hard work and a sense that they were not alone. In the corner, a guy in an Under Armour T-shirt was just standing around chatting, on two bionic legs.
They toured labs where cameras surrounded treadmills, so researchers could study walking on prosthetics, and reached the gym Caterson was talking about: The Military Advanced Training Center, MATC (Mat-see) to the people who used it.
All around, soldiers with missing limbs grunted, hoisted medicine balls, stormed up ramps while attached to harnesses. The TV showed ESPN; a whiteboard advertised jiu-jitsu and adaptive lacrosse. This did not look like rehab in Boston, it looked like an NFL combine.
A barrel-chested quadruple amputee bounded over, Army Staff Sergeant Travis Mills, who had met Norden’s brother on a Boston hospital tour. Before Norden knew it, Mills, in a whirlwind, scooped up his BlackBerry with a synthetic hand, imploring Paul on the other end. “Bro!” he shouted into the phone. “You’ve got to come check this place out.”
Near some stretching tables, Sergeant Luis Remache, a 28-year-old from Queens with two artificial legs and a Marine Corps pin on his cane, told Norden that his family had to carry him upstairs two years ago; now he can drive and walk limp-free. “It’s not hard,” he said. “It’s all on you.”
Norden nodded. “I really just want to walk again, more than anything,” he said.
By the wall, Norden met Will Parker, a 29-year-old Army medic dressed for the beach, in Top-Siders and a bright-blue pair of Wayfarers. He told Norden about the good that came from losing his left leg; no foot odor, no ingrown hairs.
Norden smiled. “If you go hiking, you don’t have to worry about getting a blister,” he said, catching the drift.
Parker pivoted and revealed a tattoo adorning his good leg, a smiling stick figure stepping on a bomb in Afghanistan, with a cartoon “pow!” and a sign reading “Watch Your Step.”
Norden laughed. “That’s one of the best things I’ve ever seen,” he said.
There was more: They toured the prosthetic lab and the firearms training center, where Norden got to put on a flak jacket and a helmet and shoot beams of light from a modified M4 at insurgents in an intensely real interactive movie. Ross Colquhoun, the instructor, invited Norden to come fishing sometime in Maine, gave him a fist bump. “Keep your head up,” he said. “Keep on rocking.”
They ate at the Warrior Cafe, Caterson’s surgeon friends stopping to chat and check out Norden’s injuries while he picked through his onion rings, gamely removing his leg wraps in the cafeteria. Nobody at the tables nearby turned a head.
Staff Sergeant Jeffery Redman, hit by two mortars in Iraq in 2006, recognized Norden from a visit to Boston. “What’s up, brother, how you doing?” he asked, and soon they were all checking out his scars.
“I can’t believe the rehab situation down here,” Norden said.
“For real, bro,” Redman nodded. “It’s definitely awe-inspiring to go over to the MATC.”
Caterson agreed. “It inspires you to go to the next level,” he told Norden. “That’s your job now, to go to work.”
Redman warned him to expect bad days.
“I’ve had ’em,” Norden said.
“We all have ’em,” he said. “It’s what you do after [that counts], you get up and go again.”
Back on the Gulfstream, Norden said he would try to describe the MATC to Paul and show him videos but didn’t know if he could fully convey “the energy in that place.”
Caterson nodded. “You need to take that,” he said, “and put it somewhere you can use it.”
“I’m working on it,” Norden said. He studied a panel in the burnished wood next to him and pressed a button. The window shade lowered. He raised it, lowered it, raised it again. He looked around the plane and smiled, having seen what was possible.