Nonfiction

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AS YOU READ,THINK ABOUT:

JOEY PAULK WAS SEVERELY BURNEDWHEN HIS HUMVEE HIT A BOMB INAFGHANISTAN. THIS IS THE STORY OFHOW SCIENCE—AND RESILIENCE-HELPED HIM HEAL. BY JAMES DAO

A scar is a mark left by an injury. As you read, think about howa scar can be both visible and invisible.

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hree weeks after he was burnednearly to death in Afghanistan, ArmySpecialist Joey Paulk awoke from acoma in a Texas hospital. Wrappedin bandages from head almost totoe, he immediately saw his

girlfriend and his mother, and felt comforted.Then he glanced at his hands, two balls of whitegauze, and realized that he had no fingers.

So it began: the shock ofrecognition. Next came what burndoctors call "the mirror test." As hewas shuffling along a hallway atBrooke Army Medical Center inSan Antonio, Texas, he passed alarge mirror. He steeled himselfand looked at his reflection.

His swollen lower lip hungbelow his gums. His left lowereyelid drooped hound-dog like,revealing a scarlet crescent of rawtissue. His nostrilswere squeezed shut,his chin haddisappeared, andthe top of one earwas gone. Skingrafts crisscrossedhis face like lines ona map. "This is whoI am now," he toldhimself.

Every severeinjury is disflguringin its own way. Butthere is somethinguniquely devastatingabout having one'sface burned beyond

recognition. Many burn victims donot just gain lifelong scars. Theyalso lose noses and ears, fingersand hands. The very shape of theirfaces is altered.

"It's yourmilitaryuniform, andyou can't take itoff," Paulk saysabout bums ona soldier's face.

Since 2001, more than 900American service members havesuffered severe burns in the warsin Iraq and Afghanistan. Accordingto the military, the majority of theinjuries are caused by roadsidebombs. Most of the victims receiveextraordinary care at Brooke'sstate-of-the-art burn center. Butfew will ever have their facesrestored.

Patilk, however, has come close.

Engulfed in FlamesPaulk joined the Army in 2004, a

year after graduating from highschool. He thought the experiencemight help him get a job in law

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enforcement one day. On his firstdeployment, in eastern Afghanistanin 2007, he was in a Humvee whenit struck a buried mine.

The mine ignited the fuel tank,killing his team leader instantly.Paulk was thrown from the truckand lost consciousness. When hewoke up, he was 20 feet away,engulfed in flames.

After the fire was extinguished,Paulk—in searing pain andshivering despite the 90-degreeheat—waited to he evacuated. Ashe lay there, an odd questionpopped into his head: Do/5ft7/have hair?

Yes, another soldier said; hishelmet had saved it. "Maybe theburns aren't so bad, and I'll stilllook like me," Paulk thought.

That was not to be.

When he awoke in San Antonio

from a medically induced coma,he had already had severaloperations. Surgeons had patchedhis charred face, arms, and legswith skin grafts—a type oftransplant in which healthy skin issewn onto damaged flesh. All hisfingers had been removed, becausethey were burned to the bone andlikely to become infected. He hadlost 50 pounds in four weeks.

Surgery FatigueOver the next 18 months, Paulk

slowly regained strength. But afternearly 30 operations in 18 months,he began to resign himself to hisappearance, suffering from whathis doctors called "surgeryfatigue."

"Everyone has a limit," says Dr.Evan Renz, the director of the burnunit at Brooke and the person

Paulk says saved his life. "You getto a point where you go: 'Hold it,I've got to go through anesthesiaagain?'" explains Dr. Renz.

In December 2008, Paulk metwith a representative from aprogram called Operation Mend, atUCLA Medical Center in LosAngeles. The rep explained thatOperation Mend provided freecosmetic surgery for severelyburned veterans like Paulk. It hadalready treated dozens of patients.

Paulk was skeptical. How couldanyone make him look good again?

He decided not to pursuetreatment.

Operation Mend BeginsOperation Mend began in late

2006 when wealthy philanthropistRonald A. Katz was watching anews story about a badly burnedMarine. Katz's wife, Maddie, wascharmed by the Marine butappalled by his wounds.

"You have to do something!" shesaid to her husband.

The Department of VeteransAffairs provides healthcare tomilitary personnel. The focus ofmilitary healthcare is on savinglives and getting wounded veteransback on their feet. So thedepartment does not providereconstructive surgery unless it ismedically necessary—and makingsomeone look better isn'tconsidered medically necessary.

So what about those whosefacial injuries are so severe thatthey don't want to leave thehouse?

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POEMKatz knew that he couldhelp them. Over the nextyear, he worked with UCLAMedical Center and asurgeon named Dr.Timothy Miller, a veteran ofthe Vietnam War. Katz alsomet with General Peter W.Chiarelli, who embracedKatz's idea for OperationMend. "Buddy families"were recruited to meetpatients and their lovedones at the airport and gowith them to the hospital.

Since treating its firstpatient in 2007, OperationMend has been a wildsuccess. It spends about$500,000 on each patient,and has treated more than 65veterans. In addition to facialreconstruction, it now offers otherservices to veterans, includingprosthetic ears and limbs.

A Remarkable DifferenceIn 2009, Paulk returned home to

Vista, California, and becamesomething of a recluse. His mouthand eye were still deformed. Herarely went out. When he did, hehid beneath hooded sweatshirts,baseball caps, and dark glasses.

A rep from Operation Mendcontacted Paulk again, but he stilldid not believe they could helphim. Eventually, though, thesmaller indignities of his injuriesmade him reconsider.

Paulk could not open his mouthwide enough to eat a hamburger.Could Dr. Miller fix that? And what

A poet imagines what it's liketo come home after war.

Let Me Tell You Thingsby Rebecca Kai Dotlich

That moon wasn't this moon;that moon haunted the skies,and even the stars.

And even the starsthat followed me homeare broken.

Even the stars.

about his misshapen lips, whichmade it impossible for him topronounce his own name? Dr.Miller promised he could havePaulk whistling and chowing downdouble cheeseburgers again.

Finally, Paulk agreed to giveOperation Mend a try.

With the first surgery. Dr. Millerremoved some of Paulk's scartissue, raising his eyelid and lowerlip. With the second and thirdoperations, he improved thealignment of Paulk's eyes and lipsby replacing scars with healthytissue. A fourth surgery implanteda material called silicone thatadded definition to his chin.

The difference was remarkable."The surgery changed so much

on my face that it completelychanged my whole outlook on life,"Paulk says.

A New LifeThe surgeries restored

not only a part of Paulk'sformer appearance, but alsohis confidence. He hasstarted venturing out again,to parties, beaches, and ballgames. On Veterans Daylast year, he rode in the leadcar of the New York Cityparade, his head bared fortens of thousands to see. Ata recent checkup in Dr.Miller's office, Paulkadmired his new profile inthe mirror. "From adistance, you can't tell I wasinjured," he says.

There are stilluncomfortable moments.

He was taunted about his looks ata baseball game. He still feels self-conscious about his hands, tuckinghis palms under his armpits if hecatches anyone staring at him.

But he has learned how tofunction: to put on socks, pull upzippers, and tie shoes. He can sendtext messages and drive. He can'tplay baseball—his favorite sport—and video games are a challenge.But he manages to catch a footballand spike a volleyball with hispalms. He can even hold a drink.

"Sometimes I'll hold my cupagainst my body so I can talk withmy hands, and I'll maneuver andpick it up and everyone thinks it'sso intriguing," he says. "But I'mjust doing what I'm doing tosurvive." •

COPYRIGHT © 2012 BY THE NEW YORK TIMES COMPANY.U5ED WITH PERMISSION OF THE NEW YORK TIMES.

8 SCHOLASTIC SCOPE ' NOVEMBER 12, 2012

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