Each would be a major accomplishment for Marrocco, who a year and a half ago came so close to death that doctors still marvel over how he dodged it. At 22, he was an infantryman in the United States Army. Then, on Easter Sunday 2009, a roadside bomb exploded under his vehicle, and he became the first veteran of the wars in Iraq and Afghanistan to lose all four limbs in combat and survive.
Since then, Marrocco has pushed past pain and exhaustion to learn to use his four prosthetics, though he can walk for only 15 minutes at a time. He has endured 14 operations (but he refuses to allow a dentist to replace the eight teeth he lost in the blast). He has met sports stars like Yankee catcher Jorge Posada and Tiger Woodsand become something of a star himself at Walter Reed Army Medical Center in Washington, D.C., where his determination and humor are an inspiration to hundreds of other wounded soldiers.
More than 1,400 service members have lost limbs, hands, feet, toes, or fingers in combat since the first of the wars, in Afghanistan, began in 2001. But the extent of Marrocco's injuries raised so many questions. Would he crumble mentally? Was his brain intact? How would he eat, bathe, or even get out of bed and dress himself? Fourteen operations later, Marrocco "has exceeded the expectations of everyone but himself," says Benjamin Kyle Potter, the orthopedic surgeon who has treated him since he arrived at Walter Reed last year. Marrocco can already write legibly, use a computer (but not play video games), and text furiously.
Enlisting in the Army
Growing up on Staten Island, N.Y., Brendan had been smart and outgoing, but college didn't work out, so he enlisted in the Army. When he got to Fort Benning, Georgia, in January 2008 for basic training, he felt grounded for the first time in his life.
He arrived in Iraq on Halloween 2008, eager to fight. But after several years of terrible violence, the situation had stabilized, and his days were spent mostly on patrol, conducting occasional raids, and lifting weights at the base's makeshift gym.
"You kept the danger in the back of your mind," he says. "You didn't want it to happen, but you had to train for it."
It is difficult, though, to train for hidden bombs, which is one reason why the wars in Iraq and Afghanistan are so treacherous.
Not quite six months into his combat tour, Brendan sat behind the wheel of an armored vehicle in Baiji, a town in northern Iraq. His was the last truck in a four-vehicle convoy on a routine mission.
The bomb shredded his armored vehicle. His best Army buddy was killed. Another soldier was wounded; the fourth man in the truck walked away unharmed.
Jayson Aydelotte, the trauma surgeon on duty, got the call before dawn: incoming wounded. Private Marrocco was rushed in. Within eight minutes, his clothes were off and he was connected to a giant bag of intravenous fluid. Both arms and a leg had been sheared off. The other leg, the left, "was hanging literally by a thread," Aydelotte recalls.
Doctors began pumping blood into his body, but it sprayed straight onto the ceiling and walls. Aghast, Aydelotte looked more closely. One of the two carotid arteries, which carry blood from the heart to the brain, was severedan injury so lethal it can kill within minutes. "He had a hole in his neck," the doctor explains. "But we didn't suspect it to be a carotid injury because it wasn't bleeding."
It wasn't bleeding because there was so little blood left in his body㭌 percent of it had spilled out in the field. "Any one of his injuries was life-threatening," Aydelotte says. "It's incredible."
The medical team cleaned out each amputation wound, took a vein from his groin to reconstruct the carotid, and sewed him up top to bottom. He had survived the initial trauma and surgery. But other serious threats loomed: Infection. Pneumonia. Brain injury.
Within 90 hours of the blast, Brendan was in Walter Reed's intensive care unit. He drifted in and out of consciousness. He began to realize something was wrong with his arms, but he couldn't see them at first, in part because one eye was swollen shut.
'I Have No Hands'
"He looked up at me and lifted his arms up," his father recalls. "He kind of looked at them and realized they were bandaged and they were different sizes. He couldn't talk. He had a tube down his throat. But he mouthed the words, 'I have no hands.' I nodded to him. And that was it. He put his arms down. 'OK.' "
His father did not have the heart to tell him about his legs.
"During that first week, Brendan kept pleading, 'Dad, Dad, take my boots off. My feet are burning. My feet are burning.' I would say, 'Brendan, your boots are off.' "
In those early weeks, the worst of the pain often seized Brendan in the middle of the night. On good nights, he slept 20 minutes and then wrestled with pain for three or four hours. And his father sat watching, unable to do anything. It was, his father says, "the hardest thing for me to bear."
The family worried about Brendan's brain. Bomb blasts are notorious for shaking up the head so severely they leave tracks of destruction, despite the Kevlar helmets. Soldiers who return home with even moderate brain injuries can have trouble holding jobs or remembering to pick up a child at school. Even after Brendan's brain passed a battery of tests, his family fretted about his mental health.
A week or two after learning that his friend had died in the blast, Brendan told his father, "I am really sorry that Mike died, but I am glad to be alive." He saw that as a good omen for his son's mental health. "That moment made me think, 'He will be OK.' "
The Marroccos were trying to figure out how to care for Brendan long-term when his 26-year-old brother, Michael, unexpectedly volunteered to leave his friends, his social life, and his job at Citigroup in New York to move to Washington and be Brendan's caretaker.
Since May 2009, the brothers have lived on the Walter Reed campus in connecting dormitory-style rooms. The Army does not charge Michael rent and it gives him $64 a day for living expenses. The military also pays all of Brendan's expenses and a $2,400 monthly salary.
Michael wakes Brendan each morning, gives him his pills and a glass of water, and "that's about it," Michael says. Brendan has come a long way from when he struggled to put on his own T-shirt and brush his teeth. In the evenings, they argue about what to watch on TVMichael likes South Park; Brendan prefers Law & Order or NCIS.
Michael also keeps track of his brother's many mechanical parts. "So many things to remember," Brendan jokes. "Arms. Legs. We'll get out the door and down the block and I'll say, 'Mike, you got my arm?' "
His left arm is a rubber myoelectric model, complete with a hand that responds to muscle impulses; he wears it most of the time. The right is a primitive body-pressure hook that he puts on mainly for therapy sessions. He has the high-tech C-Leg X2, which has a knee joint sensor.
He mastered standing in his prosthetics within two months, and walking a few steps shortly after that. But walking long stretches is a lot more difficultlike balancing on stilts without the benefit of knees or real arms for balance. He spends a lot of time doing sit-ups and side body lifts to build up core strength.
Before and after lunch, he has occupational therapy: writing, picking up small items like popcorn, opening a can. In his wheelchair, a BlackBerry balanced on his thigh, Marrocco pecks furiously at the keys with his rubber hand or with his "fluffy finger," an upside-down pencil created just for this task.
Around Walter Reed, Brendan is a celebrity. At the center where the wounded learn how to walk, run, and climb again, he inspires people with his toughness and wit.
"It's funny the complaining that goes on when Brendan's not there," says his therapist, Luis Garcia. "And then when he's there, everybody shuts up. It puts things in perspective."
Finding His Place
One day last spring, a Marine who had also lost all four of his limbs saw Brendan practicing walking on prosthetics outside Walter Reed. "I'm hoping to be just like you soon, man," he shouted to Brendan.
A few months after Brendan arrived at Walter Reed, he met 23-year-old Kate Barto, who was an intern with a nonprofit group working at the medical center. They fell in love and have talked about getting married and having children. But the stress of Brendan's injuries has been hard on their relationship; they've broken up and then gotten back together several times.
It did not take long after the bombing for Brendan's wry, dark humor to break through. "Look at all the legroom I got!" he announced after boarding a flight to Hawaii last November, to reunite with his unit as it returned from Iraq.
He does not blame the military or curse the war. If he had his way, he says, he would be back in Iraq, behind a machine gun.
There are times, though, when Brendan's optimism and confidence are no match for his pain and fatigue. He rarely sleeps more than four hours a night and still suffers phantom pain in his right arm. And he admits to "down days," and acknowledges, "This does suck."
"You know, Mama," his mother recalls him saying quietly one day, "it would have been really nice if they left me even one hand."
And despite his remarkable progress, Brendan is still struggling to find his place in the wider world. His family tries to coax him out of Walter Reed for more trips to shopping malls, restaurants, and sporting events. But he finds such outings draining and awkward. People stare, or look away. "I just tell them I got blown up," he says with a shrug. "I don't like it, but I can't do anything about it."
He is, however, eagerly anticipating leaving Walter Reed to get a double arm transplant. The call could come at any time; the brothers will jump into Michael's car and high-tail it to the University of Pittsburgh Medical Center.
More than 40 people have received hand or arm transplants since the first successful one in 1998. Four teams of more than 20 surgeons must attach nerves, blood vessels, muscles, tendons, and elbow joints, all within 11 hours.
Brendan's nerves would begin regenerating an inch a monthit could be two years before he gains feeling in the fingertips. It will never be like before, but doctors say the new arms could be almost as good in terms of touch and motor skills.
His legs would still be missing. But new, human arms would mean he could put on his leg prosthetics himself, as well as hug someone, drive, twist open pill containers, catch himself when he falls, play Modern Warfare 2, and greatly increase his chances of getting a job.
"It's going to give me so much more independence," he says, "to do more stuff on my own."
(The New York Times Upfront, Vol. 143, October 25, 2010)