Airman undergoes 40 hours of complicated surgery to reconstruct his lost nose, regain senses, identity
July 16, 2007
ARLINGTON, Va. — What would you endure not to lose the savory smell of a plate of barbecue shrimp, or the powdery innocence of your baby’s neck?
For Airman Michael Fletcher, 23, regaining his sense of smell meant a yearlong medical journey after a Humvee rollover that took his left arm and most of his face.
It’s meant a long and difficult recovery at Walter Reed, and one of the most complex nasal reconstruction surgeries ever performed at Johns Hopkins Medical Center in Baltimore, Md.
Fletcher is a security specialist stationed with his wife, Yolanda, 25, at Andrews Air Force Base in Maryland with their two children, Michael Jr., 2, and MiTrell, 1.
He met Yolanda when they were stationed in Alaska, and the couple married in June 2005, right before Fletcher was deployed to Camp Bucca, Iraq, with the 586th Expeditionary Security Forces Squadron.
On Aug. 12, 2005, Fletcher was manning the 240-B machine gun on an up-armored Humvee at the end of a long patrol when the truck caught some loose gravel in a hard turn.
“I tried to pull myself back in,” Fletcher said. “But gravity is a bitch.”
Unable to climb back inside, Michael was crushed by the five-ton vehicle. As the truck landed upside down on its first rotation, the edge of the hatch immediately severed Michael’s left arm.
Only the airman’s Kevlar helmet prevented his head from being crushed, although his skull was fractured, his palate broken and his left eye blinded.
And helmets don’t cover faces. So when convoy members rushed to the crumpled figure on the road and rolled him over, all they saw where Fletcher’s nose should have been was a gaping, bloody hole.
Fletcher was still conscious, and not yet feeling the massive damage.
“Adrenaline is the best thing in the world when you’re in pain,” Fletcher said.
Rescuers were doing their best to hide their shock at his appearance, “but I could tell they were like, ‘Oh, wow,’” Fletcher said.
Fletcher was losing massive amounts of blood, and in danger of going into shock and cardiac arrest.
Keeping the wounded airman calm and conscious as long as possible was crucial to his survival.
This is when the Saints came marching in.
To keep Fletcher conscious, one of the first responders started talking to Fletcher about football.
“And that’s all it took,” Fletcher said, “because I’m a football addict. I live and breathe the New Orleans Saints.
“So when he started talking about football — the whole time, I was thinking about Deuce McAllister,” a running back for the Saints, he said.
Bleeding, broken and dying, Fletcher began to think about a 62-yard McAllister run that set up a touchdown in the Saints’ 35-20 victory over the Green Bay Packers on Sept. 15, 2002.
“That was a big play in the game, because it helped us with a touchdown we needed, and it helped seal the game. It’s so crazy how that one play was in my head,” he said.
McAllister is traveling in the offseason and was unavailable for comment.
The decision was made to put Fletcher in a truck and drive him back to Camp Bucca, where he would be airlifted directly to Kuwait for emergency surgery.
Bumping along in the truck, Fletcher kept focusing relentlessly on his beloved Saints.
“It helped a lot, because there was fear there, you know,” Fletcher said, his voice cracking. “You know, the fear, ‘I don’t want to die!’”
Fletcher’s heart stopped twice in the helicopter from Bucca to Kuwait. On the operating table in Kuwait, his body refused to accept the blood doctors were frantically trying to give him.
Military officials sent Fletcher’s mother and wife “a notice that they don’t think I’d be here [surviving] after 20 hours, initially,” he said.
From Kuwait, Fletcher took a trip familiar to thousands of wounded veterans: to the Army hospital at Landstuhl, Germany, then on to Walter Reed.
He remembers nothing of it.
“When everything got dark, when I initially went out, and when I went out for good, I thought, like, OK, this must be what death feels like,” Fletcher said.
“And right after that, it was like, blink! I’m up at Walter Reed.”
But tragedy was not finished with the Fletcher family.
While sitting at her son’s bedside in Washington, watching him hover between life and death, Fletcher’s mother lost her New Orleans home to Hurricane Katrina.
Undaunted, she bought a house in the Washington area, so she could remain close to Fletcher through his recovery.
With his mother and wife by his side, Fletcher recuperated quickly at Walter Reed. The doctors said he would be in the hospital for six months at least.
He was out in 10 weeks.
He urgently needed, Fletcher said, to get home to his children — the thought of his wife left all alone to deal with the responsibility “made me feel terrible.”
Life at home
At home, Fletcher continues to work at mastering life with one arm, which he said “was never such a big deal for me.”
“If you think about it,” he said, “what do you really need two arms for? I mean, I drive, I cook, I diaper my kids, I even swim,” Fletcher said. “I taught myself. It was scary as hell when I first jumped in the pool. But I might not have an arm, but it’s more torso to float with, you know?”
“When you’re in a position where things are difficult [without an arm], you just got to say to yourself, ‘Oh yeah, this is going to be fun!’”
But the facial injuries — specifically the hole in Fletcher’s face where his nose had been — were an entirely different matter, even for someone who is “basically a really positive person,” Fletcher said.
First, there was the problem of people staring.
“I was so tired of those double-takes every time I went out,” Fletcher said. “I just wanted not to be noticed. People forget what a luxury it is just to walk down the street and not have anyone look.”
Then there was the issue of smell.
Most people don’t give it much thought, Fletcher said, but the sense of smell is very much tied into the sense of taste.
Losing your nose, Fletcher said, “is like having a really bad head cold all the time, except you’re not all stuffed up: everything tastes the same. Chicken tastes like sausage. Fish tastes like steak.
“When you’re from New Orleans, losing your sense of smell, [and by association taste] is the thing you don’t want to lose,” he said. “Not having that was killing me.”
One of the military surgeons at Walter Reed, Ife Sofola, had trained in facial plastic surgery at Johns Hopkins under Patrick J. Byrne, an assistant professor in otolaryngology, or head and neck surgery, at The Johns Hopkins University School of Medicine in Baltimore.
Byrne has pioneered several nasal reconstruction techniques for cancer patients, who sometimes lose their noses to tumors.
Sofola, who was treating Fletcher at the time, referred his patient to Byrne in January 2006 to see if there might be some way to reconstruct the airman’s nose.
Byrne assembled a team of experts, who agreed they could give Fletcher a nose — but at huge risk, Byrne said.
The rollover had left Fletcher with very little underlying facial structure strong enough to support the new nose. And since Fletcher is black, he is prone to keloid, or excessive, scarring. The process required Fletcher to endure at least six major operations, each one requiring full anesthesia.“The whole thing was a house of cards,” Byrne said. “If one part came down, it all would come down.”
Fletcher needed every ounce of his positive outlook when he was wheeled into the operating room on July 18, 2006.
That procedure, which lasted eight hours, “was a complete success,” Fletcher said.
It eventually took more than 40 hours of surgery and 60 check-ups and tests before Fletcher’s nose was completed — one of the most complicated nasal reconstructions ever performed at Johns Hopkins, Byrne said.
Throughout the ordeal, Fletcher refused to take pain pills.
The reason, he said, is that after the rollover, doctors at Walter Reed had kept him deeply medicated, so his wounded body and brain could begin heal.
But the pain medicine gave him terrifying hallucinations, he said.
“When I woke up in the ICU (intensive care unit) everyone was a fish, and my head nurse was Fish King,” Fletcher said.
“It sounds funny, but it was so terrifying. I hated it. And whenever I take pain medicine I start getting that woozy feeling that makes me feel like I’m going back [into the hallucination]. I’d rather deal with the pain, no matter how bad it is, than deal with that again.”
The last of the stitches on Fletcher’s nose were removed in May.
It will take some time for the swelling to completely subside, but Fletcher’s new nose is almost as good as the old one. The scarring is minimal and no one stares when he goes out in public any more.
The nose isn’t just decorative — it’s also functional. Fletcher can breathe, sneeze, and most important of all to the airman — smell.
He had been told that his sense of smell might come back, but until he caught his first whiff of food, he hadn’t quite believed it, Fletcher said.
“I had a plate of oranges in my hospital room, and the first time I smelled them, I thought I was trippin’,” he said.
Like most physicians, Byrne is careful “to keep a certain distance and semi-detachment” between himself and his patients.
“It allows us to make intelligent choices (about patient care) without allowing emotion to get in the way,” he said.
Nevertheless, as he has worked with Fletcher over the past year it has been difficult, if not impossible, to maintain that psychological distance from the airman.
“I found I’d almost have to pull myself back sometimes, because I had this tendency to want to do anything and everything for him,” Byrne said.
“You just can’t not root for the guy.”