Air Force and Army medical crews work to stabilize Lionel Sanchez Jr., a 7-year-old boy on Saipan, who was the focus of a dramatic airlift in late December. The military crews came from Okinawa and Hawaii to treat the boy and move him to Hawaii, in the hopes that more comprehensive care would save him.

Air Force and Army medical crews work to stabilize Lionel Sanchez Jr., a 7-year-old boy on Saipan, who was the focus of a dramatic airlift in late December. The military crews came from Okinawa and Hawaii to treat the boy and move him to Hawaii, in the hopes that more comprehensive care would save him. (Courtesy of the U.S. Air Force)

Lionel Sanchez Jr.’s ordeal started a week before Christmas with a game of dodgeball at his school near Lito, his home village on Saipan.

The ball glanced off the 7- year-old’s right hip. It hurt, he told his mom.

By the end of the day he was running a fever. In the next few days, he stopped eating and sleeping. By Dec. 22, he broke out in a hive-like rash and began to gasp for air. By Christmas Day, after spending three nights in the hospital, he was vomiting blood and couldn’t walk.

“It got worse,” his mother, Amy Sanchez, said.

The day after Christmas, his lung blew a hole, filling his chest with too much air. His heart stopped. The medical team in Saipan called a code blue, inserted a chest tube, and revived the little boy, whose family calls him L.J.

“I wasn’t sure if he was going to survive,” said Lt. Col. Anne Naclerio, an Army pediatric intensive care doctor at Tripler Army Medical Center in Hawaii, who spent her Christmas on the phone with the medical team in Saipan. She offered advice, heard the code blue, and got ready to go.

Within hours, two U.S. Air Force C-17s were headed to the island.

One came from Kadena Air Base in Okinawa, filled with an Alaska-based flight crew and a group of Kadena flight nurses and medics from the 18th Air Medical Evacuation Squadron.

The second came from Hickam Air Force Base, manned by a Hawaiian Air National Guard unit. They had been scheduled to go the Philippines. Instead, they took on an Air Force pediatric critical care air transport team, including Naclerio and an anesthesiologist, and headed for Saipan.

Everyone landed on Dec. 27, Saipan time.

The Kadena squadron is part of a specialized Air Force unit whose mission includes airlifting servicemembers and other Americans with medical emergencies throughout the Pacific and Asia. They respond with their air ambulance about 300 times a year.

The pediatric critical care air transport team out of Hickam responds less frequently but carries the same mission, Naclerio said. As the military’s only pediatric intensive care specialist in the Pacific, Naclerio makes emergency airlifts about three times a year. She goes only when specialized care is needed.

In this case, L.J. needed all the help he could get.

After the landing, the medical teams rushed to the hospital and worked for hours to stabilize L.J. so he could fly.

On the tarmac, the Alaska crew — part of the 517th Airlift Squadron from Elmendorf Air Force Base — refueled and waited. The Hawaii-based plane flew on to the Philippines; only one plane was needed to get L.J. to Hawaii.

Finally, after dark, L.J. was in an ambulance headed to the airport. His respiratory system was so weak that manual compressions were needed during the ride.

“That was just heartbreaking,” said Air Force Lt. Col. David Almand, the commander of the Elmendorf squadron and himself a father of two sons, 4 and 8. Even after everyone got L.J. onto the plane, the pilot had to wait until the boy was stable.

An unofficial escort of family and friends had followed the ambulance in their own cars, honking their way down the island’s Middle Road through the daily traffic jam — crowds emerging from evening Mass.

The family stopped their cars at the runway’s fence line. Nadine Aquino, L.J.’s aunt, and the others scrambled onto their car hoods and called family members on cell phones. When a plane takes off on the small island, most residents can hear it. L.J.’s family wanted to know when his plane was overhead.

Air Force Capt. Donna Hornberger, a flight nurse with the Kadena crew, had never seen such a unified effort from so many units to get a patient to a safer place.

“That mission solidified why I do what I do and highlighted the extent the U.S. military will go to save a life,” she said. “His only real hope was to get him off the island.”

The medical teams had figured out what was wrong with L.J. long before they put the planes in the air.

That dodgeball landed on a spot on his right hip that was infected with staphylococcus bacteria. Worse, the hip held an infected blood clot lying in wait. When the staph-laced clot went skipping throughout L.J.’s bloodstream, it started a war.

Part of the infected clot went into his right leg. Most of the bacteria settled in his left lung. When the body gets that sick, it fights so hard that healthy tissue falls victim to the attack, Naclerio said. With too little tissue and too much air, pressure builds on the lungs and heart.

A quick response from the doctors in Saipan — inserting the chest tube — kept him alive, Naclerio said. But they remained limited by the island’s facilities, including the fact that the local hospital had no pediatric intensive care unit, L.J.’s mother said.

Saipan is the capital of the Commonwealth of the Northern Mariana Islands, a chain of U.S.-controlled islands just north of Guam. Most of the islands’ 70,000 residents live on Saipan, a place where immigration rules make it easy for migrant workers to power the islands’ factories while gaining access to U.S. territory.

More than that, Saipan is a small place. It’s the kind of place where the family of a sick boy orders pizza for the military teams gathered to save his life. It’s the kind of place where a patient’s relative can walk up to a C-17 crew and ask, politely, if he could take a peek at the place where the boy would be lying during his flight to Hawaii.

Two of L.J.’s uncles are serving in Iraq and Afghanistan. At the airport, before L.J. stabilized, Amy Sanchez got to talk to one of those brothers by phone. He wanted to know the type of plane. She read off some numbers from a wing.

“That’s a C-17,” her brother told her. “Oh yeah, that’s a good plane.”

It helped, she said, a little.

Two months later, L.J. has had three surgeries and a head-to-toe bone scan. In the first week of February, doctors found more infection in his arm and created a hole to pump antibiotics in directly to the spot.

The next week, surgeons cleaned out more of the bacteria from his right hip-joint. Then they put the 7-year-old in a hip-to-foot cast to keep the leg stable, Amy Sanchez said. He must wear it for at least a month, she said. It was a setback. Until then, L.J. had begun to walk a little.

But the family remains hopeful. L.J. has started to gain back some of the 10 pounds he lost. With physical therapy and a few months of antibiotics therapy, L.J.’s doctors think he will make a full recovery.

For his part, L.J. is watching too many cartoons and still worried that everyone let him miss Christmas, Sanchez said.

“Why didn’t you wake me up?” he has asked his mom as January passed into February.

“We were trying,” she replied. “You were in a deep sleep.”

Christmas is still waiting for L.J. in Saipan. His presents are still there, along with two younger sisters. They’ve been living with their grandmothers while Amy and Lionel Sanchez stay at a hotel near the Kapiolani Children’s Hospital in Hawaii.

With the therapy, it may be months before the family can reunite, Amy Sanchez said.

“We’re still crossing our fingers,” she said.

Air Force Capt. Andrea Whitney, another flight nurse from the Kadena crew, has kept in touch with the family. A few weeks ago, she finally got to speak to L.J. on the phone.

Recounted Whitney: “He said, ‘Thanks for the ride.’”

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