Adam looked bad—his face was swollen, and he was unconscious—but at that point, “everything seemed fixable,” Julie says. He was scheduled for surgery to reset his ankles the following Monday. By Saturday, however, a virulent systemic infection had set in.
Infections are not uncommon among victims of IEDs, which may include unsanitary materials deliberately put into the bomb to make the blast more deadly. The bacteria that raged through Adam’s body is present in soil all over the world, says Navy trauma surgeon Carlos Rodriguez, who has operated on Adam several times, “so we weren’t caught off guard.” Though they did their best to abrade the wounds in order to clean away possible sources of infection, he says, once septic shock has set in, little can be done other than to keep the heart pumping.
By Sunday night, Adam was no better. Julie stayed at the hospital after the others returned to their hotel in Silver Spring. It was then that the doctors revealed the seriousness of Adam’s condition. His kidneys were failing, and the medication that kept his heart going was preventing blood from reaching his extremities. His feet, ankles and one forearm were beginning to die; if they weren’t removed immediately, he would die, too.
The amputations “were all done while I was out, so it didn’t really bother me,” Adam says. “It was harder on my family,” he adds, glancing at his mother, who smiles faintly.
Though he made it through the surgery, he remained catastrophically ill. Putting his chances of survival at less than 1 percent, doctors at Walter Reed wanted to transfer him to wound specialists at Brooke Army Medical Center (BAMC) in San Antonio, but knew he wouldn’t survive the flight. Instead, they decided to send him to the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center in Baltimore, where doctors had extensive experience in the type of surgery needed to repair soft tissue damaged by infection.
It was only a 15-minute helicopter ride, but the trip had to be aborted twice when Adam went into cardiac arrest. When he finally arrived in Baltimore on the third try, he was in even worse shape than doctors had anticipated. He “coded” four more times, Julie says, before he could be stabilized.
The Keyses were told that because his brain had been deprived of oxygen during the cardiac episodes, Adam might never wake up or be the person they remembered.
“And we kept saying, ‘He will be,’ ” Julie says.
Over the next few weeks, she talked to him constantly. When she couldn’t think of anything to say, she read aloud from books. She started an online diary so that family and friends could follow his progress. “He moved his fingers today!” she wrote on Aug. 20. After a brief period in which his eyes were open on Sept. 2, she wrote: “I spent most of the night holding his hand. He seemed sad and just needed the contact. He didn’t try to talk, he just looked at me.”
After Adam spoke and the trach was reinserted on Sept. 16, he was still too drugged to be able to form words, and too weak to hold a pen. At last, though, he passed a swallowing test that allowed the trach to be removed. “I thought his first words might be, ‘Will you shut up,’ ” Julie says.
“They were, ‘I love you,’ ” Adam says.
He asked for ice cream cake, so the family went out and got a big one. From a strapping 185 pounds, he had wasted away and needed every calorie to combat infection.
As autumn progressed into winter, Adam’s speech became clearer with the help of speech therapy, but heavy pain medication meant that he was often confused. He’d complain that his feet were cold and Julie would have to remind him, as gently as she could, that they were gone.
He still hadn’t been told that he was the only survivor of the bombing. “But I guess I sort of knew, in the back of my mind,” he says. He’d spoken by phone to members of his unit who were still in Afghanistan, and he told himself that the guys who were with him in the truck that day must be out working. Somehow, he couldn’t bring himself to ask.
In December, his captain, first sergeant and platoon leader were due home on leave and planned to visit him in the hospital. Adam’s family decided that it would be best if he knew the bad news ahead of time, so Julie, Rosie and Courtney gathered in his room and told him that Jesse and the others had been killed. Doctors stood by in case he went into shock. He didn’t. But he didn’t want to be alone, so Julie and Rosie took turns sitting at his bedside all night. Along with Adam’s grief came a fresh resolve to survive. The best I can do is do my best here, for them, he thought.
By the time the men from Adam’s unit showed up—sneaking away from a layover in Baltimore in the middle of the night—he had rallied, and seemed more concerned about how they were doing than about his own heavy losses, Julie says.
Adam learned that he was something of a celebrity when he arrived at the Warrior Transition Brigade at Walter Reed on Jan. 5, 2011. The doctors who had sent him to the shock trauma center in Baltimore had hoped he would survive, but they hadn’t expected such a full recovery of his mental faculties.
“You know you’re one in a million, don’t you?” one of the neurologists told him.
“Well, I couldn’t really see how bad I was,” Adam replied.
Many people had tried to talk him out of doing rehab at Walter Reed, according to Julie, “because of the stories [published in February 2007 in The Washington Post] that it was dirty. But when I checked it out, the buildings were old, but clean. And the rehab center was just amazing. Anything new in prosthetics, the latest technology, comes out there first. So I was adamant that he go there.”
Not everything about his return went smoothly, however. In February 2011, Adam developed another devastating infection. And Rosie left him.
“It happens a lot—there are millions of stories like mine,” Adam says. “I guess you don’t really know how you’re going to handle something like this until you go through it. But my family stayed with me the whole way through.”
For the Keyses, there was never any question that Adam was their priority. Julie quit her job to devote herself full time to her son’s care. Stephen, who had been laid off shortly before the attack, was able to remain at Adam’s side while he was critically ill. However, with Julie also not working, the family needed an income. He was offered a position in Las Vegas, but opted instead for a job repairing and installing cable lines in Fort Meyers, Fla. The hours are long and demanding, but Walter Reed is only a short flight away.