By Alleen Brown
By Maggie LaMaack
By CP Staff
By Jesse Marx
By Jesse Marx
By Maggie LaMaack
By Jake Rossen
FROM THE TIME Bob Briggs was a kid, what always thrilled him most was the romance of operating heavy equipment—the big machines that made roads and dug holes and moved steel beams, that got jobs done and kept the world moving. The fascination never left him. It was part of the reason that the then-23-year-old Briggs enlisted in the National Guard in 1992, after the first Gulf War, as a combat engineer and equipment operator. And it was certainly the reason he chased after, and eventually won, what he calls his "dream job," as a road maintenance worker with the Iowa Department of Transportation.
These days, the heavy machine Briggs is learning to operate is his own body. Last April 16, at an encampment 70 miles west of Baghdad, an Iraqi insurgent's rocket-propelled grenade exploded about 10 feet from Briggs. The blast shredded the right side of Briggs's skull with shrapnel. His right eye was destroyed, along with most of the vision in his left eye. The resulting massive brain trauma effectively wiped out a lifetime's worth of vital neural connections that encompassed tasks as varied as walking, feeding himself, and making and storing memories. The left side of his body was almost completely paralyzed. Shrapnel littered his brain and right hip. After being evacuated from the field, he spent nearly a week on life support. "I got so much metal in me I probably won't be able to go through airport security ever again," he jokes now.
Since June 2, Briggs has spent countless hours in physical rehabilitation here at the Minneapolis Veterans Administration Medical Center, one of four newly designated "polytrauma" units created in April 2005 to deal with the complex and multiple injuries soldiers are sustaining in Iraq and Afghanistan. The staff at the new polytrauma units (the others are located in Tampa, Palo Alto, and Richmond, Virginia) have had to readjust and receive fresh training to deal with a set of life-changing injuries not seen in previous wars. "We're seeing a lot more brain injuries. That's definitely the most common injury," says Dr. Larisa Kusar, one of the lead physicians for the brain injury and polytrauma team. "But we're also seeing multiple orthopedic fractures, amputations, severed limbs, blindness—a lot of multiple traumatic injuries."
The physical therapy room where Briggs has spent countless hours since June is a drab, bare-walled beige. Today he's working to ascend a plywood riser built to simulate a curb. The diminutive physical therapist at his side is reminding him to lead with his right side, then to move the cane and drag the left side of his body onto the raised pallet. As a natural left-hander, Briggs is accustomed to leading with that side when he moves, and it doesn't work anymore. He has a hard time at first trusting his none-too-steady right side to carry the entire weight of his body, and the exertion wears him out quickly. He needs to stop and rest on a nearby chair for a few minutes. After a couple of more tries, Briggs executes the necessary movements more confidently. His rule of thumb in rehab: Don't stop trying until you get it right at least once.
Besides the curb-stepping exercise, Briggs's rehab regimen includes tasks such as climbing a set of stairs, rising from a chair, and getting up off the floor. The last is especially brutal given the essential uselessness of his left side: He compares the job of lifting his 200-pound frame into a standing position to "picking up a couch with one hand tied behind your back." Without the stabilizing tripod-base cane he uses in all his mobility exercises, it would be entirely impossible.
Briggs practices walking in the hallway outside the PT room, a 50-foot corridor finished in sedate institutional brown and beige. Before starting, he often touches the padded green helmet he wears, almost unconsciously. Portions of his skull had to be removed to accommodate the swelling of his brain, so the helmet is an absolutely vital part of his rehabilitation. Without it, falling down could be deadly.
The physical therapist tucks herself under Briggs's inert left arm and they set off. As they go, she uses her right foot to gently kick his near-paralyzed left leg out ahead of him, and a certain faltering rhythm is established by the clack of Briggs's cane and the little kicks the therapist is giving his bad leg. Together, they look a little like the equipment manager and the star linebacker, hobbling off the field.
As if the walking itself were not arduous enough, the therapist is peppering Briggs with questions as they go: "How are you feeling now?" and "How have you been sleeping lately?" and "How has this week been for you?" She encourages me to ask him questions, too. As they pass the waiting area where his wife, Michelle, is sitting, Briggs struggles to call up the answers while still pulling the weight of his body forward. The point of making him talk is to teach his brain how to do more than one thing at a time again. Briggs says the energy this requires is palpable, and that it's made his walks even more exhausting.
"My leg has come back a lot," he offers when it's over, studying his brace-trussed left leg. "I'm actually starting to get some movement in my upper arm, too." He smiles, showing off a baby face accentuated by fleshy cheeks that belie his age.
On top of dealing with the brain injury and the physical and emotional issues that come with it—he says his moods are sometimes a mystery to him now, and that sadness overtakes him without warning—there is another issue compounding Bob and Michelle Briggs's troubles: Like many families of Iraq vets, they're not sure how, or even if, all the medical and travel expenses they are bound to incur will be covered. The Army to which Bob dedicated almost 14 years as a reservist has abandoned them, they say. Three months after his injury, the Army medically retired Bob and shifted his benefits to the VA, leaving unclear how his future care will be paid for.
"They shoved me out quick," Bob says. "It's pretty bad when you're knocking on heaven's gate and you darn near die for your country and the Army doesn't want to take care of you."
BOB BRIGGS grew up in Keokuk, Iowa, a Mississippi River town of 11,000 located at the southeast corner of the state, just north of the Missouri state line. After graduating from high school, he went to work at Keokuk Steel Castings. "It was a dirty, awful place to work," remembers his sister, Brenda Best. "Just a dead-end job. You work at a factory and that's where you end up the rest of your life. And he wanted to do something better with his life." He joined up as a National Guard reservist not long after the first Gulf War ended, she recalls, hoping in part to learn skills that could catapult him into a better job.
Briggs re-upped his Guard enlistment in August 2004, almost a year and a half after the U.S. invasion of Iraq. He had almost 13 years of Guard service under his belt at that point, and he was hoping to get to 20 years so that he could earn an early retirement pension from the military. With a wife, a four-year-old daughter, and a three-month-old son at home, he hoped his unit would not get the call-up to Iraq. "Nobody really wants to go," he says now. "But I knew what I had to do. I could never allow my company to go and me not go. I could never live with that." Two months later, on October 14, Briggs's unit was on its way to Fort Sill in Oklahoma for training. They later celebrated the coming of the New Year—twice—in the air en route to Iraq, where they landed on January 1, 2005.
During the long days in the Sunni Triangle, the group of 500 or so soldiers from southeastern Iowa was responsible for route-clearing patrol missions, which involved traveling either on foot or in vehicles searching for improved explosive devices (IEDs) planted by Iraqi insurgent fighters. They'd scour the landscape and rifle through dirt in search of anything suspicious-looking: ground that appeared freshly dug up, piles that seemed out of place, wires, packages—anything that could camouflage a makeshift explosive. Sometimes they'd use a "Buffalo," a heavily armored vehicle outfitted with an articulated arm capable of digging around to find IEDs and detonate them.
On April 16, Briggs and his fellow soldiers in the 224th Engineer Battalion were setting up their barracks at Camp Ramadi west of Baghdad. They had moved from Habbinaya the day before, where the group had put up in an old Air Force base when they weren't running security missions for the second Marine division. That night, at around 8:00, the soldiers had just finished erecting walls to partition the various offices and facilities of their new base. Some of the soldiers were assembling beds, while others were putting pictures up on the walls of their new sleeping quarters.
Briggs and some friends were out back in the gazebo-like smoking shack, waiting to go to a late dinner. They decided to play a quick game of horseshoes to pass the time. Dusk was turning into nighttime. "We were just waiting to eat," Briggs says. "We didn't hear anything. No warnings. Usually there are sirens. They got closer than normal."
He has no memory of what happened next. He only knows what other soldiers and his staff sergeant later told him. Without warning, insurgents began launching rocket-propelled grenades into the barely established camp. Three soldiers from another unit were killed. Briggs and two other Iowa National Guardsmen were injured. One man in his battalion was an emergency medical technician in civilian life, and Briggs believes the EMT's fast action made the difference. "I tell you, he saved my life," Briggs says, choking up. (He hasn't been able to speak to the man since. And given the fragile state of Briggs's mind and emotions, no one is anxious to press for the encounter too soon. Right now it's one more thing than he can't deal with. "It will be a long time before [Bob] can talk to him," says Michelle Briggs. "Maybe when he comes home.")
The day after the attack, Briggs was transported to Walter Reed Army Medical Center in Washington, D.C., where he arrived on life support and in a coma. No one was sure of his prognosis, or the extent of the brain injury. Owing to the metal fragments scattered throughout his body, doctors were unable to do an MRI. Michelle and Bob's parents flew up to Washington to be with him. His sister, Brenda Best, stayed back in Keokuk to take care of the kids.
"I had daily calls," Best remembers of that first week. "Sometimes two and three times. It did me good that day my mom called and said, 'He's asking for you.' He had woken up and come off life support. And he could talk to me."
The doctors said Briggs had suffered a penetrating brain injury from shrapnel. The shards of metal that pierced his frontal and temporal lobes caused brain bleeds, and—because they remained lodged in the tissue—subsequent small seizures. The shrapnel also tore up his right eye, forcing a later surgery to remove the remains of the eye from its socket, a procedure called nucleation. He also lost much of the sight in his left eye due to internal bleeding, though the vision in that eye has since improved. "This is a good prognostic factor," Dr. Kusar notes. "He can go a long way in terms of function and independence."
Along with suffering from a penetrating brain injury, Briggs also incurred what Kusar calls a diffuse brain injury from the blast, a widespread brain trauma that disrupts a whole range of cognitive functions. "This is becoming a common combat injury," she adds, "from a new mechanism of war."
SINCE THE INVASION of Iraq was launched in March 2003, Veterans Administration statistics have recorded a total of 2,310 patients with traumatic brain injuries, all of whom are still presently under treatment. The VA's four new "polytrauma" units in Minneapolis and elsewhere have cared for 219 severely injured Iraq war vets.
But you can't measure the burden those numbers represent without consulting another set of numbers: the VA budget. In April of this year, just as VA officials were reorganizing their hospital system to accommodate these new patients, the Minneapolis VA facility was facing a $7 million budget shortfall of its own. While the Department of Veterans Affairs notes that "the average cost of treating a TBI patient is $21,231 in their various stages of treatment...[and] 101 patients have exceeded $80,000 and two have exceeded $500,000," none of the brain injury or polytrauma facilities have received added funding to pay for the care of their most severely injured patients, many of whom face hospital stays of up to six months. The VA, which sought emergency funding from Congress back in July, is facing a dollars-and-cents crisis brought on partly by underfunding in wartime and partly by the growing incidence of injuries like Briggs's, which represent a challenge that neither war planners nor VA administrators were ready for.
The American public is well acquainted with the U.S. military's death toll in Iraq, which stood at 2,108 as of last Monday. Less familiar is the number of troops who have sustained serious and, in many cases, permanently life-altering, wounds: around 15,500, according to the Department of Defense. In fact, the ratio of killed to wounded in Iraq is about one to eight, or roughly twice the ratio of the Vietnam War. "The survivability rate is much higher," says Paul Rieckhoff, an Operation Iraqi Freedom vet who served as a platoon leader in Baghdad and later founded Operation Truth, a soldiers' and veterans' advocacy organization. "Guys who would have died in past wars are living because of the advances in body armor and in medical technology." But the heightened survivability of many war injuries also means more vets with problems such as serious brain deficits, full or partial paralysis, loss of vision, or loss of limbs. ("The amputation rate has almost doubled" in this war compared to past ones, Rieckhoff notes.)
Improved field medicine and triage care are not the only reasons for the heightened incidence of major traumatic injuries in the Iraq War. Critics (who are not all opponents of the war itself) have highlighted numerous other factors: The Defense Department left troops ill-equipped for guerrilla and street-to-street combat, they say. Humvees and other vehicles used by troops were not properly armored. Insurgents used an extraordinary volume of homemade IEDs filled with projectiles from bones to nails.
Nearly 65 percent of the injuries seen at Walter Reed in this war have been brain-related. And that figure does not account for an increasing number of soldiers suffering concussive brain injuries whose symptoms may take weeks or months to manifest themselves. "We're not seeing all the mild brain injuries, and that's what's happening more," concedes Kusar. "I think as people are getting out and figuring out they're suffering from concussive brain injuries, we're going to be seeing a lot more of those."
Rieckhoff says the 1.2 million U.S. troops who have served in Afghanistan and Iraq since September 11, 2001 are about to flood a VA system that the Bush administration has funded inadequately all along the way. "There's an old adage," Rieckhoff says, "that the Army is always built to fight the last war rather than the current one. There's a wave coming. And the [VA] is not ready for it."
BOB AND MICHELLE Briggs met nearly 13 years ago while both were "cruising the strip," which for young people in Keokuk meant driving up and down the Main Street/Highway 218 drag—showing off, hooking up, waiting for something to happen. Bob and his buddies would cruise the strip in old beaters that Bob had patched up. In those days they all wore their hair long and blasted Guns 'N Roses on the tape player relentlessly. Bob and Michelle married 11 years ago. Ashlea came along six years later, in 2000, and Cody in 2004.
During the time Bob was in Iraq, Michelle Briggs took care of their two kids and worked out of the house, running a small pet-grooming operation that brought in a few extra dollars. They talked on the phone nearly every day at first, until it turned out that the $25/200-minute AT&T phone cards they bought were only good for about 14 minutes apiece. Then they wrote nearly every day, though it usually took about two weeks for their letters to arrive. After Bob was wounded, Michelle suspended her dog-washing venture and took the kids to her mother's house. In the months since, she has spent nearly every day at his side. She's been there through the meals, the physical therapy sessions, the sudden and tearful curtains of despondency that fall over him sometimes.
She is quick to point out, though, that he is still unmistakably Bob, the same guy she married, with the fast wit and twisted sense of humor. Throughout his recovery she has refused to treat him with kid gloves. The first time they were back home together on a weekend pass, Michelle brought him Thai takeout. "He said to me later, 'You'll never guess what I had for dinner.' I was like, 'You had orange chicken, Bob. I got it for you!' People think I'm mean to him," she admits, "but they don't know us. I'm like, come on! He's got to have fun. You have to be able to laugh."
A vast amount of her time with Bob in these months has been spent watching—sitting in on countless rehab sessions and offering moral support as needed. Their days have typically started at 7:00 a.m., when the nurses wake Bob for breakfast. Then they have some time together before speech therapy at 9:00. Though Briggs never lost his ability to speak (unlike many of the other 30 or so polytrauma patients the Minneapolis VA has seen), he needs the therapy to relearn the process of thinking and then speaking his thoughts. Here, he spends about an hour doing exercises designed to retrigger certain memory-related cognitive functions. The cognitive problems common to Briggs's type of diffuse brain injury are short-term memory loss, the inability to maintain focus, problems with multitasking, and some "comprehensive" loss of cognitive associations, like how to get from point A to point B, or what the relationship is of a hammer to a nail.
At 10:00, it's occupational therapy. The point here, Dr. Larisa Kusar says, is "livability" rather than "recovery"—that is, to help Briggs learn to compensate for the things he will never be able to do. These include most of the mundane tasks of daily life: dressing himself without any help from his left arm or leg, making coffee, cracking an egg into a frying pan with one hand. "We definitely know, given the severity of the injury and the weakness on the left side, that he's not going to gain full function of that side," notes Kusar. "It will not return to his baseline."
In one exercise, Briggs counts numbers backward, starting at 100 and then subtracting three repeatedly: 100, 97, 94.... He does this until the specialist throws him a random set of numbers and asks him to put them in ascending and then descending order. "It sounds childish," he says sheepishly. "But it really gets your mind going."
Another activity offers him a sentence or phrase such as "The sun is shining bright." Briggs then has to recite the statement in reverse, put its words in alphabetical order, and arrange the words according to how many letters each contains. "The goal," says Kusar, "is to restore function to those areas of the brain the best we can, but there are parts that aren't going to recover completely. With time, however, the brain can compensate and develop new pathways and connections, through what we call neuroplasticity of the brain."
Part of the point of all the repetition in the various mental and physical exercises Briggs does each day is to help those pathways heal as far as possible, and to increase the likelihood that new neural pathways will be blazed through other parts of the brain. Kusar says the first two years following a brain injury are the most crucial for any recovery of lost brain function—which is why Briggs's days, now and long into the future, are booked full of therapy sessions.
After lunch and some time to rest, physical therapy begins at 3:00. Here it's mostly about walking, regaining a sense of balance and of his body, and building strength in his left side. This is where all the simulated curb-stepping and walks down the hall take place. It's the most grueling hour of his day, and it's followed by recreational therapy at 4:00, where he continues to work on balance and body control, this time through activities like putt-putt golf.
After that it's off to dinner. Briggs has gained weight over the course of his rehab, so he's trying to watch it. This is one more thing that's not easy anymore. "That's one thing about the brain injury," Michelle explains. "He doesn't know when to stop eating. They don't know when to shut it off. I have to tell him, 'That's it. No more.'"
ON THE SUBJECT of the Iraq war, there is one main thing Bob Briggs wants to say: "They're doing a good job over there, rebuilding the schools and hospitals. Trying to clean it up. And I think the soldiers are doing a real good job training the Iraqi soldiers, even with the lack of communication between us." His feelings about the U.S. Army are less warm. Round about early September, he was ready to kick somebody's ass.
"If I see any bill from this surgery, I'm going to be screaming at every congressman," he pledged. Briggs was scheduled to leave the Minneapolis VA and travel to Walter Reed in D.C., where he was to undergo a cranioplasty that would replace the missing part of his skull with a prosthetic piece. Doctors also planned to put a permanent prosthesis in his right eye.
By this time, Michelle had stopped attending so many of her husband's therapy sessions—so that he could regain his independence, she said. But also because she was suddenly quite busy: As the scheduled trip neared, her days were brimming with phone calls, paperwork, more phone calls, research into the particulars of Bob's benefits, and constant communication with Bob's VA case manager. Three months after his injury, the Army medically retired Briggs, shedding him as their responsibility. Which means that all his medical benefits fall under the auspices of the VA.
Trouble is, the Army and the VA are two formidable, and distinct, bureaucracies. The Army/Defense Department is responsible for pay and benefits accruing to active-duty soldiers as a result of injuries. In theory, a soldier who is wounded remains on the active-duty roster and has his medical needs taken care of by the DoD. But because Briggs was retired out so quickly, everyone is unsure who will pay for what when it comes to future medical expenses, which are bound to be huge. The VA is not part of the DoD, and grants some benefits on a case-by-case basis. Disability benefits and burial, for example, are entitlements; health care measures extended by the VA are discretionary.
Since there's no guaranteed payor for the services he needs, Briggs is worried that his family will be stuck with a crushing debt after all is said and done. He's heard other horror stories about wounded soldiers who lost benefits or were required to pay back money to the military as a result of being shifted from the Army to the VA.
The moral point is clear, at least to Michelle Briggs: "The Army needs to follow through and pay for his care until he's done. That's the issue. This is a war-related injury. He should've never been retired until he was done with his treatment. They pushed him through.
"The people at the VA have been great," she added. "They're doing everything they can to work with us. But this is not their responsibility. This is the Army's."
After weeks of haggling, the VA finally agreed to shoulder the cost of his travel and surgery. In the end, though, Briggs's travel and surgery had to be delayed until the second half of October. (As of this writing, he is still recuperating at Walter Reed and will probably return to the Minneapolis VA in early December.)
Colonel David Lindberg, the Iowa Army National Guard's deputy chief of staff for personnel, claims that the reason Briggs was medically retired from the Army so rapidly was that the VA system offered a better range of services for a soldier with his injuries. "The Army did move relatively quickly to retire him," Lindberg offers. "Typically you'd remain in the Army longer before you're medically retired, which is when a soldier could not fully recover to return to active duty. But they did it because it was best for him and his family. They certainly weren't trying to wash their hands of him."
Lindberg does admit that this has caused problems with Briggs's follow-up care. "Because the health care was started at Walter Reed, the Army was telling him he'd have to go back for the surgery," he says. "And because normally you'd remain in the Army for longer, his case was unusual." Lindberg says this serious glitch in the system only has happened this one time in the two years he's had the position in the Iowa National Guard. He goes on to add this mea culpa: "We worked with the VA to make sure his and his spouse's travel and the surgery were taken care of, and made sure they got what they were entitled to. I hope the Army learned a couple of things from this, that we need to recognize this [kind of thing] early so that those responsibilities can be met."
Paul Rieckhoff of Operation Truth claims that the lengthy runaround the Briggses encountered is not really unusual at all. Once a soldier transitions from the DoD to the VA, he notes, there is no one to help him or her navigate the dual bureaucracies. "There's a major gap there," Rieckhoff says. "Sometimes people give up. They stop trying to fight the bureaucracy. If you don't have posttraumatic stress disorder by the time you get to the VA, you probably have it by the time you leave."
But the greater problem is the sheer shortage of VA resources to deal with the new wave of vets entering the system, wounded and otherwise. To date, more than 430,000 of the 1.2 million troops who have served in Iraq and Afghanistan have been discharged, and 120,000 of those have gone on to require care at the VA.
"They've dangerously underestimated just about every number throughout this war," Rieckhoff says, "from the number of troops we need on the ground to the number of pieces of body armor to the number of armored Humvees. And when it comes to the VA, they've also underestimated the number of beds we're going to need, the number of counselors, the number of paper pushers. If you figure maybe a third have gotten out so far and the VA is already overwhelmed, what's going to happen when the others come home?"
In April of this year, after reports from VA medical facilities that inadequate funding was hurting veterans' care, VA secretary Jim Nicholson wrote in a congressional report: "I can assure you that the VA does not need emergency supplemental funds in FY 2005 to continue to provide the timely, quality service that is always our goal. We will, as always, continue to monitor workload and resources to be sure that we have a sustainable balance. But certainly for the remainder of this year, I do not foresee any challenges that are not solvable within our own management decision capability."
Two months later, Nicholson confirmed that there was a $1 billion shortfall in a roughly $30 billion budget for Fiscal Year 2006, which began October 1, and on June 30, the house passed $975 million in emergency spending for the VA. And a month after that, in July, the VA acknowledged that it needed an additional $300 million to fund FY 2005.
Critics have called Nicholson another egregious example of Bush administration cronyism. Prior to heading the VA, Nicholson had never held a position with any veterans' organization or the DoD. Instead, the Vietnam vet and Denver lawyer/real-estate developer's résumé includes a stint as U.S Ambassador to the Vatican, and one as chairman of the Republican National Committee from 1997 to 2000.
In June 2004, Bush signed an executive order requiring the VA to establish a center for faith-based and community initiatives. The Department of Veterans Affairs refuses to reveal how much of the budget is being spent on these initiatives. However, in April of this year, the VA forked over $4.9 million for a $21 million Catholic Charities housing project for homeless vets and outpatients. The announcement came not long after the Chicago Sun-Times revealed that wounded vets in Illinois have been receiving the lowest disability payments in the country since 1934.
As a result of the severe injuries from Iraq and Afghanistan and an aging veteran population, many Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) vets have complained of a long wait time for care in the VA system. Tales of interminable clinic visits—Briggs says he has waited up to five hours to be seen for eye appointments—and of weeks- or months-long delays in getting doctor's appointments are common. The Department of Veterans Affairs claims that in August of this year, 94 percent of appointments for OIF/OEF were within 30 days of the veteran's desired appointment. Of the 101,235 disability claims filed since 9/11, 72,910 have been processed and 28,325 are still pending. Of the claims processed, 64,810 were granted service-connected benefits for one or more claimed condition, and 8,100 were denied.
THE LAST TIME I visit Bob and Michelle Briggs at the VA, shortly before his scheduled trip to Washington for surgery, the improvement in his mobility since we first met in August is tremendous. His left arm has gained some mobility, and he tries to move it from his lap to the handle of his wheelchair. "He's showing off now," Michelle jokes.
His spirits are better, too, he says, because after much experimentation, they've finally found a seizure medication that doesn't make him too drowsy. He's also on antidepressants, which have moderated his mood swings. "He's still real up and down," Michelle confirms. "Most people coming back, even though they're not being diagnosed, they have some sort of post-traumatic stress disorder. How can they not?"
Briggs is slowly regaining his memory of the night of the blast, but the visions he had in those first days after he was blown up, when he was near death, are still crystalline. "You didn't want to be near my bed," he says. "I thought I was in Iraq. I kept seeing things." He says he recently visited the Indian Trading Post in Shakopee to try to get a better understanding of what the visions meant. He won't tell me what he saw. "I don't really like to talk about it," he says apologetically.
Briggs's mental acuity, his ability to focus, has also improved greatly. But the change in the weather mostly has him thinking one thing: "I can't wait till it snows again. I love getting that call at 3:00 a.m. to go work the plows." He never worked as hard at anything else as he did at getting that job with the Iowa DOT, according to his sister. "They've been great," Briggs says. "They're holding my job for me. If I can't go back to work...."
He pauses, shaking his head as if he doesn't want to consider the possibility. "It took me a long time to get that job."