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A Soldier's Heart Beats On
He had been in Iraq only a few weeks, but Brett Schlifka already had grown used to seeing death laid out on the operating table before him. And yet something was different on the morning of Dec. 14.
The young men and women brought to the U.S. military hospital in Balad were often burnt beyond recognition, missing limbs or torn through with shrapnel. By contrast, Tim Boyce didn't have a scratch on him. And yet the 29-year-old soldier from Utah was dying. That much was very clear and perfectly inexorable.
At the same moment, thousands of miles away in southern Germany, a 39-year-old woman also was dying.
But her condition, unlike Boyce's, was treatable. All she needed was a new heart.
'What does that mean?' The phone rang before sunrise. Sharon Boyce, staying with her in-laws in Farmington, Utah, while her husband was away in Iraq, was used to calls at odd hours, but the uncertainty was always unsettling.
She answered. It wasn't Tim. The man on the other end of the line said he was calling from Washington, D.C. Tim Boyce had been hospitalized. Not injured, but very sick. That was all the caller knew.
Sharon Boyce had dealt with hardship before: two bouts with cancer; a husband gone for three of their first five years of marriage; and then, his time in the military nearly up, an involuntarily extension of his enlistment for a second combat tour in Iraq.
Yes, she thought, she could cope with whatever this new challenge would be. Perhaps her husband might even be sent home early. She tried not to worry.
It was mid-afternoon in Utah before she again heard from the military. This call, from a doctor in Balad, was far less vague - and far more unbearable.
Tim Boyce had suffered an aneurysm, a ballooning of a blood vessel in an artery of his brain, the doctor explained. Surgeons had performed a hemicraniectomy, removing a section of his skull to relieve pressure on his brain, and a lobectomy, extracting part of his left temporal lobe.
Sharon Boyce didn't understand. "I'm not educated in medical terminology. I asked, 'So what does that mean? Will he be in a coma? Is he conscious?' "
The doctor was blunt.
"He's brain-dead, ma'am."
'Many lives could be saved' Kai Nehammer's mobile phone chimed at half past 5 p.m. Delicate in his gigantic hands, he held the tiny receiver to his ear.
It always seemed to happen this way. The towering physician from Saarbrucken, Germany, often lamented that organ donation seemed to be an afterthought for German doctors attending to dying patients.
"Right before they go home, they think, 'OK, I have done this and this and this, and - oh - I think maybe there was something to do with organ donation," said Nehammer, who links organ donors to recipients as a case manager with Deutsche Stiftung Organtransplantation, which coordinates all transplants in Germany.
But this call was different. The subject was a U.S. soldier.
And while Nehammer knew that many of those who died at Landstuhl Army Regional Medical Center, in southern Germany, were in no condition to be donors, this individual's organs appeared to be in perfect condition.
"And if that was true," Nehammer recalled, "I knew many lives could be saved."
'It makes it better' To Marta Maltby, no patient meant more than any other. But from the time Tim Boyce arrived at Landstuhl hospital, lifted on a stretcher from the back of a long blue bus and immediately wheeled into the intensive care unit, the trauma nurse paid special attention to his care.
Perhaps it was because Boyce, like Maltby, was from Utah. And perhaps, co-workers say, it was because Maltby always had a desire to comfort those whose lives could not be saved.
But there was another aspect to Boyce's presence at Landstuhl that likely contributed to the neurosurgical nurse's interest. Maltby, who died suddenly of natural causes a few months after Boyce's arrival at her hospital, found great solace in an arrangement forged between Landstuhl's doctors and the German transplant system.
" 'Our kids,' we call them, it hurts when we lose them," said Insel Angus, Maltby's friend who, as a fellow trauma nurse, also worked on Boyce's case. "But Marta always said, whenever we could make a donor match, 'It makes it better.' "
Yet, the nurses also knew there were considerable legal, ethical and medical issues to be surmounted.
"When we get these patients, when they pass on here, there are often complications that go along with their injuries," Angus said. "Frequently those complications are the very thing that preclude them from being organ donors."
Yet test by test, Boyce's body was passing. His heart. His liver. His lungs. His eyes. The sorrow for Boyce's loss was tempered with anticipation.
"To be able to make something good out of the inevitable is a very special thing," Angus said.
"We were ready, but I remember we had to wait. We had to give his brother a chance to get here."
'I just broke down' Brad Boyce wasn't certain why he had been called to Germany. The U.S. Army soldier, stationed in Kuwait, knew his brother had been hospitalized but was not alarmed when his commander suggested he get there for a visit.
"I knew that when soldiers get hurt in Iraq, they usually go to Landstuhl," Brad Boyce said. "So that is all I was thinking. He got injured. Something happened, but he is OK."
Sitting in the passenger seat of a good Samaritan's car, speeding south on the autobahn from Frankfurt toward Landstuhl, he learned the truth.
"My wife, she got me on my cell phone. She told me my brother was brain-dead," Brad Boyce said. "And at that point, I just broke down."
Long before Tim Boyce arrived, in a coma, at the Air Force Theater Hospital in Iraq, doctors had made a decision: In all cases possible - so long as a "glimmer of life" remained - they would get wounded troops to Germany.
"We'd rather our soldiers not die in theater," said Schlifka, Boyce's surgeon in Balad. "Often we know the outcomes are going to be bad, but we prefer not to play God. We want families to be able to make decision about organ donation and, if they can, to say goodbye."
Now, in Germany, Brad Boyce had been given that opportunity. After meeting with Maltby and others from the hospital staff, he stepped into the operating room.
"He had a black eye from the surgery and I really couldn't even recognize him," Brad Boyce said. "The only way I knew was that he had a distinctive mole on his chest. That's how I knew it was my brother."
Brad Boyce held a phone to his brother's ear. One by one, back in Utah, the dying soldier's family said goodbye.
'To continue saving lives' A small, soft-spoken man, Eric Harp was peculiar in the Army's chaplain corps, not for the way he stood out, but for the way he didn't. He wore the cross on his collar as a welcome sign, then simply, frequently and quietly placed himself in areas of the hospital in Landstuhl where he might be wanted, figuring those who needed him would seek him out.
Harp wasn't used to hard-selling anything, much less the idea of harvesting a dying soldier's body of its organs on behalf of German citizens. But within moments, he was expected to do just that.
He didn't know Tim Boyce, nor his Utah family. But he did understand something about them: All shared his faith. Harp, a bishop in The Church of Jesus Christ of Latter-day Saints, prayed this connection would serve his God's will.
Taking a telephone from the hand of a doctor, who had been discussing the nature of Boyce's injuries to the soldier's father, the Pendleton, Ore., native took a deep breath. He began by explaining how he and another Mormon soldier had anointed Boyce's body with oil, an LDS blessing for the sick and dying.
"It turned out I didn't need to say much more," Harp said. "His father had the same thoughts as I had. He said: 'My son would want to continue saving lives.' "
Sharon Boyce concurred. Soon, a team of German and American doctors was standing side by side over Boyce's body.
'The cleanest liver they'd ever seen' Over the next two days - and even before Boyce's death was recorded in the military's computerized medical records tracking system - the dead soldier's organs were transplanted into the bodies of patients across Germany.
The German Transplantation Act prohibits contacts between the families of donors and recipients. The names of doctors involved in specific transplant operations are, by law, confidential.
Recipients who try to make contact with donor families may be fined. Some German officials joke that, while no one has had their new organs taken back, they wouldn't put it past the authorities to do so.
Kai Nehammer, the transplant manager who handled Boyce's case and several others from Landstuhl, understands the secrecy surrounding transplants in Germany is difficult for families of fallen U.S. troops to accept. Wanting to help make the process feel complete, he has fought for permission to share some basic details about those who have been saved.
Here is what he was able to tell Tim Boyce's family:
The woman who received his heart was 39 years old and the mother of a daughter about two years older than Boyce's son, Ammon, 5. The victim of an inherited heart disease called cardiomyopathy, which had killed several members of her family, she was in critical condition when news came that she would get a new heart.
Boyce's eyes were delivered to a cornea bank.
Both of his lungs went to a 56-year-old man who was being treated for pulmonary vascular disease.
A 47-year-old man received Boyce's left kidney and pancreas. The man's kidneys had been destroyed by diabetes and, having previously had another pancreas transplant, hope for finding a matching organ was wearing thin.
Boyce's right kidney was given to a 27-year-old man with a rare immune system disease, called Goodpasture's syndrome, in which the body's own defense system creates antibodies that attack the lungs and kidneys.
The soldier's liver was split into two parts. The larger section was given to a 54-year-old woman who had overcome her alcoholism early enough to save her life but too late to save her liver.
The smaller part of the liver went to an 8-year-old girl.
As a Mormon, Tim Boyce did not drink "and the doctors told us, when they saw his liver, they were amazed," said Rick Boyce, the soldier's father. "It was the cleanest liver they had ever seen."
'This is who he was' Sharon Boyce sits at her kitchen counter, her 1-year-old daughter propped upon her lap, her 5-year-old son kneeling atop a tall chair, hunched over a crayon drawing. The widowed mother flips through the pages of a photo album.
"Who is that?" she asks the little girl.
"Da," the child replies. "Dadda."
"It was the first word I taught her," Sharon Boyce explains. "I wanted her to recognize her father, to know that he is part of her life."
To that end, Sharon Boyce would have liked to have shown her children some tangible proof their father's death was not in vain. And she would like to have seen - and heard - the outcome of his sacrifice.
"I really wish I could meet the person who got his heart," she said. "Just for a moment. I would like them to lie here and I would put my head on their chest and listen to his heart beat."
She's not bitter over the way things have worked out. "Tim never needed to know the people he was helping," she said. "He didn't need thanking. This is who he was."
There is something comforting in the anonymity of the exchange - something that allows her to believe that part of her husband could be anywhere, everywhere.
And so she is content to know, somewhere in Germany, her soldier's heart beats on.