As healing begins, a painful decision

Second of four parts

On Oct. 6, just as 12-year-old Rakan Hassan steered his wheelchair out of his hospital room, President Bush appeared on the television hanging above his bed, saying the United States must stay the course in Iraq. Moments later, Rakan was on his stomach, on a blue-padded therapy table, in the pediatric unit of Spaulding Rehabilitation Hospital, hiding a timer from his physical therapist, Alison Tate.

''Where is that thing?" Tate said, hands on hips, looking side to side.

Rakan flashed a conspiratorial glance at others in the room, arching his eyebrows twice, before pulling the timer with great flourish from beneath a white towel he had tucked under his chin.

''You!" Tate said, wagging a finger at him.

Moments earlier, Tate had been stretching Rakan's hamstrings, trying to lengthen the muscles that had tightened like taut rubber bands as he lay untreated for months after he was shot by mistake by US troops in Iraq. The stretching was painful, and Rakan's squinting eyes glistened, but he refused to cry.

''Rakan rest?" Tate asked.

''No," Rakan replied, resolutely. ''Rakan PT, PT, PT."

Tate put heat packs on the back of his legs and set the timer for 10 minutes.

''A lot of kids don't like this," Tate said. ''Rakan just does it."

When Rakan was evacuated from Iraq and brought to Boston in early September, his doctors believed surgery was urgently needed to repair the damage that a bullet had done to his spine, bladder, and bowel. But that plan was quickly abandoned when Dr. William Butler, a neurosurgeon at Massachusetts General Hospital, determined that Rakan wasn't permanently paralyzed, as doctors in Iraq had concluded. Butler and other doctors feared they could do more harm than good by excising the bullet fragments. So the surgery was shelved and most of the responsibility for getting Rakan back on his feet and walking fell to Tate.

Tate, 31, grew up in Marlborough, working her way through Simmons College by waiting tables at Charley's in the Back Bay. Her bubbly personality belies a toughness when it comes to pushing her patients. She would cuddle Rakan one moment, then press him to the limit the next.

But, mostly, she worried about him, even as she tried not to spoil him.

On Oct. 11, as the news ticker on CNN in Rakan's room reported that a suicide bomber had driven into an open-air market in Rakan's hometown of Tal Afar, killing 30 people, Tate sat at her desk, trying to navigate the maddening bureaucracy to obtain a customized wheelchair for him.

The next day, as Rakan ate lunch with the other children in the dining room, unaware of the carnage in a town where a year before he kicked a soccer ball through dusty streets, Tate was a few doors down, staring up at a television screen, which showed people scurrying around in the aftermath of still another bombing in Tal Afar.

''What are we sending him back to?" she asked, almost in a whisper, shaking her head.

There are six pieces of shrapnel in Rakan's midsection, the largest the size of a dime, lodged in his abdominal wall. The metal has settled deeply in.

''At first, we thought the shrapnel compromised his nervous system," said Dr. Laurence Ronan, the Mass. General internist who oversaw Rakan's care. ''But it's like a tree trunk in a dam: if you take it out, it causes more damage than if you leave it in."

Ronan sat in the Dodd Room, an open, dimly lit space in Mass. General where computer terminals used to review X-rays and CAT-scans throw off an eerie glow.

The bullet struck Rakan's sacrum, the triangular bone at the base of the spine, slicing it in two and causing the neurological damage that left him incontinent and unable to walk.

''He was lucky," Ronan said, pointing to the fragments. ''If the bullet was slightly higher, he would have been paralyzed from the waist down."

From the beginning, those caring for Rakan felt confident that they could treat Rakan's physical wounds, but worried whether they could heal the mental and emotional damage they believed must be there. But Dr. Patrick Brennan, the pediatric unit's chief physician, said Rakan showed no obvious sign of post-traumatic stress.

''No nightmares. He's not jumpy," said Brennan.

Still, his therapists and nurses were concerned because Rakan regularly used crayons and magic markers to draw tanks with turrets dripping blood and other combat scenes. Despite regular assessments indicating that Rakan's mental health was fine, they worried that their inability to communicate with the child in his native language was masking some lingering psychological hurt.

On most days, Rakan was upbeat, willing to do whatever was asked. But, sometimes, Rakan would think back to what had happened to him, and his endearing smile vanished.

''I just showed him this picture," said his uncle, Falah Abbas, who accompanied him to the United States. The dog-eared snapshot showed Rakan's parents, his older sisters Intisar, Sosan, and Jilan, his younger sisters Samar and Rana, and his baby brother, Muhammed. Rakan's parents were killed and he was wounded when US soldiers, fearing an insurgent attack, opened fire on the family's car by mistake. His siblings escaped injury in the shooting, but were badly traumatized.

As his uncle named those in the photo, Rakan sat in a wheelchair, by the window, staring out over the brownstones of Beacon Hill.

There were tears, dripping slowly down his cheeks.

Healing Rakan also meant understanding Rakan, and here, language became a bigger barrier than ever imagined. Rakan is an ethnic Turkoman, about 500,000 of whom live in Iraq, mostly in the north of the country. He understands some Arabic and Turkish, but his native tongue is a distinct language with Turkish roots. His uncle, who speaks Arabic, became as much an interpreter as a guardian. Finding a translator who spoke fluent Turkoman proved impossible. But gradually, a stable of Arabic speakers, some of them professional translators, many of them students at Harvard, MIT and Boston University, was assembled.

From the outset, Aomar Nait-Talb, a Moroccan who works on the housekeeping staff at Mass. General, became a regular visitor. He dropped by almost daily, translating for the medical staff, offering companionship to Abbas, giving Rakan someone to talk to besides his uncle. He also became Rakan's barber.

''Uncle Aomar!" Rakan sang one day in October when Nait-Talb showed up with his haircutting kit.

Only weeks after arriving in Boston, Rakan had begun to change noticeably. The shyness that seemed to envelop him when he arrived melted away. He put on weight. His sunken cheeks filled out. He flexed his once scrawny arms into a muscle. Tate had him up, walking on a treadmill.

Already, too, he had experienced things other Iraqi children could only imagine. He went sailing on the Charles River. He ate popcorn watching the Ringling Brothers circus. He went apple-picking at a farm in Peabody on a warm autumn day. And, having said just about nothing the first few weeks, he had become a veritable chatterbox. Just by listening to those around him, he picked up a remarkable amount of English. He would tease Tate by repeating her demands of him in affected, pidgin English.

''You crazy," he would tell anyone who amused him.

Abbas, meanwhile, was going crazy. He was bored, unable to communicate with Rakan's caregivers, and increasingly homesick. He slept on the bed next to Rakan's, in a hospital ward that was, for all intents and purposes, the domain of non-Muslim women, nurses and therapists, some of whom dressed and comported themselves in ways he found shocking. His one pleasure was Camel Lights, but even these he had to beg money for from the unit's social worker, Amy Simpson.

One day in October, he sat in Rakan's room, complaining that he needed to get home, to make money driving his taxi. Rakan and his siblings were a burden, he said. Rakan sat in his wheelchair, glumly listening to his uncle's lament. The television was tuned to CNN, with the sound off.

Saddam Hussein appeared on the TV screen. He was on trial.

''Do you remember Saddam?" Rakan was asked.

''Yes," Rakan said, turning a small blue basketball over in his hands.

''What do you think of Saddam?"

''I love Saddam," Rakan said, his voice betraying no emotion, staring at the screen.

''He is programmed to love Saddam," his uncle explained. ''He is afraid to say anything else, even here. He fears that Saddam would jump through the TV."

Abbas's clamor to go home posed a problem -- for Rakan, and for his caregivers. Ronan was adamant that, under the terms he agreed to when bringing Rakan here for treatment, the boy and his uncle were an inseparable package: if one had to go home, so did the other.

Homesickness wasn't the only issue with Uncle Falah. He had been the source of some turmoil, behaving boorishly with some of the women on the floor.

''It's a good thing he didn't touch me," Tate said, folding her arms. ''I would have decked him."

He had also accidentally caused even more pain for Rakan. One day in late October, he spilled a cup of water he had boiled for tea on his nephew, severely scalding his ankle and foot. The burn set Rakan back for weeks, and it became, for the staff, the clearest sign that Abbas's continued, reluctant presence was holding the boy back.

But how much worse would it be if Abbas took Rakan with him, months before he was physically prepared to go? Ronan saw that, but also saw no alternative.

Rakan's caregivers were crushed.

''He's not even close to ready," Tate said, angrily. ''He is going to lose everything he's gained this far . . . . To show him what was possible, and then to take it away from him, that's worse than cruel."

Ronan grasped for alternatives. At one point, he proposed making a physical therapy training video for Rakan's relatives. Then he asked an incredulous Tate if she'd volunteer to go to Iraq or Jordan to train Rakan's sisters in some rudimentary therapy skills. But Ronan gradually discerned the rebellion in the ranks, and concluded that Rakan needed to stay, even if Abbas had to go. He called Rakan's brother-in-law, Nathir Bashir Ali, the family leader, in Iraq, and got him to agree to temporarily grant guardianship of Rakan to Richard F. Ready, a Wellesley-based lawyer who is also trained as a registered nurse.

Then Ronan sat Abbas down and laid out a deal: he would give him some money, to help defray the wages Abbas lost not driving his taxi for two months, and Abbas would agree to leave Rakan behind for further treatment. Abbas agreed, shaking hands.

''I don't know if I could have done what you have done," Ronan told him.

Next, Ronan and the medical team went to the therapy room, where Rakan sat in his wheelchair, his furtive glances suggesting he knew something momentous was about to happen.

Ronan explained the dilemma; his uncle was miserable and wanted to go home. Rakan needed more time to recuperate and heal and grow strong. Could Rakan stick it out, alone, for another month?

Rakan said he knew his uncle was homesick. So was he.

''But if he is going to go home and take care of my sisters and my brother, then I say yes," Rakan said. ''He can go."

Deb McSweeney, one of the therapists, covered her mouth with both hands and left the room, overcome by Rakan's selflessness.

Abbas, meanwhile, tried to take advantage of the moment. As a taxi was summoned to bring him to the airport in the first week of November, he announced that he needed more money.

By now, Ronan had gained a fragmentary feel for Iraqi mores, a process greatly aided by Iraqi colleagues, including Dr. Ayad Abrou, who worked at Tufts-New England Medical Center, and who sometimes dropped by to visit Rakan and translate. When Abbas tried one last shakedown, Ronan folded his arms and stood his ground.

''We had a deal," Ronan said, as Abrou translated. ''If you don't honor this deal, you are not a man."

Abbas's eyes widened. Then he nodded.

''I gave you my word," he said, shaking Ronan's hand. ''As a man."

As Abbas collected his bags for the airport, Abrou leaned toward Ronan and whispered, ''Perfect."

Rakan and his uncle kissed each other on the cheek three times and said goodbye. There was genuine affection between them.

Though they were relieved to see Rakan's uncle gone, Rakan's caregivers also worried that his departure would lead the boy to regress, psychologically and physically. He had come so far. The silent, spindly boy who had arrived in September had grown robust, mischievous, outspoken, engaging. Tate had managed to get him out of his wheelchair. He was walking with crutches.

But now he was on his own.

A few days after his uncle went home, Rakan sat in his room, in his wheelchair. He fingered a soccer book, and looked longingly at a photo that showed a member of Iraq's national team. Before he was shot, Rakan was known in his neighborhood as a good soccer player, nimble and quick.

''Some day, I play, again," he said matter-of-factly, looking up, betraying no obvious emotion. ''I play, in Iraq."

It was hard to say whether even he believed that.

Thumbing through another book, he pointed to a skyscraper and said he wanted to jump off of it.

TOMORROW: Should Rakan stay in America?

Kevin Cullen can be reached at cullen@globe.com. Michele McDonald can be reached at mmcdonald@globe.com.