Restless patient, agonizing choice

Third of four parts

After three months in Spaulding Rehabilitation Hospital, 12-year-old Rakan Hassan had gained one critical preteen skill -- popping wheelies in his wheelchair. It scared the hell out of his nurses and therapists, who feared he might fall over backward and crack his skull.

Their dismay delighted the imp in Rakan.

And so, on Dec. 12, as he rolled down the hall to take his weekly telephone call from his family in Iraq, it was wheels up all the way. The calls were the treasured highlight of Rakan's time in the hospital, which had become drudgery. He was especially looking forward to this call, because, by his calculations, he should be returning to Iraq in a couple of days.

''Home," he said, smiling, holding his arms out like an airplane's wings.

His smile vanished almost as soon as he put the phone to his ear. On the other end was Nathir Bashir Ali, Rakan's brother-in-law, who had taken custody of Rakan and his siblings a year ago, after their parents were killed and he was wounded, in a tragic accident, by US troops. Bashir Ali said that he and his wife, Intisar, Rakan's oldest sister, had spoken with the doctors and learned that Rakan needed to stay longer, maybe a month, maybe more. And, another thing, he said: They had been told that Rakan was not listening to his caregivers in Boston.

Rakan began to protest, but Bashir Ali cut him off.

''You will do as you're told," he said.

During each previous call home, Rakan had been joyous and animated. Now he was crying.

The average stay in Spaulding's 15-bed pediatric unit is less than 30 days. Rakan had already been there three times as long, watching other kids arrive, get better, and leave. By December, he didn't really need to be in the hospital. But the conditions under which he had been allowed into the United States made it no easy thing for his caregivers to place him, as they would have liked, with a temporary foster family.

After hanging up, Rakan sat on his bed, wondering aloud if he would ever be allowed to go home.

''I don't want to stay here," he said, burying his head under a pillow.

After his uncle, Falah Abbas, who had accompanied him to the United States and spent the first two months with him, returned to Iraq, Rakan seemed to flourish. His quirky personality, a bit subdued in his uncle's presence, emerged. He was upbeat, joking constantly with his nurses and therapists. But he was sometimes more difficult. Where, in his uncle's presence, he had obediently followed orders, he now sometimes ignored his caregivers, perhaps because nearly all of them were women. For a couple of weeks, he refused to get out of bed in the morning.

By word of mouth, and especially by e-mail, it became known in the local Muslim community that an Iraqi orphan who had been wounded was being treated in Boston. An ad hoc group of Muslim students began appearing at Rakan's bedside, keeping him company, talking to him in Arabic or Turkish, bringing him the kebabs he preferred to hospital food. A Turkish couple from Cambridge, Hesna and Himmet Taskomur, visited often and took him to their home. Amy Simpson, the unit's social worker, noticed she was spending more time organizing Rakan's calendar, scheduling his regular forays outside.

''He has a busier social life than me," she said.

After his uncle left, Rakan got a roommate: 11-year-old Will Parr from Salem. Will was Rakan's first peer, the only boy close to his age, who had been in the pediatric unit. They hit it off immediately. Rakan began attending Will's therapy sessions, encouraging him to push through the pain.

''Before, I look like this," Rakan told Will, pulling his legs to his chest, crunching himself into a ball. ''But now, PT, PT, I look like this," he said, straightening his legs, puffing his chest out.

A group of therapists stood clustered around the main desk, complaining that because Will and Rakan were staying up so late, talking, even after lights out, the boys were too tired to get up in the morning.

''But," said a perplexed Dr. Ayad Abrou, an Iraqi physician, ''they don't speak the same language."

''Yes, they do," said Anne McGrail, an occupational therapist. ''They speak 12-year-old."

As Rakan became more settled and continued to make progress in therapy, his caregivers increasingly worried about his approaching return to Iraq. Would he relapse, given the inevitable uncertainties of care in a war zone? Was it fair to send a boy who still struggled to walk from the safety of Boston to the daily hazards of home?

There were times, indeed, when even Rakan sounded like he was conflicted about it.

Early in December, he and his physical therapist, Alison Tate, had finished a particularly grueling session. Tate sensed that he was trying to cram in as much stretching and exercise as possible before he left. He was hanging around the therapy gym after his sessions were over, asking to do more.

''Maybe," Rakan began, speaking in the pidgin English he had become proficient in, ''I no go back to Iraq."

Tate was stunned. She turned slowly and looked at Rakan, who sat on a padded bench.

''Maybe," he continued, ''I stay here."

But where, Tate asked, would you live?

''I stay at your house, on your sofa," he said, propping his feet up on an imaginary couch, putting his hands behind his head. ''Play video games, do my PT."

He seemed to be kidding, and he probably was. But throughout Rakan's stay, the risks inherent in his eventual return to Iraq had been the elephant in the therapy room, impossible to ignore, impossible to resolve. Most of the people who were caring for Rakan had talked about it, to themselves, to their colleagues, and concluded that it was for the best, that he missed and loved his siblings.

Who were they, they asked, to impose their culture, their beliefs, on this sweet, mischievous child from a place they knew so little of.

But then, they would confess: They were kidding themselves. They didn't want him to go back to Iraq, didn't believe Rakan would be better off living in a war zone, with a family that had to worry as much about day-to-day survival as about the follow-up care Rakan would need.

Rakan told Tate he wanted to return to Iraq without the crutches, which he needed to walk around the house, and without his wheelchair. She sensed that he knew he couldn't expect the quality of care he had received to continue in Iraq, and also that he hoped, above all, to avoid the stigma of returning home disabled.

It wasn't just Rakan's caregivers who resisted the idea of sending him home. Fred Gerber, the Project Hope official who organized Rakan's airlift out of Iraq, was adamant that Rakan should stay and eventually be adopted. Gerber knew the dangers of Iraq first-hand. Two years earlier, while still a colonel in the 82nd Airborne, he had been shot in the head and seriously wounded in Baghdad. He believed that, however much Rakan's family loved and wanted him, sending him back was irresponsible at best and immoral at worst. He said only a handful of Iraqi children had been adopted in the United States after coming here for medical care.

''This kid has a shot," Gerber said. ''Why take it away from him?"

Gerber considered moving Rakan to the National Rehabilitation Hospital in Washington while he looked for a family to adopt him.

Dr. Laurence Ronan, the Massachusetts General Hospital internist who was overseeing Rakan's care, was sensitive to the pressure from those caring for Rakan, and from Gerber. But he also felt his ultimate duty was to his patient.

''Rakan wants to go home," Ronan said. ''Is it better to be a person who is sick or with disabilities in America than Iraq? You bet it is. But it's not what he wants. And contrary to what some people think, a 12-year-old boy is capable of making that decision. If you listen to him talk to his family on the phone, there's love there. There's attachment. There's longing."

Ronan paced next to a computer bank outside his office. He called up an e-mail from Gerber. It was another plea.

''Larry," it began, ''I'm not fighting you on this, but . . ."

Ronan began pacing again.

Ray Tye doesn't outrank Fred Gerber. Tye was an MP during World War II. But he speaks with the authority of a self-made millionaire who grew up in a three-decker in Haverhill. He wears a US flag pin on his lapel and his heart on his sleeve.

''Why can't we keep him here?" Tye asked Ronan.

They were sitting in the lunchroom of the pediatric unit, while Rakan lounged in a nearby chair, oblivious to the nature of the conversation. Tye, a liquor distribution magnate, had agreed to cover Rakan's medical expenses, and now he was saying he would pay whatever it took to keep Rakan in the United States.

''Why not bring one of the sisters over?" Tye suggested. ''Maybe we could get a family to adopt him."

Ronan looked at Tye, then at Rakan.

''God," Ronan said, sighing, conflicted again.

Spaulding Rehabilitation Hospital has big plans, plans to build a $100 million facility at the Charlestown Navy Yard. In early December, the hospital held a dinner for donors, and someone had the idea of inviting Rakan.

Rakan had other ideas. ''No way, Jose," he said, crossing his arms, and using one of the stock phrases he has picked up from hospital staff.

The idea of attending a glitzy gala at the Boston University Club, 33 floors above the city, held exactly no appeal for Rakan. But Aomar Nait-Talb, a Moroccan native on the Mass. General housekeeping staff who had become a regular visitor and male authority figure in Rakan's life, persuaded Rakan that he owed it to the people who had taken care of him.

Tate, Simpson, Alyssa McCarthy, a speech therapist, Anne Dodwell, the program director at the pediatric unit, and Nait-Talb accompanied Rakan to the dinner. Tedy Bruschi, the Patriots linebacker who had been treated at Spaulding after suffering a stroke, was the featured speaker, and came over to the table to meet Rakan.

''Hey, buddy," Bruschi said, bending down.

Rakan smiled, but said nothing.

A publicist came over and told Bruschi the plan for the evening. Toward the end of a video that would show images of Rakan's rehabilitation, the linebacker was to pick Rakan up out of his wheelchair and carry him on stage to the strains of the song ''He Ain't Heavy, He's My Brother." The publicist and Bruschi walked away.

Tate's mouth hung open. ''Is anyone going to ask Rakan if that's OK?" she asked.

Nait-Talb did, in Arabic. It wasn't.

At the end of dinner, a video was played, and Bruschi was shown making tackles during a game. Rakan recognized him as one of the helmeted men whose posters hang in the therapy room. He warmed to the idea of going up on stage. But it would be on his terms, not theirs. At the appointed time, when Bruschi came over to get him, Rakan pulled himself out of his wheelchair and insisted on walking up to the stage, assisted on either side by Tate and Bruschi.

The dining room erupted in cheers.

On Dec. 14, the day that Rakan had believed he would touch down on Iraqi soil, his roommate and pal, Will Parr, was discharged from the hospital.

The nurses came in and told Rakan he had to move across the hall, to a new room.

It was all too much. He refused to empty his bladder, and resisted attempts to do it for him. He wouldn't shower. He wouldn't eat. He became listless at therapy sessions.

Tate walked into Rakan's room and told him if he didn't tend to his bladder, he could develop kidney problems.

Rakan shrugged. ''I don't care," he said.

''Well, I care," Tate told him, folding her arms across her chest. ''If you don't do this, you could die."

Rakan folded his arms back at her.

''I don't care," he repeated.

Rakan's rebellion convinced Ronan that to keep him in the United States, against his will, would be a disaster.

''You know something," Ronan said one evening after work, ''We've done the best we can . . . What Alison has done, getting him to walk, is a freakin' miracle. He has all these visitors, he gets all these gifts. But you know what? Ninety percent of the time, this kid is by himself. Alone. All alone."

Even as Rakan grew moodier, he grew stronger. By mid-January, Ronan was back on the horn to Gerber, making the elaborate plans to bring Rakan home. In a rare retreat, Gerber had deferred to Ronan on the wisdom of returning Rakan to Iraq.

On Jan. 23, Rakan walked into Dr. Patrick Brennan's office to make the most important telephone call in his life. If he was nervous, he hid it well. As Ronan punched in the 16-digit phone number to Iraq, Rakan burped six times, in rapid succession. It was one of the skills Rakan had perfected during his convalescence -- the ability to burp, on cue.

''I'm coming home," he told his brother-in-law and guardian, Nathir Bashir Ali. ''Saturday."

Bashir Ali asked how he felt.

''Fine," Rakan replied.

His brother-in-law asked for more specifics about his health, but Rakan was purposely vague. He had a surprise for his family. After hanging up, he seemed pleased with himself.

''I told them nothing," he said, smiling, rubbing his hands together.

The day before he was to go home, Rakan sat on his bed, absent-mindedly playing a video game. He was asked what he would miss most about Boston and he replied that he wanted to grow up to become a fighter pilot, so he could come back and destroy Boston.

But, he was asked, if he did that, what would happen to Alison Tate?

He didn't want to hurt Alison, he said.

What about Amy Simpson?

He didn't want to hurt Amy, he said.

What about Himmet and Hesna Taskomur, the Turkish couple that visited him and treated him like a son, and Dr. Ronan, and Renee Wilson, the nurse who introduced him to the joys of Fruit Loops?

Rakan sighed.

''OK, OK," he said.

When he grew up, he said, he would become a commercial pilot instead.

When the day came, Hesna Taskomur tried to hide her tears but didn't do a very good job of it. Rakan, in what amounted to a victory lap, had just walked down the long corridor on his crutches, pausing to high-five other kids and to receive hugs from nurses and therapists.

Just before the door, he got to Tate. Their last month together had been stormy, but Rakan knew that without her pushing him, he would not have reached this point. He tried to give Tate a tough guy look, but it quickly melted.

He smiled and he hugged her and she rested her forehead on his.

TOMORROW: Part four: A homecoming for Rakan.

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