A foot and half separated Marc Burleson from the buried bomb he was trying to defuse last December in a narrow alleyway of a small Afghanistan village.
The bomb exploded, mutilating the Marine's face, ripping off part of his right arm, paralyzing his left arm, blinding him in one eye and leaving him unconscious for nearly a month.
Burleson, a 31-year-old Texan, finally awoke to a pain he never imagined could exist. An excruciating burning sensation came from the paralyzed left arm — a pain that overpowered any of the hurt he felt from his other injuries.
The ache persisted day and night. Even as doctors at Walter Reed Army Medical Center in Bethesda pumped him with narcotics. Even as they reconstructed his face and fixed his right arm so he could wear a prosthetic. He would jerk awake in the middle of the night screaming from the pain coming from a paralyzed arm he thought should feel nothing.
Burleson reached a breaking point in March. He had become addicted to the painkillers and told doctors to take him off cold turkey. He contemplated suicide.
Then his hand doctor told him about a procedure where doctors could burn off damaged nerves in the spinal cord to stop pain in other parts of the body. A neurosurgeon at Johns Hopkins Hospital performs the procedure three or four times a year, mostly on accident victims.
Last week, Dr. Allan Belzberg performed the rare surgery on Burleson.
This time when Burleson awoke in the hospital, he felt an awesome sensation — no pain. He told Belzberg he loved him and that he could marry him. Then he burst into tears.
As he recovered at Hopkins earlier this week, Burleson said that sometimes he stares at his arm, thinking that it all seems too good to be true.
"I sit here waiting for the pain," he said. "I keep thinking it's going to happen. It's going to get me again."
The surgery used on Burleson was first performed in France in 1972 to ease cancer-related pain. It is now used mostly for patients who have suffered severe trauma, such as from a motorcycle or car accident.
The spinal cord transmits messages between the brain and the body, including pain. Pain like Burleson experienced is created when nerves are ripped from the spinal cord. In Burleson's case, the nerves were yanked out when the explosion popped his arm from its socket.
"It's like pulling a cord out of the wall," Belzberg said.
The damage can cause the spinal cord to develop epilepsy, like in the brain, but, instead of seizures, the spinal cord's epileptic fits manifest in shocks of pain.
Most patients describe the pain as a crushing, very hot sensation, Belzberg said. Burleson said he felt like a torch was being rolled up and down his arm or like his fingernails were being ripped out repeatedly.
Many times doctors don't realize the pain is connected to the spine and try remedies, such as narcotics, that do nothing for the pain.
"The saddest issue is when a patient's arm is amputated and that has nothing to do with the pain," Belzberg said.
Epileptic medicine works for some patients, Belzberg said. It didn't for Burleson.
Since the nerves can't be plugged back in, doctors burn the spinal cord endings to remove and repair the damaged area.
Not many doctors perform the procedure or even know what it is. Burleson said it took weeks to convince military doctors to let him travel to Hopkins for the surgery.
The surgery comes with risks because it involves opening up the spine to get to the cord. An operating microscope is used to find the damaged nerves and a radio frequency probe is used to burn them away.
"I really want to fry that tissue," Belzberg said.
Burleson's surgery took six hours and involved 140 burns.
"The risk is damaging any other part of the spinal cord," Belzberg said. "The nerves that go to the leg are immediately in the area where I was operating. You can easily paralyze the leg and take away sensation in the leg."
After the surgery, some pain can reoccur. But Belzberg said the surgery has become more precise with fewer complications. Doctors now know better what temperature to use for the burn and can better monitor the spinal cord.
Some of his patients have odd sensations or numbness after the surgery, Belzberg said, but none have been paralyzed.
Most see instant results.
"This is one of the most gratifying surgeries I do because you can truly change lives," Belzberg said.
Burleson said his condition has improved noticeably since the surgery. He has some pain from the incision and some muscle soreness, but nothing like what was in his arm. His appetite has returned.
"He's eating like a pig," said his grandfather Dan Burleson, who came to town from Texas for the surgery. He said he's glad to start to see his grandson's personality return.
Burleson knew bomb disposal was a dangerous job, but volunteered anyway because he knew it would make an impact in combat. He detonated several bombs a week. Soldiers in Afghanistan didn't wear the 90-pound safety suits as they did in Iraq because they were too heavy to carry on long foot patrols in difficult terrain, he said.
He is grateful he didn't die in the explosion. Now that his chronic pain has disappeared, he hopes his recovery will be easier.
Tuesday he headed back to Walter Reed, where his three kids and wife awaited him.
"This was epic," he said of the surgery. "My miracle."
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