TWIN FALLS — First, Robert Ramos' right arm went limp. Then the left. When the paralysis streaking down his body hit his lungs, he stopped breathing and collapsed in his fiancee's Twin Falls apartment. She knelt over him for 10 minutes, breathing air into his lungs until paramedics arrived.
When Ramos awoke in the hospital last April he could only move his head. His doctors were baffled.
The Iraq veteran had been home for six months. He had no bullet or shrapnel wounds. His only mishap in Iraq was a car accident in which he suffered a mild concussion.
Doctors now know that Ramos' paralysis is likely caused by a wayward blood clot. The clot, they theorize, formed after the car accident, which happened nearly a year before the April day Ramos stepped out of the shower and collapsed.
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The Twin Falls soldier's ordeal started when the Humvee he was riding in crashed into a car in Kirkuk, Iraq. The last thing Ramos remembers before blacking out that day is being thrown forward in the truck. Ramos quickly regained consciousness. A military doctor told him he suffered a mild concussion. Ramos, a National Guard specialist, was back on duty the next day.
Ramos, 21, joined the Guard just after graduating from Valley High School and served with the 116th Brigade Combat Battalion in Iraq in 2005. After serving as a guard at a base in Kirkuk, Ramos returned to construction work in Twin Falls.
Now, he and his family are adjusting to round-the-clock care, a fleet of medical equipment and frequent doctor visits.
Today, Ramos, a former high school basketball player and avid snowmobiler, rarely makes it past the mailbox at the end of his driveway. His condition makes illnesses especially dangerous, and he can't stay in the cold for too long.
Speaking over the rasping hydraulic exhale of his ever-present ventilator, Ramos said the hardest part is the loss of his independence. He is no longer engaged. He can't enjoy the outdoors. Many days Ramos wakes up depressed and finds diversion in his growing DVD collection.
"There's days when I just don't want to get out of bed, don't want to do anything," he said. "Most days have been hard days for me."
Ramos gets around on a wheelchair powered by a "sip and puff" tube — he controls the direction and speed of the chair by blowing and sucking on the tube with varying force. When he first got the chair, he took it out in the hospital hall and sped off to see how fast it could go, his mother, Barbara Ramos, said. That story prompted Ramos, tall with jet black hair and limbs thin from lack of use, to flash a wide, mischievous grin.
Despite his devastating injury, Ramos said he's glad he joined the military, which he said taught him discipline.
"I'm glad it took me in the direction it did," he said.
Every little movement
Ramos' unofficial doctor is his mother, a retired special education teacher's aide. A stack of medical journals and bulging binders attest to her determination. Since the day her son's injury was diagnosed, Barbara has read voraciously about his condition. She's also learned her how to care for him.
Breathing with a ventilator leaves Ramos susceptible to infections, and his breathing tube must be regularly cleaned. He needs medication every four hours, and at night he must be turned over every four hours to avoid bed sores.
To give him this constant care, Barbara and Robert's father, Bob Ramos, sleep in shifts. Bob goes to sleep and rises early; Barbara takes the late shift.
They closely monitor Ramos' progress, noting every minute movement. He has made small strides and can wiggle one arm and a thumb.
"Every little movement can mean something. Can be a possibility," Barbara Ramos said.
She credits a no-nonsense upbringing for helping her cope.
"I was raised to just believe you've got to do what you have to do even though it's hard," she said.
The Ramos family struggles with mounting medical bills. They rely on Bob's job as a gravel truck driver and Robert's $700 per month disability check from the federal government.
The military recognizes Ramos' injury as a war injury and has provided for much of his care, Barbara Ramos said. They are waiting on word of whether the Guard will pay for a modified van that can handle Ramos' wheelchair and ventilator.
But not everything is covered, and every time Ramos goes to the hospital, the family waits and worries until they see how much insurance will cover.
There's also the $200 per month in medication and hundreds more to rent various pieces of equipment related to the ventilator that they must pay out of pocket. A recent bout of pneumonia landed Ramos in an intensive care unit and left his family with a bill for $12,000. They're not sure how much insurance will cover.
When Ramos was injured, the family lived in Hazelton, paying about $400 per month for their house. It was not equipped for the large wheelchair and portable ventilator, and the family had to move to Twin Falls. They found a home that was wheelchair-accessible, but their rent doubled.
"It's just little things like that that we now have to budget for," Barbara Ramos said.
Dr. Michael Hsu specializes in spinal cord and brain injuries at Craig Hospital in Colorado. He has treated Ramos almost from the beginning of his hospitalization.
Ramos' injury likely started as minor damage to a blood vessel near his spine, Hsu said. As time went on the vessel never properly healed and eventually part of the wall and some blood broke free, sending a blood clot, or "embolus," toward a spinal artery. Once the embolus stopped on the artery, it cut off blood flow to part of Ramos' spine, paralyzing his limbs and some respiratory muscles.
Craig Hospital specializes in spinal and brain injuries, and Hsu said Ramos' case is unusual in that most spine injuries involve direct trauma to the spine, such as often happens in car crashes.
"In our hospital here, we may see one or two cases per year (like Ramos')," Hsu said.
Because Ramos' spine is still intact and the injury affected only part of it, he still has touch sensation throughout his body and limited movement in his arms and some fingers.
Hsu said it's too early to know Ramos' prognosis, but he said an exam scheduled in March at Craig will give doctors a better idea of how much improvement Ramos can expect. But Hsu said there are at least two factors in his favor.
"He's a very motivated person and has a lot of family support," Hsu said.
Contact reporter Heath Druzin at firstname.lastname@example.org or 373-6617.