After the Fire

Shawn Simons was home from the hospital only three days when death began to close in on his college roommate. The crisis that Hani Mansour and his Saint Barnabas burn team had feared all along was upon them.

Alvaro Llanos, 18, who had been burned along with Shawn in the Jan. 19 Seton Hall University fire, had been showing signs, however slight, of improvement.

Then, suddenly, on Feb. 25 his temperature shot up to 105. Every measurement indicated he was dying. His blood pressure and heart rate were dropping, his respiratory system was failing.

Mansour suspected a catastrophic infection was building in Alvaro’s lungs, and X-rays suggested adult respiratory distress syndrome. ARDS usually occurs within the first few weeks of burn treatment. It is an insidious killer, stiffening the lungs of burn patients and literally stealing their breath until even a respirator can’t work hard enough to keep them alive.

Mansour had wished — indeed, prayed — that the roommates’ story would end well. Shawn, also 18, had progressed better than anyone had predicted.

And Alvaro had managed to hold on for more than a month. Mansour, the director of the burn unit, had begun to think that maybe his prayers would be answered. But now, 38 days after the fire, it seemed likely that Alvaro would die.

The burn unit was as gloomy as the raw, rainy late winter. The team took it personally when one of the patients took a turn for the worse.

"We don’t lose 18-year-olds here," nurse Susan Manzo vowed. "Uh-uh. Not here."

Of course, that was wishful thinking.

That same day, Feb. 25, 14-month-old twins, burned in a house fire in Roxbury, were brought to Saint Barnabas. One was beyond saving. He was kept alive long enough to harvest his organs.

Even Alvaro’s parents realized their son was on the brink of death. They knew it, but they had difficulty coping with it. Sometimes, driving home from the hospital, Daisy Llanos, 40, would scream with grief until her husband shook her to make her stop. Shawn was getting better, getting on with his life, but not Alvaro. "When will our son react?" Mrs. Llanos sobbed.

Only when Shawn went home from the hospital did Mrs. Llanos finally realize just how sick Alvaro was. She was still trying to deal with that harsh reality when Alvaro’s lungs began to fail.

The Llanoses’ life since Dec. 1, 1997 — when Mr. Llanos awakened in the night with a vicious headache and watched in the mirror as his face contorted against his will — had been one long string of ill fortune.

He was hospitalized at St. Joseph’s in Paterson and the Kessler Institute in East Orange for three months after the stroke. Alvaro Llanos Sr., now 46, recovered, but his speech was permanently affected and he still walked with a cane. He reluctantly gave up his factory job at Marcal Paper Mills in Elmwood Park. To take care of him, Mrs. Llanos quit her job as a clerk at the Paterson post office.

The Llanoses never had a lot of money, but with both of them working, they had been able to make ends meet. The family lived in a spotless five-room apartment in Paterson within blocks of their large extended family.

Family gatherings were a mainstay of life. Dozens of aunts, uncles and cousins gathered for Saturday afternoon cookouts or Sunday dinners. While the women fixed lasagna, barbecued chicken and rice and beans, the children played dominoes or basketball, and the men drank Corona and talked about baseball and futbol. Once in a while, Mr. and Mrs. Llanos would go dancing at a Latin club in the city.

They were gentle people who took joy in simple things. They drove a 13-year-old Acura, paid their bills on time, and even managed to save some money toward their son’s college education.

After Mr. Llanos’ stroke, that changed. Suddenly, the family was dependent on Social Security checks. Young Alvaro took on two part-time jobs — one as a stock boy in a bird store, another as an orderly in a nursing home.

Life for the family had become a series of doctor’s visits and financial worries. Insurance bills piled up. Everything fell on Mrs. Llanos, a worrier by nature anyway. She rarely slept. Her nerves were in tatters. Still, every day she went to St. Joseph’s Roman Catholic Church in Paterson to thank God for her good fortune: Her husband was alive; her daughters, Shirley, then 25, and Shany, 16, were thriving; and young Alvaro was the greatest blessing of all.

There was something about Alvaro. Everyone who met him felt it. His dark good looks made him seem the very definition of a lothario: macho, seductive, egotistical.

What was so disarming about him was that he was a shy, sweet, vulnerable boy.

Alvaro was oblivious to the dozens of girls who wanted to date him. Indeed, he never had a girlfriend before he met Angie Gutierrez at the start of their senior year at Paterson’s John F. Kennedy High School.

Baseball was Alvaro’s passion, and he had shown a real talent for it, beginning with a PeeWee league, then Midgets and onto a citywide team. He intended to try out for the Seton Hall team, and fantasized about one day playing for the Mets.

Of nine male cousins who grew up together in Paterson, Alvaro was the only one to go to college. The others looked up to him, and he wanted to be a good role model for them. While other teenagers skipped classes, he took his studies seriously, shutting himself in his bedroom on most weekends with instructions to his family not to disturb him until his homework was finished. His goal was to make something of himself, then buy his mother the house she had always dreamed of owning.

Alvaro had an acute sense of fairness. When other boys picked on someone weaker, Alvaro defended the harassed youngster. He included those who were overlooked, especially old people and little kids.

He was almost too good to be true, Angie thought, when she met him.

To Daisy Llanos, the thought of losing her son was so traumatic that the burn nurses feared she was headed for a complete emotional collapse.

For his part, Alvaro Llanos Sr. held in all his fears — he wanted to spare his wife — but he, too, was in turmoil.

One day while at Saint Barnabas, Mr. Llanos’ left eye began to droop and his head ached. He went to see the doctor who had treated him when he’d had the stroke 21/2 years before. Stay home and rest, take a few days away from Saint Barnabas, the doctor told him. Mr. Llanos stayed away for one day.

Thinking they were sparing each other, the couple avoided talking to each other about their son. Yet every day in the burn unit they asked the same questions.

When will Alvaro wake up?

Were his eyes damaged in the fire?

Was his brain affected?

Mrs. Llanos was aging more every day. Dark circles formed under her eyes. Some days she was angry; others, heartbroken. When her husband was stricken, she’d been able to get some help by visiting a psychologist. She went back, but this time therapy provided little relief.

If only she could be next to Alvaro — she wanted to sleep with him so that when he had nightmares, she’d be right there and he wouldn’t be afraid.

What if he couldn’t deal with being burned? "He was always so proud of himself and the way he looked. He was great in sports and liked to wear shorts and short-sleeved shirts. Now the doctors say his body won’t be the same."

When Alvaro’s condition worsened, Mrs. Llanos stood at the pay phone in the hallway outside the burn unit, commiserating with relatives and friends. "No quiero que mi hijo muera," she cried bitterly. "I don’t want my son to die."

Mr. Llanos hovered nearby, clutching his heart. "Oh, please God! No! Please! I want him to wake up now."

Susan Fischer, the burn unit social worker, told a meeting of the burn team on March 7 that she was worried about the couple.

"The family is in hell," she said. "This is their golden child and he’s not getting better. They are looking for answers to comfort them — answers we can’t give them.

"She’s not sleeping at all. He’s not sleeping at all. They don’t sleep because they are constantly expecting the phone to ring. Even sleeping medications aren’t working. It’s just an impossible situation, really."

The Llanoses began to focus on insignificant things: a tear in Alvaro’s eyelid, a quarter-sized sore on his leg.

One day in mid-March, they reached the breaking point.

The three burn surgeons — Mansour, Sylvia Petrone and Michael Marano — were standing at the nurses’ station when the couple approached them and began their daily inquisition.

What was the tear in their son’s eyelid?

What was the sore on his leg?

Petrone, who tended to be direct, decided it was time to jolt them back to reality. "Look," she said, "don’t worry about his eye or the thing on his leg. He’s very, very sick. He’s in critical condition."

Mrs. Llanos broke down in tears, and Mansour prescribed Valium to calm her down.

"That’s when we realized that she understood all along, and that her questions were a foil," Marano would say later. "She was hanging onto these little things so that she didn’t have to focus on the big picture. They were holding so much in. We realized that they were at their emotional end. They were losing their grip."

To make matters worse, Angie, who had been at Alvaro’s bedside every day since the fire, now was coming to the hospital less often.

The Llanoses adored their son’s girlfriend. Mrs. Llanos refused to believe her daughters when they began hinting that maybe Angie was pulling away from Alvaro.

"If she leaves him, it is God’s will," she said. "Right now she loves him a lot and I don’t think she will do anything like that. ... I hope that never happens because it will tear him apart."

In the weeks since the fire, Angie Gutierrez had become a favorite of the burn nurses.

They watched as she whispered in her boyfriend’s ear: I’m here, baby. It’s Angie. I love you. I miss you. I’ll be right here when you wake up.

They watched as she rubbed lotion on his swollen brown feet, the only part of him she could touch.

They read her letters, which hung on the wall: "I love you, baby. I love you so much. We will never be apart. Never. God is taking care of you and I know that when you come out, God will give me the strength to take care of you."

Angie was more devoted than many spouses, the nurses told her. Privately, they were taking bets about how long she would last.

The first signs of strain began to surface early in March.

"You know what?" Angie said one Sunday afternoon as she left Alvaro’s room. "I hate coming here. I hate it. When you come here every day you don’t see any change. I know he’s not going to wake up for at least another month and my body is exhausted."

A few days later, Angie arrived at the hospital, agitated, her eyes red and swollen. She had skipped two visits that week. She would not be coming quite as much now, she explained to the nurses almost apologetically.

Getting a ride to the hospital from Seton Hall was hard, Angie said. She had schoolwork to do. She hadn’t been to the gym in weeks. She was just so tired.

She loved Alvaro, but she was starting to despise the hospital.

The sounds. The smells. The hiss of Alvaro’s respirator. If only he could talk to her. Comfort her. If he would just wake up.

The day had begun badly for Angie.

All of her friends were out doing their thing and she was in her room, listening to music and thinking about everything that had happened. It was like she was living two different lives now. In school she was with her friends and they sat around talking and laughing. But Alvaro was in the hospital, fighting. She wanted to live her life, but she just felt so bad.

As if the day weren’t dark enough, Angie saw some of Alvaro’s wounds for the first time. The doctors had removed the bandages from his legs that morning so that his donor sites, where patches of healthy skin had been sliced off his thighs and calves for grafting, could heal better. Alvaro’s legs looked like a checkerboard of red, raw flesh.

Angie was stunned.

"Will it get better than this?" she asked with fear in her voice.

"It’ll get better," burn nurse Sharon Iossa said matter-of-factly, "but the scars will never disappear completely."

Angie felt like her head would explode. She hadn’t wanted to admit it, even to herself, but she had been worrying about Alvaro’s appearance.

Nominated as one of the best-looking boys in their Kennedy High School senior class and voted best-dressed, Alvaro had always been concerned about people’s impressions of him. He wore only brand-name clothes: Polo, Chaps, Tommy. And he loved to make an entrance.

"Baby, do you think I’m cute?" he would ask Angie. "Baby, you’re gorgeous," she would reply.

Angie enjoyed being seen with Alvaro. He was a real catch. In high school, countless girls were jealous after he chose her. Would it be the same now?

"It scares me a little — what he’s going to look like," she said. "He was always so self-conscious. I know how he is. His self-esteem is going to go down a lot. He won’t be the same person."

People were expecting too much from her, Angie said. "They think this is easier for me because my father went through it, but I think it makes it harder."

Her father, Angie recalled,

hadn’t coped well. His face and hands were badly burned in a car crash in 1995. He had hidden in his house for a year after he was released from the Saint Barnabas burn unit. He took down all the mirrors in his house. When he finally did go out, people stared. "Little kids would point," said Angie. "I saw it."

Angie hadn’t told her closest friends that her father had been burned. "I hate people who feel pity for me."

She worried now that she might not be able to stick it out with Alvaro. "I’m not proud of that, so I try not to think about it, but say he has a big operation and he wants me there for him and I have a big calculus test the next day?

"I’m 18," said Angie, starting to cry. "I’m supposed to be with my friends, chilling and going shopping, and I’m going to be here in the hospital with my sick boyfriend? My life hasn’t been easy. But when I got to college I was so happy. Everything was perfect. Then this happened and it all just fell apart.

"Am I going to be able to help him through this? I just don’t know."

Chris Ruhren, 41, understood Angie as well as any of the burn nurses.

Ruhren began her nursing career in the burn unit in 1983. Since that time, she had risen steadily through the ranks to become the director of burn and critical care services at Saint Barnabas — 125 critical care nurses come under her supervision today, including the burn staff.

Over the years, she had seen dozens of Angies. They all tugged at her heart.

"People forget about these poor young girlfriends and boyfriends and what they have to deal with," Ruhren said one day as she watched Angie at Alvaro’s bedside from a distance.

"I feel so sorry for kids in this predicament — and we’ve seen plenty of them come through here."

The mother of three boys, 8, 11 and 16, Ruhren, a wisecracker and a prankster, was one of the best burn nurses in the business. Though her job had grown beyond the burn unit, she still spent most of her time there.

When peals of laughter escaped from the burn unit break room, where the staff ate their meals together, usually it was because Ruhren was there.

She was as brazen as she was benevolent, as fresh as she was gentle.

When Seton Hall freshman Tom Pugliese, 18, who was burned in the fire, had to be told that his roommate and best friend, Frank Caltabilota, 18, hadn’t made it out of the dormitory, it was Ruhren who broke the news.

The other burn nurses said they had never seen her so tender.

Ruhren was their boss, their best friend, their adviser — and their partner in crime.

Her gags were legendary: When burn nurse Eileen Gehringer was chosen to travel to Malaysia to train her counterparts there, Ruhren told her she was required to wear a headdress on the trip and should practice at work. For a week Gehringer came to work with her head covered. Only when she announced that she was embarking on a shopping trip to buy a wardrobe of scarves did Ruhren finally let her in on the joke. Gehringer, always a good sport, laughed harder than anyone else.

As irreverent as she could be, though, Ruhren was solicitous of the needs of everyone involved in the treatment of burns — including a patient’s girlfriend.

"My heart breaks for Angie," Ruhren said.

"Chances are she and Alvaro wouldn’t have stayed together anyway. They’re only 18. But now she’ll feel too guilty to leave him.

"Kids shouldn’t have to be in this predicament."

After three weeks and massive amounts of antibiotics to combat Alvaro’s lung infection, the doctors started to feel not only that their patient was back in the game, he might actually be winning it. First the fever broke. Then Alvaro’s breathing improved, so they began cutting back the morphine that was keeping him sedated.

One day, during the third week of March, Mrs. Llanos was sure he was trying to communicate with her. "Babito," she whispered, "I know you can hear me. If you can, give me a sign."

Mrs. Llanos swore he blinked.

Privately, the staff chalked it up to the desperate fantasy of a mother. But veteran burn nurse Ann Marie Majestic, 44, began talking to the boy on the off chance that he really had responded.

Majestic was the model burn nurse. She was fiercely protective, even possessive, of Alvaro. One time she yanked the curtain closed around the boy’s bed when a stranger stopped to stare. "This isn’t a circus act," she said with plenty of attitude.

When she was a child growing up in Denville, Majestic had been burned, too. A boiler exploded and scalded her right leg. The scars were still visible. That childhood experience was the main reason she chose burns as a specialty.

Two days after Mrs. Llanos said she saw her son blink, Majestic thought she saw a sign, too.

She was talking to Alvaro as she washed his burns in the tank room. Majestic always talked to her patients.

"You’re in the hospital because there was a fire on campus," the nurse told the boy. "We’re taking care of you. It’s all right, honey. You’re on a machine that is helping you to breathe, and your eyes are stitched to protect them."

Alvaro’s breathing quickened.

"Angie got out of the dorm without injury," Majestic chattered on. "Shawn’s okay and you’re doing better.

"Do you understand what I’m saying, honey?"

Ever so slightly, the boy nodded.

Majestic was taken by surprise. Wow! There’s really someone in there, she thought to herself.

She had watched Alvaro struggle to live for weeks. His damaged lungs were the worst threat to his life, although a host of potentially menacing burn-related infections festered in his system, and his burns bled so badly he needed repeated blood transfusions, sometimes two a day.

When she went home each day, Majestic wondered whether Alvaro Llanos would be there when she came back.

Could he beat the odds and survive his terrible burns?

About the only thing he had going for him was his age. A 30-year-old with the same burns almost certainly would have died. Majestic was never sure that Alvaro would pull through, either.

Now he seemed about to wake up. How about that? She couldn’t wait for the day he could look at her, talk to her.

"You’re getting better, Al," Majestic said, misting up. "You’re getting better, honey."

Downstairs, Alvaro’s Seton Hall roommate was finishing his last session with physical therapist Roy Bond.

Shawn had been coming to Saint Barnabas as an outpatient for nearly a month. Now he could climb four flights of stairs or pedal a stationary exercise bicycle for 20 minutes straight without becoming fatigued.

He would have to return to Saint Barnabas every day for occupational therapy to relearn how to use his hands. The pins put in four of Shawn’s fingers to keep them from disintegrating had been removed. But his skin-grafted hands were stiff and fragile, and he had a long way to go before he could perform routine tasks. And even worse, now he had to wear gloves — they put pressure on the skin to keep scar tissue from rising.

When Shawn was first brought into Saint Barnabas after the fire, his mouth and nose were packed with soot — clues that he had inhaled toxic levels of smoke from the fire. Time would tell whether his lungs would ever return to a healthy pink.

Shawn still tired easily, and now it would be up to him to regain his strength. He could no longer rely on Bond, the physical therapist who had always pushed him to "try a little harder" or "do just one more."

Shawn had sometimes been contrary and complaining, but he had never said no to his physical therapist.

Bond was a bear of a man: barrel-chested, and with hands that looked as if they could uproot an oak tree. He started his career at Saint Barnabas 27 years ago in the hospital’s linen department, then studied at night to get his degree in physical therapy and quickly became one of the most respected physical therapists in the profession.

Bond could get patients to do anything with his smooth, persuasive voice and colossal grin. He had a reputation for cracking the toughest burn cases. Even the most depressed patients worked for Bond. He became attached to his patients, and they to him.

Shawn was no exception.

The two hugged before Shawn turned to leave the physical therapy gym on his last day there.

"Turn out the lights, the party’s over," the therapist said with a hint of sadness. "What’s that song they used to sing? ‘It’s so hard to say goodbye’?"

Shawn was melancholy as he left Bond behind and headed upstairs to the burn unit to look in on Alvaro. He felt so conflicted. Here he was celebrating another milestone in his recovery. It was Friday and he had weekend plans with his girlfriend, Tiha Holmes. He should be happy. But all he could think about was Alvaro. When would his roommate start getting better?

Burn therapist Melissa Kapner greeted Shawn when he got to Alvaro’s room. She was grinning excitedly.

"Hurry and come inside! Come in and talk because he can hear you!"

Shawn couldn’t pull on the required gown and gloves fast enough.

"Al! Wussup? It’s Shawn," he said as he hurried toward his friend’s bed. Alvaro blinked slowly and unmistakably.

"It’s okay," Shawn continued breathlessly, not sure what to say next. "I’m okay. ... I’m going to get Mets tickets so we can see a game. ... Al ... you’re going to be okay. ... You’ve been through a lot. ... But I’m going to be right here for you. I’m going to be right here." Alvaro blinked harder. Shawn cried.

"He hears me," he said, wiping away the tears with the back of his gloved hand. "That’s why he’s trying to blink — to let me know he hears me."

Alvaro felt so confused. He couldn’t really see Shawn, and blinking took all the concentration and strength he could muster. He knew he was burned in his dormitory, and he knew he was in the hospital. He was relieved to hear his roommate’s voice.

Two months had passed since that frigid Wednesday in January, when he and Shawn were awakened in the middle of the night by the sound of the fire alarm, and crawled out of their room into the dark, smoky third-floor hallway in Boland Hall. Alvaro thought it was the next day.

Over that weekend, Alvaro continued to show small signs that he was coming back. They were signs that might have seemed inconsequential to anyone outside the burn unit, but inside the unit the blink of an eye, the wiggle of a finger or toe were momentous.

"He’s waking up!" Mansour said excitedly when he looked in on Alvaro on Monday morning. "I can’t wait to meet him."

It was the first day of spring, and Bond was excited, too. He could hardly wait to get started with Alvaro. The way this boy already had beaten such extraordinary odds told Bond that he was a real fighter.

But there was something else — something inscrutable — that told him this was an extraordinary young man.

"Al! How you doing?" Bond said as he walked into Room 4 to the sight of Alvaro, flat on his back, eyes sewn shut, gauze wrapping all but his feet and a patch of his face.

Without a second’s hesitation, Alvaro lifted both arms high off the bed. It was as if he knew this was the man who was going to lead him back to his life and he wanted Bond to know he was ready to get started.

Bond flashed that colossal smile. He was astonished, and not a little awed.

"Welcome back, buddy."