After the Fire

Alvaro Llanos' first words came fast and frantically. "Hello, hello, hello." Maybe he thought he'd never get the chance to talk again. Maybe it was his desperate need to let someone know he could hear them — and that he understood.

"Okay Alvaro, come on now, can you say something to us?" Saint Barnabas burn surgeon Michael Marano had asked seconds earlier.

Marano had removed the breathing tube from Alvaro's trachea for a few seconds, allowing him to speak for the first time since he had arrived at Saint Barnabas Medical Center in Livingston.

It was Wednesday morning, the 5th of April. Seventy-seven days after the Seton Hall University dormitory fire that left three students dead and 58 injured. Among the critically injured were Alvaro and his roommate, Shawn Simons, both 18.

The doctors had been slowly reducing the heavy dosages of narcotics that had kept Alvaro unconscious since the fire, and for the past 10 days there were small signs he was beginning to awaken. On command, he could blink, wiggle a finger, even raise an arm slightly.

When he first heard his girlfriend, Angie Gutierrez, in the room, he lifted both arms and both legs off the bed. Tears flowed from the corners of his sutured eyes.

"It's been so long since I've been able to talk to you, and I have so many stories to tell you," Angie told him.

At the same time they were reducing Alvaro's medication, Hani Mansour, the director of the burn unit, along with Marano, and their colleague Sylvia Petrone, decided to wean him from the respirator. He was almost ready to breathe on his own.

"Hello, hello, hello." His first words, though fleeting, meant so much. The doctors knew the boy had fight. He had survived merciless odds, but his eagerness to communicate also told them he yearned to return to life.

"This is a milestone, but now we are hitting the emotional part. It's like he's in a cage and the cage is his own body. He's scared and intimidated," Mansour said.

"It's a very, very dangerous period of time for him over the next week," Petrone said. "We've had patients die after coming all this way, more than I'd like to think about."

From what the burn staff had learned about Alvaro from his family during the 11 weeks he was asleep, few on the burn staff questioned his will to live.

"This is not a child who gives up," said Susan Fischer, the burn unit social worker, just before Alvaro began to awaken at the end of March. "He's still here, so he has great inner strength. And he has not a clue of what is ahead of him — and that is in his favor.

"When he wakes up he will be weak, compliant, anxious to do what people tell him to do," Fischer predicted.

Indeed, once Alvaro started speaking over the next few days, the burn team couldn't get him to stop. The day after he muttered his first hello, the doctors gave him a smaller breathing tube, allowing air to flow through his vocal cords and letting him speak at will. Within a week it was removed altogether.

Alvaro's voice was fragile and his speech was stilted, almost robotic. His throat was swollen and irritated from having a tube in it for almost three months.

Still, Alvaro spoke to everyone who walked into his room.

"It feels good to talk," he said to Roy Bond, his physical therapist, on the first Thursday in April.

And talk he did.

"Please wipe my eyes," he asked one of the nurses.

"The TV, please," he implored another.

"Cream for my lips," he beseeched nurse Andy Horvath.

Shawn arrived at Alvaro's room for his regular noon visit after his therapy, not knowing his roommate was talking. "Al, how you doin'?" he asked, as he did every day.

"Chillin'," Alvaro replied. Shawn was stunned.

The burn staff was eager for Alvaro's parents to arrive. Daisy and Alvaro Llanos knew their son was waking up — they had seen him raise his arms and blink in response to their entreaties. But they thought it would be days before he could actually speak to them.

Visiting hours began at 12:30 p.m. At 12:35 the Llanoses walked through the double doors to the burn unit.

Shawn and burn therapist Melissa Kapner could hardly wait for Alvaro's parents to get to their son's room.

Alvaro, still wrapped like a mummy with only his face and toes exposed, was out of his bed for the first time, seated in a chair. He could see only shadows through the slits in his stitched eyelids.

Kapner leaned over and whispered something to the frail boy. He nodded slightly. Unsuspecting, Mr. and Mrs. Llanos entered the room.

"Hi, Mommy. Hi, Poppy."

Mr. Llanos dropped the cane he had used since his 1997 stroke and fell to his knees. "My son!" he cried. "Oh! My son."

Mrs. Llanos looked dazed. Then she smiled for the first time in weeks. "He is better," she said softly. "He is really better." Later she said that at that moment she felt the deepest happiness she had ever known.

Shawn, his arms crossed, leaning casually against the doorway, watched the scene unfold, then breathed a huge sigh of relief. "This is a big breakthrough for Al," he said.

"He's on the way back."

The burn surgeons always said that once their patients woke up, they made progress swiftly.

By Friday, Alvaro was begging for water. All burn patients do when they first awaken. It was April 7, and not a drop of water had passed Alvaro's parched, burned lips since mid-January. "Water!" he cried, like a man wandering in the desert. "I want water."

He wasn't allowed to have it. A cardinal rule in the burn intensive care unit was that patients were allowed only sustenance packed with calories. Up to 5,000 calories a day was crucial for recovery. Water filled them up so that they didn't want the milkshake or ice cream that would hasten their healing.

And because water was forbidden, burn patients wanted it even more.

"I've seen patients pull their IV down to get water," nurse Laura Thompson said. "I've seen them under the sink trying to lick it off the pipes. I've seen them trying to drink water from the hoses in the tank room."

Instead, Thompson fed Alvaro melting strawberry ice cream — though he let her know he wasn't a big fan of ice cream.

He also asked questions about his medical condition, and told what he remembered about the fire.

"Is my face burned?" Alvaro asked his mother that day.

Mrs. Llanos hedged, afraid to tell Alvaro the truth so soon. "Only your eyelids were burned," she said, "and they will get better."

"What other parts of my body got burned?" the boy asked.

Mrs. Llanos took a deep breath. She rubbed her son's bandaged arm.

"Your arms, your back, your chest and your neck," she said.

"Okay," Alvaro said, then fell silent.

"Don't worry," Mrs. Llanos continued, fearful that her son would want to give up. "Just thank God you are here and alive. We can worry about the burns later on with plastic surgery."

"Do you know how long you have been asleep?" Mrs. Llanos asked Alvaro, changing the subject.

"Yes. Three months. One of the nurses told me."

"What do you remember about the fire?"

"Everything," Alvaro said. "I remember everything."

He remembered walking Angie to her room at 2 a.m. and then e-mailing her good night when he returned to his room. He remembered Shawn waking him at 4:30 a.m. because a fire alarm was ringing. And he remembered following Shawn out into the smoke-filled hallway.

He remembered losing his roommate instantly in the smoke. He was disoriented, and so frightened. I have to get out, he remembered saying to himself. I'm not going to die here.

Alvaro's eyes burned and the heat was so searing he hesitated for a second, not sure whether to turn back. He decided to go ahead and crawl toward the stairs near the lounge. Just as he did, a flash of fire seemed to drop from the ceiling and engulf him.

His back was being incinerated. The clothes were burning off his body. A boy and a girl who were running down the stairs from the floor above beat Alvaro with their sweaters and jackets. The boy screamed at him to "Run! Run!"

Alvaro tumbled frantically down the two flights of stairs to the main floor. Students were everywhere and they were all staring at him in horror. He made it to the main lobby and dropped onto the couch. Everything hurt. He was so cold. He studied his hands, then his arms. Students surrounded him. "Don't worry," they were saying. "Everything will be fine."

Within moments, people Alvaro recognized as Seton Hall nursing students were helping him. One put an oxygen mask over his mouth. Another took off his gold chain. It felt like it had melted into his neck.

Time passed slowly as Alvaro lay there, thanking God that he wasn't hurt badly. At least it didn't seem too bad.

The last thing he remembered was being put on a stretcher and carried toward an ambulance outside. Everyone moved away as he passed by.

Within a week of regaining consciousness, Alvaro was breathing on his own, his feeding tube was removed, and he was learning to take his first steps. His burns were bleeding less, so he no longer required twice-daily blood transfusions. In all, he had 82 units of blood. That's more than 10 gallons. An average man's body holds 11/3 gallons of blood, so all the blood in Alvaro's body was replaced six times.

He remembered only one thing from his long, deep sleep: being taken to the tank room each day to have his burns scraped and scrubbed.

"I hated it when I heard them coming because I knew it meant I was going somewhere where they were going to hurt me.

"I used to think they were rubbing me with something hard, like Brillo pads. It really hurt, and I used to get really mad, but I couldn't say anything because I couldn't talk."

The burn staff was encouraged by Alvaro's spirit.

When Libby Davis, a burn technician, challenged him to remember her name, Alvaro didn't miss a beat. "Superwoman," he cracked.

Alvaro was an inspiration, physical therapist Bond told the Llanoses during a burn team meeting with his parents in the second week of April.

"He's made a lot of progress already," Bond said. "He took 10 steps this morning."

"His attitude is incredible," added Kapner, Alvaro's occupational therapist.

"This morning I came in right after Roy was working with him, so I told him I'd give him a little bit of a rest and come back. He said: ‘No, please stay. I want more therapy.' "

That was the boy the Llanoses knew: Strong. Motivated. He wasn't a quitter.

They were so proud of Alvaro. But would he ever be the boy he was before the fire?

"He will have disfigurement, but the worst burns are on his chest, abdomen and back," said burn surgeon Marano.

"Does he have brain damage?"

The team laughed.

"Have you heard him talk?" Bond asked the couple. The Llanoses enjoyed a rare chuckle.

"What about his ears?" Mr. Llanos asked.

Trying to reassure Alvaro's father, Marano answered:

"Most of his ears are there."

In the book "Harry Potter and the Sorcerer's Stone," there is a mirror as high as the ceiling. It is called The Mirror of Erised: "a magnificent mirror ... with an ornate gold frame, standing on two clawed feet."

An inscription carved around the top of the mirror reads, Erised stra ehru oyt ube cafru oyt on wohsi. Read backward, it says, "I show not your face but your heart's desire."

While Alvaro was still unconscious, Denise Pinney, a publicist at Saint Barnabas who spends much of her time in the burn unit, dreamed about the Mirror of Erised, or Desire.

"In my dream," Pinney said, "Al stood before the mirror and he was whole again."

If only Alvaro could have seen himself that way.

Instead, he saw himself for the first time in an ordinary hand-held mirror. The decision — that it was time for Alvaro to face himself — was made the morning of Tuesday, April 19.

Catherine Ruiz, the kind but no-nonsense head of occupational therapy, had learned that Daisy Llanos had told her son his face had been spared. Good intention. Bad mistake. The most important rule in the burn unit was never lie to the patient.

Ruiz was incensed that Alvaro had been awake for nearly two weeks and still hadn't seen his face. She summoned therapist Kapner into her tiny office and shut the door.

Ruiz, a 14-year veteran of her profession, knew how critical it was for burn patients to see their injuries. And the sooner, the better.

She also knew the most seasoned members of the burn team squirmed when it came time for the mirror to come out.

Kapner was relatively new to the team. This would be her first time and the anticipation made her feel sick.

Alvaro already knew the truth, Ruiz was sure. She also was convinced that, alone in his room, he was torturing himself with anxiety. Maybe the anticipation of seeing himself was what was making Alvaro nauseous lately.

"He needs to see his face," Ruiz told Kapner.

"This needs to happen now. Today."

Kapner headed up to the second-floor burn unit. Alvaro was in a chair when she got to his room. She sat on his bed and leaned in close.

"It's time for you to see yourself," she said gently.

"I don't know," he said, his eyes widening in fear. "I'm scared."

Kapner wished she could be anywhere but there. "You have to do this, Al. We're going to bring in a mirror so that you can see. We're all friends here. You can scream. You can cry. You can yell — do whatever you want. We'll be here for you."

Tears streamed down Alvaro's cheeks.

Just the night before he had lain awake fretting about how the kids at Seton Hall would stare at him. A couple of days earlier the stitches were removed from his eyes and he had seen his hands for the first time. He broke down and cried. They didn't look anything like his hands.

Susan Fischer, the burn unit social worker, was dispatched to fetch the mirror, locked in a drawer near the nurses' station.

Shawn, who was in therapy downstairs and had heard what was about to happen, arrived in Alvaro's room at the same moment the mirror did.

He and Kapner stood on either side of Alvaro. Ruiz watched from the doorway with Fischer.

Kapner placed the mirror on Alvaro's lap, but he couldn't look at it.

"Al, pick up the mirror," she prodded. "You have to pick it up and look at yourself."

Shawn rubbed Alvaro's left hand. With his right hand trembling violently, Alvaro reached for the mirror and slowly drew it up to his face. He studied his eyes, his cheeks, his chin, saying nothing.

"What's that?" he asked, pointing to darker skin below his mouth.

"Your chin has been grafted, but your cheeks were not," Kapner told him. "You still have beautiful eyes, and a beautiful mouth."

Alvaro stared at his image in the mirror. He was frightened by what he saw. Kapner groped for words. "Shawn is going through the same thing," she said, then urged, "Al ... Al ... Look at his face. Look at Shawn's face, Al."

Shawn removed the surgical mask he was required to wear in the ICU, revealing for the first time to his friend his own burned face.

"See, Al?" Shawn pleaded. "It's my face, too. I look like you. We're going to get through this together."

Alvaro studied Shawn, then glanced back in the mirror one last time. The face looking back didn't look like him. It was unfamiliar and scary.

"Okay," Alvaro said, resignation in his voice. He put the mirror down in his lap.

There is no way to hide a burned face, or burned hands.

Two days after Alvaro saw himself in the mirror, Shawn asked Ruiz if patients ever wore gloves after their burns had healed.

He thought he would.

Shawn's hands — burned so deeply that initially the doctors were afraid he would lose fingers — were grafted with skin from his shins a week after the fire. But three months into the healing process, they looked like melted wax.

Shawn was embarrassed by them. What was worse was no one could reassure him that his hands would ever look normal again.

Scarring from burns is unpredictable. With all their years of experience, Mansour and his staff can never say precisely how their patients will scar. Genetics plays a role. Very light-skinned people, blue-eyed blonds, generally scar less than patients with darker skin. Browner pigments scar more thickly. No one knows why.

The scarring process goes on for one to two years, so it is not uncommon for burn patients to look worse later on than they did when they left the burn unit.

Shawn studied his image in the bathroom mirror every morning. He looked at his forehead and questioned whether he had made the right decision by refusing Mansour's suggestion of another skin graft. He also wondered whether the rich brown color would ever return to his pink, mottled cheeks.

Shawn rarely wore the clear plastic mask prescribed for him, even though the doctors and therapists told him that it could significantly reduce his facial disfigurement by stretching the skin and compressing the scars.

The scarring process was aggressive and constant — 24 hours a day. Pressure garments acted in place of natural skin, replacing the pressure that normal skin provided. This decreased blood supply to the area, hastening scar maturation and flattening the scarring.

"The more hours you are out of the mask, the scar will grow thick and bumpy and can distort your features," Ruiz told Shawn. "Do you understand?" The mask was tight, hot and scary. It reminded Shawn of the Michael Myers character in the "Halloween" horror movies. He would deal with some disfigurement and skin discoloration, he decided, rather than wear it 12 hours a day.

What Shawn couldn't deal with were his hands.

He rarely removed his black, tightfitting Jobst gloves, also prescribed to compress his scarring. When he occasionally misplaced one, he became agitated and shoved his hands into his pockets. He knew the gloves were temporary. They stopped working once the scarring process was finished. What then?

"I know my mother and a lot of my women friends have always said they always look at a man's hands first, and I always kept my hands nice," Shawn said.

"Catherine (Ruiz) says she knows people who continue wearing the gloves after the healing process is done. I'm thinking about doing that, or maybe I'll have some nice custom leather gloves made. I guess I hope I don't always feel like I have to hide them."

At least his girlfriend, Tiha Holmes, was not bothered by his burns. Tiha, a junior at University High School in Newark, met Shawn in music class in 1997. The two became fast friends and started dating a year later. After Shawn was home, Tiha told friends that, honestly, she didn't see his burns and that their relationship was stronger than ever.

"You know what I love about Tiha?" Shawn would ask. "She doesn't care about my burns at all. She wants to work on my hands. She puts lotion on them. She asks lot of questions. ‘What hurts?' and ‘What will change?' Tiha's the person I feel most comfortable with besides my mother. I could never, ever see her leaving me because of my burns.

"I'm more concerned about strangers' reactions than hers."

With her son on the mend, Christine Simons had time to think about what had happened to him.

She was angry at Seton Hall for what she saw as the university's indifference to her son and his roommate.

Mrs. Simons scanned newspaper stories quoting Seton Hall's president, Monsignor Robert Sheeran, talking about the fire. He would invoke the names of the students who had died in the fire, but never Shawn or Alvaro. Asked later, Sheeran would say he didn't mention them to protect their privacy.

To make matters worse, when she went to Seton Hall to see about her son's belongings, Sheeran told her he kept the telephone numbers of the families of the deceased in his wallet. Earlier, a priest had run into Shawn in Alvaro's room at Saint Barnabas. The priest told Shawn he was sorry he hadn't inquired about him after he was released from the hospital. "We seem to have lost track of you," the priest told him.

Mrs. Simons was devoted to Shawn. It hurt her when someone hurt him. So she sent a letter to President Clinton.

"My son was critically injured in the dormitory fire at Seton Hall University on Jan. 19," Mrs. Simons wrote. "His hands have been grafted and he has had to learn to use them all over again. The scars on his face will be there for the rest of his life. ... I've had to take an unpaid leave from my job to take care of my son. He still needs physical therapy every day. I don't know if we'll be able to eat tomorrow, or pay the rent next month. ... The victims of the Seton Hall fire seem to have been forgotten. The staff at Seton Hall is pretending we don't exist. No one from State Government has asked if we need assistance. Our Governor doesn't even inquire about the health of the injured children. ... I am a citizen of the United States. I voted to help put you in office. Yet I don't even know if you are aware of what we're going through."

Her letter was never answered.

With all that his son had been through — the fire, the grueling recovery, his changed looks — Ken Simons wondered why Shawn wasn't angry.

Ruiz suspected Shawn was, but she saw him express it in indirect ways. Shawn had come a long way in the weeks since he had left Saint Barnabas, and was making significant gains in his daily 90-minute outpatient sessions with Ruiz. The third-degree burns caused a loss of sensation in Shawn's hands, but the exercises with Ruiz had begun to give him back some flexibility and strength.

By the end of April, Shawn could dress himself, except for buttons. He finally was able to bathe himself, wash his own hair and brush his own teeth. He could pull on his gloves and turn a doorknob with one hand. Chronic pain in his joints and from his scars sometimes caused Shawn to wince when Ruiz bent and stretched his hands.

The corners of Shawn's mouth were so tight from scarring he could open it only half as wide as before he was burned. Even laughing was hard.

Shawn wanted more than anything else to drive again, but that was still weeks away. Ruiz anticipated that Shawn eventually could regain 90 percent of the dexterity in his hands — but there was no guarantee, even with additional surgery or skin grafts, which he resisted.

"He'll kick and bite and scream, but he'll get better anyway," the therapist predicted.

"For an 18-year-old he has the capacity to handle so much. He has such inner strength. He has a level of faith that most people don't. A lot of this comes from his mother and he's extremely lucky to have her."

Shawn's obstinacy, Ruiz suspected, was a disguise for his anger. "Not the seething anger we see in some burn patients," she said. "But it's there — where he comes across as dawdling in therapy, joking all the time, being stubborn — that's how it's manifesting itself, I think. To me, it's healthy."

There was another way Shawn expressed his anger, though, that troubled Ruiz and others on his medical team. He frequently made cracks about the "settlement" he thought he would eventually get. Both the Simonses and Llanoses had hired personal injury lawyers and intended to file lawsuits.

When he was a millionaire, he would say, everything would be better. He would buy a big new house in Livingston, a Mercedes-Benz, and enough expensive designer clothes that he would never have to wear the same outfit twice. Ruiz hoped Shawn understood that even millions wouldn't make up for all that he and Alvaro had lost.

His resentment was predictable, though — and it was part of the process. "The way people deal with burns is the same as the grieving process," Ruiz said. "You're grieving the body image you had prior to the burn. Burn patients mourn their looks years later. Anger, denial, sadness, acceptance. That's what I expect burn patients to go through. Right now I see all four of them in Shawn. I see him angry, but I also see him planning ahead, and that is acceptance."

Alvaro Llanos had his eye on the future, too.

He knew his recovery would take at least a year, and probably much longer. He was burned at 18. He would be in his early 20s before he didn't have to deal with the consequences of that event every single day. Reconstructive surgeries to improve the appearance of his neck and his torso could go on for years.

Alvaro was anxious to get on with it.

His daily routine at Saint Barnabas was heavy. Physical therapy to restore his agility and build his strength and endurance. Occupational therapy to relearn the basics: walking, writing, feeding himself.

The goal was to get him well enough for the next stage of his convalescence: the inpatient program at Kessler Institute for Rehabilitation in West Orange, where the actor Christopher Reeve had recuperated after his spinal cord injury.

Every step Alvaro took was hailed as a victory. His first 25 steps earned him a standing ovation from the whole burn staff. Pushing a video into the VCR, raising a fork to his mouth, holding a cup of juice were all causes for joy. The most critical aspect of Alvaro's recovery was also the toughest: stretching his burned skin to counteract scarring. That job fell to the mighty Bond. For an hour at a time, the brawny physical therapist bent, pushed and pulled the boy's grafted arms and kneaded the thickening tissue from his chin to his neck. Sometimes, the scarred skin would rip and bleed from the stretching.

The process was torment for burn patients, but it had to be done faithfully. "It's a constant tug of war between you and the scar," the therapist told Alvaro. "You can't say, ‘Okay, I'll do this tomorrow' because the scar will win."

Bond knew that Alvaro and his family were concerned about his appearance. All burn patients and their families were. But the consequences of scarring were more than cosmetic.

Scarring could cause muscles and joints to contract permanently, leading to deformities. If Alvaro wasn't stretched regularly during the months-long scarring process, he would wind up unable to raise his arms more than 90 degrees or turn his head from side to side. He wouldn't be able to reach high enough to open a kitchen cabinet, drive his jazzy blue Mazda or hug his girlfriend tight.

So Bond stretched until Alvaro wept. "Give me more," Alvaro would say as tears streamed down his cheeks. "Go on. Keep stretching. I want to get out of here and go home."

For a boy whose future seemed so far off, Alvaro was making big plans. "I see myself finishing school, finding a nice job, buying a house — I want to buy a house for my parents, too," he said one day.

"I want to get married and have two kids, a boy and a girl. A house somewhere nice and quiet, not Paterson. A job where every day I love to go to work, not a job that I work at every day and hate it. Marriage, to a person like Angie. A person who is independent and works hard, just like me."

Alvaro turned 19 in the Saint Barnabas burn unit. It was not altogether a happy birthday.

The day — Wednesday, May 10 — started out well. Occupational therapists Kapner and Jennifer D'Aloia planned the celebration: a combination therapy session and birthday party. Shawn would be there.

Shawn and Alvaro had grown closer since the fire. Once compatible roommates, they had become faithful friends. Shawn was there for Alvaro for every momentous event. He gave Alvaro pep talks and filled him in on what lay ahead in his burn treatment. Alvaro was happier when Shawn was around, and Shawn was happy to be with him.

A piñata in the shape of a baseball hung from the ceiling in the center of the therapy room. While Shawn led a chorus of "Happy Birthday," Alvaro was handed a baseball bat and told to "have at it."

The party was good therapy. Alvaro, who loved to play baseball, got to swing a bat for the first time since the fire. It felt good. He decided he wanted this to be a day of firsts. "Let's see if I can write," he said.

With the same look of determination he had when he was playing ball for the Kennedy Knights, Alvaro picked up a pen and gripped it in his gloved right hand. The hand shook so violently he had to steady it with his left. Then he began to write, ever so slowly. The printing was shaky, but the message was clear. "Shawn," Alvaro wrote. "You are a good friend."

The roommates' relationship had been based on kidding each other. In college, everything was said in jest. Shawn kidded Alvaro about being a neat freak. Alvaro cracked about the clothes that were strewn all over Shawn's side of the room. Shawn teased Alvaro about being bookish. Alvaro called Shawn a ladies' man.

Shawn never expected such tenderness from his friend.

"Oh my goodness, Alvaro," he said, first laughing, then choking up. "I thought you were going to write something silly!"

The birthday celebration continued when Alvaro went back upstairs to the burn unit, where the nurses had planned a little party of their own. The cake was maple walnut and the gift of a music box was inscribed, "A friend is one who knows you as you are, understands where you've been, accepts who you've become."

Alvaro looked at the box for a long time. He was touched by the nurses' gesture.

Now he couldn't wait for the family party to start. While he was waiting, Jabrill Walker, the 8-year-old burn patient who had become friends with Alvaro, came to visit. Alvaro was like an older brother to him, coaching him on what was to come in his burn treatment. Jabrill idolized Alvaro, following him whenever he could.

Angie arrived first at 5 o'clock. Shawn, who had spent most of the afternoon visiting with the nurses, returned to Alvaro's room. While the three teens talked and laughed, Mrs. Llanos sat alone in a waiting room down the hall. She didn't want to be in the same room with Angie.

"She doesn't love my son," she said. "She didn't get him a birthday present. She didn't even say happy birthday. I used to love her. No more."

The tension between Angie and Alvaro's family had been escalating for weeks — since mid-March when Alvaro was still in a coma and Angie had spent spring break in Puerto Rico with her mother.

Tonight it would boil over.

The family birthday party began in earnest at 7:30. Alvaro's family arrived in bunches. Aunts, uncles, cousins, friends — 45 people crowded into the hospital room. Contemporary Latin music played. A giant buttercream sheet cake waited to be cut. Everyone took turns having their picture taken with the birthday boy.

Angie, crowded out and ignored, watched TV in a corner.

When the party spilled over into the larger waiting room, Angie followed, then stood by herself away from the crowd. She was thinking about last year when she planned Alvaro's party at his parents' house and even brought the cake.

Suddenly, Angie felt tears coming on. She was determined not to let Alvaro's family see her cry.

As the candles on the cake were about to be lighted, Angie made her way through the crowd to Alvaro, who was sitting in a wheelchair. She leaned close so no one but he could hear. "I love you. I really love you," she said.

Alvaro couldn't look at her. "I know you're leaving," he said. Angie told him she felt too uncomfortable to stay. "Your family doesn't want me here. You see, right?"

Alvaro wouldn't take sides.

"I want you here, but I know you have to leave." Angie kissed him on the cheek, then fled to the elevator. When the doors closed, she sobbed.

Moments later, after the candles had been blown out and the cake had been cut, Alvaro cried, too. He had wanted to spend his birthday with Angie more than anyone else. Now she was gone.

Alvaro wondered if she would ever come back.