Who Killed John McCloskey?

A time would come when the investigation into John McCloskey's injuries would consume his family's full attention. But not yet. At the moment, John was still with them, debilitated though he was.

A month had passed since that Sunday morning, Dec. 18, 1994, when John collapsed from stomach pain at Western State Hospital, where he had been committed for mental illness after his arrest in Rockbridge County.

A month had passed since he was rushed to the University of Virginia Medical Center, where a surgeon, after opening him up, suspected he'd been sodomized.

A month of four surgeries, attempts to repair the torn bowels, ruptured liver and punctured colon, and fight the deadly infection that had invaded his body.

A month in an intensive care unit, tethered to 10 tubes that did his breathing and eating and drinking and defecating, that pumped in gallons of fluids to stabilize his blood pressure and mind-dulling drugs so he wouldn't go crazy from the pain and constant shrilling of the monitors that kept him alive.

Yes, his parents, Pete and Rebecca McCloskey, desperately wanted to know the cause of John's injuries: the who, the how, the why. But they had the effect to cope with first. John was still here, and until the end, here they would remain.

'Comatose' to conscious

Dr. Jack Remson had heard about the patient in the surgical intensive care unit. Young guy, 18, in for several weeks with some serious abdominal injuries. Wasn't supposed to survive the first day. Presumed comatose from the blood loss and brain trauma caused by an infection.

Remson, a rehabilitation physician, regularly checked on the SICU's bedridden patients to see if he could stop the muscle loss and rigid joints that set in from prolonged inactivity. From what he'd heard of John McCloskey -- uncommunicative, eyes open but not moving, arms and fingers stiffening into gnarled stumps -- there wouldn't be much help.

The television was on when Remson entered the room. John lay on his back, arms straight and tensed, fingers splayed, toes pointed down from his contracting calves. He was puffy from the fluids, and his eyes stayed on the TV, not registering Remson's presence.

Still, Remson talked to John as he prodded and flexed John's limbs, starting with his right arm, moving down to the legs. No response.

He poked his way up John's left arm, feeling the fingers, the elbow, the shoulder.

"Do they have that TV on for you," Remson jokingly asked, "or do they have it on for the staff when they're in here working?"

John's eyes cut to Remson's and stayed there.

"Oh, God," Remson whispered, a chill gripping his flesh. "You're in there, aren't you?"

John stared harder, blinked, then flicked back to the TV.

He had been aware for a long time, Remson realized, but no one had known. He'd felt the dressings being changed three times a day, smelled the foulness wafting from his wound, heard all the gasps and whispers of visitors shocked at his condition, who had peered into his wounded belly and recoiled in disgust.

John's mind had been trapped inside a body locked in a rigid paralysis called neuroleptic malignant syndrome, a rare reaction to one of his sedatives, Haldol. As one of his nurses, Beth Turrentine, later explained, "He knew what went on. He just wasn't able to respond to us."

No more, Remson vowed.

He cut Haldol from John's drug therapy and convened the surgeons and therapists to raise the awareness that John was "in there." The tracheotomy that allowed John to breathe wouldn't let him speak. His fingers, now curling into his palms, forbade writing. But he could still communicate if they kept their conversations simple.

One blink, "yes." Two blinks, "no."

They rigged a tube next to his mouth in which he'd blow to change the TV channel and suck to call a nurse.

Therapists put splints on his hands to keep them straight. To loosen the joints, they massaged and bent his fingers and arms for as long as he could bear the pain. He was like a child, forced to relearn the simple tasks -- how to pick up a pencil, how to scratch his nose and comb his hair.

As winter turned to spring, John's health stabilized, then collapsed. The skin around the hole in his stomach became decayed and wouldn't close.

Three times a day, nurses came in to change the bandages packed inside. The blood infection, or sepsis, he'd contracted when bacteria-laden feces escaped through his ruptured colon into his abdominal cavity, routinely manifested itself in fevers of 100-plus degrees and an uncontrollably rapid heart rate. The tears in his intestines wouldn't heal, but oozed fluids that formed adhesions that clung to the stomach wall.

The sepsis almost killed him in February. In March, he slipped into a semi-coma that lasted for weeks. Other infections invaded through the intravenous needle holes and urine catheter.

In May, Dr. Jeffrey Young, the surgeon who had been treating John since his arrival from Western State, again stood over John at the operating table, removing 15 inches of bruised, torn intestine. In June, the month of his 19th birthday, John developed "overwhelming sepsis" and adult respiratory distress syndrome, a severe breathing problem caused by fluid filling his lungs.

"He just developed every complication known to man," SICU nurse Kathryn Staves said.

And still he lived.

After he recovered from each bout of infection and each surgery, his therapy would resume. More agonizing massages. Touch your finger to your nose. Try to sit up in bed. Unclip this clothespin and clip it over here.

His criminal charges of disorderly conduct and indecent exposure had been dropped so that when he got well enough, he could be discharged to a rehabilitation hospital. Western State wasn't equipped to handle his medical needs.

By August, he had stabilized enough to be taken off the ventilator. Physically, he could now speak. His mind was a different matter.

For nine months, he had been silent. For nine months, his family had awaited the moment to hear his voice once again.

"Come on, John. Say hi to your Mom," Rebecca McCloskey would plead again and again at her son's bedside. But John said nothing.

The doctors were encouraging. "Keep trying," they'd tell her. "He should be able to talk now."

She tried. Still, one blink yes, two blinks no.

Lost and Found

Whenever Pete wasn't driving a tractor-trailer, he and Rebecca were with their son. That spring, the couple had moved from Natural Bridge Station to Fishersville, near Waynesboro, to shorten the trip to the Charlottesville hospital. They left his side only when the nurse came to change the dressings packed inside his festering wound. The hole, the exposed bowels -- too difficult to watch.

One day, Pete steeled himself and didn't look away.

"I figured if John can deal with it, I ought to," he said.

Every two to three weeks, they were joined by their children, who would drive down from Carlisle, Pa. Sometimes, John's close friend Steve Oyler came along. A few times, so did John's girlfriend.

"The last time, she was crying," recalled John's older sister, Joanne. "John knew she was there, but couldn't talk because of the trach [tracheotomy]. We didn't hear from her again after this visit."

At the hospital, they would shrug on gowns and masks for fear of further infecting their brother's fragile body. The first few months, as John lingered in semiconsciousness, they would hold his hand and talk as if he heard them. Maybe he did.

Once he was aware and could blink-speak, the family's weekend afternoons would be spent watching what John wanted on TV. "Seinfeld." NASCAR and his favorite driver, Mark Martin. And the Oakland Athletics, where he'd watch his favorite player -- years before the rest of the nation would -- Mark McGwire.

Of course, some days his only visitors were the nurses and doctors and images on TV.

But the day it happened, the family, a couple of cousins and Steve were all there. They stood looking on as Rebecca gripped John's hand and began the now-familiar mantra. Come on, John. Say hi to your Mom. Say hi to your Mom. Come on, John.

Still, nothing.

A few minutes passed, then they turned toward the TV and began chatting to one another. They weren't looking when, like a diver gasping for air, they heard, "Ah, ah, ah . . . Hi, Mom!"

No one recognized the strange voice, but it didn't matter. Tears fell from every face. John's, too.

"Oh my gosh, Johnny, you did it!" Rebecca squealed.

Overjoyed, his family saw these words as steppingstones on John's path home.

Steve saw it differently. When John gasped those two words, his voice was tinny, high-pitched, as if he'd sucked in some helium. The voice Steve heard was emasculated. A child's. Not a man's.

John did cry, Steve remembered, but his tears did not spring from joy. Their source, his friend believed, was shame.

A few weeks later, John's parents asked if he recalled anything about his injuries, whether he'd been hurt during his arrest in Rockbridge County or while in Western State.

"There were four of them" was all he said. Then he began to cry, and his parents didn't pry further.

"Eventually, you come to realize just what you've lost," Dr. Remson would explain years later. "For a while, you're occupied with just trying to get back. But then you realize what you'll never be able to do again."

Somehow, his hospitalization had quelled the manic-depression that had waged war for so long in his brain. Still, John realized he would have a colostomy bag strapped to his hip for the rest of his life. He realized he'd never regain full use of his atrophied hands, and never again tinker with the car engines he loved.

This on top of everything he had missed. He'd sometimes cry when his family talked of their lives outside his hospital room. One weekend, Joanne showed him the new design of her Pennsylvania driver's license. On it, John saw she was no longer Joanne McCloskey, but Joanne Keck. She had married in March.

"I never told him because I didn't want him to get upset or anything, because I didn't know how he would take it," she said. He ignored her the rest of the visit.

Then there were the more mundane joys. The McDonald's hamburger, the chocolate shake, the slice of pizza -- delicacies his battered intestines hadn't let him taste in a year. A tube to the vein supplied his sustenance.

One day a therapist handed him a card and asked him to write something. The word he scrawled was "HOME."

One last chance

Perhaps this is what led him to try the final surgery.

Since he'd begun to speak again, John had been trapped in an agonizing cycle.

On Aug. 30, 1995, after 254 days at UVa, he was discharged to the nearby Blue Ridge Rehabilitation Hospital. There, speech and physical therapists worked with him three hours a day.

Remson and his team first got him to sit up, then to swing his legs off the bed. Eventually, they got him onto a "tilt table" that gradually rose from horizontal to vertical. Because he'd been bedridden for so long, his muscles had atrophied and his bones resembled those of an 80-year-old man.

"He looked like some of these you see on television in them starving countries," Pete said.

As the table rose and the tears of pain started to fall, therapists would support him, making sure one kept a gloved hand over his tightly bandaged stomach wound so his bowels wouldn't spill out.

But in late September, his intestines sprang a leak. Infection struck. His temperature spiked to 104 degrees. His blood pressure plummeted, and his heart raced 160 beats a minute, and he was sent back to UVa. Another operation, another stay on the SICU to recuperate, and back to Blue Ridge. This cycle repeated itself three times that fall and winter.

It became clear to Dr. Young that John couldn't survive much longer like this, tethered to the tubes, fed intravenously, confined mostly to his bed.

In early February 1996, after almost 14 months of hospitalization, Dr. Young offered the McCloskeys an option. One major surgery to remove all the adhesions, cut away all the bruised bowel, and, finally, close the stomach. In the previous operations, Young had tried to do as little invasive work as possible, hoping John's body would take care of the rest. But it didn't. In medical lingo, John had "poor protoplasm." He didn't heal like a normal person. And healing is what he needed most.

The surgery would be risky, Young stressed.

John was for it. In rehab, he'd just stood up for the first time -- a taste of independence. He knew the operation wouldn't make him normal, but it might give him something near a normal life. Food to eat. A walk with friends. Home.

John's fingers wouldn't let him pen his name to the authorization. "You can sign it, Dad."

Pete signed.

"Dad, you think I'm going to die?"

Pete couldn't answer.

"No, John," Rebecca said in her Filipino accent. "That same doctor who operate on you the first time, he's a good doctor. He's not going to let you . . . you know."

For what felt like the thousandth time, Joanne, Julie and Joey found themselves on the road, heading south to the Charlottesville hospital. This time, though, they had hope. In three days time, on Valentine's Day of 1996, John was to have the final surgery, the final push he needed to get back home.

Careful not to disturb his tubes, they squeezed his arm and kissed him goodbye, and promised they'd return the following weekend.

But the next weekend John was too sick for visitors. He hadn't handled the surgery well. In the five-hour operation, Young had removed several feet of damaged intestine. He and a plastic surgeon had tried to find enough healthy stomach lining to close the wound. But there was too little, and by that time John had lost a lot of blood. He was in intensive care again.

The infection flared up the following week. His blood pressure and heart rate plummeted. Friday, Feb. 23, doctors pumped in five gallons of fluid to stabilize him. His body ballooned even more; his eyes swelled shut. His kidneys, heart and lungs started to fail.

Don't come to visit, Pete cautioned his children. "You don't want to see him like this."

That night, Dr. Remson stopped by on his way out of town for the weekend.

"Hey, John, do you know who this is?"

John couldn't see, couldn't speak, because he was on the ventilator again, but he vigorously nodded his head.

Always the cheerleader, Remson said, "Hey, John, we're going to get through this. You're going to be OK." Remson talked enthusiastically of the next round of rehabilitation, knowing there wouldn't be one. Then he got up to leave.

"I'll see you, buddy," he said. "I know this sucks, but you're going to be OK. I'll see you Monday."

Outside, Remson stripped off his gown, found a private place, and cried.

The call

Rebecca was alone when she got the call.

Earlier that Saturday, Feb. 24, she and her husband had been at the hospital, where John now weighed 100 pounds more than when he had first arrived.

Before they left, Rebecca kissed her son's arm and told him she loved him.

Yellow tears trickled from his swelled-shut eyes. He couldn't speak, but Rebecca understood the words he mouthed.

"I love you."

Then Pete caught a truck heading for Nashville, and Rebecca was alone when the phone rang.

"Is Mr. McCloskey there?"

"No, he's working."

"Oh, um, somebody's looking for him," the caller said.

"Why, why you looking for him? He in trouble or something?"

"No, no, no."

"Something wrong with John?"

No reply. Then a familiar voice came on the line -- one of Young's residents.

"Mrs. McCloskey, I'm sorry. We couldn't save John. He's gone."

Rebecca snapped.

"No, no, not my Johnny!" she cried. "He strong! He fight for 14 months! He don't want to die! He told me that. He don't want to die!"

"I'm sorry," the doctor said. "His heart just stopped."

Rebecca called the trucking company. Pete hadn't reached Nashville yet, the dispatcher said. They'd tell him to call when he did. She called each of her children. None was home.

She flitted about the house. What will I do? What will I do? Johnny's dead. Johnny's dead.

The phone rang, Joanne calling her back.

"Mom, what is it?"

"JoJo, my Johnny's gone, my Johnny's gone," Rebecca cried.

"Mom, what are you talking about?"

"Johnny died. The doctor called and said Johnny died."

Joanne broke down in her husband's arms as her mother kept repeating into her ear, "Johnny's gone. Johnny's gone."

The funeral was five days later in Carlisle. The casket was closed. You wouldn't want it open, the funeral home told the family. You wouldn't want to remember him that way.

Each family member had brought a gift to put in the coffin. Joanne, a teddy bear whose fur John had once teasingly threatened to put gum in. Julie, a picture of the two of them taken in a mall photo booth. And Joey, a pendant of the ankh, a cross with a loop at the top, an Egyptian symbol of eternal life.

At the funeral, the three read a poem they'd written. It ended with, "The only comforting thought that comes to mind is that you are no longer in pain and no one can ever hurt you again."

At the graveside, a heavy rain had muddied the ground at the Huntsdale Church of the Brethren cemetery. Steve Young, their old neighbor and a minister, encouraged John's family to live a faithful life so they could see John again in heaven.

A couple of weeks later, the hospital staff held a memorial service -- a rarity in a place so accustomed to dying and death. But this was for John -- a rarity in himself.

"I have had no other patient like him that developed such a long relationship with everybody and then eventually died," Dr. Young explained. John had survived so much, "it was almost like he was going to get over everything."

In memoriam

Pete and Joey didn't flinch as the needle pricked their forearms.

The funeral was several weeks past, and the here-and-now worry of caring for John had transformed into an aching rage.

When the artist finished, Pete's arm bore a black cross with JOHN written on a blue banner. A simpler cross inked Joey's arm, the same design Julie would get on her ankle months later.

Now, John's memory branded their flesh as well as their minds, as their thoughts turned to the past.

The family had been told John was assaulted 48 to 72 hours before arriving at UVa. Seventy-two hours put him in the custody of the Rockbridge County Sheriff's Office. Forty-eight hours put him in Western State Hospital.

Forty-eight hours. Seventy-two. A flicker in most lives. In John's, perhaps everything.