http://www.spiegel.de/international/spiegel/0,1518,443754,00.html
October 23, 2006
THE POLYTRAUMA OF WAR
Severity of Injuries Requires New Forms of Rehabilitation
By Jörg Blech
Never before have so many US soldiers survived such terrible injuries as
during the current conflicts in Iraq and Afghanistan. Many have suffered
multiple injuries, including brain damage. In special rehabilitation
centers, caretakers are battling to restore the lives of severely
injured GIs.
One sunny morning, not far from the Afghan city of Jalalabad, a United
States military Humvee explodes. The driver and the gunner die
instantly. The athletic man in the passenger seat is Sergeant Tim Wicks.
He's 39 years old, from Bismarck, North Dakota. He has a German wife and
two teenage sons, and he's been on active duty in Afghanistan for three
months.
Wicks is catapulted back and forth inside the vehicle. Then he's hurled
through the window. His spleen bursts, his left lung collapses and one
of his kidneys is torn open. The fillings fall out of his teeth, his
hipbones are shattered and his shins break.
He also suffers a concussion between the moment of the explosion and
that of his body's impact. Billions of axons -- the fibrous projections
that link nerve cells together -- are torn apart inside him. Then
everything goes black. Wicks only wakes up from his coma 16 days later.
He looks around, dumbfounded. He's lying in a hospital bed in the Walter
Reed Army Medical Center in Washington, DC. He can't remember the
explosion.
The novelty of the military operations in Afghanistan and Iraq is that
more and more soldiers like Hicks are now surviving their injuries. The
survival rate for US soldiers was never as high in any previous military
operation. The reasons include the new state-of-the-art, bullet-proof
vests that soldiers are equipped with and the fact that mobile army
field hospitals are equipped with the best technology available. As of
early October 2006, the number of American soldiers killed in Iraq and
Afghanistan was 3,094; the number of injured soldiers was 21,649. That's
seven injured soldiers for every dead one. During the Vietnam War, the
ratio was only two or three to one.
But there is a high price to pay for this achievement. A disturbingly
high number of young US citizens are returning from Afghanistan and Iraq
with serious cases of brain damage. Most of them were injured by mortar,
grenades or other explosives. Bullet-proof vests may protect the heart,
but not even Kevlar helmets can offer complete protection for the head.
Shrapnel can make its way into the brain via the face, the forehead or
the nape of the neck. The blast wave moves through the skull like a
thunderstorm, and the brain is rocked back and forth inside the cranium.
Arteries are torn open, and brain tissue swells dangerously.
That's what happened to Wicks. When he was still in Afghanistan, US Army
surgeons drilled a hole into his skull in order to relieve the pressure
that had built up inside his cranium. It was only then that he was flown
to Washington, DC, via Kuwait and Germany.
When Wicks woke up in Washington, the right side of his body was
paralyzed. But he was able to recognize his wife -- she had waited by
his bed for days. He asked her about the "two boys" quietly, but
couldn't believe that the 17 and 18-year-olds in the photograph by his
bedside were his sons. He was also convinced that he still lived in
Germany -- where he had in fact once been stationed. According to the
calendar, it was June 21, 2006, but Wicks thought he had woken up in the
1980s.
The $35 billion hidden cost of war
More than 3,000 American soldiers have suffered brain damage in
Afghanistan and Iraq. In half of these cases, the trauma will lastingly
affect their capacity to think, their memory, their mood, their behavior
and their ability to work. Many of the victims are hardly adults, barely
even 20. And many of them will require special treatment for the next
five, six or seven decades. A joint study conducted by Harvard and
Columbia unversities estimated that the cost of caring for them will be
at least $35 billion.
Many of the soldiers affected haven't just suffered brain damage.
They've also been mutilated so badly or have have suffered so many
severe burns that the term "polytrauma" has become a common one for
military doctors.
The number of soldiers with these types of mulitple injuries is so high
that US government had to create four so-called "polytrauma
rehabilitation centers" last year -- in Palo Alto, California; Tampa,
Florida; Richmond, Virgina; and Minneapolis, Minnesota. There, the
"latest generation of America's heroes" -- as the injured soldiers are
called in a statement issued to their relatives -- is shielded from the
public.
Wicks was transfered to the polytrauma rehabilitation center in
Minneapolis, Minnesota at the end of July. Of the four centers, it's the
one closest to his home in North Dakota. He shows a picture of himself
taken by a fellow soldier a few days before the explosion that changed
his life forever. The man in the picture wears an olive bandana, has a
cigar stub in the corner of his mouth, and is holding an M4
semi-automatic firearm. He looks self-confident. His wife loves the
picture -- she says it captures perfectly what he used to be like.
Wicks grew up in the sparsely populated state of North Dakota and signed
up for military service as a high school student. He needed permission
from his parents, as he was only 17 at the time. Not much later, he was
stationed in Erlangen, Germany, where he met a young German woman at a
nightclub. Tim and Angie married four days after she turned 18, had two
sons and in 1993 moved back to North Dakota. There, Wicks became a
member of the National Guard, although he was also a reservist for the
US Army. Early in 2006, he was sent to Afghanistan.
Now Wicks is confined to a wheelchair -- he has to avoid straining his
left hip for the time being. His bleeding spleen was removed. His
slashed kidney is back in working order, thanks to dialysis treatment.
The doctors removed a loose bone splinter from his legs. They drilled
metal screws into his hip, drove nails into his knee and fixed his
shinbones in place with titanium rods.
The T-shirt Wicks is wearing hangs loosely around his shoulders. He's
lost 30 kilograms (66 pounds). His voice sounds hoarse -- he kept
removing the tube inserted into his neck to help him breathe, and when
the doctors urged him not to, he forgot what they had told him within a
few minutes. He had temporarily lost his short-term memory.
A NEW KIND OF PATIENT
Every patient who comes through the doors of the polytrauma
rehabilitation center in Minneapolis suffers from a specific combination
of different injuries, explains Larisa Kusar, one of the doctors working
there. "For about three years now, we've been seeing a new kind of
patient," she says. "Many of them would have died in Vietnam." It's not
unusual for 12 specialists to deal with a single case.
Kusar hesitantly presents a CT scan showing the skull of a soldier
injured in Iraq. A piece of shrapnel from an exploding grenade shot
through his right eye and buried itself deep inside his brain. The piece
of shrapnel has a diameter of five millimeters (0.2 inches). In the
image, it gleams like a bright particle inside the dark tissue
surrounding it. But there's something else that isn't normal: A full
third of the skullcap is missing.
A soldiers' sacrifices
The doctors sawed it off on purpose. Thanks to this so-called
"decompressive craniectomy," the injured brain tissue was able to swell,
Kusar explains. Later on the hole in the cranium will be sealed with a
steel plate.
The doctor proceeds to the next patient, speaking quietly. He's about 20
years old and tried to defuse a bomb built by an insurgent in Iraq. The
attempt went badly wrong. The young soldier lost both arms and his
sight. The blast wave that moved through his skull reduced his mental
capacity to that of a small child.
"We know what sacrifices these soldiers have made," Kusnar says. "Now
we're concentrating on improving their lives -- on making sure they can
make the greatest possible use of the abilities they have retained."
The doctors in Minneapolis have at least been able to treat the
patient's brain to the point where he has been able to return home. He
lives in a suburb of Minneapolis with his wife and two small children
and is currently undergoing rehabilitation training for the blind.
Compared to the young soldier, Tim Wicks is making great progress.
Orthopaedists are currently restoring mobility to his legs by means of
titanium and bone cement. Making his mind agile again is a task reserved
for occupational and speech therapists. Day after day, they present him
with increasingly difficult problems to solve.
At first, the therapists asked him to tell them what day and what year
it was and where he was every couple of minutes. For a time, Wicks had
to think hard before answering, but at one point he replied: "Hey,
didn't I just tell that to your colleague?" His short term memory was
slowly returning.
In the polytrauma unit's handicraft room Wicks has already disassembled
and reassembled a gasoline-powered lawn mower three times. He puts the
components that are left over in a plastic bag -- each time there are
less of them. His memories of what happened to him since the 1980s have
also been returning -- in chronological order. Wicks now seems perfectly
normal in conversation, apart from the odd absent-mindedness that
sometimes overcomes him. "Learning new things takes a little longer than
it used to," he explains.
The story of Wicks's recovery is reassuring to the 38 employees at the
polytrauma unit. Their efforts have clearly produced remarkable results:
The severed links between nerve cells have reconstituted themselves. The
paralysis of the right side of his body has all but disappeared.
Not even the doctors know exactly what goes on with nerve cells during
such a recovery. But speech therapist Jack Avery suspects that "patients
use their brains in a different way than before."
Two weeks ago -- just over four months after the explosion in
Afghanistan -- Wicks was using his restored brainpower to start making
grand life plans. He wants to return to his sons and buy or build a
bigger house. He wants to pass a fitness test for injured soldiers so
that he can re-join the National Guard.
Wicks has to perform another five years of service -- only then will he
be entitled to a full pension.
/end
--
Fundies and trolls are cordially invited to
shove a wooden cross up their arses and rotate
at a high rate of speed. I trust you'll
be 'blessed' with a plethora of splinters.
.
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