We Sent Them to Brutal Wars: Now, the Untold Story Of What Happens When Soldiers Come Home
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At midnight the drill starts all over again. The choppers, the litters borne through the doors, the doctors huddled over the patients— three Americans this time, their uniforms already cut away, their wounds field dressed, their legs and arms apparently intact. No catastrophic injuries here. Or none that I can see. But that offers no reassurance. An invisible wound is another signature of this war, as it was in Iraq—the traumatic brain injury, or TBI. Current military medical protocol calls for every wounded soldier to be screened for TBI within 72 hours of being injured by a blast or fall or blow to the head, but that means asking the soldier himself what happened.
If he is conscious and can answer, he may not remember, or he may not remember accurately. Or he may “suck it up,” as he has been trained to do, and say nothing. If he is unconscious and intubated during treatment for more urgent and bloody physical wounds, he can’t answer at all. Even the terminology of TBI suggests the complexity of the diagnostic problem: if the wound is invisible, how can you spot it? How can you know how bad it is? And if you can’t ask the soldier, what then? For the soldier badly wounded in an explosion, his brain may become like his damaged penis—the last item on the doctors’ list of priorities. The exigencies of modern life-saving surgery rank legs and arms before genitalia and far ahead of the brain.
In the emergency room, the staff neurologist, an Army major, is talking to one of the newly delivered soldiers who is conscious and seems to mumble in reply. The dustoff medics reported that these three soldiers were in the vicinity of an explosion, and the neurologist believes that a blast affecting the brain must be diagnosed and treated right away. Concussion has been a problem in all modern wars—think of “shell shock” in World War I—and the prescribed treatment has always been the same: rest. But until he talks to the soldiers and observes them, the neurologist doesn’t know whether he is looking at a simple concussion, which the military labels “mTBI” (mild traumatic brain injury), or a far more serious brain injury.
Unlike the Bagram surgeons who read the cause of injury in the wounds themselves, the neurologist wants to know exactly what happened. It’s the history, and not the all-too-common symptoms— headache, nausea, memory loss, and so on—that will tell him whether or not the soldier is a candidate for the little rest home he runs on the base. There, a concussed soldier can sleep and eat well, play diagnostic board games with the doctor’s good-natured assistant, and maybe even get to hang out with Timmy, a golden retriever who exudes an incomparable kind of canine comfort.
I had visited that barracks a few days earlier to talk with three recuperating young soldiers. Two of them told me terrible sad stories of blasts that vaporized friends nearby and then moved on, like a tornado cutting a swathe across a prairie, to level those walking some distance away. The third soldier had been blown out of the passenger seat of an armored personnel carrier when an IED ex ploded beneath the driver. The neurologist said, “Seeing a concussion a day or two after it happens is completely different from seeing it even a couple of weeks later. By then, it’s a different animal.”
Visiting his resting soldiers I can see for myself. Edgy and brittle, they slump in armchairs looking pale and exhausted. They seem startled to have a civilian visitor. They are willing to talk with me, but our conversations take place as if on tiptoe. They are nervous and tentative. The youngest soldier, only 18, who came in just the day before, is still tightly wound in anticipation of the next blast. Timmy, the therapy dog, crosses the room to sit beside him, and the boy reaches out to touch him.