We Sent Them to Brutal Wars: Now, the Untold Story Of What Happens When Soldiers Come Home
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The following is an excerpt from Ann Jones' new book, They Were Soldiers: How the Wounded Return from America's Wars—The Untold Story (Haymarket Books / Dispatch Books, 2013). Jones' new book takes us on a powerful journey from the devastating moment an American soldier is first wounded in rural Afghanistan to his return home for recovery. This excerpt picks up at Ann Jones' visit to Craig Hospital, a Level III Trauma Center at Bagram Airforce Base in Afghanistan. Craig Hospital is often the first serious medical stop on the "medevac pathway" that sends critically wounded soldiers to Landstuhl Regional Medical Center in Germany and the US for further extensive treatment.
At Bagram the three orthopedic surgeons work 14-hour days at a minimum with one night on call, the next night on backup, and the third night, if they’re lucky, asleep. When I talked with them in 2011 they were riding a long wave of wounds, and it was still spring. The winter when fighting falls off was just passing, and in summer they knew everything would be worse.
The catastrophic blasts brought other surgical specialties to Bagram. The explosions seemed to everyone only to get more powerful and the wounds more extensive. Blasts now regularly rose into the perineal area, where the two legs meet, to smash genitals and into the pelvic cavity to pulverize soft tissue and sever intricate bodily systems. In response to a surge of such catastrophic injuries, the army dispatched a urological surgeon from Walter Reed to Bagram in 2010. Six months later, in March 2011, a navy commander stepped into that position. It was his first deployment to a war zone, but after his residency at a level one trauma center and seven years of work as a Naval surgeon at hospitals in the States and Japan, he thought he knew what he was in for. After two months at Bagram, he told me, “Nothing in my experience prepared me for the catastrophic nature of these injuries.”
His first surgical patient, three days after he arrived at Bagram, was a young soldier who had stepped on an IED, triggering an upward blast that destroyed his legs and left his pelvic cavity “hollowed out.” His urinary system was in shreds. His testicles were destroyed. His penis was attached to his body by only “a little thread of skin.” That first surgery, the doctor said, was “emotional” for everyone on the surgical team. “The others hadn’t seen anything like these injuries for a while,” he said, “and I had never seen anything like it. To have to amputate that boy’s penis and watch it go into the surgical waste container—it was emotional.”
In two months at Bagram, the urological surgeon had done 20 similar surgeries, though that was the worst. Injuries confined mainly to the testicles are “easier,” he says, but for the soldiers they are brutally serious. Most soldiers who survive blasts that require high-level amputations of their legs also suffer severe injury to the scrotum and ruptured testicles. Surgeons can debride and clean the scrotum, and in many cases salvage at least part of one testicle and put it back. Keeping even part of his genitals is a psychological break for the soldier, but since the testicles produce testosterone, he still faces the inevitable ill effects of a deficient supply—a long and imperfectly understood list headed by osteoporosis, metabolic syndrome, cardiovascular problems including coronary artery disease and atherosclerosis, erectile dysfunction with its attendant psychological difficulties, low sperm count impairing fertility, obesity, depression, and a lifetime seesaw of hormonal treatment.