The Unknown Soldiers


Gene Bolles has seen more than his fair share of human suffering. Two years in Landstuhl Regional Medical Center – the U.S. military hospital in Germany that receives all injured soldiers evacuated from Iraq and Afghanistan – is no doctor's dream job, especially not if you are a neurosurgeon who specializes in brain and spinal injuries – the kind that can destroy a 19-year-old kid's life. Yet as he speaks of the shattered soldiers who were once his charge, Bolles is neither overwrought nor angry.

The soft-spoken 62-year-old civilian speaks not of politics but of humanity – the terrible toll imposed by all wars, unjust or otherwise, on all involved, soldier or civilian. He speaks not of blame but of compassion and duty – our duty as a nation to pay attention and tend to the young men and women we ask to sacrifice life or limb in battle. At a time when the reality of the suffering in Iraq has been rendered invisible by media hype and partisan battle, Gene Bolles remains a steadfast advocate for the scarred, the maimed, and the tormented – whose numbers are far, far greater than what the Bush administration would like to admit.

So how did you end up working at Landstuhl hospital?

I am a neurosurgeon and have been in the practice for 32 years. I was approached to consider working for the Department of Defense and going to Landstuhl right after 9/11. So I took a leave of absence from my hospital and became the chief of neurosurgery in Germany.

That was right at the time the war in Afghanistan began and carried through Feb. 1, 2004.

Were the 9/11 attacks part of the reason why you agreed to go to Landstuhl?

Sure, in part. I had been in the military years ago, during the Vietnam era. I'd had that experience. So when this came up, I felt honored to have an opportunity to go help out and do what I could.

What kind of cases did you treat in Landstuhl? And these were mostly kids, right?

Well, I call them that since I'm 62 years old. And they were 18, 19, maybe 21. They all seemed very young. Certainly younger than my children.

As a neurosurgeon I mostly dealt with injuries to the brain, the spinal cord, or the spine itself. The injuries were all fairly horrific, anywhere from loss of extremities, multiple extremities, to severe burns. It just goes on, and on, and on. There were just a lot of serious injuries.

As a doctor myself who has seen trauma throughout his career, I've never seen it to this degree. The numbers, the degree of injuries. It really kinda caught me off-guard.

What about the soldiers themselves?

The soldiers, initially because of how they're trained, don't think of themselves. They're thinking of the buddies they've left behind. Almost all of them don't accept the reality of what's happened to them. They're still back in the war zone. And they care about their buddies so much.

And this is what makes the soldiers do what they do so gallantly – this feeling for each other. So when they get injured, they first feel guilty that they're not still back with their buddies. But then as time goes on, they realize that the price they paid for the war and then there is anger. And then there is frustration, then sadness, then depression. They realize they may never walk again or are so disfigured that the rest of their life is going to be very difficult.

But when they're going through this depression, we don't write about them so much. We don't display them. We want to only look at those soldiers who have either recovered from it or those who are acting as though nothing has happened. It's because we want to look at them as heroes. And they are heroes. But it's a reality that is not talked about much.

One of the soldiers interviewed in a recent documentary, titled "The Ground Truth," said that post-traumatic stress disorder is going to be to the Iraq War what Agent Orange was to the Vietnam War. Do you agree?

Yes. I have talked to many people who've been in the war zone. Perhaps I had a unique relationship with these soldiers because I was not an officer but a civilian; I didn't have direct control over them. Many of them felt more comfortable in allowing themselves to talk to me. They would talk about the nervousness they constantly felt, especially after the first part of the war ended and it became more a guerilla war. And they'd get attacked while sitting around waiting for orders to come in or just driving along the road. It started driving them batty. They were afraid and unsettled – it was different from charging ahead.

Many would break down talking about seeing their buddy get hurt or killed. They would even talk about the Iraqi soldiers – how awful it was, all that carnage. One guy hadn't slept for a long time because of nightmares because of what he saw early in the war, when we were killing high numbers of Iraqis. And he saw some of them got run over by tanks. He just couldn't get those images out of his mind.

They talk about hearing screams of comrades or enemies or civilians, or children. To see it and be there creates a lot of reaction. Sometimes they might initially act really tough, but underneath it all most soldiers have a lot of humane feeling. They feel this horror very deeply – more than many are willing to admit.

Do you think that soldiers who suffer from psychological damage get enough help? Their injuries may not look as "bad," but they've suffered terrible emotional damage because of the sheer horror of war.

I've seen experienced officers break down because of what they've seen just as much as young recruits. They're covering up and carrying such deep emotions. A soldier doesn't want to show that emotion. He is fearful that if he does, others will perceive him as weak. And there is some truth to that.

So even when they are going through emotional upheaval, they won't seek out help or admit that they are having these feelings. A lot of it doesn't come out until after they're discharged.

Are they prepared to deal with or not? Probably not. But they are trying to do better than what happened during the Vietnam era.

No I don't think they receive enough help. At the same time, I don't want to be critical of the present system. All of us are learning how to deal with this. What is important is that people need to be made aware of this issue. Rather than attack the system, I would much prefer to raise awareness of this issue and how it affects the soldiers. We're going to see as much if not more as what happened after the Vietnam War. The incidences of alcoholism, substance abuse, homelessness, inability to work, marriages that crumble, and so on. So we need to do something right now.

But many of these soldiers are not included in the numbers put out by the Pentagon for soldiers wounded in action in Iraq, which is right now around 7,500. Is there an important distinction between combat and non-combat related injuries?

Well, you should probably look up a military manual to get the definitions exactly right, but here's how I understand it: Say you're on duty, something blows up or you get shot, that's what they call a combat injury. But if you get in a truck accident or a Humvee rolls over you, that's defined as non-combat. So you can get a Purple Heart for the former and not for the latter.

And yes, we don't hear about the non-combat injuries and illnesses. I've seen figures that are now upwards of 30,000. I know that at least 20,000 have been air-evacuated into the Landstuhl system. These are also people who have suffered doing what we as a country are asking of them. As to why they're not recognized, they seem to be of lesser importance in that they're not mentioned. I don't think that's fair.

The numbers are even higher when you look at the numbers once the soldiers return to the country from Iraq or Afghanistan. According to some of the veteran groups, 33,000 have sought VA care, 26,000 have filed VA disability claims, and 10,000 have sought VA counseling. When you look at these huge, huge numbers, what do they indicate?

It's just starting and it's only going to get worse. Those numbers are going to do nothing but increase. You have the physical injuries which speak for themselves. I've seen the breakdown of that 33,000 number (who've sought VA care) and they include a significant percent of spine injuries. As a neurosurgeon, I saw all the complaints in that area and I can only say that there's an overwhelming number of them.

These are people in a lot of chronic pain. They're seeking help from our VA system, which is undergoing changes and is still under-funded. So these people don't get the help they really need. There's a lot of people suffering from post-traumatic stress syndrome – that number is going to go up, and up, and up as time goes on.

So what is at stake in this undercounting of the casualties in Iraq – in not making clear what the toll of the war has imposed on our soldiers?

I really don't know why it's not out there for all of us to see. The question is why isn't our news media reporting this night after night so the American people can know about it. If you know about it, then why isn't CNN or NBC pushing this stuff?

What you see on TV and what you see in reality, is like night and day. The embedding of the journalists seemed to sterilize the war. When I heard them report, it was like it was a football game. The true effects of war are just awful. I'm now hearing estimates of upward of 30,000 in terms of civilian deaths. Let alone, all the Iraqis who have been injured.

Do you get the sense with this administration that even talking about the costs of the war is equivalent to challenging it?

I think wars should be challenged because they're absolutely devastating. The way it's made out is that if you're against what's happening in Iraq, you're against the present government or against the soldiers. And no, it doesn't have to be that way at all.

Why does the government make these differentiations? Why do they not talk about the reality of war? I suspect it's because they don't want upset all of the people who may then turn against the war. This is a war that has been debatable from the beginning.

But the soldiers don't seem to be questioning the war even though the initial reasons for the war such as WMDs have crumbled. I saw a CNN report on how many of them now see the reason for doing their job is to take care of their buddies – to make sure that everyone gets to go home in one piece.

My personal feeling is that the average soldier doesn't go to war because of the country. The reality is that the reason why they fight is the community that they've been a part of in the military. They don't look at the rationale or reason for war with that degree of depth. Maybe many soldiers would argue with me, I didn't really hear that in my conversations with them. It's more about their buddies. So it makes sense that it's more so now than ever.

But maybe now we're seeing some cracks. Depending on how this ends up – maybe not if the war ends better than we expect – but I suspect we're going to see a lot of anger among the GIs and veterans when they come back.

How have these very emotional years affected you?

I think about it a lot when I go to bed at night. I can't get it out of my head. It haunted me then and it haunts me now – the horrific, horrific injuries that these young people will now have to deal with for their rest of their lives. And I don't know if I'll ever stop thinking about them. I just feel a tremendous sadness – and that's just the way it is. I just hope everything in the world can be done to make what they have left for the rest of their lives as positive as possible. I sometimes fear that once they come back – with all the injuries and damage – they'll be forgotten about very quickly.

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