Treating Soldiers With Severe Combat Wounds
This interview was originally broadcast on October 13, 2011.
Improvements in medical care and equipment mean fewer troops are dying on the battlefield. But more troops are returning home severely wounded, with injuries that require lifelong care and cost millions of dollars in medical bills.
On Thursday's Fresh Air, veteran combat reporter David Wood talks about some of the challenges that severely wounded soldiers face when they return from Afghanistan and Iraq. Wood is the author of a new 10-part series for The Huffington Post called "Beyond the Battlefield" that examines some of those challenges and setbacks.
One of the things that we as a country are learning is that people who are wounded in war are wounded forever.
Wood tells Fresh Air's Terry Gross that fewer U.S. troops die outright on the battlefield — because of protective equipment and better medical care. But more Americans are being wounded, and their injuries are more "severe and complex." The number of American soldiers who lost at least one limb doubled from 2009 to 2010, and the number of triple amputees has nearly doubled, he says. Almost all of the severely injured troops return to the U.S. with traumatic brain injuries (TBI).
"It's so tragic to see these young men and women struggling not only to master prosthetic legs, for example, but to try to fight their way through the fog that descends into your brain when you have a brain injury like that," says Wood. "It's often very hard for them to think clearly, to recall words, to do small problems, to remember to take their medication and make their appointments. Surprisingly, there's been so much advancement in physical medicine during this war — but it's only been in recent years that the military has recognized TBI as a combat wound, and it's pretty clear that no one knows what the best treatment is."
A Soldier's Story
One of the soldiers Wood profiles is Lance Cpl. Tyler Southern. Southern was 19 when an improvised explosive device, or IED, blew up underneath him in Afghanistan. The blast tore up both of his legs and one arm, and mangled his remaining left arm. Southern was taken to an intermediate battlefield medical facility where he flat-lined.
"He was bleeding so heavily that they could not keep blood in him, and the blood was pouring out of him," says Wood. "As soon he came off the helicopter and they rushed him into an operating room, doctors slashed off the side of his chest and reached in and clamped off all of the veins leading to the lower part of his body in an effort to squeeze what little remaining fluid was left up to his brain to keep his brain alive."
After he had stabilized, Southern was transferred to Walter Reed Army Medical Center's amputee center, where wounded veterans learn how to adapt to their injuries. He faces years of rehab, after having endured dozens of surgeries to clean and repair his limbs. But he manages to make light of his situation — he has handed out T-shirts to other Marines on his floor that say "I had a blast!" and spends most of his days working out to try to build muscle in his remaining limb.
"He's an extremely active, very funny, very bright, very quick person ," says Wood. "It's hard to get him to stand still to talk to him. He's constantly moving."
'People Who Are Wounded In War Are Wounded Forever'
But not all of the soldiers Wood writes about have thrived as much as Southern. Jimmy Cleveland Kinsey II, a Marine, returned from Iraq after driving over an IED. The blast tore through his leg, leaving him with shrapnel wounds, burns, post-traumatic stress disorder and TBI. When he returned home, Kinsey was in chronic pain.
"He was a good Marine, a fun-loving guy. I never knew him, but he's the kind of guy you'd like to hang around with," says Wood. "He got drugs to control the pain. His leg got worse and worse, and they had to take it off. ... That set him into a depression. His addiction to pain medication and anxiety medication got worse. Jimmy was a strong guy, but in the end his wounds and the effects of them did him in. He died in a PTSD clinic of an overdose of [the pain killer] fentanyl."
It's not clear whether Kinsey's overdose was intentional or accidental, but what is clear, says Wood, is that Kinsey didn't get the help he needed. And he's not alone. Wood writes that 18 veterans kill themselves every day. (That figure includes veterans from Vietnam and other wars.)
"When you think about it, one of the things that we as a country are learning is that people who are wounded in war are wounded forever," he says. "Even though there are many cases like Tyler Southern, people who seem to almost thrive on the challenge of their new life, even with Tyler Southern, he'll be dealing with his wounds for the rest of his life. They don't go away."
"IEDs are designed to create mayhem on the human body. For dismounted troops especially, stepping on or near an IED when it explodes beneath you, it tends to traumatically amputate one or both limbs, very often it severs the genitals and on up through the body, slashing through flesh and bone, ripping off cartilage — and on top of that, there's a fireball that burns away the damaged flesh that's left. ... Trying to clean out the wounds, trying to prevent infections, is often the first order of business, and a lot of the wounded who arrive at Walter Reed [Army Medical Center] in suburban Maryland or the Brooke Army Medical Center in San Antonio, Texas, spend many, many days having their wounds gently cleaned and cleaned and cleaned over and over again."
On troops losing their genitals after stepping on IEDs
"The Army sent a team of doctors to Afghanistan earlier this year to talk to soldiers about IEDs [and the] kinds of injuries [that result]. One of the things they reported back is that soldiers and Marines are signing do-not-resuscitate pacts — in the event that they lose their genitals, they don't want to live. ... It does reflect a deep fear among many troops that they, in essence, lose their manhood."
On getting vets the care they need
"The [Department of Veterans Affairs] is an amazing place. They do a lot of great stuff and almost everyone I've met there has been smart and creative and dedicated, and I have a lot of admiration for the people who work there. At the same time, it's a gigantic bureaucracy and it's hard to transform that bureaucracy to take care of the unique problems that we're seeing among the wounded coming back from Iraq and Afghanistan. There's been a gigantic demand for mental health services, which the VA has scrambled to keep up on, not always successfully. A lot of veterans have difficulty getting services. The wait times are sometimes very, very long. Things got so bad that a federal appeals court in California ruled that the VA was denying veterans their constitutional rights by not providing good services on time."
On being a Quaker and a conscientious objector who has been embedded with troops on and off for the past 35 years
"I got interested in telling the stories of people who were caught up in conflict. People who were fighters, people who were refugees, people who were victims — the vast number of people who work constantly to resolve conflict and to get sides talking. I never felt that by reporting the stories of people in conflict that I was endorsing conflict in any way. ... Being a conscientious objector is a very personal thing. The way I thought about it: Do you want to spend the next several years killing people, or do you want to spend it doing something more productive? And that's really the way I came at that."
"I'm terrified when I'm out on a battlefield. Telling these stories, I think it's important that people understand what it's like out there, what people go through, who are the people who are doing this in Afghanistan on our behalf. Most of us have sat this war out. I want them to know what it's like and who is in the middle of it and what the consequences are. Beyond that, I don't really have an agenda. I think that's really important, especially in a democracy. We need to know who is doing it and what it's like for them."
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