http://www.baltimoresun.com/news/world/iraq/bal-te.md.blast25may25,0,1853761,full.story
Blast injuries define two wars, thousands of lives
Veterans of
By a
May 25, 2009
The explosive device detonated without warning, in a fireball that seemed to erupt in slow motion. Army Pfc. Robert Bartlett could count the rocks and shrapnel drifting toward him over the hood of his Humvee. Then he felt a sledgehammer slam into his face. In unbearable pain, he went blind. Through the ringing in his ears came faint screaming - his own. The soldier beside him was killed instantly. The turret gunner above
The blast tore into
Blast from improvised explosive devices, or IEDs, is the enduring agony of the American experience in
It has killed 2,400 Americans, who are among those who will be remembered on this Memorial Day as overseas wars continue to unfold.
It has also left 23,000 wounded, many so severely that they will require lifelong intense medical and psychological care.
Many more, medical officials say perhaps tens of thousands, have returned from long deployments under constant threat of or exposure to blast, bearing mental scars and brain trauma about which little is known.
"Blast injury will be the defining long-term medical burden of this conflict," said a Navy combat surgeon in
Bartlett and others agreed to talk about their experiences to deepen the public's understanding of what troops face in the war zone, and to share their pride of service.
The
"It was, hands down, the best thing I have ever done in my entire life," he says. "I will never complain, ever again."
IED blasts cause a ghastly array of wounds. The shock wave can rupture lungs, eardrums and even eyeballs, shear tissue and shatter bone. Victims are often smashed against steel wreckage, and dirt and metal fragments are driven into their bodies. The flesh on
Those like Bartlett who survive suffer severe, multiple wounds that together are beyond the scope of ordinary medicine.
To meet the avalanche of IED survivors, the Department of Veterans Affairs has expanded a small "polytrauma" program originally designed for car wreck victims into a national network of four major polytrauma hospitals and 21 regional centers that specialize in the challenges of the grievously wounded
In one typical case, described by Dr. Shane McNamee, medical director at the
The blast had torn off both legs, severely injured one arm and shattered his pelvis into 60 or 80 fragments.
He had bled so badly his blood had been replaced five times. His possible brain damage due to lack of oxygen and a spinal cord injury had destroyed his lower-limb muscular control, meaning he could not wear prosthetics.
He was severely disoriented, often waking up screaming. His wounds had become infected.
He was 22 years old.
"One of the most gruesome things I've seen in medicine," McNamee said in an interview. "How do you fix a guy like that?"
It takes a large staff and intensive care. For 12 inpatient cases, McNamee directs a staff of 36 nurses, three physicians, three mental health specialists, a psychologist, four physical and occupational therapists, pain management experts, a dietitian, a wound specialist and others - some 60 people in all.
Treatment is specialized, and innovative. When the patient's wife gave birth, they moved mother and baby into his room.
After two years he was moved home, attended by full-time caregivers and therapists. He can dress himself and feed himself. His family declined to be interviewed.
"But it's not good, just getting around at home, getting a pat on the back," said Dr. David Cifu, chief of physical medicine and rehabilitation service at the Richmond polytrauma center. "
Even for veterans without visible wounds, the searing experience of combat, the constant threat of IEDs and the often jarring return to "normal" life produce readjustment problems that often can be solved with family support and what some mental health experts refer to as "beer-sex-sleep-pizza" therapy.
IED blast survivors have a wider range of mental health challenges. Most, like
Depression is common; blast victims often experience damage to their brain's frontal lobe, making them "more susceptible to depression - a lifetime risk," said McNamee.
For others, damage is less visible and not well understood. Some 40 percent of troops returning from
Living under daily threat of IED blast takes a toll as well, said Dr. Sonja V. Batten, a clinical psychologist and senior mental health expert at the VA in
Troops exposed to IEDs over a typical 12-month deployment are more likely to have "significant long-term adjustment problems than people exposed to one or two IED blasts," Batten said in an interview.
But she stressed: "The science is very new; there is still a lot more we need to learn" about the mechanisms of mental injury and how to treat it.
For
"Guy said to me the other day, 'How can I stand in a river? I got no legs!' He's a quadriplegic. He can move his arms a bit. He goes out there and fishes. We got a blind guy, he fishes."
"It's important that we look after one another. Nobody knows our pain more than each other,"
"My first steps out into the world with half a face, I was drooling, my jaw was wired shut, I couldn't talk. People couldn't help but stare, and I couldn't give them a smile back. How do you focus on the positive?
"Being able to walk again, talk again," he answered. "You count your blessings every step you take."
Copyright © 2009, The Baltimore Sun
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"The master class has always declared the wars; the subject class has always fought the battles. The master class has had all to gain and nothing to lose, while the subject class has had nothing to gain and everything to lose--especially their lives." Eugene Victor Debs
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