> Dead Men Walking

>
> By Michael Mason
>
> February 21, 2007 | Medicine
>
> In a flash, the blast incinerates air, sprays metal, burns flesh.
> Milliseconds after an improvised explosive device (IED) detonates, a blink
> after a mortar
>
> shell blows, an overpressurization wave engulfs the human body, and just
> as quickly, an underpressure wave follows and vanishes. Eardrums burst,
> bubbles
>
> appear in the bloodstream, the heart slows. A soldier-or a civilian-can
> survive the blast without a single penetrating wound and still receive the
> worst
>
> diagnosis: traumatic brain injury, or TBI, the signature injury of the
> Iraq War.
>
> But in the same instant that the blast unleashes chaos, it also activates
> the most organized and sophisticated trauma care in history. Within a
> matter
> of
>
> hours, a soldier can be medevaced to a state-of-the-art field hospital,
> placed on a flying intensive care unit, and receive continuous critical
> care a
>
> sea away. (During Vietnam, it took an average of 15 days to receive that
> level of treatment. Today the military can deliver it in 13 hours.) Heroic
> measures
>
> may be yielding unprecedented survival rates, but they also carry a grim
> consequence: No other war has created so many seriously disabled veterans.
> Soldiers
>
> are surviving some brain injuries with only their brain stems unimpaired.
>
> While the Pentagon has yet to release hard numbers on brain-injured
> troops, citing security issues, brain-injury professionals express concern
> about the
>
> range of numbers reported from other military-related sources like the
> Defense and Veterans Brain Injury Center, the Department of Defense, and
> the Department
>
> of Veterans Affairs (VA). One expert from the VA estimates the number of
> undiagnosed TBIs at over 7,500. Nearly 2,000 brain-injured soldiers have
> already
>
> received some level of care, but the TBIs-human beings reduced to an
> abbreviation-keep coming.
>
> "We would get about 300 helicopters landing a month, all having some level
> of trauma," says Dr. Elisha Powell, an orthopedic surgeon who served as
> commander
>
> of the U.S. Air Force Theater Hospital in Balad, Iraq, a facility
> described as "MASH on steroids," where most of the severely brain injured
> are treated.
>
> A soldier treated at Balad Air Base stands a 96 percent chance of
> surviving; several hundred come through every month. I ask Dr. Gerald
> Grant, who served
>
> as one of the few neurotrauma surgeons in Iraq, how the hospital managed
> to keep patients alive.
>
> "It's complex in that it's not only medical advances," he tells me. "This
> war is different in that the aerovac system is superb. The ability to get
> someone
>
> into your care facility with many forward surgeons and subspecialists so
> close to the front line, very quickly, is a novel concept in this
> theater."
>
> The moment an injured soldier hits the helipad at Balad, he's swept into a
> whirlwind of critical care. It's the one ER in the world where up to 10
> surgical
>
> specialists are hell-bent on saving a life. Patients get lined up with IVs
> and catheters, undergo CT scans and X-rays, and then hit the operating
> table-the
>
> hospital's best time is 18 minutes. The head-and-neck team tackles their
> trauma while a cardiothoracic surgeon and a vascular surgeon go to work on
> the
>
> chest. They're shoulder to shoulder with the urologist, who's brushing
> against the chief trauma surgeon, who's coordinating everything over the
> buzz of
>
> orthopedic surgeons drilling external fixators into bone. It's crowded.
> It's hot.
>
> Amid the cramped bustle, doctors are pushing the boundaries of medicine.
> They're going through crates of the hemophilia drug Factor VII, yet to be
> approved
>
> for trauma but a wonder drug in stopping bleed-outs. At $3,000 a vial, two
> vials per dose, the price is a drop in the bucket compared with the
> expenses
>
> incurred during the critical phase of recovery, which can easily exceed a
> million dollars in the coming weeks. The lifetime cost of care for
> brain-injured
>
> troops could reach $35 billion, according to a Nobel Prize-winning
> economist and a Harvard University budget expert.
>
> If the diagnostics come up positive for blast-related brain trauma, the
> neurosurgeon takes action based on observable signs of trauma. Depending
> on whether
>
> the brain was pulled, pushed, twisted, or punctured in the blast, the
> neurosurgeon could elect major surgery.
>
> "Our expression is 'Go big or go home,' " Grant says. "We really want to
> do the definitive operation that we know will be OK for them."
>
> In a matter of minutes, a surgeon will saw the skull in half and discard
> the damaged portion. There will be a plastic replacement waiting farther
> down
> the
>
> line. Shrapnel is excised, cerebral tissue swells, and the scalp is pulled
> taut and sewn back over a ballooning brain. Thanks to the wealth of
> surgical
>
> resources, a procedure that takes several hours in any general hospital in
> the United States might take Balad surgeons 30 minutes. "The secret to our
> hospital's
>
> ability is throughput," Powell says. "We have to keep churning. Things
> that would overwhelm a major hospital would not overwhelm us. During the
> worst incident,
>
> we had 35 people come to us in 90 minutes, all by helicopter, landing with
> just horrible injuries."
>
> "There are soft tissue traumas where we have no scalp, no eye, and no
> skull base left," Grant says. "And we have to somehow treat that acutely
> in one surgery
>
> setting."
>
> Many of the soldiers treated at Balad won't remember being there. After
> leaving the frontline hospital, they're loaded onto a massive C-17 cargo
> plane
> that
>
> has been retrofitted to hold an entire intensive care unit-up to 8
> critical care patients and 27 noncritical litter patients. It's basically
> a flying warehouse
>
> abuzz with armor-clad clinicians and portable life-support units. Known as
> a critical care air transport team, each consists of a critical care
> physician,
>
> a critical care nurse, and a respiratory therapist. There are 249 of these
> teams in the Air Force, catering to all branches of the armed forces.
>
> Five hours later, the C-17 lands at Ramstein Air Base in Germany. Having
> been prepped through a satellite tracking system, doctors at Landstuhl
> Regional
>
> Medical Center (just across the autobahn from Ramstein) already have a
> strong grasp of any patient's treatment needs. In Balad, surgeons don't
> have the
>
> time to check medical records or advance directives, so every life is
> saved at any cost. But that's not the case in Landstuhl. In addition to
> being a transitional
>
> facility, Landstuhl also happens to be the place where the family has a
> voice in their loved one's fate.
>
> "You can look at someone and see they will not survive," says Dr. Gene
> Bolles, former chief of neurosurgery at Landstuhl. "When you see that, you
> are up
>
> front with the families. But so often, you don't know enough. When you are
> in the military, you don't question, you just save life. When I was there,
> our
>
> modus operandi was to maintain them and keep them alive to get them to the
> States."
>
> "It is very rare for us to have family contact in Iraq because the
> communication is so difficult," Grant explains. "The family can meet the
> patient in
> Germany.
>
> They are there to make decisions for them, and they can withdraw care
> there, whether the patient has an advance directive or not."
>
> When one veteran's wife, Michele Reid, spoke with a doctor at Landstuhl
> about her husband, Pete, she was surprised to learn that he had survived
> an attack
>
> on May 2, 2004. She had feared him dead after receiving funeral notices
> for some of the friends he served with. A Navy Seabee, Pete Reid was one
> of the
>
> three severely injured servicemen hit by a barrage of mortar shells in
> Ramadi, Iraq. Thirty people were injured, six were killed.
>
> "First they told me he lost his eye and that his brain was bleeding," she
> says. "But then they said that they didn't think he was going to make it."
>
> Michele asked for the phone to be placed next to Pete's ear, and she told
> him to hang on, that she wanted to see him get better. Later that day,
> Pete emerged
>
> from his coma, opened his eyes, and asked a nurse when he could see his
> wife. The team immediately flew him back to the States to see Michele.
>
> The aggressive level of care continues once the troops return to either
> Walter Reed Army Medical Center in Washington, D.C., or the National Naval
> Medical
>
> Center in Bethesda, Maryland. At Walter Reed, troops undergo intensive
> therapies aimed at helping them regain their independence. Reid was
> transferred
>
> to Bethesda, where Michele was waiting for him.
>
> "When they let me see him, I lost it," she says. "I could see his open
> wounds when they pulled back the sheet. He didn't say anything-he just
> squeezed
> my
>
> hand."
>
> While in the intensive care unit at Bethesda, doctors told Michele that
> her husband had a 1 percent chance of recovery, and if he survived, he
> would be
>
> vegetative.
>
> "I cried, I prayed, I cussed, and I screamed," Michele says. "After a few
> days, Pete turned his head toward me and said, 'Enough already. I'm going
> to
> be
>
> OK.'"
>
> From Walter Reed, soldiers are then triaged to one of the nation's VA
> polytrauma centers, where the hard work begins. (There are only 4
> polytrauma centers
>
> and 21 designated polytrauma rehabilitation sites, a painfully small
> number to deal with the great many injured troops.) Weeks ago, a staff
> sergeant might
>
> have been conducting complex tactical operations; on the polytrauma unit,
> his biggest challenge might involve lifting his head off the pillow.
> Another
>
> soldier experiencing sequencing problems might try his hand at
> disassembling a carburetor in one of the rehab rooms. That same soldier
> could then be taken
>
> to physical therapy to work on his balance. Because of the brain's
> complexity, each injury manifests its own unique set of challenges.
>
> "All the polytrauma centers offer patients highly individualized care,"
> says Dr. Rose Collins, a psychologist with the Minneapolis polytrauma
> center. "One
>
> of my roles is to decrease the barriers that get in the way of your
> participating in rehabilitation." Soldiers are not the only ones whose
> issues get addressed
>
> at the center. "Part of my job is to help their families," she says. "How
> do you make positive meaning out of this? How do you grieve ambiguous
> losses?
>
> On some level, family members prepare for the possibility of death, but
> they don't prepare for the possibility of severe disability. Who, outside
> in the
>
> real world, thinks about the lifetime impairments of a traumatic brain
> injury?"
>
> At the polytrauma center in Tampa, Florida, Michele had a better idea of
> what condition her husband was in. He arrived at the center with a hundred
> stitches
>
> along his scalp and a missing eye. Surgeons had removed some of his
> stomach muscles along with portions of his hip bone and transplanted them
> to his right
>
> leg. Michele could come to terms with his physical injuries, but the
> personality changes brought on by the TBI made her feel as though her
> husband was
>
> a different man altogether. The injuries to Pete's right frontal lobe
> caused severe impulse control and reasoning problems.
>
> "Near the beginning, Pete threw his urinal and grabbed people by the
> throat," Michele says. "He thought he was still in Iraq, and he even tried
> to stab
>
> out his one good eye with a pen. He could never be left alone, ever."
>
> Inside the Minneapolis VA's polytrauma unit, military insignias adorn the
> walls, and the milieu is preternaturally calm-a necessity in brain-injury
> treatment
>
> centers. Color-coded floor tiles in front of entryways help soldiers who
> can no longer read room numbers. Halls and doorways are extra wide, all
> the furniture
>
> is movable, and even the bathroom fixtures are amputee-friendly. The unit
> was recently redesigned to be completely focused on treatment. Like Balad,
> Landstuhl,
>
> and Walter Reed, the polytrauma center represents the culmination of
> research and resources, a level of care to which many private hospitals
> aspire. The
>
> patients on the unit represent some of the most complicated treatment
> challenges in the world.
>
> While there, I met a young soldier who had received the military's full
> battery of services. He had been blown apart and put back together, but
> not entirely,
>
> not yet. The upper left quadrant of his head was missing, pending a new
> skull plate, and the remainder was dappled with tufts of dark hair and
> notches
>
> left by shrapnel. In place of two limbs, he had prosthetics-one arm, one
> leg. The visible parts of his body were replete with fresh skin grafts,
> giving
>
> him an uneven, patched-together appearance. In some respects, he didn't
> look quite possible, but because he could talk and interact and function,
> he was
>
> a success story. The guy parked in the foyer's corner, whom I didn't meet,
> wasn't faring as well. He was wrapped head to toe in heavy white blankets,
> with
>
> only his mouth and a single gray hand exposed. A plastic tube ran from his
> lips back behind the chair; he never moved for the duration of my visit.
> From
>
> a far room, the angry wailings of another brain-injured patient broke the
> calm. As I passed that soldier's room, I could see him sitting on the edge
> of
>
> his bed, swiping an arm at the nurse who was trying to help him.
> Behavioral outbursts, particularly those driven by agitation, are a common
> side effect
>
> of brain injury.
>
> What looks otherworldly to us now will be commonplace in a matter of
> years. Projections based on a recent VA report suggest that 400,000
> veterans deployed
>
> in the global war on terrorism will file for disability. Can such a number
> be adequately treated? With the lifetime costs of civilian brain injuries
> escalating,
>
> are local communities prepared for the complex treatment measures many
> veterans will require?
>
> In high heels and a business suit, Marilyn Price Spivack makes an unlikely
> rock star, but in the world of brain-injury experts, that's exactly the
> image
>
> she conjures up. She is innately tenacious, bold, and energetic. The
> availability of cognitive, neurobehavioral, and mental health services is
> sorely lacking,
>
> Spivack explains. Men and women in the military will receive excellent
> care for a time, but eventually, they are going back to their communities.
>
> "The military is doing an extraordinary job in saving young soldiers and
> treating them through the acute rehabilitation phase," says Spivack, who
> works
>
> with the brain-injured population at Spaulding Rehabilitation Hospital in
> Boston. In the early 1980s she founded the Brain Injury Association, today
> the
>
> foremost advocacy organization for TBI survivors.
>
> "Now the government must make a commitment to help them in their recovery,
> but where are the resources going to come from? As brain-injury
> professionals,
>
> we know that TBI services aren't available in many places across the
> country, and we are aware of huge holes in the system," she says.
> "Frankly, I'm frustrated
>
> and angry about the government's refusal to give the TBI population the
> support it desperately needs."
>
> Spivack is not being glib; the giant holes are glaringly apparent. Many
> states do not have a single brain-injury rehabilitation center, and of the
> states
>
> that do offer some level of TBI treatment, few actually provide enough
> assistance to acquire even the most basic level of specialized care. At
> rates that
>
> can exceed a thousand dollars a day for postacute TBI rehabilitation,
> there aren't many American families that can afford a month's worth of
> treatment,
>
> much less the recommended minimum of 90 days.
>
> As recently as mid-July 2006, the VA Office of the Inspector General
> admitted that patients and families were dealing with major inadequacies.
> The reality
>
> is that a fundamental level of care is simply absent in most states.
>
> The military did not anticipate the magnitude of the problem, and now they
> are scrambling to add new brain-injury programs and services. Problems
> experienced
>
> by patients and families include inadequate or absent communication with
> case managers, lack of follow-up care, and being forced to pay
> out-of-pocket for
>
> necessary treatments and medication.
>
> An evaluation of TBI programs and services conducted by the Institute of
> Medicine reads like a list of indictments. It concludes that "finding
> needed services
>
> is, far too often, an overwhelming logistical, financial, and
> psychological challenge . . . . the quality and coordination of postacute
> TBI service systems
>
> remains inadequate."
>
> Samuel Reyes Jr. had never heard the term "traumatic brain injury" before
> he enlisted in the Marines. As a machine gunner who patrolled Route Mobile
> near
>
> Fallujah, he was well aware of the loss of limb and life. He regularly saw
> the unspeakable, and then he lived it.
>
> On September 6, 2004, Reyes rode in the back of a seven-ton supply truck
> with his patrol buddies and members of the Iraqi National Guard. A suicide
> bomber
>
> pulled up next to the truck and detonated its payload of C-4 explosive and
> 250-millimeter shells. The blast reduced the truck to little more than a
> chewed-up
>
> driveshaft. Only Reyes and four other marines survived the attack.
>
> Reyes's body sustained a range of trauma in the attack. The impact of the
> blast cleaved his tongue in two and tore open his abdomen from rib cage to
> navel.
>
> It slammed both his knees into a metal barrier and peppered his back with
> shrapnel. His left arm was blown open to the bone.
>
> "I remember waking up, being on the street, being hot like I was on fire,"
> Reyes recalls. "People were talking to me, asking questions I couldn't
> understand.
>
> Someone told me I got hit by an IED [improvised explosive device], and I
> got scared because I knew what it meant."
>
> Reyes could not have guessed what had happened inside his skull.
>
> Blast-related brain injuries like those sustained by Reyes can deliver
> multiple TBIs. First there is barotrauma, in which the body suffers the
> same magnitude
>
> of pressure felt deep underwater. It's theorized that portions of the
> brain swell and decompress almost instantly during this stage, causing a
> host of
>
> cellular defects throughout the brain. Objects like shrapnel and gravel
> penetrate the skull, ping-ponging within the cranium walls. The force of
> the blast
>
> then blows an individual against an object, like a wall or a roof, causing
> blunt trauma to the head. Finally, in response to these injuries, the
> brain
>
> releases a metabolic cascade of neurochemicals that have a toxic effect on
> brain tissue. Reyes had no penetrating fragments; he experienced three of
> the
>
> four blast insults.
>
> Reyes's ride through the military's medical system wasn't as clean as
> most. The medevac helicopters never arrived, so he was trucked to an ER.
> His heart
>
> stopped on the way to Baghdad-twice. Reyes awoke in a blur of bandages,
> surrounded by other wounded soldiers. Later that day, his platoon
> commander appeared
>
> from out of the haze and told him seven of his friends had died in the
> blast. The accompanying Iraqi soldiers had all died as well, he said.
>
> "I had already lost a lot of friends before that, and this was another
> really big kick," Reyes says. "It's really bad to feel it, to hear it, and
> to know
>
> it."
>
> The lieutenant left Reyes alone with his grief, and eventually Reyes's
> mind wandered to his own well-being. "It was all really going downhill
> then," Reyes
>
> says. "I was wondering what was going to happen to my military career, or
> if I could ever have a career at all anywhere else. It was hard to think
> of all
>
> that."
>
> At the time of his injury, Reyes had only two more weeks of duty remaining
> before his tour was over. A natural-born athlete, he had planned to try
> out
> for
>
> Marine Recon, a component of special operational forces, and then move on
> to Officer Cadet School. He dreamed of someday leading his own platoon,
> then
>
> working his way up the chain of command until retirement. His entire
> future began to crumble away as he lay helpless among the damaged.
>
> In less than a day, Reyes was transported to Balad, where a critical care
> air transport team accompanied him to Landstuhl. There he regained enough
> strength
>
> to make it to the National Naval Medical Center in Bethesda, Maryland.
>
> "I was just waiting at Bethesda," Reyes explains. "By then, I was walking
> a bit better, but I still had a lot of headaches, a lot of pain, and
> vision blurs."
>
> Prior to his injury, Reyes had perfect eyesight; now he wears glasses in
> order to drive.
>
> After a couple of days as an inpatient, Reyes was discharged to Camp
> Pendleton, near San Diego, where his father saw him for the first time
> since his injury.
>
> "I was just happy to see he was alive and walking, but I knew something
> was different," Reyes Sr. tells me. "I could tell by the expression on his
> face
>
> that he didn't know me at first."
>
> Reyes accompanied his father home for a three-week medical leave. During
> his entire journey through the military's most elite treatment centers,
> nobody
>
> mentioned anything about a traumatic brain injury to him-the most that was
> discussed was the likelihood of a mild concussion. Meanwhile, Reyes's
> concentration
>
> was shot, his tolerance was low, and he still could not shake the terrible
> headaches. He figured he was just a little shaken up and that his head
> would
>
> clear in a short time.
>
> During his convalescence at home, Reyes didn't tell his family or friends
> about his memory gaps. Initially, he recognized no one. Reyes's father
> grew increasingly
>
> concerned.
>
> "I had to keep explaining things to him," Reyes Sr. says. "He would ask me
> how everyone was, and I would have to tell him who they were and how he
> was
> related
>
> to them."
>
> Reyes smiled and shook the hands of high school buddies and cousins,
> trusting that his memory would be jogged, but other problems began to
> creep in. Once,
>
> he drove an old girlfriend to work and then lost his sense of direction.
> When he dropped her off, he had a full tank of gas. He pulled into his
> driveway
>
> hours later with less than a quarter of a tank. Reyes also began drinking
> heavily; it was the only thing that soothed the searing pain in his head.
>
> When he returned to Camp Pendleton that October, Reyes complained and
> complained, but the Marines put him back to work training new recruits. He
> misidentified
>
> guns; he forgot to include details about special combat procedures. It
> took the Marines a month to realize that Reyes wasn't the same, but
> instead of looking
>
> deeper, he says they simply allowed him to whittle his time away playing
> video games in the barracks while the rest of his friends prepared for
> another
>
> tour in Iraq. Finally, in June 2005, out of concern for Reyes's
> unrelenting headaches, a civilian doctor tested him for neurological
> problems. It was the
>
> first time Reyes heard the term "brain injury."
>
> "I didn't know what a brain injury was, how it was caused, what it did, or
> what it was going to do to me," Reyes says. "It was just another term.
> They
> told
>
> me I would have to deal with these problems my whole life and that I
> needed to work with it and to find ways to live with it."
>
> The military sent Reyes straight to the polytrauma center in Palo Alto.
> "They told me that his mild concussion wasn't as mild as they thought it
> was,"
> Reyes
>
> Sr. says, recalling his first meeting with the Palo Alto treatment team.
> The team told both father and son that the memory damage might be
> permanent but
>
> that the son could still benefit from rigorous rehabilitation.

>
> At Palo Alto, Reyes spent more than a year learning to learn again. The
> rehab team gave him a handheld organizer that beeps when he has
> appointments. They
>
> taught him meditation in hopes of relieving his anger. They educated him
> about brain injury and warned him that it would probably be tough on his
> social
>
> life.
>
> Reyes is currently stationed back at Camp Pendleton. His primary duty
> involves chauffeuring a sergeant major around the base, a job he feels
> comfortable
>
> doing. As he grows more aware of his limitations, he is beginning to draw
> connections between his injury and its effect on his life.
>
> "I don't really tell people about my injury," he says. "I don't like to go
> out at all. I stay inside and do things with people I know. I don't talk
> to
> my
>
> friends as much. When I get really upset, I forget how to calm myself."
>
> Reyes's injury may be fresh, but his challenges mirror the complaints I
> hear from other survivors many years after the injury. Isolation,
> addiction, agitation-they
>
> are all quintessential characteristics of a serious TBI. When I ask
> officials in the VA system if they knew about the long-term outcomes faced
> by blast-injury
>
> survivors, I am met with shoulder shrugs. The injury is too new, the
> research is ongoing, the book is still being written.
>
> I ask Reyes's father if he has any advice for other families dealing with
> the effects of a blast injury. "There ain't no really easy way to get
> through
>
> this," Reyes Sr. says. "You got to hope like hell someone is there to help
> you."
>
> After five months of multiple transports between VA hospitals in Bethesda
> and Tampa, Seabee Pete Reid was finally cleared to return home. He still
> struggles
>
> with frequent nightmares, and sometimes he asks for the car keys, thinking
> he can still drive. His behavioral outbursts occur only every few days
> now.
>
> "When someone dies, you go through all the steps of grieving," says his
> wife, Michele. "When someone goes through what we have, you grieve over
> and over
>
> because the TBI never goes away. This has ripped our family apart
> emotionally, physically, and financially. He was once the strong one who
> kept our lives
>
> together, and now our roles have changed drastically."
>
> Pete Reid has a good sense of what he has lost, and what remains. "My
> biggest problem right now is staying focused," he says. "But I also miss
> being able
>
> to drive and do things around the house. It's frustrating to be taken care
> of, to not be able to wash myself and use the toilet on my own."
>
> Reid knows he won't return to the service, but he still carries a strong
> sense of duty. I ask him what he sees himself doing 10 years from now, and
> he
> doesn't
>
> hesitate a moment in his answer. "I hope to help other vets so they don't
> have to go through what my wife has had to deal with," he says. "To me it
> seems
>
> like we had a lot of paperwork and mess to deal with. If they're going
> through the trouble of fixing me up, then they ought to help walk us
> through the
>
> red tape."
>
> In its ambitious efforts to save lives, the military did not expect the
> dire circumstances that await surviving soldiers. With most other kinds of
> injuries
>
> and disorders, there are a wealth of services in place. Any heart patient
> can find affordable treatment within city limits, and any kidney patient
> can
>
> get dialysis within state lines. But brain-injury patients are stranded in
> their communities, isolated without basic services. Why have we devoted
> such
>
> tremendous effort to sustaining life while investing so little to support
> and nurture it? How did we become so shortsighted about such a serious
> problem?
>
> Spivack agrees that the equation is unbalanced. "Our government will spend
> whatever it takes in pharmacology and technology to save people, and if
> they
>
> don't die, it's OK," she says. "Prevent fatality. They speak to caring,
> but meanwhile services are being cut and access is an issue. When we first
> began
>
> this effort, everybody talked about the quality of life, maximizing
> functionality. It costs money, and a lifetime of commitment."
>
> Today Samuel Reyes Jr. perseveres despite the realities of his
> impairments. He plans to enroll in college and pursue a career in business
> management. "I
>
> expect school to be really hard, but I just want to try," he says.
>
> Behind the impairments, you can still sense the soldier. Reyes's
> determination is rivaled only by his loyalty to the Marines. He believes
> they'll take
> care
>
> of him, Semper Fi. I want to believe Reyes, but I know there are obvious
> problems with service delivery. What happens when he and others are taken
> off
>
> active duty? In my eyes, he's the future. He's one of the thousands of
> veterans who will be in routine contact with brain-injury centers, asking
> for advice
>
> and help. Bolles points out that the actual number of troops wounded in
> Iraq is likely to betwice as many as reported. Will local VA hospitals
> have brain-injury
>
> clinicians ready to deal with a plague of psychological and social issues?
> Can communities already overburdened with brain-injury patients sustain
> the
>
> new influx of veterans?
>
> The military has done a spectacular job repairing bodies, but it has not
> yet learned how to put lives back together. "More lives are being saved,"
> says
>
> Bolles. "At the same time, those that are being saved are the more
> critically injured. There's a higher incidence of permanently disabled
> people." America
>
> isn't prepared for the injured's medical demands. After the dream-team
> care is finished, soldiers are finding themselves trapped in a nightmare.
>
> http://www.discover.com/web-exclusives/iraq-vets-brain-injury/
>
> **************************************
> Posted by Miriam V
>