The U.S. has been at war for more than seven years, yet the conflicts in Iraq and Afghanistan directly touch very few Americans. Most of those who have paid the price are members of the all-volunteer military and their families.
Weekend Edition's four-part "Impact of War" series is a collaboration with member stations and NPR's Impact Of War project. These stories explore how the wars in Iraq and Afghanistan have affected service members and their loved ones.
The Impact Of War project is an outreach effort to NPR member station reporters around the country to help increase local coverage of the experiences and sacrifices of U.S. troops and their communities.
In 2006, NPR's Melissa Block reported on the Brooke Army Medical Center's burn unit. Explore those stories:
The occupational therapy room in the burn unit of Brooke Army Medical Center in San Antonio smells of antiseptic and sweat. In one corner, a therapist examines the wound on a soldier's head. The skin is burned completely down to his skull. In another area, a patient rides a stationary bike slowly, trying to rebuild muscles in what's left of his badly burned legs. Inside this room, burn patients push through their pain in the relentless pursuit of one goal — getting their lives back to normal.
The wars in Iraq and Afghanistan have left lasting scars on the young men and women recovering at military hospitals across the country. Many of them injured by roadside bombs were burned beyond recognition. The medical staff who dress their wounds and help ease their agonizing pain also fight a daily emotional battle.
Balancing Objectivity With Compassion
Lt. Col. Maria Serio-Melvin, 41, is a veteran in caring for savage burns. She is a critical care nurse specialist in charge of improving nursing practices for the 16-bed burn Intensive Care Unit. Melvin supervises the care of a man severely burned on more than half of his body. Most of his torso is an open wound — layers of tissue charred, oozing with fluid.
"Notice how graphic it is," Melvin says. "I look at this stuff very scientifically and from a medical perspective — at the same time still trying to be nurturing and compassionate and realizing that this is a human being in a bed who is awake — or half awake — who can still hear."
Capt. Christine Broger is an Army nurse working next to Melvin. She cuts away dead tissue from the patient's wounds. The process can cause unspeakable pain, but this patient is heavily sedated.
"We're in here for up to four to five hours on a burn dressing," Broger says. "From the time we come in and start cutting down — to the time that we exit the room and have them prepared for the family to come visit. That could be four to five hours."
Badly burned patients often spend many months in recovery. Lt. Col. Melvin says it's difficult not to become attached to them. She remembers one in particular. When Marine Sgt. Merlin German arrived here from Iraq, he had burns over 97 percent of his body. He spent more than 500 days in this hospital. To the surprise of medical staff, he began to recover. But German died unexpectedly during a routine surgery. Melvin remembers getting a phone call late at night.
"Just literally started crying," Melvin says, "just standing here at the counter — on the phone just crying. And John's like, 'Maria what's wrong? What's going on?' And I had to let him know. 'John, I've got to go into work. I just have to go in. I have to go in and say goodbye.'"
Melvin was asked to participate in German's memorial service at the hospital. She chose a passage from the Old Testament book of Isaiah — one often used for Marines killed in the line of duty. It reads:
"So do not fear, for I am with you. Do not be dismayed, for I am your God. I will strengthen you and help you. I will uphold you with my righteous right hand."
Melvin says one of the ways she deals with stress and grief on the job is talking with her husband, Maj. John Melvin. He is also an ICU nurse at the Medical Center.
"You just need to tell a story about how someone got burned in your day — and all he needed to do was listen," she says. "He didn't have to say a word, he just needed to listen, and I felt so much better."
The staff is acutely aware of the fragility of their patients — and the pressure takes a toll on doctors and nurses. People here call it "compassion fatigue." It's enough of a problem that the Army has implemented a program to help the staff. Counselors are available and the hospital is creating a respite room, where staff can escape temporarily from the job. Col. Cynthia Spencer is a psychiatric nurse at the hospital. She says in a military culture, service members don't like to admit they need help.
"Some people would say it was a sign of weakness," says Spencer, "and I am starting to see — and I'm so happy at this point in my career — that people are saying it's not a sign of weakness. It's a sign of strength, and when you take care of yourself, then you can take better care of other people."
Lt. Col. Melvin also finds solace in the normalcy of family life. She and her husband have three children — ages 16, 11 and almost 2. When Mom and Dad work long hours at the hospital, the two older boys help watch their little sister. Every Saturday morning, the Melvins make breakfast together. Pancakes and bacon are usually on the menu.
Maria Melvin says it's very important to her and her husband to maintain a balance between work and family.
"We're tired and we work darn hard at what we do and we give so much of ourselves all day long at our job, that sometimes, we may not have a lot left for here — and that concerns both of us. But we just do it. It just is who we are."
Maria Melvin's job is about to get a whole lot harder. Her husband John deploys to Iraq this month.