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Treating Soldiers With Severe Combat Wounds

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Treating Soldiers With Severe Combat Wounds

The Impact of War

Treating Soldiers With Severe Combat Wounds

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DAVE DAVIES, HOST:

This is FRESH AIR. I'm Dave Davies in for Terry Gross.

Today is Veterans Day and we're going to hear some remarkable stories of soldiers rebuilding their lives, after suffering horrific injuries in Afghanistan and Iraq. These wars have created a new kind of casualty, with IEDs tearing off limbs and genitals, burning faces, and leaving soldiers with traumatic brain injury. But with new medical breakthroughs, soldiers who would never have survived these catastrophic are alive and facing a future of difficulty and pain.

Our guest, David Wood, has written a series of articles about what this means for survivors, their families and the VA medical system, which wasn't prepared for the severity or quantity of injuries from these wars.

Wood is senior military correspondent for the Huffington Post, where you can still read his series "Beyond the Battlefield." It includes videos of some of the soldiers featured in the series. Wood's been a correspondent for Time, the L.A. Times and the Baltimore Sun. He's accompanied troops in Iraq and Afghanistan, as well as other war zones.

Terry spoke with David Wood last month. This conversation does include some disturbing description of war injuries, as well as the heroic work war veterans and their doctors do to overcome those injuries and get on with their lives.

TERRY GROSS, HOST:

David Wood, welcome to FRESH AIR. Why did you want to do this series on the catastrophically wounded?

DAVID WOOD: Terry, I've been a combat reporter for a long time, many, many years and I've covered a lot of wars, and most recently, of course, during the last 10 years, being embedded with combat troops in Iraq and Afghanistan.

I've seen people get wounded and it's always a terrible situation, very high-stress, ending, of course, with the helicopter coming in and taking them away in a big cloud of dust. And that's it and then there's silence. And I never knew what happened to these guys who were wounded. Where do they go? What's it like for them? What do they do? What happens to them?

And so, when I got the opportunity to really spend a lot of time tracking down the severely wounded and telling their stories, I leaped at it.

GROSS: For people who survive IED blasts, they're living with catastrophic injuries the likes of which people never were able to survive before. Would you describe some of the injuries that people are living with?

WOOD: Well, they are horrific injuries. IEDs are intentionally designed to create mayhem on the human body. For dismounted troops, especially, stepping on or over an IED when it explodes beneath you, it tends to traumatically amputate one or both limbs, legs. 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, very often there's a fireball that burns away the damaged flesh that's left.

GROSS: And you also say that as the blast erupts upward, it drives sand, dirt pebbles, bone fragments and barnyard filth deep into vulnerable soft tissue, leading I'm sure to, not only tears and ruptures but also horrible infections deep inside the body.

WOOD: It's a terrific problem for the surgeons who receive these severely wounded. Trying to clean out the wounds, trying to prevent infections, is often the first order of business. But you can imagine an IED is usually a plastic bucket full of explosives, buried not very deep, a foot or two under the dirt. And in Afghanistan, it is an agricultural society, so there's a lot of goats and other animals around. It's pretty filthy. When that erupts underneath you, it does drive that stuff deep into your body and it's hard to get out.

GROSS: And you say that because of the counterinsurgency strategy, more of our troops are on foot patrol in Afghanistan. So they're more likely to have this kind of stepping-on-an-IED injury.

WOOD: Yeah, under the strategy devised by David Petraeus, the retired general who used to be in charge in Afghanistan and Iraq before that, the strategy has been to put soldier and Marines out into the villages on a level with the villagers. And in that way secure their cooperation with the U.S. and Afghan government war aims.

The problem is that that does expose our troops to these IEDs, which are deadly.

GROSS: You described before how if you're walking over an IED, the explosion can sever your legs and your genitals. And you say that's the most disturbing war injury: the loss of both legs and genitals. Why would you describe that as the most disturbing, at the risk of asking the obvious?

WOOD: I am reflecting what soldiers say, and Marines. If you are in a platoon on patrol in Afghanistan that's the thing that they worry about the most, is losing their manhood.

The Army sent a team of doctors to Afghanistan earlier this year to talk to soldiers about these kinds of weapons, IEDs and the kinds of injuries. And one of the things that they reported back was that soldiers and Marines are signing do-not-resuscitate pacts, in the thought that if they lose their genitals, they don't want to live.

Now, I don't know how legally binding such a pact would be, but it does reflect a deep, deep fear among many troops that they will, in essence, lose their manhood.

GROSS: And I have to say you add up all these injuries, and then you add on top of that the probability of traumatic brain injury.

WOOD: Almost all of the severely wounded come back with traumatic brain injury. And 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.

It's often very hard for them to think clearly, to recall words, to do small problems, to remember things like to take their medicine and to make their appointments, and it's a real struggle.

Surprisingly, there's been so much advancement in physical medicine during this war, and we can talk about this later, it's only been in recent years that the military has even recognized traumatic brain injury as a combat wound. And it's pretty clear that no one really knows what the best treatment is.

GROSS: You write that triple amputees are becoming more common, and you profile one triple amputee. His name is Tyler Southern. Describe what happened to him.

WOOD: Tyler Southern was a Marine Corps lance corporal who served in Afghanistan, and in May of 2010 was leading a squad around the side of the house and stepped into an IED ambush. And one of the IEDs blew up underneath him.

It immediately tore off both his legs and his right arm and mangled his left arm. The corpsman who saved him told me he heard the blast and rushed around the side of this adobe building, where the IED attack had occurred. And Tyler Southern, what was left of him was lying in a crater, in a smoking crater.

He was bleeding heavily. The corpsman got tourniquets quickly on all three of his stumps, started an IV solution into him to - with what's called blood volumizer to try to keep his blood in him and did some other things: cleared his airway and put in a breathing tube and so forth.

That was the first combat casualty that corpsman had ever treated. He was 20 years old, a brand new combat corpsman, and he did a terrific job. He saved Tyler's life.

GROSS: So Tyler Southern arrived at the first place he was treated essentially dead. I mean, he'd flat-lined. He'd just about bled out. What did they do to save him?

WOOD: Well, this sort of illustrates the huge burden that's put on surgeons and surgical staffs in Afghanistan. The fact that battlefield medics can now save a lot of people on the verge of death means that some of the patients arriving at these intermediate care facilities in Afghanistan are virtually dead. And they have to do some extraordinary things to save these guys. In Tyler's case, he was bleeding so heavily, he was punctured all over his body, that they could not keep blood in him, and the blood was pouring out of him as fast as they could get it into him.

And in that case, the surgeons really focus on the brain: How do we keep the brain alive? And what they did in Tyler's case was as soon he came off the helicopter, and they rushed him into the operating room, which typically is in a tent, doctors slashed open 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.

That's an operation that is like the final Hail Mary, last-ditch, extremely dangerous, high-risk operation, and they're doing more of those kinds of things now because, as you said, many of these patients are coming in virtually dead.

GROSS: So Tyler Southern is brought back to life through this extraordinary treatment and all the blood transfusions, but he's still missing three limbs: both legs and one arm. So what shape is he in now?

(SOUNDBITE OF LAUGHTER)

WOOD: He's very active. It's hard to talk to him. In many cases, I went to Walter Reed to talk to him, and we met in the amputee center, which is basically a gym full of people trying out their new limbs, trying to run, practicing going up and down steps. And for lower-limb amputees like Tyler, building up their torso muscles because when you walk with two artificial limbs, you're basically using your torso muscles to power those legs.

Tyler would skip around, and it was hard to get him to stand still or to sit still to talk to him. He's an extremely active, very funny, very bright, very quick person and really goes to answer the question that I started my reporting with, and that was: OK, if these guys are so badly wounded, wouldn't it be better if they died?

And many, many people answered that question in the affirmative. I never met somebody who said no, I really prefer to be dead. You know, there was a nurse at one of the hospitals, a trauma nurse, who said: If you can save them, you do. And I said to her: Well, but, you know, what kind of quality of life would they have? And she said, in sort of a chiding tone: It's not up to us to define their quality of life. It's a very personal thing, and they decide.

All of the severely wounded that I talked to were upbeat and positive, and that's what gets them through this. It's such a life-changing experience. They get a lot of mental health counseling, therapy. It's a hard struggle. It's a struggle that will go on for the rest of their lives in most cases. But the ones that I've meet seem to be coming through it okay.

GROSS: One of the things I really love, you know, you have a series of videos on The Huffington Post website, where your reporting series is. And in a video of Tyler Southern, you see him working out at Walter Reed. And one of the exercises he's doing, he's taking the stump of one of his arms, and that goes into a sling that's attached to basically a weight machine, and so he's exercising his torso by exercising the stump of his arm. And it's not a very big stump, and it just made me think of how remarkable the human body is that, you know, he's still able to work out.

WOOD: A lot of the credit goes to the folks that design and fit the prosthetics.

GROSS: Absolutely. Absolutely.

WOOD: And I think it's pretty much acknowledged that the folks at Walter Reed are the world's experts in doing this, and they are so creative and ingenious. Their approach really to these amputees is tell us what you want to do, and we'll build you a prosthetic device that will enable you to do that. If you want to ski, if you want to mountain-climb, if you're a runner, if you - you know, we can fit you out on a bicycle. They told me of one amputee who said, in sort of a wistful tone, well, I used to play ice hockey. I'd love to play ice hockey. He's now got a prosthetic leg with an ice skate attached.

GROSS: Wow.

DAVIES: David Wood is senior military correspondent for The Huffington Post. We'll hear more after a break. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

DAVIES: Let's get back to Terry's interview with Huffington Post senior military correspondent David Wood. His series "Beyond the Battlefield" chronicles the treatment and rehabilitation of soldiers returning from Iraq and Afghanistan with horrific injuries. This note: their conversation does include some disturbing descriptions of battlefield injuries.

GROSS: You just told us an inspiring story about Tyler Southern, who returned from Afghanistan missing two legs and one arm and having a lot of other injuries, as well.

And he has prosthetics, he's working out, he's able to walk, and he's really upbeat. I mean, he describes himself as happy. I mean, it's a really amazing story. Not all the stories you tell, not all the people who return home catastrophically wounded are as inspiring. And I want you talk about the story of Jimmy Cleveland Kinsey II, and this is a Marine who got blown up in Iraq. Describe his wounds.

WOOD: Jimmy Kinsey was riding in a vehicle in Anbar province in Iraq that ran over an IED. It was blown up. He was badly injured but did not suffer traumatic amputation. He was medevacked back to the United States.

His case illustrates a problem that many of the wounded have, and that is that their limbs are so badly beat up that astonishingly bad things happen to them. One of the things is called compression syndrome, and basically it means that your limb swells inside the skin, and it's very hard to control.

The other thing is called ossification, and it's basically your body is, as I understand it, your body is so medically traumatized that it kicks off uncontrolled bone growth. And some of the wounded have described to me the feeling of bone growing inside a knee joint, for example, that feels like coral, sharp branch coral, and that's the way it grows.

DAVIES: Pain is a big problem for these guys, chronic pain. The Army has acknowledged that it doesn't do a good job in pain management. So they struggle with that. All of these things affected Jimmy Cleveland Kinsey. He was a good Marine, a fun-loving guy.

WOOD: I never knew him, but he's the kind of guy you'd like to hang around with. He got a lot of drugs to control the pain. His leg got worse and worse. After several years, they had to take it off, it got infected, and they just couldn't save it. That sort of set him into a depression. His drug addiction got worse. He got out of the Marines.

GROSS: This is his addiction to pain medication?

WOOD: Yes, pain medication and anxiety medication. It's such a difficult thing. People struggle and struggle with this. Jimmy was a strong guy, but in the end his wounds and the effects of them did him in. And he died in a PTSD clinic of an overdose of fentanyl, which is a very, very powerful painkiller.

GROSS: And if I understand correctly, nobody knows for sure whether that was an intentional overdose or an accidental one.

WOOD: It's not really clear. But what is clear is that like many of the wounded, he volunteered to serve his country, went to a distant place, got blown up, came back and for a variety of reasons did not get the care that he needed. And his family feels that the country really let them down and let him down, that he should've been taken better care of.

GROSS: Now, as part of your series "Beyond the Battlefield," you write about how the military and the VA medical system weren't prepared for the number of injuries, the duration of the wars in Iraq and Afghanistan, and the terrible wounds that people are returning home with. And it's also been very difficult for veterans returning home and for the medical advocates to get the kind of care that they need sometimes, not always but sometimes. What are some of the problems that wounded vets are up against now?

WOOD: The Veterans Administration is an amazing place. They do a lot of great stuff and almost everyone I've met there has been just so smart and creative and dedicated. I really 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 catch up on, not always successfully. A lot of veterans have difficulty getting services. The wait times sometimes are very, very long. Things got so bad that earlier this year a federal appeals court in California ruled that the Veterans Administration was denying veterans their constitutional rights by not providing good services on time.

GROSS: Is there an effort to change that?

WOOD: Yeah. Because there's so many gaps in what both the Defense Department and the Veterans Administration can do for veterans, there are a huge number of nonprofit private organizations that help out, and we list them on our website at the Huffington Post. Veterans could not get along without these private organizations and they do great work. And one of the purposes of writing this series that I've done is to try to get people aware of the needs and really to encourage people to get involved.

DAVIES: David Wood is senior military correspondent for The Huffington Post, where you can find his series "Beyond the Battlefield." He'll be back in the second half of the show. I'm Dave Davies and this is FRESH AIR.

(SOUNDBITE OF MUSIC)

DAVIES: This is FRESH AIR. I'm Dave Davies sitting in for Terry Gross. Let's get back to Terry's interview with David Wood, a veteran war reporter who is now a military correspondent for The Huffington Post. His series "Beyond the Battlefield" was published earlier this fall and is available online at The Huffington Post. You can also link to it on our website, freshair.npr.org.

The series is about troops who've returned home from Iraq and Afghanistan with catastrophic injuries caused by IED's, horrific injuries like multiple amputations and ripped off faces. Terry spoke with Wood last month.

GROSS: Now another soldier who had his face blown off is now doing some standup comedy. How did he get from, basically having no face, to going before an audience and doing standup?

WOOD: Well, you're referring to Bobby Henline, who was a sergeant in the 82nd Airborne, who was blown up in Iraq in a Humvee in which there were five paratroopers riding. He was the only one to survive. And when he started to recover, he told me look, I'm not a terrifically religious guy. I, you know, I don't believe in all this stuff, but you can't go through an experience like that, being the only one out of five people who survived without thinking why did I survive?

(SOUNDBITE OF LAUGHTER)

WOOD: What of my supposed to do, because those four guys, my buddies, are watching, saying you better do something with this opportunity. And he said it was so clear to me, God wanted me to do something but he didn't tell me what it was. And it was several years before Bobby was convinced to try to take his humor public.

I should say that Bobby Henline's face was just about completely burned off and he hasn't had a lot of cosmetic surgery. And he's pretty shocking to look at, which he freely admits. He didn't like being stared at, and he would often smile and make a joke in an attempt to get people to, sort of, approach him as a person. You know, he's like many of these veterans - proud of his wounds. These guys volunteered, sacrificed, survived and their wounds, their scars are visible sign of their sacrifice and they want to be acknowledged; they're proud of them.

And so Bobby was looking for a way to say, come talk to me, I'm a human being. And the way he found was comedy. And he started to do standup comedy, and it was a - I think it was kind of a painful beginning. He made a few jokes about his face. People didn't quite know how to react. Are we supposed to laugh? And how do we - what do we do here? But his comedy sort of won people over and now he does a lot of standup comedy.

We went to Fort Jackson, South Carolina where he was doing his standup act during a concert - a benefit concert - for wounded troops. And it was so interesting to watch him come out on the stage and there were probably 3,000 young soldiers there. Fort Jackson is a place where they do basic training, so these were young soldiers.

And he came out on the stage and it was kind of a hushed silence, and he started doing his routine. And in about 30 seconds those soldiers were just - they were weeping with laughter. They were just absolutely out of control and he's very, very good at this.

GROSS: So let's hear a short clip of Bobby Henline performing before troops.

ANNOUNCER: Ladies and gentlemen, please welcome Bobby Henline.

(SOUNDBITE OF APPLAUSE)

(SOUNDBITE OF CHEERING)

BOBBY HENLINE: I usually walk out and I'm quiet. I kind of look at the crowd. Let them take it in. And I tell 'em, you should see the other guy.

(SOUNDBITE OF LAUGHTER)

HENLINE: I did four tours in Iraq. You know, I love my job. I tell you, I would do it again. I had a great time. But for real, that last tour, was a real blast.

(SOUNDBITE OF LAUGHTER)

HENLINE: And if I continue to do this and I help people the rest of my life and I help better them, then that's the best revenge I can get on this guy that did this to me and my buddies because I will help more people than he will ever hurt.

(SOUNDBITE OF CHEERING)

GROSS: That's Bobby Henline, performing before troops, and his face was blown up in - was it Iraq or Afghanistan?

WOOD: It was Iraq.

GROSS: One of the horrible statistics you have in your series "Beyond the Battlefield," is that 18 vets kill themselves every day, that figure includes Vietnam veterans.

WOOD: Yes it does.

GROSS: It's an appalling statistic.

WOOD: It is appalling, but one of the things that we as a country are learning, is that people who are wounded in war are wounded forever. And even though there are many cases like Tyler Southern, people who seem to almost thrive on the challenge of their new life, even for Tyler Southern, he'll be dealing with his wounds for the rest of his life. They don't go away. The other thing we're learning is that PTSD does not appear very often, does not appear immediately, but months, years or even decades later.

GROSS: So when a soldier comes home and needs long-term care that affects the family very directly. And, you know, wives, husbands, parents often become full-time caregivers. And there's been a movement from the family caregivers to have that recognized with payment. Because for a full-time caregiver, you can't go to work, means you've given up your income. So where does that movement stand now?

WOOD: The Veterans Administration finally agreed to recognize and compensate mostly spouses - sometimes mothers - who are suddenly thrust, with no preparation, into this role of being a full-time caregiver. You can imagine if you are married to a soldier who is a very active and, sort of, high adrenaline person who suddenly comes home as a triple amputee or a double amputee, or someone with severe PTSD and traumatic brain injury. It's a huge burden to take care of that person. Even those who, injured people who can walk and even drive a car, very often their traumatic brain injury means that they can't remember when to take their medicine or they can't remember how to get to the doctor's office. And so it's a full time and draining kind of role.

GROSS: So what's the compensation going to be like?

WOOD: The Veterans Administration will now train full-time caregivers in whatever they need, basically - how to give injections, how to deal with a person's PTSD, how to deal with a person's anger and violent outbreaks and other mental health and physical problems. Very importantly, they will give them a stipend and two weeks of paid vacation a year - I think it's two weeks - so that that caregiver can get away and go sit by the ocean and do nothing, because it's such an intensive job taking care of a traumatically wanted person.

GROSS: Now, it's so interesting to me. You are Quaker by birth and by wish you are a conscientious objector. I mean that's your position. Yet you spent 35 years putting yourself in war zones to cover wars, to report on wars. Why if you're opposed to war have you voluntarily put yourself in the middle of war zones for so long?

WOOD: 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 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, for example, on our behalf. Most of us have sat this war out. I want them to know what it's like and who's in the middle of it and what the consequences are. Beyond that, I don't really have an agenda. That's - but I think that's really important, especially in a democracy. And we do conduct wars and most of us don't participate. But we need to know who is doing it and what it's like for them.

GROSS: I wish you well. Stay safe and healthy, and thank you so much for the series and for this interview. Thank you.

WOOD: Thank you, Terry.

DAVIES: David Wood, speaking last month with Terry Gross, about his Huffington Post series "Beyond the Battlefield." You'll find links to his articles and a video profile of veteran and triple amputee Tyler Southern on our website, freshair.npr.org.

Coming up on today's Veterans Day show, the Bay State Winds, the clarinet Quartet of the Air Force Band of Liberty. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

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