Two Iraq Vets Learn to Live with Brain Injury Advances in combat medicine have helped more injured troops -- even those with severe head trauma -- survive their wounds. Jason Margolis of member station KQED profiles two young Iraq War veterans who suffered serious brain injuries and are now learning to live with their conditions as civilians.

Two Iraq Vets Learn to Live with Brain Injury

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This is DAY TO DAY. I'm Madeleine Brand.


And I'm Alex Chadwick.

Since the wars in Afghanistan and Iraq began, more than 1,000 troops have been treated for traumatic brain injuries. A year ago, we brought you the story of two young men, one a U.S. Marine, the other a soldier, who both suffered head wounds in Iraq.

BRAND: At the time they were at the V.A. hospital in Palo Alto, California. Both were in the critical first few months of recovery. Recently, reporter Jason Margolis of KQED visited them, and he has this update on their progress.


In December of 2004, then 21 year old Eric Castillo was emaciated, thin and weak. The right side of his forehead was missing; it had been blown off by shrapnel during the summer of 2004, while he was serving with the Army in Baghdad. He'd lost control of much of the left side of his body. This is what Castillo sounded like then, speaking from his hospital bed.

Mr. ERIC CASTILLO (Iraq War Veteran): I can't move my arm or my leg like normal. So that means I can't do just regular stuff, like I used to walk, grab things with my left arm. Just normal stuff.

MARGOLIS: Today Castillo is a different man.

Mr. CASTILLO: I do different types of things. I go to the malls sometimes. Sometimes I watch movies in the theater.

MARGOLIS: Surgeons applied prosthesis to Castillo's skull, which now appears rounded and normal. His right eye still looks upward and can't align with his left. But he's walking again with the assistance of a cane. He makes his own meals and lives with his brother in a Phoenix apartment. His body appears robust. He's put on 75 pounds in a year. Today Castillo goes to an outpatient rehab center five days a week.

On most days, Castillo walks on a treadmill for 30 minutes to build up his strength. His physical therapist, Willy Jacovini(ph), manipulates Castillo's left leg to mimic a smooth walking pattern and improve muscle memory. Castillo begins walking one mile per hour. The speed gradually increases, topping out at two.

Mr. WILLY JACOVINI (Physical Therapist, V.A. Hospital): How's that feel, Eric?

Mr. CASTILLO: Good when you help me.

Mr. JACOVINI: Okay, good. It looks good. It looks really good.

MARGOLIS: For a person with a traumatic brain injury, the first six months to two years are considered the period of spontaneous recovery, when progress is most pronounced. Castillo is at the tail end of this window. He says he feels stronger and is pleased with his improvement. But he's still angry about what happened to him.

Mr. CASTILLO: I miss the physical activities I use to do that I'm not able to do now.

MARGOLIS: You use to run a lot?

Mr. CASTILLO: Run, lift weights, play basketball. Just, I guess, normal stuff, which I can't do now. I've been pretty much frustrated with my progress 'cause it's not quick enough.

MARGOLIS: Besides physical therapy, Castillo also works with neuropsychologists and occupational therapists who help him adapt to his limitations. Castillo's occupational therapist, Kathy Vanderworp(ph), says it's extremely important for patients like Castillo to develop a sense of their new self, what's normal for them now. Part of Castillo's therapy is to take him out into the community.

Ms. KATHY VANDERWORP (Occupational Therapist, V.A. Hospital): Just to a shopping center, just so he learns how to maneuver around with crowds, and get use to having other people look at him. That's a huge component of it, because he's different. He's disabled.

MARGOLIS: Right now, Vanerworp and Castillo are trying to figure out what he'll do next with his life. Will he go back to school? Get a job? And what type of job could and should that be? For Castillo, the blast in Baghdad mainly injured the part of the brain that controls his motor skills. His decision-making and reasoning abilities are largely intact.

Twenty-four year old former Marine Raymond Warren's injury was different. His motor skills are fine but his frontal lobes, the part of Warren's brain that deals with decision making, higher order thinking and empathy, were impaired. He finds it difficult to summarize his thoughts. In this tape from 16 months ago, Warren works on a problem solving drill with speech pathologist Janice Hargadon(ph).

Ms. JANICE HARGADON (Speech Pathologist): You sign up for a class, but you change your mind about it. What would you do?

RAYMOND WARREN (Iraq War Veteran): I go to the class?

Ms. HARGADON: So you decide you don't want to go to the class.

Mr. WARREN: Yeah.

Ms. HARGADON: Okay. So then what would be the best solution to take in taking care of that?

Mr. WARREN: Find another class that I like?

MARGOLIS: Exercises like this have greatly improved Warren's memory and decision making; essentially, it's like rebuilding a muscle. Warren also uses techniques therapists taught him to work around his deficits, such as keeping to a schedule or writing down reminders. Warren says he's slowly getting his life back.

Mr. WARREN: The day I got my car, I was like yeah! I don't have to wait on the bus.

MARGOLIS: Warren drives his Mitsubishi Galant listening to hip hop music and lip synching the words. His seat is reclined way back. We drive to his new job at a deli where he prepares food. Warren says he likes his job and the feeling of being productive. He hopes to become a chef. But he says dealing with people, like when he's taking orders, can be frustrating. When questions or statements start coming at him too quickly, it overwhelms him.

Mr. WARREN: If someone says something, I don't really understand it, I'll ask him to repeat themselves more slowly so I can contemplate it and think about it real quick, and then answer the question. It's just not like it use to be, where like, oh they say something and I'm like bam, bam, bam.

MARGOLIS: This can also be frustrating for his family. Warren's little brother, 18-year-old Randall, describes a recurrent scene at their home.

Mr. RANDALL WARREN (Brother): I asked him did mom make dinner? And he went, What? And I went, Did my make dinner? And he went, What? And I was like, Did mom make dinner? And he went, What? And was like, oh, my God, dude, did mom make dinner? And he was just like, and he was like, No. And he got all mad. I was like, Okay, you could have said no like the first time I asked you.

MARGOLIS: Ray Warren's neuropsychologist, Harriet Zeiner(ph), says this type of interaction is common. Zeiner says Ray Warren becomes socially embarrassed and irritated that he can't keep up with his little brother. And Zeiner says the hard reality is that he'll never be able to.

Dr. HARRIET ZEINER (Clinical Neuropsychgologist): One of the things people ask me is, oh, isn't it depressing to work with people who have head injuries, because they're not going to be the same? And one of my answers to that is no, it's actually an amazing field to be in because what you find is how resilient the majority of human beings are.

MARGOLIS: Zeiner says for both Eric Castillo and Ray Warren perhaps their biggest challenge will be accepting who they now are.

Dr. ZEINER: They have to reinvent themselves and sort of stretch the boundaries of self to incorporate handicaps and disabilities, and still feel okay about who they are and feel that life is meaningful and that they have a contribution. And the majority of people can do that.

MARGOLIS: Castillo and Warren's conditions will continue to improve. But the period of dramatic recovery is ending. Doctors say they want young men like these to have hope for a better future, but not a false hope that traumatic brain injuries can be completely overcome. As Warren and Castillo adapt to this new reality, both men say in the end they still want what we all want, to meet somebody, fall in love and settle down.

For NPR News, I'm Jason Margolis.

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