Rebuilding Bodies, and Lives, Maimed by War

http://www.nytimes.com/2003/11/16/national/16WOUN.html?hp

November 16, 2003
Rebuilding Bodies, and Lives, Maimed by War
By NEELA BANERJEE

WASHINGTON, Nov. 10 — Every hour of every day for the last four months,
Robert Acosta has thought of the moment when the grenade slipped from his
fingers.
In the early evening of July 13, Specialist Acosta, of the Army's First
Armored Division, was riding in the passenger seat of a Humvee toward the
gates of the Baghdad airport. Something entered through his window, flew
by his face trailing a ribbon of smoke, hit the windshield and landed next
to the driver.
Specialist Acosta grabbed the grenade with his right hand, but as he
turned to throw it out the window, he dropped it between his legs. He
picked it up again. Somewhere between his ankles and knees, the grenade
exploded in his hand.
"It was gone, it just disintegrated," he said of his hand. "It was just a
mist of blood."
The driver of the Humvee was unhurt. Not only did the blast destroy
Specialist Acosta's hand, it also shattered his legs, the left one now
mended with a steel plate and skin grafts and the hole in his heel almost
closed. In place of his right hand and part of his forearm, he wears a
prosthesis that ends in a two-pronged claw.
"I think I should be dead right now," the 20-year-old Specialist Acosta
said one recent afternoon, resting from doing pull-ups in physical therapy
at the Walter Reed Army Medical Center here. "But I feel like I failed
myself. If I hadn't dropped it, I would still have my hand."
Reminded that he had saved his friend's life, Specialist Acosta stared
straight ahead and kept silent.
More than 6,800 have been evacuated from Iraq for medical reasons,
including disease and "nonbattle injuries," the Army said.
[By Friday, the Defense Department said, 1,994 had been wounded in action,
with 342 more injured. The dead totaled 399, with 272 from hostile action.
At least 18 more soldiers were killed and five wounded in Iraq yesterday.]
Some of the most seriously wounded come through Walter Reed.
Thanks to advances in everything from flak jackets to battlefield medical
attention, many soldiers survive attacks that would have killed them a
generation ago. But as more survive, more inevitably return from Iraq with
grievous injuries, including amputations. Already, 58 amputees have been
treated at Walter Reed, 47 with major single-limb removals and 11 with
multiple-limb amputations.
For all the numbing similarity of the ambushes with rocket-propelled
grenades and roadside bombs that wounded the soldiers now at Walter Reed,
each has begun to piece his life back together in a different way, into a
shape he never expected.
There is Staff Sgt. Ryan Kelly, a reservist from Abilene, Tex., who is
determined to become a firefighter as he had planned. There is Specialist
Edward Platt of Harrisburg, Pa., who focuses his hope and unremitting
anger on the use of a prosthetic leg he has just received. And there is
Specialist Acosta of Santa Ana, Calif., who plays practical jokes on
hospital staff members yet remains haunted by regret.
When soldiers are ambushed in Iraq, they are rapidly evacuated, their
vehicles quickly towed and their plight boiled down into the day's tally
of dead and wounded.
"When we get injured, all it says is `one soldier wounded,' " Specialist
Acosta said, echoing others at Walter Reed. "Not that a soldier has lost
an arm or a leg, or how hard that is."
The wounded stay at first in the main hospital building at Walter Reed,
its Greek revival campus about eight miles north of downtown Washington.
Once the threat of infection and the need for serious surgeries have
passed, they go home for several weeks before returning to a hotel on the
Walter Reed campus called Mologne House, while continuing rehabilitative
therapy at the hospital.
The wounded from Iraq tend to gravitate toward each other and to memorize
each other's stories. They are comforted to find others who knew towns
like Hilla, Ramadi and Tikrit and who lost a part of themselves on some
identical, stunningly hot Iraqi day.
"I hate this place so much, but all these guys, we form a bond,"
Specialist Acosta said. "Talking to Vietnam vets, that's cool. But it's
not like talking to someone who's been through Iraq."
The wounded from Iraq have changed the population at Walter Reed, hospital
staff members said, from retirees with chronic ailments to young men and a
few women — many under 25 — often with limbs missing.
"We have a greater demand, so we have had to hustle a bit, ramp up staff,"
said Joseph Miller, the chief prosthetist at Walter Reed. "And the nature
of the patients, too, is different. They're younger and they want to get
moving more quickly."
Specialist Platt's Ordeal
A soldier with the Army's 101st Airborne Division, 21-year-old Specialist
Platt enlisted right after finishing high school in Harrisburg in June
2001. His parents had been in the Air Force, and he had loved living in
Germany as a child.
"I liked the military, and it was a guaranteed paycheck twice a month," he
said. "There's not that kind of guarantee anywhere else these days."
By January 2002, Specialist Platt's unit was in Afghanistan, and talk
began almost immediately that it would be deployed to Iraq next. "We were
in Operation Anaconda, and we landed in Chinooks and we got attacked," he
said of a mission in Afghanistan. "But no one got hurt, and I think
everyone took it for granted that it would be the same in Iraq."
After his unit entered Iraq in the spring, it went north to Mosul. On
Sept. 23, a rocket-propelled grenade near the Syrian border tore away
Specialist Platt's right knee and the top of his shin, but a flap of skin
and muscle along the back of his leg still attached his thigh to the lower
leg and foot.
"I could still wiggle my toes," he said.
Specialist Platt arrived at Walter Reed with his lower leg, but after
realizing that surgical reconstruction would very likely fail, he decided
in early October to have the leg removed a few inches above the knee.
"Like my mom said, the leg isn't what made me a man," Specialist Platt
said.
To prove his point, he fiercely pursues rehabilitation, and his recovery
so far has been impressive, hospital therapists said. He knows he is lucky
that his wound is not worse: unlike him, many amputees have secondary
injuries like burns, blindness, deafness, splintered bones in an intact
limb, smashed internal organs. At an occupational therapy session early in
the week, between criticizing the 70's rock on the radio and talking about
the latest additions to his 30 pairs of shoes, Specialist Platt hopped on
his left leg along a Foosball table and handily defeated nearly all
comers.

-- continued --

One Thursday afternoon, though, Specialist Platt growled quietly through
his occupational therapy. The day before, he had taken his first halting
steps on his new prosthetic leg: a sleek silver bone of titanium and
carbon fiber with a microprocessor in the knee that recalibrates the gait
50 times a second. The devices cost $60,000 to $100,000. Immediately,
Specialist Platt wanted to use his all the time.
Yet therapists at Walter Reed insist that soldiers begin using their
prostheses gradually, so their bodies can adjust to the change, a notion
Specialist Platt understood but could not reconcile himself with. He had
been waiting so long for this: the chance to run and snowboard again; to
argue with someone who might criticize him for parking in a handicapped
spot because he would not look handicapped; to stroll through the mall
without getting stares.
Maybe a leg did not make him a man, but the prosthesis seemed to give him
hope that he could take back a life that had been stripped away.
The next day, about six soldiers, including Specialist Platt, went on an
outing organized by the physical and occupational therapists to a bowling
alley at the Bethesda Naval Base in nearby Maryland. The soldiers divided
into two teams: arm amputations versus legs.
The bowling did not vex them as much as the temperamental electronic
scoreboard, except for Specialist Platt, who wore his prosthesis but still
leaned on his crutches. "I'm a very good bowler," he said. "I want to
throw my curve, but I have to get into moving and grooving."
The first time, the curve was a gutter ball. The second time, a strike.
But the ball would not be controlled and Specialist Platt was still wobbly
on his new leg. After a few rolls, he left the game.
"He's coming to terms with the loss of his leg," said Isatta Kanu, 29, a
physical therapist's assistant who had helped Specialist Platt bowl. "He
used to be a soldier, a killer, an athlete, and now he's reduced to this."

"I think Ed is determined," Ms. Kanu continued, "but in a stubborn way, in
that he wants to do it on his own. I think those who are more successful
get help from others. It's hard for a young guy. He may not be conscious
of his anger. They weren't bargaining for this: to be 19 or 20 years old
and disabled."
A television behind Ms. Kanu was showing the news. The soldiers fell
silent as they saw videotape of the Blackhawk helicopter that had been
shot down in Tikrit that day, killing all six servicemen aboard. "How can
they say the war is over?" Ms. Kanu said. "It's not over."
Feeling Guilt Despite Wounds
When Specialist Acosta and his friend Specialist Cory McCarthy from
Gilroy, Calif., went to their homes for a few weeks recently, people
regularly asked them, is the war over?
"No," Specialist McCarthy said.
"No," Specialist Acosta said.
The two men were flopped on beds in Specialist Acosta's room at Mologne
House, one night, smoking cigarettes. Specialist Acosta lay on pillows
that hid his amputated arm. On television, professional wrestlers feigned
rage and pain.
"We went over there for a good cause: to push Saddam out," Specialist
Acosta said.
"But it backfired," he continued. "We're still there, and all these
soldiers are still getting killed. We hadn't prepared for it. I really
feel bad for the soldiers that are still over there and their families."
Specialist McCarthy, with the 173rd Airborne, said: "That's a big reason
we all want to go back to Iraq. We're sitting over here with hot food and
A.C., and there, you were lucky if you had power, and you just want to be
back there sucking with the rest of them."
Specialist Acosta said, "That was a big thing at the beginning: guilt."
After the last Marlboro burned away, Specialist McCarthy went downstairs
for more cigarettes. His right hand was mangled by a roadside bomb in
Ouja. Part of the cast around his fingers had just been taken off. "I can
finally scratch my head again," he said, smiling and doing so and then
putting on his sneakers. Specialist Acosta watched every turn of his
friend's hand, the twitch of his fingers.
A hierarchy of injury subtly governs relationships at Walter Reed,
defining the respect and empathy the wounded show one another. Specialist
Acosta said he never knew what pain truly was until his legs were broken.
His hand, he said, felt only like it had gone to sleep.
In nearly every room of Walter Reed, a pain rating scale is taped to the
wall, giving people a vocabulary for the ineffable. Ten is the worst. The
scale also offers more subtle shadings, from pain that is cutting to one
that is raw, burning, stabbing.
"I talked to this guy the other day and I asked him why he was here, and
he said, `Stress.' " Specialist Acosta said. "Stress? I told him he was a
coward and just walked away."
In his friend's absence, Specialist Acosta changed the dressing for his
left foot, tearing open packages of gauze with his teeth. "I bet I still
can't move my toes."
But then he flexed them ever so slightly against his left palm. "Cool," he
said.
When he was first wounded, Specialist Acosta could still feel his right
hand and its phantom fingers move. Now he feels as if his hand is balled
into a fist.
A Wife Who Understands
One evening, Sergeant Kelly and his wife, Sgt. Lindsay Kelly, were packing
to leave Mologne House for two months, and procrastinating. The real
world, as they call it, is welcoming but scary. They need a new car,
because the one they have is a stick shift, which is hard for Sergeant
Kelly to drive with his prosthetic right foot. The stairs to their
second-floor apartment in Abilene will be tough to negotiate, at first.
They say they have already heard the dumb questions that nearly all
soldiers get: whether they killed anyone, and, what did it feel like? But
Sergeant Kelly, 23, may be better off than other soldiers. He is much more
accustomed to his new right lower leg, a Cadillac of a prosthetic that
will let him run again and perhaps be a fireman someday. His wife served
in Iraq, too, and so, understands what her man has been through.
Sergeant Kelly does not obsess about the attack. He refuses to go it
alone, relying on his wife and an amputee support group that meets twice a
week at Walter Reed. He seems to understand that his recovery extends far
beyond the mechanics of his leg.
Only in the quiet before sleep, when the ringing in his ears from the
blast trembles loudest, does the old fear rise in him again.
Sergeant Kelly and his wife, 21, were both in Iraq as civil affairs
officers with the 490th Civil Affairs Battalion, she in Baghdad and he in
Ramadi. On July 14, a group of seven from Sergeant Kelly's unit left the
base just after dawn in two Humvees for a health and education conference.
The convoy came under attack as it neared Baghdad.
"I don't remember a blast," Sergeant Kelly said of the roadside bomb. "It
was a gorgeous morning, that time when it's still cool. Then everything
went black for a second, like when your TV goes out, and then the film
comes back.

-- continued --

"I couldn't hear anything but a loud tone," he said. "The Humvee filled
with dust and this smell, this smell that I can't describe. And the blood.
The windshield was shattered, and we went from 70 to 40.
"I was knocked backward and I tried to use my foot to get back up and it
felt like there was nothing under my foot, like there was a hole in the
floor of the Humvee, and I pulled back my foot and I couldn't see it, the
way it was hanging.
"I looked at Zayas, the driver, and there was blood all over his face and
I said, my leg is gone," Sergeant Kelly said. "My leg is out on the road
back there. I switched my weapon to fire and emptied it. I was scared out
of my mind and furious at the same time."
Sergeant Kelly said he joked with the soldiers who evacuated him, though
he knew he would probably lose his leg, which dangled by a strip of skin.
Finally, at the military hospital, he wept, he said. First, when the nurse
pulled back the covers to show him his bandaged wound. And then, when his
wife arrived.
"I knew it would be hard for Lindsay," he said, smiling at her while she
sat on the bed looking back at him. "If I was a wreck, it would be hard
for everyone."
Once her husband was on his way to Walter Reed, Mrs. Kelly went back to
work in Baghdad, angry at first at the Iraqis. "There was a female
interpreter I had worked with for five months and we had become pretty
good friends," she said. "When I got back, she had bought us a gift.
Before she could give it to me, she started crying. They hadn't even met
him — " Her voice caught suddenly on the memory.
Sergeant Kelly said, "Out of the blue about a month ago, I got an e-mail
from an Iraqi man I knew in Ramadi who was kind of an unofficial
interpreter, saying he was real sorry for what happened and hoped I was
doing O.K."
The smile stayed on Sergeant Kelly's face, but his color rose. Still in
the shadow of that morning four months ago, he chose now to look at the
small kindness that had washed toward him. He bowed his head and swiped
the back of his hand across his eyes. "It's not losing the leg that gets
me," he said, "but what people then do for you after."

Copyright 2003 The New York Times Company