The War Comes Home
By RICHARD LARDNER The Tampa Tribune
Published: Feb 18, 2007
http://www.tbo.com/news/metro/MGBCSGJVAYE.html
In Tampa, thousands of miles from the furious fighting in Baghdad and dozens of
other towns and villages, the difficult business of repairing the physical and
emotional damage caused by the war in Iraq takes place.
On any given day, more than a dozen of the most severely wounded troops are
being treated by doctors, nurses and therapists at the James A. Haley VA Medical
Center, home to one of four polytrauma centers in the nation. Since late 2001,
nearly 3,500 troops have received care here.
Often these are patients with multiple and serious injuries, each one bringing a
special set of challenges to them and their caregivers. Given the damage to body
and mind, there are no minor successes. Swallowing, talking, walking - the
basics of life - can be major milestones. But the staff at Haley is as practical
as it is positive.
"Rehabilitation is a lifelong project," said Steven Scott, chief of the
polytrauma unit.
TAMPA - Lee Jones can tell you the sound the roadside bomb made when it exploded
near his Humvee. He can tell you how he rolled on the ground to put out the
flames that would leave nearly half his body terribly scarred. And he can tell
you he was the only soldier in the vehicle who lived.
But ask Jones a question requiring an answer with a date or time, such as when
he enlisted in the Army, and his memory blurs. He stutters, stops and then
begins to count out loud, an exercise that helps him visualize the correct month
and year.
"May 2001," announces Jones, who was three weeks into his third deployment to
Iraq when he was injured.
The power of the blast that disfigured Jones also resulted in a series of
strokes that produced other problems, including aphasia, a disorder that makes
it difficult for him to turn thoughts into words.
For more than a year, Jones has been recovering at the James A. Haley VA Medical
Center, where doctors, nurses, psychologists and therapists are continually
discovering more about the damage done by improvised explosive devices, the
signature weapon of the Iraq war.
The external wounds are hard to miss, but the internal injuries, especially to
the brain, are as complex and life-changing.
At 24, Jones, born and raised in Fayetteville, N.C., is learning again how to
talk, to read, to drive and, ultimately, to care for his wife and 17-month-old
daughter.
Caregivers at Haley marvel at the progress he has made since Oct. 3, 2005, the
day an improvised explosive device ripped apart the vehicle he was riding in
northwest of Baghdad. Three of his Army buddies were killed, including Pfc.
Roberto Baez, a 19-year-old Alonso High School graduate.
Baez was driving. Jones sat beside him in the front passenger seat.
When Jones came to Haley from a military hospital in Texas, "he couldn't even
swallow," said Steven Scott, the affable and unfailingly optimistic director of
the hospital's Polytrauma Rehabilitation Center.
Jones has been an outpatient for the past four months. Medically retired from
the Army, he works part time at the hospital delivering mail, a job that gives
him a sense of independence and a $200 paycheck every two weeks.
But Scott acknowledged Jones will never fully recover.
"He'll never be like he was," Scott said. "But that's true of a lot of head
injuries."
While IED is a new term in the dictionary of war, blast injuries have existed
since armies began using explosives in increasingly potent combinations. In
decades and centuries past, however, the most severely wounded died on the
battlefield long before reaching the doctors who could save them.
Outfitted with body armor, Kevlar helmets, armored vehicles and other protective
gear, today's wounded troops are surviving in far greater numbers than before.
On average, they receive high-quality medical care within 30 minutes of being
injured. During World War II, this so-called "golden time" was six hours.
Paradoxically, doctors are grappling not only with the enormity of the wounds
caused by homemade bombs but also the variety. One patient may have a severed
limb, a head injury, hearing loss and third-degree burns. Another may have a
damaged spinal cord, blurred vision, broken bones and collapsed lungs.
And there's always the enormous emotional upheaval for patient and family.
"One blast has multiple ways to hurt you," said Scott, who doubles as Haley's
chief of physical medicine and rehabilitation.
With more and more blast survivors returning home, two years ago the Department
of Veterans Affairs established four Polytrauma Rehabilitation Centers to handle
the extended care needed by the most seriously wounded troops. The others are in
California, Minnesota and Virginia.
The center at Haley generally accepts patients with hometowns in the Southeast,
although there are no geographic restrictions.
Since the fall of 2001, Haley has treated almost 3,500 troops wounded in Iraq
and Afghanistan. More than 200 of those have been admitted as inpatients. A stay
can last as little as a few weeks or as long as a year, depending on the extent
of a patient's injuries.
"What we want them to do is to return to as much functionality as possible,"
said Edward Cutolo, Haley's chief of staff.
Some come in on gurneys and walk out on their own. Others will be in wheelchairs
for the rest of their lives.
Families often follow and stay with relatives or at the Haley House, a hotel
near the hospital that provides rooms paid for with money raised by local
veterans groups. Operation Helping Hand, another volunteer initiative, supplies
family members with dinner coupons, movie tickets, rental cars and cell phones.
'One Day At A Time'
To spend just a few days at Haley is to see the war brought home. On Monday,
Army Sgt. Brad Gruetzner was in a wheelchair being pushed along a second-floor
corridor by his wife, Rachel. His 2-year-old daughter, Brayden, sat on his lap
and played with a pink plastic toy.
"Where's my owie?" Gruetzner asked Brayden. She carefully touched his right arm,
bandaged heavily where the hand used to be.
Gruetzner, 25, has the alarming catalogue of injuries the Haley staff has become
so accustomed to seeing. The loss of a limb was accompanied by head wounds,
burns, infections and broken bones in his back.
Gruetzner has been at Haley since mid-January. His first stateside stop was
Brooke Army Medical Center in his home state of Texas. Others come by way of
Walter Reed in Washington or Bethesda Naval Medical in suburban Maryland. On any
given day, there are 12 to 19 polytrauma patients at Haley.
"I'm just taking it one day at a time," Gruetzner said. "I don't know what the
future holds."
In November, a little more than a month into his second Iraq tour, Gruetzner was
traveling in a Humvee north of Baghdad when an IED detonated. The explosion
produced huge flames, fueled, he would learn later, by a bottle of oxygen
attached to the bomb.
"Now I'm part of the Army video they don't show you on television," he said. "I
didn't think it would be me, but here I am."
A Delicate Balance
As Rachel Gruetzner wheeled her husband to lunch, Scott, in his perpetually
upbeat way, emphasized how much the young soldier's condition has improved in
recent weeks.
But blast injury patients hang in a delicate balance, Scott quickly added, both
emotionally and physically. They can be stable and seemingly on the upswing one
day and in critical condition the next.
The amount and speed of a patient's progress depends primarily on how badly the
brain has been damaged.
"It's like a train," Scott said. "If the engine doesn't work, the cars and the
caboose won't follow."
In a PowerPoint briefing he gives to visitors, Scott dissects the impact of the
blast from an IED. As the bomb goes off, air molecules compress, creating a
sudden and punishing wall of wind moving hundreds of miles per hour.
"It's your worst hurricane times five," he said.
After the initial blow comes flying debris and "displacement," the technical
term for being thrown from one place to another. If the attack happens in an
urban area, falling structures heighten the chance for further trauma to brain
and body.
With the ability to think and to memorize so important to rehabilitation, a
cognitive patient is much more likely to recover than one who is not, Scott
said.
For a patient with a traumatic brain injury, putting on shoes is an enormous
task. If that patient has lost a leg, learning to move with a prosthetic becomes
overwhelming.
"The simple becomes complex," Scott said. "Just walking becomes a multitask
event. It becomes his life."
Small Steps
Before being wounded, Jones was assigned to the 82nd Airborne Division out of
Fort Bragg, N.C., one of the first-to-fight units that make up the tip of the
American military spear.
Ask Jones what his job was with the 82nd, and he has no trouble delivering that
answer: "11 Bravo," he says proudly, using the Army's nomenclature for an
infantryman.
The demands of Army life have been replaced with a different set of challenges.
At Haley, his days are spent visiting doctors and therapists whose collective
goal is to wean patients such as him from lives of dependence.
Kim Floore, a kinesiologist at Haley, is his driving instructor. The lessons
take place indoors, in front of several computer screens simulating road
conditions. A console with a steering wheel, accelerator and brake pedals forms
a driver's seat.
"It's like going to the arcade," Floore tells Jones.
She's pleased with his vision and reflexes; Jones speeds up and slows down
without a problem. But he has difficulty steering. His hands were so badly
damaged in the explosion he has trouble controlling the wheel, even with a
special attachment.
Jones may be a long way from driving a real car again, but that hasn't dimmed
his enthusiasm. He wants a red Mustang to replace his old Mazda sedan.
Family Support Is Crucial
For many of the patients at Haley, medicine and therapy are only part of the
cure. A strong support system is critical.
"If the family is not healthy, then the patient is not going to do well," said
Steve Klemz, a Haley social worker and rehabilitation counselor.
Klemz holds a group session with the families of patients once a week. Their
emotions can range from anger to despair to bitterness, he said. Dysfunctions
dormant for years can surge to the surface, triggered by uncertainty and fear.
Some expect their loved one to make a complete recovery.
"It's just denial," said Klemz, who has been in a wheelchair for more than three
decades after a high school football injury left him paralyzed from the chest
down. "Reality hasn't set in."
Klemz said it is not unusual for disruptive family members to be ushered from
the hospital because they're interfering with a patient's treatment. Conversely,
families that bond together in a crisis can supply a form of healing no
physician can provide.
"It's the touching and the caring," Klemz said. "If it hadn't been for my
support system, I wouldn't have made it."
Nellie Bagley often sleeps in a chair in her son's hospital room so she can be
close to him. Mother's intuition tells her it's helping even though her son,
Jose Pequeno, can no longer speak.
"When the family stays by him, you see the improvement so much more," said
Bagley, whose home in New Hampshire is being looked after by neighbors while she
stays in Tampa.
Pequeno, 32, was a staff sergeant with the New Hampshire Army National Guard
serving in Iraq in March when an insurgent tossed a grenade into his Humvee. The
explosion tore off the left side of his skull.
Bagley has come to terms with Pequeno's condition, although she refuses to lose
hope.
"I have no words to express how devastating these injuries are," she said
Thursday as she wheeled her son through the hospital. "But they told us he
wasn't going to make it, and here he is."
On Friday, Scott and a small army of doctors and therapists make their
twice-weekly rounds. Called a "multidisciplinary team," this is the essence of
the polytrauma approach. Specialists from a variety of disciplines are present,
each ready to weigh in on a particular aspect of a patient's care.
Their first stop is Gruetzner's room. Maulik Bhalani, a resident in physical
medicine and rehabilitation, opens the conversation by saying how well Gruetzner
is doing.
There have been issues, however, with wounds to his abdomen. A meshlike dressing
applied right after he was injured may have led to an infection and abnormal
bone growth in his lower rib cage. The doctors decide more research is needed
and plan to contact the Defense Department for information about the dressing.
While that discussion is taking place, Gail Latlief, director of amputee
services at Haley, is examining the stump at the end of Gruetzner's right arm.
Latlief talks with Dick Smith, a surgeon at Haley, about how quickly he can be
fitted with a prosthetic hand.
Latlief and Smith also agree surgery will be required on Gruetzner's right elbow
so he can flex his arm.
Separately, Scott and Rafael Mascarinas, a rehabilitation specialist, run
through the problems Gruetzner is having with his eyesight, yet another
complication caused by the bomb.
As the doctors move on to the next patient, Gruetzner is smiling. He heads back
to Texas in a few days. More appointments at Brooke Army Medical Center near San
Antonio are in store, but he'll be reunited with his daughter, Brayden, who left
earlier with Gruetzner's in-laws.
The staff at Haley will prepare for another patient to replace him, not always
an easy task. Space is limited at Haley, and that's a touchy subject for the
otherwise unflappable Scott.
Under the current arrangement, the polytrauma center's components are spread
throughout the hospital, leaving patients and staff to crisscross the facility.
That makes for fragmented care, Scott said.
There are plans to spend $110 million on a 120,000-square-foot addition to the
polytrauma unit, but the project has not received final approval or funding.
"If we cannot take care of the most severely wounded people in the war, then we
shouldn't take care of anybody," Scott said.
Reporter Richard Lardner can be reached at (813) 259-7966 or
rlardner@tampatrib.com .