The Wounded Come Home

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SSG Charles Gallegos, of the 720th Transportation is airlifted

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The homemade weapons put together by the Iraqi opposition and hidden along supply routes traveled by U.S. troops are devastating. "The energy of these rounds on impact is phenomenal," says Colonel Keith Albertson, chief of surgery at the 28th Combat Support Hospital. "These weapons were made to maim, and they do a good job at it. And a lot of the time the tissue damage done isn't apparent at the time of operation. A discouraging number of patients who left here with a damaged limb intact have ultimately needed to have it taken off later."

The reinforced vest and helmet, by protecting the soldier's vitals, have cut down on the instantaneous deaths once common in combat, and now bleeding has become the key threat to battlefield survival. Soldiers can bleed to death in almost no time at all. A wound to the aorta, the body's major blood vessel, can kill in about 5 min.; wounds to less vital vessels can kill in 10 to 15 min. On the modern battlefield more than 9 of 10 deaths occur before a soldier can be evacuated — and about half those deaths are the result of what military doctors call uncontrolled hemorrhage.

The military is using new products on the Iraqi battlefield to do one basic thing: keep a wounded soldier's blood inside him. One of the most promising is QuikClot, a 3.5-oz., $10 packet of mineral powder that sucks the water out of blood so clotting occurs more rapidly. The powder can even be poured into a gaping wound by the bleeding soldier himself. Military officials credit it with saving 23 lives in Iraq. In one case it saved the life of a Marine after a bullet pierced his neck, sliced his carotid artery and exited through his skull. The military is also using new $80 bandages made with chitosan, which is derived from shrimp shells. The chitosan chemically combines with blood cells to form a clot. And troops have begun getting new $8.50 one-handed tourniquets. The standard one requires a pair of hands to apply, which can be a problem for a soldier who has just lost an arm.

In addition to the physical and emotional toll they suffer, the wounded in Iraq face other challenges — rehabilitation, retraining, postcombat counseling and long-term medical care, to name a few. All of these will drive up spending at the Department of Veterans Affairs for decades to come. There are also the wounds you cannot see. Post-traumatic stress disorder is a legacy of any war, especially those — unlike the 100-hour first Gulf War — that demand months, if not years, of U.S. occupation. "We have become much better at keeping people with severe injuries alive," says Loren Thompson of the Lexington Institute, a military think tank in Arlington, Va. "But the range of treatments provided — including counseling, assisted living, disability benefits and so on — can be quite extensive."

Early-morning light spills into the physical-therapy room at Walter Reed, as wounded soldiers sweat and grimace aboard stationary bicycles. Each man is steadily grinding out the miles with a single leg, his crutches leaning against a nearby wall. This morning happy-go-lucky PFC Wyatt meets with Joseph Miller, the hospital's chief prosthetist, who makes wounded soldiers close to whole again with man-made arms and legs. The types of wounds coming back from Iraq — blast and shrapnel injuries — make his job tougher. "Those kinds of injuries mean more infections and multiple surgeries," he says. Wyatt nods; he knows this from experience. He has had 10 surgeries since being wounded, with several inches of thigh carved off in the process. "So I'm going to start off with a mechanical knee?" the young soldier asks. Miller says no. Like all soldiers now who have lost a leg above the knee, he's going to receive the high-tech, German-made CLeg, which is made of carbon fiber and has a hydraulic knee. "Cool!" says Wyatt with a smile.

Wyatt and more than 300 of the most seriously injured have come to the bucolic Walter Reed, which has been treating wounded U.S. soldiers since World War I. The men — and a few women — coming off the Iraqi battlefields in stretchers tend to be young: Castro is 23, Meinen 24, and Wyatt, from Franktown, Colo., turned 21 two weeks before losing his leg. Many enlisted as a way to earn money for college and get in shape, but now they're wheelchair bound. Contrary to the old Army recruiting motto, they're not fighting to be all they can be anymore. They're fighting to be as close to normal as they can be.

Monday through Friday, their mornings start at 9 o'clock and are filled with hours of physical and occupational therapy. They also take bus trips and tour the capital. The typical stay averages about six months — half the time healing and preparing for an artificial limb, the other half learning to live with it. The pain is decreased by the presence of family members, many of whom can live on Walter Reed's 147-acre campus. Although the soldiers relish stop-bys from stars like Bruce Willis and Jennifer Love Hewitt, they glow when speaking of getting their Purple Hearts from President Bush. "Laura and I are here to thank the brave souls who got wounded in the war on terror," Bush said in the hospital lobby this past Sept. 11.

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