Gulf War Vets Home Page

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 .