The Wounded Come Home

By MARK THOMPSON

For several seconds after the rocket-propelled grenade (RPG) drilled through the back of their armored M113 "battle taxi," the soldiers inside, mainlining adrenaline, continued firing. Then they started screaming. "It blew my leg clean off," says Private First Class Tristan Wyatt, who was standing at the rear of the armored personnel carrier (APC), unloading an M-240 machine gun at a dozen or more Iraqis who had ambushed them minutes before. He was the first to be hit. The RPG then passed through Sergeant Erick Castro's hip, spinning him violently to the floor. His left leg was still attached--but barely. "I picked up my leg and put it on the bench," he says, "and lay down next to it." Finally, the RPG shredded Sergeant Mike Meinen's right leg. "It was pretty much torn off," he says. "There was just some meat and tendons holding it on."

There is horror and there is luck, and in war they sometimes come together. The RPG that severed three legs in a fire fight late last August near Fallujah didn't explode, which probably saved the lives of Wyatt, Castro and Meinen. But even a dud traveling at nearly 1,000 ft. per sec. can slice through limbs like a meat cleaver. The three men were alive, but there was a real danger that they would bleed to death in minutes amid the smoke, dust and confusion. As troops on the two other APCs continued firing, the lone medic among the 15 soldiers on the patrol climbed up the back ramp into the compartment. "'Holy s___!' was the first thing out of his mouth, and it looked like his eyes were about to pop out of his head," Wyatt remembers. "That's kind of disheartening when he's talking about you."

The medic, the wounded soldiers and their comrades began a frantic race against the clock. Buddies pressed their hands into Castro's hip wound to keep him from bleeding to death. The wound was so massive that his tourniquet was useless. He handed it to Wyatt, who needed two to stanch the blood flowing from his femoral artery. Amid the mayhem, Meinen, who had been manning a 50-cal. machine gun, noticed that he didn't have any feeling in his right foot. "It felt like it had gone to sleep on me, so I picked my foot up and was trying to massage it, trying to get the feeling back," he says. "But then it dawned on me: it wasn't even connected. So I put it on the floor."

They tried to raise their wounded legs to slow the bleeding. "There was nothing to elevate my leg except for the piece of my leg that had been blown off from the knee down," Wyatt says. "So I took my leg and jammed it under the stump to keep it pointing up. It was kind of messy." It may have been messy, but it worked. Meinen and Wyatt held hands, trying to reassure each other. "We're not gonna die in this track," Meinen said. "We're not gonna die over here." He was right. About an hour after being wounded--thanks to their colleagues and a Black Hawk medevac flight--the three U.S. soldiers were receiving some of the world's best medical care at the 28th Combat Support Hospital, south of Baghdad. Wyatt and Meinen were back in the U.S. about three days later. It was a week before the more seriously wounded Castro landed on U.S. soil.

This is a story of the unseen war--and the grim, quiet battles that take place when wounded soldiers arrive home. What happened to members of the 2nd Squad of the 1st Platoon--who call themselves the War Machine--of the 43rd Combat Engineer Company is a tale that has never been told. Soldiers have been wounded in war since the beginning of time--a fact that armies never like advertising. The Pentagon, which makes terse announcements when U.S. soldiers die in combat in Iraq, doesn't inform the public about those who have been wounded or release month-by-month injury counts. The wounded are mentioned only when some other soldier has been killed in the same attack. "When you join the Army, they send your picture to your hometown paper because they want everybody to know that you're leaving for the military," says Meinen, a dark-haired practical joker from Grangeville, Idaho. "But if you're wounded, the military doesn't tell them, because they might be worried about the public getting negative about what's going on over there." Says the serious, quiet-spoken Castro, from Santa Ana, Calif.: "Nobody knows what happened to us, even though it was one of the biggest ambushes in Iraq. People are only finding out about soldiers who are dying, but American soldiers are getting injured too."

October was the bloodiest month yet for the U.S. military occupation of Iraq, and the number of wounded is plainly on the rise. Daily attacks against U.S. troops have tripled. The number of U.S. troops who have died in hostilities in Iraq from May 1, when President Bush declared "major combat operations over," through last week has topped the 114 who died in the invasion and its immediate wake. By week's end 122 U.S. troops had been killed in action in Iraq, for a total of 236. But the number of U.S. wounded since May 1 is 1,242, more than double the 551 injured during the war.

Yet the American soldiers in the current Iraq war have a better chance of surviving those wounds and getting back home than any other soldiers in history. Better protection, faster evacuation and improved medical techniques at the edge of combat have dramatically reduced battlefield mortality. At the same time, although body armor and wound-sealing potions have made it less likely that soldiers will be killed in battle, they have also increased the likelihood of certain kinds of injuries, especially amputation, because a soldier's extremities remain vulnerable to the kind of homemade munitions the Iraqis are routinely deploying. The Iraqis lack the air power and artillery that can easily kill, but the weapons they are using--RPGs, car bombs and improvised explosive devices--have increased the ranks of the wounded. And these wounded seem to be threatening the morale of the soldiers left behind. While the Air Force has flown 1,513 battle casualties from the Iraqi theater, 9,341 have been flown out for other health reasons, including mental stress.

When the wounded come home, they are rarely greeted with waving flags and parades. Maimed soldiers are routinely flown from Iraq to Landstuhl Regional Medical Center in Germany, where they are stabilized before heading to the U.S. The most seriously injured are flown to Andrews Air Force Base, outside Washington, usually on nighttime flights, and then transported to Walter Reed Army Medical Center in Washington or Bethesda Naval Hospital in Maryland. "The wounded are brought back after midnight, making sure the press does not see the planes coming in with the wounded," said Democratic Senator Patrick Leahy of Vermont on Oct. 16 on the Senate floor.

In World War II, about 1 in 3 U.S. casualties died. During the next three wars--Korea, Vietnam and the Gulf--about 1 in 4 died. In the current war, about 1 of every 8 wounded soldiers have died.

Half of battlefield deaths occur within 30 minutes of wounding, largely on account of blood loss. But survival rates skyrocket if a casualty can get to a medical facility within the so-called golden hour after an injury. There are four major U.S. military medical outposts in Iraq, and the medical corps' critical mission is to keep wounded soldiers alive until they can be taken to one of them.

So far, a key rescue unit has a sterling record. The 159th Medical Company (Air Ambulance) has whisked more than 3,600 injured and ill troops to medical help with only a handful dying along the way. "We've given people a lot of tomorrows," says Major Arthur Jackson, chief of the unit's Baghdad squad. But many will face grim times. "People say, 'Well, he didn't die,'" says Captain Todd Farrell, a 159th helicopter pilot. "But a lot of these guys have an arm blown off or their leg blown off below the femur. Their lives are still going to suck."

At the front these days, small mobile surgical teams travel with combat forces. Navy Captain H.R. Bohman, a surgeon, was one of an eight-member medical team that did surgery 8 miles from Baghdad--the closest American operating room to the city--as the Iraqi capital fell to U.S. forces in early April. "We can document at least four Marines who are alive today who would have died if they'd had to be sent back as far as we were sending people back in the first Gulf War," says Bohman, a 30-year Navy veteran.

Such units generally consist of a trauma surgeon, an orthopedic surgeon, an emergency physician, an anesthetist, nurses and technicians. They carry with them a rudimentary field hospital in 70-lb. rucksacks. Their supplies include 5-lb. portable ultrasound units that allow quick and accurate diagnosis of internal bleeding and collapsed lungs. The ultrasound devices also can be used to locate shrapnel deeply buried in a thigh or torso. The teams also carry football-size electronic equipment for monitoring a patient's vital signs, small anesthetic-delivery devices and portable ventilators that help a wounded soldier breathe.

Despite improvements, new battlefield gear can't protect a soldier from top to bottom. Most troops in Iraq wear new $1,600 Kevlar vests with ceramic plates that slip into pockets in the front and rear to protect against small-arms fire. Their new $325 Kevlar helmets, although not bulletproof, afford greater protection than older models. While this gear shields the head and heart--along with the liver, lungs and guts--it leaves the extremities exposed. That's why 2 of every 3 wounds incurred by U.S. troops in Iraq involve legs or arms. It's also why some 100 U.S. troops have lost legs, arms, hands or feet in this war. Nearly half--45%--of the U.S. soldiers wounded in Iraq have been hit in the legs, with 19% injured in the arms, according to a recent Pentagon accounting shared with the American College of Emergency Physicians.

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.

For Wyatt and Castro, who came to the U.S. from Mexico as a baby, the grimaces that come from pedaling a bike with a single leg are followed by grins. Both men are certain that they are getting better all the time. They, along with Meinen (who is finishing his recovery at the Denver VA so he can be close to his wife Amber and baby daughter Abbigail), were each fitted late last week with a CLeg, which "knows" when to bend because its built-in microprocessor detects stresses 50 times a second and uses lithium-ion batteries to flex. Soldiers using the $100,000 device after having worn older, mechanical limbs that have to be swung forward with every step say the CLeg is much more natural. "Civilians get crappy legs," Castro says, "but ours is going to be top of the line."

There is a can-do spirit inside Walter Reed and scant grumbling from these soldiers about the war or the wounds it has inflicted on them. Most of these men were at the tip of the spear--warriors, in military parlance--and tend to gripe less about hardships than other troops. "We're on the brink of being able to walk again," Wyatt says. "When we first got here, I felt I was screwed and thought I never would." Seeing other soldiers learn to walk is powerful medicine. "They don't see it as a problem. They see it as a challenge," says Dr. Harold Wain, a Walter Reed psychiatrist in charge of monitoring the patients' psychological states. "These guys are very proud of what they've done, and they don't want people to feel sorry for them. They want people to support them."

Each of the three soldiers wounded in the back of their APC two months ago says he is glad he went to war in Iraq and misses his buddies who are still there. "I think the Iraqi people will finally get a government that works over there," Meinen says. "You don't want to get wounded, but you can't go to war and expect nothing to happen to anybody." His apartment in Colorado is near the 3rd Armored Cavalry Regiment's home base at Fort Carson, and he hopes to remain in the Army. But his voyage back was not made easy. When Meinen wanted to head to Denver, the military would not buy him a direct ticket and said he had to hitch rides on military planes, which hopscotch the country and are not regularly scheduled. At one point he was stranded at an Illinois air base for a week, which delayed his therapy. He finally made it to Colorado when an outraged soldier got him a commercial flight.

He has been back home for a month now, preparing for his new leg. "This life has its challenges," he says. "When the baby cries, I can't just run over and pick her up to put her in the crib. I'm kind of a stationary person right now, and sometimes I just have to drag myself across the floor." On the day he received his new leg at Denver VA last week, he walked around on it for two hours. But the VA won't let him take it home just yet. That's fine with him: he was thinking that his missing limb could make a fine homemade Halloween video. "I'm planning on getting together with my brothers-in-law," he says. "I'm going to make it look like they ran me over in a parking lot and have these other guys pull me out and make it look like they ripped my leg off." He never executes the idea, but the thought of it makes him laugh.

The three wounded soldiers are united not only in their good humor but also their unequivocal support for the war. Wyatt doesn't much care for those who think Bush fudged the intelligence on Saddam Hussein's weapons of mass destruction. "That makes you feel like you fought for nothing or you fought for a liar," he says. "They're telling me I went out there and I got my leg blown off for a liar, and I know that's just not true." Wyatt says he would stay in the Army if he could remain in a combat unit, but he knows that's unlikely. So he's considering college.

Castro says he just did what he signed up to do. "Someone has to do the job, and we did it," he says. "The price was my leg." He plans to return to college--his four-year hitch was up a week after he lost his leg--and marry his fiance Elizabeth Gonzalez, who quit her California job and moved to Washington to help him recover. Later this month, if all the paperwork comes through, Castro should reach another milestone: becoming a U.S. citizen.

--With reporting by Romesh Ratnesar/Baghdad

With reporting by Romesh Ratnesar/Baghdad