Troops’ horrific injuries are conflict’s hidden cost

Sgt. David Pettigrew remembers the night.

He remembers his buddies in the 4th Infantry Division, their shouts and cries as they struggled to get a tourniquet on his leg, and he remembers the stare of his sergeant, who looked at him, “and you could see in his eyes that he thinks that something is massively and horribly wrong.”

And Pettigrew, then a corporal, remembers the orthopedic ward at Walter Reed Army Medical Center, and seeing all the amputees back from Iraq.

“It’s a crazy place,” he says. “It’s filled with young guys like me who are all blown up.

“There was a guy there who was missing both legs and an arm,” the 26-year-old soldier says. “My last roommate had no hands left at all.”

Pettigrew is home in Colorado Springs, learning how to walk on a prosthetic leg and dealing with the memories of that midnight patrol near Tikrit on July 8, when the grenade came shrieking out of the darkness and struck his Bradley Fighting Vehicle.

Others have taken his place at Walter Reed; the Iraq war yields no shortage of patients.

“I would like to tell you business is bad at Walter Reed, but business is good,” says the commanding officer, Maj. Gen. Kevin C. Kiley.

As the first stop for many of those injured in Iraq, Walter Reed, in the nation’s capital, admits about 10 new patients from Iraq a day, Kiley said. The National Naval Medical Center in nearby Bethesda, Md., also is busy with casualties. As is Brooke Army Medical Center in Texas. As are base hospitals and VA facilities near Fort Bragg in North Carolina, Fort Carson in Colorado Springs and other sites around the country.

According to the Pentagon, as of Thursday there had been 424 U.S. troops killed in combat and noncombat incidents since the war in Iraq began in March, and 2,009 wounded in combat. After declining last summer, the rate of those wounded has rebounded in recent weeks to levels experienced during major combat operations in the spring. October’s 393 wounded, according to Pentagon statistics, was the highest monthly total yet.

Critics say the Bush administration has tried to downplay the human toll of the conflict in Iraq.

“They want the good-news stories; they don’t want the stories of sacrifice,” said Steve Robinson, executive director of the National Gulf War Resource Center, a veterans’ group.

There are no public ceremonies for the dead coming back through the military receiving center in Dover, Del. The flights of wounded personnel heading for Walter Reed often arrive at night at Andrews Air Force Base in Maryland.

“The wounded are brought back after midnight, making sure the press does not see the planes coming in,” U.S. Sen. Patrick Leahy, D-Vt., said recently on the Senate floor. “These are not a broken wrist or scratched leg. These are terrible wounds: lost limbs, lost eyesight, lifetime disabilities.”

It is “something the administration prefers not to talk about,” Leahy said.

The Department of Defense would not comment on the criticisms.

Some of those wounded share the feeling that the price they’re paying is not fully recognized by the public, the government or the media.

“They seem to underplay it a lot,” said Pfc. Tristan Wyatt, of Franktown, who is being treated at Walter Reed after losing his right leg in an August ambush. “They think the war is over, and it’s not. It’s getting worse and worse with everybody coming here wounded.

“They say ‘wounded’ like they have a cast, or a splinter. There are people who lost both legs, in wheelchairs, here. That’s not wounded: that’s (expletive) up. They’re giving everything they have for this cause,” Wyatt said.

Battlefield care improves

Each war brings its own medical challenges, and this one is no different. If the wounded from Iraq have a signature, it is the relatively high percentage that suffer from wounds to their arms and legs, which in many cases require amputation.

In a way, it is good news: The science of military body armor has progressed to the point that torsos are protected.

“Their armor is allowing them to survive injuries that would have been fatal in Vietnam or World War II,” Kiley said.

“Most of the casualties coming back are all orthopedics because of the body armor and the ballistic helmets that they’re wearing,” said Air Force Col. Elisha Powell, an orthopedic surgeon with the 10th Medical Group at the Air Force Academy. “Basically … you either have an orthopedic injury or you’re dead. If it penetrates the body armor, there’s not much we can do for you.”

“We don’t have the sucking chest wounds” seen so often in Vietnam, said Marianne Coates, director of communications for the assistant secretary of defense for health affairs. Indeed, the demand for body armor is so high that the military is rushing to fill shortages in Iraq.

Another improvement involves time. There is an initial “golden hour” when a man or woman wounded in combat needs to be treated for loss of blood, shock and other urgent needs, said the U.S. Navy surgeon general, Vice Adm. Michael Cowan. “You have to stop the dying process, before you get to the point to start the healing process.”

Building on lessons learned in the first Persian Gulf War, the Balkans and Afghanistan, the military services are meeting the demands of the war on terror by pushing specially outfitted surgical teams, with modular equipment, as close to the front as possible.

The battlefields in Afghanistan, said Capt. Martin Snyder, a Navy surgeon, were hundreds of miles inland, with hours-long flights on airplanes that needed midair refueling. “We know for a fact, that if you are bleeding, you are not going to survive,” he said.

In the first Gulf War, Snyder said, military hospitals were well behind the front lines, with concrete floors, full kitchens and working bathroom and shower facilities. Now, small teams of medical personnel carry miniaturized gear – like patient ventilators or suction machines the size of laptop computers – in backpacks and duffel bags to stay close to the front where they can sedate, analyze and operate on a patient almost immediately. In the Marine Corps they are known as “devil docs.”

Several thousand yards behind them are new “expeditionary medical units” – collapsible, air-conditioned, plastic-tented surgical centers with computerized digital X-ray machines that are small enough to fit in a large duffel; working laboratories; an operating room; and a recovery room.

From the forward facilities, the wounded are sped by helicopter or plane to hospital ships or to hospitals in the Middle East, Spain, Germany or the United States. On Air Force transports, critical care teams of doctors and nurses continue to work on the patients.

“From the lessons learned in the Gulf War, we need to get these patients back up in the air, as soon as possible, to a real hospital,” said Capt. Rocky Hosie, an intensive-care nurse with the Air Force 10th Medical Group. “They were losing people on the ground by taking that time to stabilize people.

“Now, they can hand that patient off while they are unstable and we can work on them while they’re in the plane,” Hosie said.

3 critically hurt GIs saved

The system appears to save lives. Each story is dramatic. Wyatt, for example, lost his right leg in Iraq in August, in a firefight near Fallujah, in the “Sunni triangle” in north-central Iraq.

There was a dirt road, a field and a tree line. “Obviously, we had been down that route one too many times, and they caught on to us,” he recalls. “First thing we knew, there was an anti-tank round over our heads.”

Wyatt, 21, was traveling in an M113 Armored Personnel Carrier (APC) with five other soldiers from the 3rd Armored Cavalry Regiment. The driver turned to outflank the Iraqis. An RPG or anti-tank missile breached 4 inches of armor at the rear of the APC and tore through the legs of Wyatt and two comrades.

“My leg got completely cut off and fell on the ground. What I felt, though, was shrapnel had peppered the other leg, and I thought that was it,” he recalls. He kept firing his M240 machine gun. “There were two (enemy) figures in the grass when we got hit, and my biggest fear was they were going to swarm our vehicle. I fired everything we had.”

The driver of the APC broke off the attack and swerved, shaking Wyatt from his perch at the rear hatch. It was only then that “I fell backward and saw my leg was completely missing,” he says.

The three wounded men began to slump toward the floor. “The scene inside that track was horrible. There was blood and flesh and sinew all over that vehicle, and it stank, like burned flesh,” he says.

A medic arrived. “He looked like he was seeing a horror movie. It was disheartening. I began to see there was a chance somebody might not make it back alive.”

Sgt. Erick Castro was next to Wyatt; he lost a leg. In the .50-caliber turret of the APC, Sgt. Mike Meinen, 24, was the third soldier hit by the projectile. His leg was mangled as well. He watched, stunned, as Castro picked up his severed limb and put it on the vehicle’s bench. They all “just kind of looked at each other in disbelief like it really didn’t happen,” Meinen says. He took Wyatt’s hand.

“We’re going to make it through this,” the sergeant said.

“How do you know?” asked Wyatt.

“Cause we’re not going to die in the bottom of this track. I can guarantee you that. That’s not how it’s going to be for us.”

When a field dressing and tourniquet just slowed his bleeding, Wyatt recognized the need to elevate his shredded limb. He looked in vain for something on which he could prop his ruined thigh.

“The only thing I had there to prop my leg up was the other piece of limb. … I took the leg and put it beneath my stump,” he remembers. “That was the last good thing for it to do, man. It saved my life.”

Wyatt woke up at Walter Reed a few days later, after being taken by helicopter to a medical facility near Baghdad where surgeons completed the amputation. He was then flown to a U.S. hospital in Germany.

Meinen also was in Germany, and went looking for his two squad mates. He’ll not soon forget how he found them.

“They were both on machines, and they weren’t letting them wake up. They were just keeping them asleep,” Meinen remembers. “That was really hard for me to go through because I was in a wheelchair, moving around the hospital, and I’m going to go see two of my best friends, you know, and they were all racked down on a bed with machines on them.”

Recovering at home

Here at home, the wounded get state-of-the-art prosthetics and visits from cheerleaders and movie stars. There is an array of drugs to still the pain and, in the case of the amputees, to end the “phantom” sensations that make them want to scratch or rub a limb that’s no longer there.

Meinen and Wyatt have carbon- fiber-and-steel prosthetics attached to the stumps of their thighs, with microprocessors in the knee that adjust to their stride – at a rate of 50 calculations per second – and let the leg swing forward as in a natural step. They each are making plans to go hunting and to snowboard some day. Pettigrew faces a tougher future: His leg was removed all the way to his pelvis.

Meinen and Pettigrew live in Colorado Springs and get treatment at VA facilities in Denver, which allows them to spend time with their families. Wyatt is still at Walter Reed, eager to get back to Colorado. He has been given a room in the hotel on base as he learns to use his new high-tech leg. Lonely, he has bought a stereo and a video game system and spends the down time listening to Jimi Hendrix, watching DVDs and playing Medal of Honor combat video games.

“I’m obsessed with the war games. The simulation is so real,” he says. “It’s funny. I never much played them before.”

None of the three has soured on the Army, or the war in Iraq.

Before he enlisted in the Army, “I thought it was just a bunch of guys who hated their lives,” Wyatt says. But at Walter Reed, “I have met some of the toughest, bravest and dedicated.”

In the areas of Iraq that are populated by Saddam Hussein’s clan and other Sunni Muslims, “the hatred for us is obvious there,” he says. But in the poorer villages, he and the U.S. forces felt welcomed.

“I can understand – everybody’s afraid of it being like Vietnam,” he says. “But what makes America such a great country is we’re not giving up.

“Nothing,” he says, “was ever won easily.”

Staff writer Erin Emery reported on this story from Colorado Springs, Denver Post Washington bureau chief John Aloysius Farrell from the Washington area. The story was written by Farrell.