Sunday, July 15, 2007

At military burn unit, difficult recoveries bring stresses and deep bonds

From the Asociated Press, here is a glimpse inside the daily activities at Brooke Army Medical Center and treatment of the members of the military who have been severely burned in Iraq & Afghanistan. They have been sent to San Antonio, TX to begin their long, painful journey of recovery. The soldiers & marines are not the only heroes; so are the medical staff who do this day after day after day. May all of their families find some peace and respite.

If you dare read the whole thing and do not shed a tear, I worry about your soul.

The five badly burned soldiers arrived around 11 p.m., sedated and swathed in bandages from head to foot _ the screech of the plane’s wheels on the tarmac and waiting ambulances marking the end of a 7,500-mile journey.
Dr. Kevin Chung had just returned from dinner as the ambulance convoy zipped through the gates of Brooke Army Medical Center. He paced back and forth from his office to intensive care, waiting for the soldiers who were coming in from Germany, after being evacuated from Iraq.
A three-continent marathon, and this was the finish line.
Chung had reviewed the soldiers’ charts and ordered medicine. He donned a blue surgical gown and put on his mask and gloves as the men were wheeled in one by one, tethered to a blinking, beeping, buzzing nest of tubes, ventilators and monitors.
Now Chung and some 30 doctors, nurses and others took over.
They cut open the men’s bandages and, using diagrams of the human body, mapped the soldiers’ burns _ shading in red for third-degree, blue for second-degree _ to plan for surgery.
They called the soldiers’ families. They needed permission to operate.
The men had been injured days earlier when a roadside bomb in Iraq turned their Bradley fighting vehicle into an inferno. One man who had escaped ran back to help a trapped comrade.
"This one’s the hero," Chung said, as the first stretcher rolled in.
"They’re all heroes," a nurse replied.
The "hero" was in the worst shape, with burns ravaging more than 70 percent of his body. His skin was leathery, his eyes swollen shut, his body bloated.
Chung did a bronchoscopy to check his lungs. He threaded a fiber-optic scope into the tube connecting the soldier to a ventilator. Tar-like soot deposits appeared on a video monitor.
To Chung, it looked as if someone had smoked 100 packs of cigarettes in 10 minutes.
If this soldier _ the one who had escaped _ had so much lung damage, what about the men who had been trapped?
He examined them and answered his own question.
Their lungs were worse.
Brooke’s burn center _ the only one of its kind for the nation’s military _ has its own rhythms and rituals.
The center’s 40 beds are tucked in a fourth-floor wing of the sand-colored hospital at Fort Sam Houston. In the halls and on the walls, there are constant reminders of the war _ the scarred young men, the clocks set to Iraq and Afghanistan time.
This is a place where the wounded celebrate small steps toward recovery, even bending a pinkie finger, and mourn the loss of the pain-free lives they once led. Where patients can spend months in intensive care and years in rehabilitation.
It’s a place where a groan or a clenched-teeth grimace speak more eloquently than words.
And it’s a place with a quiet sense of urgency.
Doctors operate in womb-like, 90-degree heat, sometimes six at once working on a soldier; nurses, in boots, masks and long gowns, sweat as they scrub down patients in steaming showers; families congregate, longing for the day loved ones will emerge from the cocoon of bandages.
In another era, another war, many patients probably would never have made it this far.
But troops today have better body armor, fast evacuation from the battlefield to war zone hospitals, then state-of-the-art treatment in Germany and the United States.
Brooke has special teams that fly to Landstuhl Regional Medical Center in Germany to bring home the most severe cases on a C-17 transport, sometimes handling emergencies in midair.
A soldier burned in Iraq can be in a hospital bed in San Antonio within 72 hours, sometimes less. In Desert Storm, it took nearly 12 days. In Vietnam, it was closer to 17 days.
Once patients arrive at Brooke, skin grafts are usually done within 24 hours to stave off infection, the major cause of death. Decades ago, doctors waited days or weeks to do surgery.
"The faster you get the burn off the patient, the better off you’re going to do," says Dr. David Barillo, chief of the flight evacuation team.
Brooke’s burn center also treats civilians. But these days there is a steady flow of wounded from Iraq and Afghanistan _ more than 570 thus far, of which only about 6 percent have died. Many survivors, however, are permanently scarred. Some also suffer from blast-related wounds, such as head injuries or fractures. Others can’t walk, sign their names or tie their shoes.
"We now have an entirely new population of burn survivors ... with oftentimes lifelong and life-changing injuries," says Dr. Evan Renz, a Brooke surgeon.
Some will recover. Others will learn new ways to become independent.
"You have to believe that you’re doing the best thing for the patient by helping them survive," Renz says. "You have to believe that in the end, when all is said and done, they will be glad they made it through."
There are always people, he says, who will look at severely burned patients and ask why put them through all the agony.
"We try not to judge too much," he says. "When you’re talking about how far should you go to save someone’s life, I think in the case of these tragic injuries you have to be realistic. You have to look at what can be done. Just because we can do it, should we do it?"
He pauses, then adds: "I certainly have no regrets about those things I’ve been able to do."
Chung woke from a quick nap on his office couch the morning after the five badly burned soldiers arrived, and walked down the hall to check on them.
All were stable. But the news quickly turned grim.
One soldier went into shock. His heart, lungs and kidneys failed. He never regained consciousness to see family members who had flown in to be at his bedside.
It was not Chung’s first loss, but, he says, every one leaves him shaken.
Chung had treated seriously wounded troops as a fellow at Walter Reed Army Medical Center. But Brooke, he says, is more intense. Patients rally, nearly die, rally again _ and then sometimes lose the struggle.
"I can’t think of a more devastating injury," Chung says. "In the most tragic instances a lot of us say to ourselves ... sometimes life is worse than death."
Some burn survivors say that, too.
"We have patients that tell us, ’I want to die. I want to die. Let me go.’ ... That’s very tough," Chung says. "The best we can do is manage the pain."
Of the five patients arriving that night, one was transferred out of intensive care.
The "hero" was rebounding, too. He was talking with his family. Everyone was excited. But it was that roller coaster again. This was the top. Then, the dip: An abdominal infection set in.
The "hero" died. Within three weeks, four of the five were gone.
Chung was reeling.
"You start wondering, ’Do I even matter?’" he says. "You start doubting whether you’re making any difference. Looking back, I felt I was very naive. I was thinking, ’I’m a young physician. I have all this knowledge. I can do all these great things. Maybe I can help save them.’ You quickly realize that that’s not the case. You have absolutely no control. I felt completely helpless."
And stressed out.
He couldn’t sleep. He was irritable with his two young children. He didn’t always want to talk with patients’ families.
Chung knew he had to change _ and he did, in several ways.
Working with other doctors, he immersed himself in developing a new treatment to help burn survivors in shock. He also made sure he spent more time with his kids.
Sleep began to come more easily. So, too, did energy for the next day’s emotional whirlpool.
"I still have my compassion," Chung says. "I want to hold on to that."
He needs it.
"You walk a tightrope," he says. "I tell the family members that they need to be realistic. ... At the same time, I don’t want to be the person to take away hope. How can you justify giving up on anybody?"
Chung always reminds himself of the most critically burned patient he helped treat who survived.
One name instantly comes to mind: Sgt. Merlin German.
German’s survival is a story of numbers:
Burned over 97 percent of his body.
In intensive care 11 months.
Nearly 17 months in the hospital.
More than 40 surgeries, and counting.
Practically everyone who has met German describes him with one word: Miracle.
How in the world did this Marine survive, rebound from infections, and manage to exceed doctors’ expectations so many times?
Renz, one of German’s doctors, offers an explanation: "God meant for him to do something else. He wasn’t meant to be beaten by this."
German knows he’s one for the medical journals.
Sitting in the therapy gym, sucking on a "fentanyl pop" _ a plastic stick tipped with a morphine-like painkiller _ he pulls a T-shirt of his own design from his gym bag.
On the front, it says: "Got 3 percent chance of surviving; What ya gonna do?" The back lists four options: "a. Fight Through. b. Stay Strong. c. Overcome Because I Am A Warrior. d. All Of The Above!" The last one is circled.
But living choice "d” means one surgery after another to replace almost every square inch of your skin.
It means learning to walk again because your new skin doesn’t allow you the mobility, strength and balance you once had.
And it means looking into the mirror at a ripple-scarred face, learning to make do without fingers (German was a saxophone player) and figuring out, at age 21, what to do with the rest of your life.
But more than two years after the former Marine turret gunner nearly died from a roadside bomb, German accepts what is _ and all he has going for him: A steel resolve. Great genes (his doctor calls it "wonderful protoplasm"). And a tremendously supportive family led by his mother, Yvonne, who moved from New York to tend to her son.
"At the beginning, my mother was the one to tell me ... ’You look great,’" says German, a baseball cap pulled low on his head. "She was the one who made me survive. Her and God. ... Me and my mother pray three, four times a day."
German’s determination has wavered at times, though, as he considers college and a career. "Sometimes I do think I can’t do it. Then I think: Why not? I can do whatever I want. ...
"Nobody has ever been 97 percent dead and survived, and lived to walk ... and dance."
Last December, after months of practice so he could lift his arms, turn and pivot, he donned his Marine dress blues and hit the dance floor at Brooke’s Holiday Ball.
He surprised his mother, taking her into his wounded arms, gliding smoothly across the room to a melody he chose _ a Rod Stewart song, "Have I Told You Lately That I Loved You?"
The crowd stood and applauded. And cried.
German’s path to the dance floor began in the intensive care unit.
It’s where Capt. Kristine Broger, an ICU nurse, thrives in heat and silence.
She’s accustomed to rooms set at 80 degrees or warmer if heat lamps are on to help those who can’t control their body temperature after their burned skin has been removed.
And she’s familiar with patients who can’t speak _ at least, at first _ because they’re sedated or hooked to ventilators.
Broger meets those patients by talking with loved ones and looking at photos they tack up on the walls _ snapshots that remind everyone of the person beneath the bandages.
Seeing these "kids" month after month, "it’s very difficult not to get attached," says Broger, just 27 herself, a veteran of Iraq with piercing blue eyes and a direct manner. "They become part of you and you get to know the family like your own."
There was one badly burned young soldier she particularly remembers. His mother, a nurse, stood vigil at his bed, day and night for four months. Early on, he was on a ventilator. But he gradually improved and was able to joke and chat. He seemed to be recovering.
Then, suddenly, he died. Broger broke down in tears.
With burns, she says, there is no timetable, no guarantee of recovery.
"Sometimes," she says, "God has another plan for you."
Broger has a strategy for coping with the ICU’s stresses. Work stays at work. When she and a colleague have dinner, hospital talk is taboo.
"After the locker room, I try not to bring anything home with me. But some days," she says, "it’s more difficult than others."
Chris Edwards is in Year 3 as a burn center regular.
The Army staff sergeant was wounded when a 500-pound bomb exploded under his Bradley as he was crossing a bridge in Iraq. Sitting just inches from 100 gallons of diesel fuel, his body was set ablaze.
Edwards was burned over 79 percent of his body.
Since then, he has endured 34 surgeries. He ticks them off as if reading a grocery list: Grafts over his entire body, eye operations (including a cornea transplant), corrective work on his ankles and fingers, holes drilled through his lower right leg bones and heel and metal rods inserted to stabilize them.
And more.
"You start thinking, what did I do to deserve this?" says Edwards, who also served in the Marines. "It really tests your faith. Not only that, you’re really thinking: What did my family do to deserve this?"
Edwards, 36, wonders how he can make up lost time with his 5-year-old son and make his older boys, 10 and 13, understand why he can’t play catch as he once did.
He worries, too, about pressure on his wife, Tammy, who helps bathe him. "That’s not something you just expect to do when you marry someone physically fit," he says.
Then there’s the pain. Some days, it’s tolerable.
Other days, he says, "I just ... beg somehow for God to kill me and take away the pain and let me die. ... It’s like walking on hot coals, having your hands put in boiling water ... and breathing with a 10-ton weight on my chest."
But as hard as it has been, Edwards still finds humor _ as he has all his life.
"If you’re a patient and you laugh for a second, that’s one second more that you don’t have to worry about how bad things hurt. ... For that second, you’re a regular person. I try to keep people laughing as much as I can."
Sgt. Shane Elder patched up the wounded in Iraq and sent them home to be healed.
Now he’s home, treating burn survivors at Brooke, gently massaging and stretching their scars so they don’t shrink and turn fingers into claws.
Elder, a former medic with the 173rd Airborne Brigade, is an occupational therapist’s assistant. Off-duty, he’s just one of the guys, hosting an occasional poker game for patients at his home or joining them for dinner or a movie.
"They’re my comrades," he says. "You don’t work with these guys an hour, an hour-and-a-half every day and just talk about your burn scar. They become your friends."
One of his first patients was a severely burned Marine who had part of his brain’s left frontal lobe removed because of shrapnel. Elder figured he wouldn’t be able to talk. But when he entered his room, the Marine started chatting amiably.
The men found they shared the same dry wit and taste in rock music. And when the Marine was about to be discharged, Elder invited him over.
Elder prepared his older son, then 3, knowing he might be frightened by the Marine’s disfigured face. Instead, the little boy was fascinated by his prosthetic arm and asked:
"Are you a robot?"
"Sort of," the Marine replied.
After that, Elder’s son would joyfully squeal the Marine’s name every time he visited. And last fall, Elder was a groomsman at his wedding.
At Brooke, Elder helps patients face their fears.
"They’ll say, ’I’m a 19-year-old single male,’ " Elder says. "’What girl would ever want to date me? How will I ever have a family? I was a young healthy stud fighting the good fight. Now I need help buttoning my pants in the morning.’"
His advice: Move on with your life.
"You’re not the same person you were before," Elder tells them. "If anything, you’re a stronger person. ... Get back out there."
Marine Cpl. Roy VanWey is plotting his path away from the burn center.
A year ago, a bomb turned VanWey’s Humvee into a fireball, killing three Marines who were with him and leaving him with burns over 70 percent of his body.
Since then, he has been through 10 surgeries _ he recently had one to hold his head straight. Slowly, he is regaining his independence. He can now spool pasta, draw and sign his name, even though he lost most of the fingers on his right hand. But he still is adjusting to his changing face _ pink, blotchy, raw.
He knows people stare when he goes to the mall, the movies or out to dinner.
"When I’m talking to people, I feel like the same person inside," he says. "But when I look in the mirror, I feel like I’m looking at a stranger."
His wife, Cassi, offers a visitor a laminated Marine photo identification card showing a handsome man with bright eyes and a wide smile. Then she turns to her husband of 18 months and says: "I don’t care what you look like. I love both faces the same."
With her at his side, VanWey sorts out his life after Brooke, "mourning the death of the person I used to be," he says, "and having to come to terms with who I’m going to be the rest of my life."
Determinedly, he looks ahead.
"I’ve got to make the best of it," he says. "At least I’m alive."

© Copyright 2007 Associated Press.

1 comment:

pogblog said...

How we could continue this war for one more instant is beyond me. And we know all but nothing about the burned Iraqis who have lousy when any hospitals.

My guess is that Mr. Bush doesn't make a sidetrip to Brooke Army Medical on his way to Crawford, nor Mr. Cheney on his stealthy way to a soothing hunting outing at the Armstrong Ranch in south Texas.

I can not but imagine that the rest of the galaxy looks down on us with baffled disgust that we allow ourselves to do these mutilations to each other.