[Mb-civic] Bringing Back the Wounded With Heart, Soul and Surgery By David Zucchino The Los Angeles Times

[Michael Butler]

    Go to Original

    Bringing Back the Wounded With Heart, Soul and Surgery
    By David Zucchino
    The Los Angeles Times

    Sunday 02 April 2006

    Injured troops are swept up in a lifesaving process unmatched in past
wars - reaching hospitals in minutes and the US in days. But their agony
doesn't end on the battlefield.

    Balad, Iraq - Vincent Worrell lay shivering on a trauma bay. He felt
something in his mouth. He sat up and spat fragments of his front teeth into
a bedpan. They were mixed with blood and tissue torn from inside his mouth.

    He heard someone say: "Significant laceration to the cheek and lip." And
then: "Frag under the eye ... frag in the face ... frag in the shoulder ...
possible thumb fracture."

    A bomb fashioned from two mortar rounds had detonated a few feet behind
Worrell, an Army staff sergeant, as he walked on patrol near Tall Afar on
the morning of Nov. 6. Now he was inside the Air Force Theater Hospital, a
tight web of interlocking tents set up on packed sand 50 miles north of
Baghdad.

    Worrell was groggy; he had been given morphine.

    He asked a doctor: "Will I need reconstructive facial surgery?"

    "Nope, just some new teeth."

    Worrell glanced down and was surprised to see a Purple Heart resting
between his legs. Somehow the medal made him think of his wife, Jayme.

    "My wife's going to be pissed," he told the doctor. "She specifically
gave me instructions not to get perforated over here."

    At that moment, Jayme Worrell was driving to the couple's ranch-style
home in Fayetteville, N.C. She did not yet know that Vinny, the gangly boy
she had dated in high school, the restaurant cook who had joined the Army to
give meaning to his life, was about to be cut open inside a tent in the
Iraqi desert.

    The grit and shrapnel in Worrell's face was just a small part of the
bloodshed from the first week of November. In a typical week in Iraq, about
110 American troops are injured in action. Doctors, medics, nurses and
litter bearers in Iraq fight daily to keep the wounded from joining the
ever-lengthening rolls of the dead.

    After three years of war, the military has honed a highly efficient
lifesaving process that moves the wounded swiftly from the battlefield to
emergency surgery in the combat zone, and on to military hospitals in
Germany and the U.S. The approximately 17,400 troops wounded since March
2003 have been swept up in a medical effort unmatched in any previous war.

    In November, 402 troops were wounded in Iraq. Among them were Worrell
and four other men who were delivered the same week, bleeding and in
excruciating pain, to the hospital here.

    On Nov. 5, an explosion tore into Marine Lance Cpl. Francisco
Ponceherbozo, 20, a Peruvian-born Californian, as his squad pursued
insurgents in western Iraq. The blast knocked him down and left a hole the
size of a silver dollar in his left foot.

    On Nov. 6, an improvised explosive device upended an armored Humvee
driven by Army Spc. Joshua Griffin, 18, who had joined the Army in Texas a
year earlier with his mother's permission. He was on a mission to hand out
soccer balls and teddy bears to children near Taji. Griffin's smooth face
was blackened by second-degree burns, his jaw was broken in two places and
his right femur was shattered.

    On Nov. 7, a land mine detonated beneath a Humvee carrying Marine 2nd
Lt. Mike Geiger, 24, a military brat from North Carolina, as his platoon in
Haditha distributed leaflets advising civilians how to avoid being shot at
U.S. checkpoints. Geiger's face was bathed in blood, and his right foot was
broken in several places.

    On Nov. 8, a grenade tossed by an insurgent exploded at the feet of
Marine Lance Cpl. Ryan Buchter, 20, a baby-faced former high school football
star from Pennsylvania, as his unit cleared farmhouses of enemy fighters in
western Iraq. Shrapnel shredded his left leg, crushed his right hand and
ripped into his nostrils.

    Those five men, each one an eager volunteer in Iraq, would spend a long
winter recovering from the most searing experiences of their lives. The
medical care that saved them was extraordinary, but it was only the
beginning. They endured dozens of surgeries in five military hospitals on
three continents. They returned to their families much different from the
fit young men who had set off to war.

    For some of them, what happened on the battlefield wasn't the worst of
it.

    Vincent Worrell's lips were a deep blue. Trauma and blood loss had
lowered his body temperature. Despite the blankets covering him, he could
not stop shivering. He had never felt so cold.

    A doctor hollered for more blankets.

    Worrell heard a gushing sound in his left ear, the one that had been
nearest the blast. One eye was swollen shut. He asked for water, but a nurse
told him he could not have food or drink because he was about to undergo
surgery.

    "If I can't have water, can we compromise and let me at least rinse out
my mouth?" he asked.

    He got the water and washed the metallic taste of blood from his mouth.

    This was not the first time he had been wounded. In January 2005,
Worrell was shot through his right thigh in Mosul, and he had been back on
duty just two months.

    He thought again about his wife, and what the news of this more serious
calamity would do to her - and to them. What if he lost his eye, his
hearing, or the use of his hand? He was only 25. They had a
5-year-old-daughter. How would they manage?

    Worrell wanted someone to tell his wife, quickly, that he was hurt but
alive.

    Jayme Worrell would not get the full story until later that day, when a
lieutenant phoned her from nearby Ft. Bragg. Jayme was so familiar with
casualty notification that she warned friends to knock rather than ring her
doorbell. She knew that casualty officers delivered news of a dead soldier
in person. But a phone call meant an injury, not death.

    "I'm sorry to inform you that your husband was injured by an IED ...,"
the lieutenant recited, and Jayme did not hear anything else until she heard
him utter the words, " ... but he's OK."

    She had expected the worst. It was her husband's third tour in Iraq and
the odds were against him, given his job as an airborne infantry squad
leader.

    "I told him very specifically not to get perforated - or shot, stabbed,
poisoned, strangled or bitten by dogs," she said later. "Then he gets his
head blown up.... I took it better this time. It's weird the things you get
used to."

    Inside the Air Force hospital, a medical technician rolled Worrell into
surgery.

    The operating room was inside a metal trailer attached to the tents that
make up the hospital. It looked like an operating room at any big-city
hospital, crammed with computerized monitoring devices, anesthesiology
equipment and surgical instruments.

    A Dwight Yoakam song was playing on a portable CD player as Col. Bailey
Robertson stared at Worrell's ravaged face. The soldier had been
anesthetized, and a blue surgical drape had been stapled to his forehead and
cheek so that only his mouth, nose and eyes were visible.

    "I need to snatch out a couple of broken teeth and stitch up his lip,"
said Robertson, a maxillofacial surgeon.

    First, Lt. Col. Bryan Angle, an eye surgeon, went to work on the
fragments embedded in Worrell's nose and cheek. He used tweezers to pluck
out bits of shrapnel from beneath Worrell's left eye. Using the back end of
the tweezers, he packed gauze into the ragged hole on the left side of the
nose and then pulled it out.

    Angle used his little finger to probe inside the nose wound. He squinted
through magnifying loupes, which looked like oversized spectacles. This is
the first war in which microsurgery is available on the front lines.

    Angle fished out a lump of grayish-brown rock, then another. He flushed
the wound and sutured it.

    Robertson used a retractor to expand the wound under Worrell's left eye.
Angle extracted bits of dirt and more rock fragments, lining them up on a
sterile field of blue fabric.

    "And my rock garden continues to grow," he said.

    Next, Col. John Ingari, an orthopedic hand specialist, used a scalpel to
slice dying tissue from the base of Worrell's broken left thumb. Dead tissue
harbors bacteria; infection is a serious threat in Iraq's unsanitary
environment.

    A nurse retracted a long, jagged wound on Worrell's left hand as Ingari
plucked out a rough brown object, either a rock or bit of highway pavement.
Ingari was pleased to see that the digital nerve in Worrell's thumb was
intact. "A millimeter over, and he'd have lost all sensitivity in his
thumb," he said.

    Ingari moved on to a deep wound on Worrell's left shoulder. He probed it
with his index finger, extracting two large rock fragments. The explosion
had blown pieces of roadway into the shoulder, but no razor-sharp mortar
shrapnel that might have caused even more damage. The surgeons worked
briskly, commenting on their work as they probed and sewed. Nurses swabbed
the wounds with gauze, and Worrell's bright red blood stained the blue
drapes beneath him and dripped to the floor.

    Robertson irrigated Worrell's mouth, washing out more tooth fragments
and dirt. He used a metal tool to latch onto the broken roots of Worrell's
front teeth and pried them out with a loud cracking sound. Then he sutured
the gums, the roof of the mouth and the fleshy mass of tissue where
Worrell's lower lip had been ripped loose.

    Final sutures went into the medial canthal tendon beside Worrell's left
eye, which keeps the eyelid tight so that tears can flow.

    After two hours, the surgery was over. Worrell was wheeled into a
recovery room, his face splotched with dried blood, scarlet wounds and black
sutures.

    Ingari was optimistic that Worrell would regain full use of his left
hand and shoulder.

    Robertson thought Worrell's face and eyes would heal nicely, with his
gums ready for titanium teeth implants to be inserted by specialists in the
U.S. "He'll have a scar on his lip," he said. "It'll make him look tough."

    Angle thought Worrell looked much better going out of surgery than
coming in. "This guy is pretty lucky," he said, "if you call getting whacked
in the face by an IED lucky."

    The wounded in Iraq receive better and faster medical treatment than in
any previous conflict. Often, soldiers are rushed to the operating room
within minutes of being unloaded from Black Hawk medevac helicopters.

    During the Vietnam War, where the nearest combat support hospital was in
Japan, it took an average of 45 days to move a wounded soldier from the
battlefield to a U.S. hospital. In Iraq, it takes less than four days.

    Medevac helicopters are able to fly quickly over the flat desert
landscape. Surgeons say no wounded American in Iraq is more than 30 minutes
from a combat hospital, where treatment is as good as at any U.S. trauma
center. In many ways, it is better. In a single busy night, combat surgeons
can repair a greater number of ghastly and complex wounds than a big-city
trauma surgeon might see in a year.

    In a war with no fixed front, military hospitals in Iraq are closer than
ever to the places where American troops are felled - most often by roadside
bombs, but also by rockets, mortars and gunshots. There are four major
combat hospitals in Iraq: The Air Force hospital in Balad, and Army combat
support hospitals in Baghdad, Mosul and Tikrit.

    Many of the most seriously wounded would have died in previous wars. In
Vietnam, soldiers often bled to death before reaching a hospital. Because
the wounded in Iraq are evacuated so quickly, 96% of those who make it alive
to the Balad and Baghdad hospitals are saved.

    On the battlefield, medics are better-prepared. The lowliest grunt is
given specialized lifesaver training, particularly in the use of tourniquets
to control bleeding. New blood-clotting agents and improved field bandages
have helped save lives.

    Despite the destructive force of roadside bombs, the rate of wounded who
die is lower in Iraq than for any war in U.S. history. Since the war began
three years ago, about 10% of those wounded have died of their injuries,
according to the Pentagon, down from 24% during the Vietnam War and 30%
during World War II. The highest lethality rate was 42%, during the
Revolutionary War.

    In 2005, the number of wounded in Iraq increased by 1,200 from a year
earlier. Yet the number of dead remained virtually the same, 844 versus 848
in 2004, dropping the lethality rate from 9.6% to 8.4%. Just over half of
those wounded have returned to duty.

    Ballistic goggles - like those worn by Worrell - have protected the
eyesight of thousands. Although body armor has saved more lives, it leaves
limbs, necks and armpits exposed. A recent Pentagon study found that
improved armor could have saved as many as 80% of Marines who died from
upper-body wounds.

    The amputation rate in Iraq is double that of previous wars. Many
soldiers face the rest of their lives without arms or legs, or with severe
brain damage. Even for the wounded who will walk again, and perhaps return
to battle, the physical damage, and the psychological scars, last forever.

    Mike Geiger was wheeled into the operating room, his fractured right
foot heavily wrapped. Geiger's narrow face was a sickly greenish-gray - not
from shock, but from road dust and smoke that had filled his burning Humvee
after it was crumpled by the land mine.

    Geiger's cheeks were streaked with blood from tiny shrapnel wounds, and
there was a nasty gash under his chin. He was alert and talking. He had
flashed a thumbs up as he was being rolled in from the Black Hawk.

    As a platoon leader, Geiger had always worked hard to prepare his men
for calamity. He had a plan in place in the event any of his men were
wounded. But when it turned out that he was the one injured, he lost his
bearings.

    Many of the wounded describe an unbearable interlude, seconds after
going down, when one cannot comprehend what is happening. They are surprised
by the way time seems to stop as they lie bleeding, and by the suspended
moment of utter quiet that follows an explosion.

    Some say they feel disconnected from their injuries, as if they are
watching something terrible happen to somebody else. Others say they feel
vaguely foolish or incompetent for allowing the injury. Getting wounded is
always something that happens to the other guy.

    Geiger remembered a rush of emotions and confusion as he considered
ordering his men to form a security perimeter. He did not realize that they
had already taken their positions after yanking him out of his Humvee.
Geiger screamed that his leg was killing him, and the unit medic injected
him with morphine.

    Now, in the operating room, the pain had eased. Geiger did not know
whether he would lose his leg; the doctors weren't saying. He tried to stay
positive. "As long as I can dance at my wedding, I'll be OK," he told the
surgeon.

    An anesthesiologist peered down at Geiger's discolored face and the
dirty black rings his goggles had left around his eyes. "Wow, man," he said.
"You have great eyes."

    Those were the last words Geiger heard before the anesthesia took
effect.

    Minutes later, Lt. Col. Jim Keeney, an orthopedic surgeon, cut two long
incisions into the top of Geiger's badly swollen foot to relieve pressure.
Thick red blood drained into a pan. Keeney bent down to study the wounds.

    "Um, this is a significant trauma," he said. "This young man didn't show
a lot of pain, but this is a very painful injury."

    Keeney used tweezers to remove temporary stitches along Geiger's big
toe, sewn earlier that day at a unit aid station before a Black Hawk flew
him to Balad.

    Keeney cleaned and dressed the wound. A nurse wiped the grime and blood
from Geiger's face. She disinfected the gash on his chin with rust-colored
Betadine. Barring a serious infection, Keeney said, Geiger would not lose
his foot.

    "He may need some skin grafts," he said, wrapping up. "But he'll be
walking again in six to eight weeks."

    In the intensive care ward hours later, Geiger called home on a
satellite phone provided by the hospital. He reached his mother, Patricia
Geiger, a retired nurse, at home in Fayetteville, N.C.

    He began, "I'm OK. My Humvee hit a land mine."

    He listened to his mother for a few moments, and answered her questions.
She was weeping. He murmured in a low voice, "I love you, too," and hung up.

    Geiger wanted to reach his fiancee, too, before someone else told her.
He was engaged to Ensign Kate Shawhan, a Navy nurse at Camp Pendleton. By
his own admission, he had been a wild kid in high school - so wild his
parents had sent him to military school. That, and the Marine Corps, had
matured him. Marriage was the next step.

    He punched in Shawhan's phone number. He got her answering machine.

    "Hey, gorgeous," the lieutenant said casually. "Just wanted to let you
know I'm on my way to Germany tonight and I'll probably be home soon.... I
love you."

    Geiger hung up and thought for a moment about what he had done. He
lowered his head. "That," he said, "was a terrible thing to leave on an
answering machine."

    On the same ward, Francisco Ponceherbozo was awaiting a flight out that
night to the U.S. military hospital in Landstuhl, Germany. He felt uneasy.
He wasn't certain the deep wound in his left foot was serious enough to
warrant a trip out of Iraq.

    "It wasn't like my arm got blown off or I had a sucking chest wound," he
told Lance Cpl. Justin Summers, who was being treated in the next trauma
bay. "I mean, it hurts like hell, but it doesn't seem all that urgent."

    Summers had suffered a slight leg wound in the same explosion that
felled Ponceherbozo. Their platoon was engaged in heavy fighting in
Operation Steel Curtain in western Iraq, an effort to seal insurgents'
infiltration routes.

    "Looks like I'm not going back out," Ponceherbozo said.

    "Sorry - damn, that sucks," Summer said, and he limped out of the
hospital, his boot unlaced, on his way back to the front.

    Ponceherbozo was rolled into surgery and given anesthesia. Lt. Col.
Scott Russi, a general surgeon, studied X-rays of his foot. The second
metatarsal was fractured. A shard of shrapnel was lodged in the side of the
foot. Russi decided not to try to cut it out.

    "I'd only create even more tissue damage if I tried to go in and get
it," he said. It would likely work its way to the surface later on.

    Russi washed out a shrapnel wound on Ponceherbozo's shoulder and packed
it with gauze. He probed the foot wound, opening the ragged hole slightly to
get a better look.

    "Oh, that's a good-sized wound," he said. "Goes all the way to the
muscle. It'll probably need a skin graft at some point."

    He flushed the wound and packed it. The corporal was ready to be shipped
home.

    In the intensive care ward later, Ponceherbozo sat up in bed, his
slender form overwhelmed by huge white dressings on his shoulder and foot.
He was making plans for combat tattoos: the word "Steel" on one shoulder and
"Curtain" on the other, in honor of the offensive that left him wounded. He
loved the Corps - he had joined right out of high school.

    His main concern at that moment was replacing the thick, ugly,
Army-issue black-framed spectacles he was wearing. They were on loan from a
buddy after Ponceherbozo broke his prescription glasses. He asked a public
affairs sergeant on the ward if she could find him something other than what
he called "nerd glasses." She promised to try.

    A nurse brought over a satellite phone so the corporal could call home.
He had spoken to his mother just three days earlier to warn her that he
would not be phoning again for a while because of the upcoming offensive.

    Ana Maria Whitley is a native of Peru who came to the U.S. 12 years ago.
She had agonized over her son's decision to join the Marines. She was so
worried that she asked a Roman Catholic bishop who patronizes her
housecleaning service to pray for Franco, as she calls him.

    Ponceherbozo dialed his mother's number in Glendale. It was 4:15 a.m. on
the West Coast. Whitley was awakened from a deep sleep.

    "It's Franco," the corporal said. "I just want to tell you I'm OK, but
I'm just a little casualty of war. I caught a little shrapnel to my right
shoulder and left foot ... "

    He could hear his mother sobbing.

    "You know what shrapnel is, right?" he went on. "It's like fragments of
metal."

    He told her he was coming home, and he heard her say through her tears:
"Thank God you're alive."

    Later that night, as the yellow lights from the tented hospital
glimmered in the black desert expanse, a bus loaded with patients pulled
away. It lumbered for just a mile, easing past sentries at a security
checkpoint that leads to the Balad air base tarmac.

    Looming in the dark was a specially equipped C-17 medical transport
plane, its big rear belly opened wide to receive patients. It was the
nightly flight to the U.S. military hospital in Landstuhl.

    The bus parked next to the plane. Six men and women in Air Force
uniforms stood behind the vehicle in two neat lines. An airman shouted out
cadences as each wounded man, wrapped in wool blankets and connected to
tubes, was lowered to waiting arms and loaded into the plane's belly.

    In the previous two months, the planes had evacuated 1,500 wounded
troops. More than a hundred were considered critical - each accompanied by a
doctor, nurse, medical technician and tangles of portable medical equipment.

    "We're basically a flying hospital," said Air Force Lt. Col. Scott
Vandehoef, who commands the evacuation service.

    Among the patients that night were Ponceherbozo, Worrell and Griffin.
Buchter and Geiger had just arrived in Balad that day, and both would leave
for Germany the next night.

    Griffin was among the critical patients traveling with three caregivers.
His face was so bloated that his right ear had disappeared. His eyes were
narrow slits. Dried brown blood was caked on his eyes and mouth. His broken
jaw was swollen and aching. A tracheotomy tube snaked down his throat. He
had emerged from major surgery just hours earlier.

    Unable to speak, Griffin wrote down phone numbers for his mother in
Texas and his sister in Germany, and gave them to the nurse accompanying
him. He wanted his mother to know what had happened to him. He wanted his
sister, Megan, an Army private in Germany, to meet his plane.

    The nurse phoned Renee Hickman in Humble, Texas. Hickman had already
received a call from her son's rear detachment, telling her that Griffin had
been wounded. But she did not know the extent of his injuries, and she felt
a curious wave of relief when the nurse described them. They sounded
serious, but not hopeless.

    "I had assumed the worst," Hickman said later. "As bad as it sounded, he
was alive. Just hearing her voice, knowing she was there with him, helped me
get through it."

    A few minutes later, Griffin wrote a note thanking the nurse and
everyone who had treated him. Then he wrote that his head and foot were
hurting terribly.

    A medical technician bent down close to Griffin's disfigured face. "I
hope you're not going to cry," the technician said. " 'Cause if you cry,
then I'll start crying."

    Griffin held back his tears.

    Earlier, nurses had described his wounds to him, but Griffin now wanted
to see for himself.

    One of his doctors agreed, reluctantly. She handed him a mirror.

    Griffin stared at his image for a long time. He coughed through the
tracheotomy tube - a raspy, guttural sound. The doctor gave him a tissue and
he wiped his eyes.

    The soldier took a pen and a notepad. He scribbled something and handed
it to the doctor. It read: "I'm scared."