Take 3

Warrior
I’ve always had an objection to the word “Warrior”. In my mind, it always had this “larger than life” connotation, like by using it you were talking about some Russell Crowe-Clive Owen-Mel Gibson character wearing bronze armor. Because I have such disdain for war (and in particular for this misguided excuse for a war our administration has mired us in) I have had a particular objection to using it to describe the soldiers fighting in Iraq and Afghanistan.In the last few weeks, however, I have had to re-think this.

As a part of a project I am working on for my job, I have been touring the hospitals of the armed forces medical center network, meeting with doctors and patients involved in the “worst case” injuries coming from the Middle East.

Before I go into what I’ve seen, I want to take a minute to put all of this in perspective for you.

Despite decades of technology advances, both in terms of weaponry and in terms of medical science, the basics of warfare haven’t changed that much. The object of the game has been to kill as many members of your opponent’s army as possible while keeping as many of your soldiers intact. So basically, every time the killing technology has become more sophisticated, the armor and medical technology has advanced to keep pace. As a result, the ratio of killed soldiers to wounded soldiers has remained relatively steady throughout the history of American warfare, with about 2.4 injured soldiers to each killed soldier.

That is, until this set of conflicts in Iraq and Afghanistan. Two very important things have changed in this set of conflicts. First, we have made a quantum leap in body armor design at a time when we are fighting an enemy that, despite claims to the contrary, does NOT have weapons of mass destruction. Second, we are now encountering an enemy that is not so much concerned with killing soldiers as it is with inflicting as much damage as possible. IED’s are designed to spread damage across a wide area, with the hope of killing as many as possible, but with the knowledge that there’s a good chance of hurting a lot of people. The blast force of these weapons used on these soldiers is equivalent to having a cement mixer dropped on a limb for a split second. But if a soldier is sufficiently well protected, it normally isn't a force that will immediately kill.  We have also become much better at training our young men and women on the front lines to provide "buddy care" where they can staunch bleeding, deliver initial pain meds, splint a broken limb or get a wound covered in minutes, saving lives.

The result? We do a much better job of keeping our people alive than we used to. We are now seeing approximately 9.8 – 11.5 injured soldiers for each killed soldier (depends on whose numbers we use). That’s four or five times as many as we’ve ever seen before. So, while we have only had about 3500 soldiers killed, we’ve seen between 32,000 and 40,000 injuries. That’s a significant number.But that’s not the tough part of this particular situation, from a healthcare standpoint.The tough part is this: Of those 9.8 – 11.5 wounded soldiers, 2.7 of them have a wound severity score that classifies them as “profoundly damaged”.

What does it take to be “profoundly” damaged? A simple missing hand or foot won’t get you in the club. No, these young men are missing multiple limbs. They’re missing eyes. Noses. Lower jaws. Whole faces. Large portions of their skulls. Their spines are a shattered wreck. They have acute compartment syndrome from the blast injuries, where the muscles swell so profoundly that the compression cuts off the arteries and nerves and the tissue dies from lack of blood flow. They have burns so unbelievable that the patients look like a prop from a Hollywood horror film.

I stand beside a hospital bed where a doctor has just uncovered a wound. Despite the fact that I know there is an arm attached to it, it takes a few minutes for me to realize that the blackened stump with the white bones sticking up used to be a young man’s hand. The fingers and most of the flesh were burned off, not blasted off. The next bed over has a patient who is missing so much of his face, I can scarcely recognize him as human. Later that day, I will be in a briefing where I see the progression of this young man's treatment.  The photographs will make me faint.

The ones who are "just" missing arms or legs are easier. Many of them are awake and want to talk. Because I am more junior than most of the physicians, I am often the last to shake hands with these young men – if they still have hands. They call me 'Ma’am'. They have a tendency to try to keep contact with me while the docs are talking. It was unnerving at first. I have come to understand it is because nearly every one of them is young enough to be my own son. They hold onto the hand they have just shaken, or give me a look that silently asks that I leave it on an arm, and they and I take comfort from each other, because in this world of men and uniforms, I am a woman in a skirt who reminds them of their mother. They are brave; all of them.  They want to get back to their units, to support their comrades.  For many of them, this will never be possible.  It isn’t easy. I find myself wanting to kiss those brows and make them a vain promise that "it’s all going to be OK". I can’t do that. But I try, with the touch of my hand, to project compassion, and calm, and hope.

The doctors are at a loss to treat many of these patients. They literally rummage through medical supply closets to find materials out of which they can fashion the prosthetics to build new cheekbones, ears and noses. Although they are very controlled during the meetings and patient visits, it's different later over lunch, when they change subjects rapid-fire and their voices often lapse into a half-panicked cadence that speaks of PTSD.

I leave at the end of these visits feeling numb. Over the following days, the numbness wears off and is replaced by…horror.

Not the movie-like horror that makes one sit bolt upright in the middle of the night, stifling a scream. This is a slow, quiet horror that unfolds like an unnamed grief. It is the kind of horror that wakes you in the middle of the night to crawl into the next bed and wrap your body around your sleeping child. It is the kind of horror that makes you drift off in the middle of a sentence, one that makes you miss freeway exits, or makes you ‘wake up’ in the middle of a load of laundry and realize you’ve been standing there for ten minutes and that a pool of slow, silent tears has gathered on the counter.

In the last few weeks, I have gained much knowledge.

I have gained a new definition of “Warrior”. It has little to do with this war. It is instead defined by the battle to be fought by men and women who will have to exhibit incredible bravery and nobility to regain their health and any semblance of their pre-war lives.

I have also gained a new respect for the medical professionals who serve these warriors. They battle daily against odds that I can only begin to fathom.

I’ve gained a new understanding of the word sacrifice.

I’ve gained a new sense of urgency to my own work.

And I’ve gained a new disdain for those who would use the debate over this war for personal or political gain, on either side.

I’m still trying to measure what I’ve lost.