Reporter
The Survivors
For the severely burned and near-fatally wounded soldiers who arrive at Brooke Army Medical Center, in San Antonio, the war in Iraq is over. But their fight has just begun.
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BAMC IS THE ARMY’S most modern hospital, a huge seven-story, 450-bed facility built in 1996. From the expansive parking lot you can see, off to the west just above the horizon, the original BAMC, which was built in the late thirties and was on the forefront of treating wounded soldiers in World War II. But BAMC became best known during the Cold War. In 1949, worried about the possibility of massive burns from a nuclear attack, the U.S. government established BAMC’s burn unit, one of the first clinics devoted solely to traumatic burns. The Army doctors in the unit eventually helped develop many of the basic treatments for burns still used today, and BAMC became famed as a destination for both civilian and military victims. Though the fundamentals of burn treatment haven’t changed much in the past forty years—clean the wound, close it with a graft, and rehabilitate the skin—burn doctors and therapists have gotten a lot better at keeping patients alive. “Now,” says Captain Ted Chap- man, chief of occupational therapy at the burn center (as it’s now called), “patients with third-degree burns over eighty percent of their body are surviving. We have better medical care, so there’s less infection, the physicians are more advanced, and the speed from the battlefield to here is really high. Patients can be here from Iraq in a couple of days.”
One of the first soldiers to arrive at BAMC with serious burns from Iraq was J.R. Martinez. In April 2003 he was driving the rear Humvee in a 94-vehicle convoy through Karbala when the left front tire hit a land mine. Everyone else was thrown clear of the burning vehicle; Martinez was trapped inside. When his comrades finally got him out twenty minutes later, more than 40 percent of his body was burned, including almost all of his head. He was nineteen. When I met Martinez, he wore a knit cap because the right side of his skull was puffed out like a water balloon. He had just had his thirtieth surgery, and doctors had inserted two 500-cc bags of silicone under the part of his scalp where his hair still grew. For the next three months they would inject the bags with saline, expanding them and the healthy skin; three months down the road, there would be a flap of new skin, which they would remove and graft onto a part of his scalp where hair doesn’t grow. The procedure is one of the less painful ones Martinez has had to put up with.
It’s not enough that burns are horribly disfiguring; they’re also among the most gruesome of all indignities a body can suffer. From the beginning—when burns have to be thoroughly cleaned (infection is the biggest killer of burn victims) to closing the wounds with skin grafts and, finally, to the physical and occupational therapy, which involve constant stretching of skin that has no elasticity and wants to do nothing but tighten up—burns are pain. “Pain is our biggest obstacle,” says Chapman. “Getting the patient to tolerate the pain is the hard part.” And burns take a long time to heal. “After one surgery,” said Martinez, “you have to give that part of the body so much time to recover before you go back and cut on it again.” He showed me the work that had already been done. “All this skin,” he said, pointing to the left side of his face, “they brought up from my chest. They took out all the bad scarring on my face. Also, I had a big scar on the right side of my face, and they released it and made one thinner scar out of it. I’ve had seven operations on my eyes, which I couldn’t fully close before. They worked a little on my nose, my head, my hands.” He said he’s had a chance to get operated on at Vanderbilt University. He’s refused. “I said, ‘This is the place I want to be. This is the place that will get me back looking better than what I looked like before.’” Part of that is testimony to the reputation of BAMC’s burn center. But Martinez is like most soldiers here—they take great comfort in being treated by soldiers and with soldiers, especially ones with similar wounds. When they look around and see others with damaged faces and bodies, they don’t feel so isolated. They’re reminded that they’re still part of something bigger than themselves.
EVERY SOLDIER FIGHTS HIS BATTLE his own way. Joshua Forbess does it with dark humor. At the end of our first interview, he told me he would be easy to find again. “I’m always running around the hospital here,” he said. “Just look for the guy with no ear and half a nose.” When I did locate him a couple of days later and asked how he was doing, he snorted, “Living in paradise.”
Forbess is a survivor of one of the Army’s first big Iraq disasters: the midair collision of two Blackhawk helicopters over Mosul in November 2003. Forbess and four others lived, while seventeen died. He was burned over 11 percent of his body, mostly his head and arms, losing his right ear and a good deal of his nose. His lungs were so polluted from inhaling smoke that he could barely breathe, and his right wrist and left hand were broken. Worse, at least to Forbess: Five of the dead were men in his command. The guilt was crushing. “Some of us survivors feel we let our soldiers down, our comrades down, our superiors down,” he said. I asked him how he could feel that way after giving so much.
He laughed. “Ever been in combat?” he asked. No, I answered. “Well, not only did I lose my soldiers, I found myself asking, ‘Why did I survive the accident? Did I crawl out and leave them?’ I promised their families that I would bring them back alive, and I didn’t, so I feel at fault. Why should I feel at fault when there was nothing I could do? I still felt at fault for a long time. Unless you’re in the military, it’s hard to explain.” Forbess, who says he has loved the Army since he joined, in 1995, was visited at his hospital bed by an ill-equipped psychologist: “He had never been in combat, and he was telling me how I should feel. So I had to learn to deal with it on my own.”
For many soldiers at BAMC, handling their physical injuries can be a lot easier than dealing with their psychological wounds. In addition to the psychic turmoil of burns and amputations, these soldiers carry survivor’s guilt and suffer everything from nightmares and flashbacks to full-blown depression. “Over there, they’re scared all the time,” says BAMC social worker Michelle Cano, who has worked with both burn patients and amputees. “When they get back home alive, they ask, ‘Why me?’ They’re angry, mostly because it hurts. They’re angry at themselves, at the Army, and at God.” Both the amputee center and the burn center have social workers and psychologists who are addressing these issues. Cano says that in most cases, medication and counseling are helping.
In some ways, amputees have it easier than burn patients. Those who have lost a limb have lost a piece of themselves that can be given back, at least in a workable fashion. Burn patients, especially those with facial burns, lose a big part of their identity, the persona they present to the world. And it takes time to reconcile with the new, disfigured persona. Recovery is a highly individualized process, says Colonel H. D. Peterson, the former chief of the burn center’s clinical division. “It has nothing to do with the degree or size of the burn or injury,” he says, “and everything to do with what the person was like before the accident.”
When Martinez first saw his new face, he almost couldn’t bear it. He was so angry and depressed that he thought of killing himself. He sat for weeks alone in his room watching daytime TV talk shows and refusing to speak to anyone. But everything changed after he took a convalescent leave to his home in Dalton, Georgia, and was given a parade; then he went by his old high school and gave an impromptu talk to students. He was nervous at the beginning but confident at the end. “I amazed myself,” he said. “One point led to another, and by the end, those kids in that class were touched and motivated. I showed them that you can live your life no matter what troubles you’re faced with.” When he returned to BAMC, he began to visit the terrified, damaged newcomers: “I would tell them, ‘Hey, life goes on. I’m not a doctor saying you’re going to be fine. I’m showing you.’ When they’d ask, ‘Why me?’ I’d say, ‘But it’s not just you.’ And then I thought that maybe this is the reason this whole thing happened. I can use my experience to help other soldiers.”
One of the men he visited was Forbess. “J.R. came to my room right after I got out of ICU,” remembers Forbess. “We have a lot of similar injuries. He said, ‘Look at me. I still go out in public. I am who I am.’ That day he motivated me to look in the mirror for the first time.” And after weeks of dread, Forbess says, it wasn’t so bad. In fact, he was kind of relieved. And Forbess started to do what his comrade had done for him, going to visit the newly arrived. “I’d say, ‘Hey, look at me. I still go out. I am who I am.’ I vowed I’d never let another soul go through what I had to go through. As long as there’s one person there to listen, it means a world of difference.”
They’ve both visited Hill, who doesn’t have their commando-like bravado but who does have family support. “My entire family will be behind me,” says Hill. “If I need help, they’ll be there for me. It’ll be okay.” Chapman is optimistic about his patient: “He’s already ahead of schedule. His tolerance of pain is high, and he works hard.”
Like most soldiers, the burn patients and amputees are fatalistic about almost everything. If the bullet has your name on it, the old Army saying goes, there’s nothing you can do about it. And if you survive the hell of war, there must be a reason. “As I look back,” says Forbess, “it almost seems like fate. It’s fate I joined the military, it’s fate I joined the artillery, it’s fate I was in the helicopter wreck—so I could talk to other soldiers, help them out.”
Forbess just wants to return to his unit in his full capacity as an artilleryman. Martinez, the optimist, wants to eventually host his own talk show, a positive one, he says. Hill, the kid who joined the Guard because he liked the uniform, just wants to fish again. Each of them is proud of what he did, proud of his service, certain of its worth. They won’t admit to any regrets. And to a man, they wish they were back with their buddies. In this sense, the war in Iraq is no different from any other.
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