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.
When it was time for Dustin Hill to receive his Purple Heart, he was wheeled from an aisle in the packed auditorium up a ramp and onto the stage. He wore glasses, warm-up pants, unscuffed running shoes, and a U.S. Army cap, under which was a white gauze bandage. His face was red with scars from the fire that had destroyed his Humvee in Iraq four months before. The smooth, red, round ends of his arms poked out of the sleeves of his jacket. There was a pink hollow where his right eye used to be.
“Specialist Hill is from Wyanet, Illinois,” said General C. William Fox Jr., the emcee. “In September, Specialist Hill sustained extensive burn and shrapnel injuries in the Green Zone in Baghdad when, on patrol, a vehicle-born improvised explosive device was detonated next to his Humvee. Specialist Hill is single and is accompanied here today by his mother, father, and two brothers.”
There is more to Hill’s story. He joined the National Guard in 2002 and was deployed in 2004. He was the only member of his squad in the Humvee; the rest were investigating an abandoned vehicle. A suicide bomber had pulled his car behind a passing convoy and, when he’d reached Hill’s stopped vehicle, blown himself up. Hill, on fire, was thrown free. He suffered third-degree burns over one third of his body. His entire right hand and the fingers on his left were burned so badly they would be amputated. He also had a broken femur, kneecap, and ankle. He is 22.
The applause for Hill lasted a full twelve seconds. He was the fifth of five wounded soldiers, or warriors, as they were called, to receive the Purple Heart at this ceremony, held at Brooke Army Medical Center at Fort Sam Houston, just outside downtown San Antonio. It was January 14, and most in the audience wore camouflage. The ceremony was a charged prelude to the official occasion that morning, the opening of the Army’s second amputee care center. The first had been opened at Walter Reed Army Medical Center, near Washington, D.C., in 2004. But with the violence in Iraq increasing, demand was high. This new facility at BAMC is 29,000 square feet, with state-of-the-art prosthetics and occupational and physical therapy rooms. To showcase what doctors at BAMC had already been doing with amputees, nine soldiers, each of whom had lost a limb, walked or were wheeled to the stage. Some, like B. J. Jackson, who stood on steel legs hidden under khaki slacks, had reentered civilian life. All nine held a long yellow ribbon, which Army Vice Chief of Staff General Richard A. Cody and Sergeant Major of the Army Kenneth O. Preston cut with a pair of oversized scissors.
At the reception afterward, men with hooks for hands mingled with men who still had all ten fingers. A four-piece military band played World War II—era Glenn Miller songs, and people milled about chatting. I watched Jackson walk among the guests, and I had to look closely to see any unsteadiness in his step. No one stared at Hill, who at one point was surrounded by his mother, Liz Kelm; General Fox, the commander of Fort Sam Houston; and General Cody. No one gawked at Joshua Forbess, who was one of only five survivors of a Blackhawk collision in 2003 and who has one ear, part of a nose, and an extensive scar running around the crown of his shaved skull. His head was shiny, especially the skin under his right eye, which had just been operated on. Forbess is stout and unself-conscious and looks like a large owl. He moved easily among the crowd, talking to friends and hospital staff. At one point an older woman walked up to him. “I need to give you a hug and a kiss,” she said, and did. A sergeant approached him and shook his hand. “You are a great warrior,” he said.
In much of the country, it’s easy to overlook the fact that we’re at war. You can’t possibly do that at Fort Sam Houston. There is a sense here of urgency and duty, and everywhere you turn you see camouflage and crisp salutes. If you have doubts about the war or its legitimacy, the doctors and nurses at BAMC don’t want to hear them, and neither do the soldiers, especially the ones who gave their arms and legs on the battlefield. They are still fighting. “You have to be a warrior once you come back,” says Corporal J.R. Martinez, who left most of the skin of his face in Iraq. “The battle in Iraq may have lasted a few minutes or a few hours, but the real battle starts when you come back.”
ALL WARS ARE DIFFERENT from the ones that came before. The main difference in the Iraq war is that an astounding 91 percent of the wounded have survived their injuries. By contrast, in World War II the figure was 70 percent, and in both Vietnam and the Persian Gulf wars, 76 percent. There are several reasons for this. Field doctors have better equipment now, plus they are truly mobile; surgeons can do trauma surgery out of backpacks and then, if necessary, airlift the wounded to BAMC or Walter Reed in 36 hours. The main reason, though, is the ceramic and Kevlar in their vests. U.S. soldiers wear 25 pounds of virtually impenetrable body armor, and much stronger helmets, so they’re not getting wounded as much in the vital organs.
But their limbs and faces are paying for it. Two thirds of the wounds in this war come to the arms, legs, and head. And if the wounds aren’t as deadly, they’re a lot more horrible. Multiple limbs lost. Burns over 80 percent of the body. As one doctor told me, “A lot of these guys should be dead.” The main causes of the wounds are explosions from mortars, grenades, and what the Army calls IEDs, improvised explosive devices. Other wars had bombs too, but the Iraqi insurgents are delivering them in frightening ways, via suicide drivers or remote control, bringing bombs up close to our soldiers, next to their Humvees (which are not, as many soldiers have complained, fully armored), even inside their tents.
The wounds are often complex ones—burns mixed with lost limbs, bone destroyed along with muscles and nerves, one leg shattered while the other is blown off. Dustin Hill’s injuries are about as complex as they come. Six days after he received his Purple Heart, Hill sat on a black couch in the amputee center’s occupational therapy room and tried to get some of his former life back. His therapist, Amy Hilliard, fitted him with a silicone myoelectric prosthetic hand that operates by responding to electrodes placed over upper arm muscles. When the patient flexes the muscles, they emit electrical impulses that open and close the hand. Hill’s right arm was bright red, like raw hamburger meat, while his left arm had a thick white gauze bandage on it. It took awhile to get the hand on Hill’s forearm, which had swelled up in the previous couple of days. At one point he grimaced. “Are you okay, Dusty?” asked his mother, who sat at his right and who accompanies her son almost everywhere he goes. He nodded. He is tall, thin, and soft-spoken. He joined the National Guard, he told me later, because he liked the uniform.
Hill was engaged in occupational therapy, which deals with the prosthetic hands. Just across the hall is a modern apartment with a bedroom and a kitchen, a kind of hands-on OT room, where patients learn all over again how to turn on a stove and open a jar of pickles. The new center also has a physical therapy lab, where patients work on basic motor skills, like walking. Patients who’ve lost legs are often outfitted with C-Legs, $45,000 computerized prosthetics that can be customized to the user’s gait. Two thirds of the amputees here have lost their legs, and they can be walking within weeks on new ones, which can then be covered by trousers.
Hands are not so easy. Once the prosthetic hand was on, Hill opened and closed the silicone fingers and thumb, looking quizzically at this robotic thing attached to his flesh. It was maybe the sixth time he had used it, and he still wasn’t comfortable with it. Hilliard began the morning’s therapy by holding out a stick of red licorice. Hill slowly reached for it. He closed the thumb and forefinger around the thin red candy, leaned forward, brought it all the way to his mouth, took a bite, leaned back, pushed his arm away again, and chewed. “Let me just say,” said Hilliard, “I’m impressed you did that reclined on the couch like you are. You really had to stretch for it.” Hill spent the next fifteen minutes methodically learning to feed himself again. It began to wear on him. “The hardest part about the exercise,” explained Sergeant Heather Martin, another occupational therapist, “is using your arm muscles to control the electrodes.” It’s tedious and it’s painful.
When the piece of candy became bite-size, Hill used his left arm to push his right arm the last couple of inches toward his mouth. “You see how close he got that to his mouth?” asked Kelm. “Yes,” replied Hilliard. “I’m very excited. You did awesome, Dusty. Awesome, ” Hill smiled. He was proud of himself, even this small thing, and his boyish grin cut through the red scars on his face.
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