Hidden Battles on Unseen Fronts
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About 45 million Americans are on antidepressants—all living, working and functioning on very different levels. The military is a microcosm of American society. Being on an antidepressant does not automatically mean that you are not functioning. We tried to look at each soldier individually, and never use a cookie-cutter approach while ultimately trying to conserve the fighting strength.
I found out over a year later that SGT K had come by Behavioral Health to say hello to us after he returned from his third tour in Iraq. I was no longer working there when he came in, but I often wonder how he is doing now.
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LANDMINE BLAST TO A SOUL
The Story of Army SPC Walter Blackston
“She asked me if I couldn’t move back with my parents until this was all straightened out. I said, ‘Ma’am, I’m 47 years old. I can’t move back in with my parents. I need to get my life back.’”
During the spring of 2003 Walter Blackston was working around the clock, responsible for far more than his formal assignment as Chief of Communications for Task Force 44 out of Afghanistan. He headed up communications for Med-Com, XVIIIth Airborne Corps, gave multiple briefings a day to Medevac crews, and ran convoys that crisscrossed the countryside outside of Kabul.
At 42, divorced with two grown sons, Walter was one of the older reservists called up after September 11. Moreover he had fully recovered from injuries to his face and eyes when a simulator hand grenade had blown up during a training accident right before his deployment with the 48th Combat Support Hospital, Fort Meade, Maryland. His work was earning him a number of medals and citations.
While deployed out of Bagram, Afghanistan, he’d even been featured in the newspaper Freedom Watch for inventing a 24-hour paging system that enabled doctors and nurses to respond to an emergency at the field hospital far faster than before. So with only a week left before returning home, while he was keen to get back to his family, he felt that he’d contributed to the war effort.
May 24, 2003 started out busy as usual. “Ever since the invasion of Iraq we’d been shorthanded so I was doing a little bit of everything. Around 1800 I got the word that command was sending me and three medics to retrieve some soldiers ‘who were down.’ That’s about all they told us. Not how it happened or if they were alive or dead. The location coordinates they gave us were bad so it took us a while to find the site, and when we got there we saw the smoke in the distance. A Black Hawk had crashed. Between us and the helicopter was a field. We didn’t know for sure but we had to figure it was mined. The Russians mined neighborhood alleys in Kabul, so sure as hell they’d mined an open field. We moved slowly. When we got to the crash site it was a nightmare. The smoke. The bodies. Two solders were dead and the third was bleeding out. If we had gotten there fifteen minutes earlier we could have saved him. I remember standing there looking down at his face while the medics did what they could and thinking,’ Just fifteen minutes sooner and he would have lived.’”
Walter and his companions loaded the bodies on two gurneys and started making their way back across the minefield to safety. “We couldn’t follow our footprints. It was too dark. One of the guys, a good friend, was walking ahead of me and I was praying that he’d know where to step. Suddenly there was a huge explosion. I threw my hands up to protect my head and that’s all I remember. The next thing I was struggling to get up and someone was holding me down, and then I felt the pain.” Walter’s friend had stepped on a land mine, killing himself and injuring the other three. The blast knocked Walter unconscious, injured his spine and embedded shrapnel in his armpits and face. No one had been wearing body armor. “That was a bad night. A bad… bad night.”
With one week left before he was to be sent home, Walter was stitched up and kept on the job with orders to report to Walter Reed Medical Center when he returned stateside. By the time he got to Walter Reed an infection had spread throughout both his arms. The doctors would have to cut out the infected flesh again and again, unable to prevent nerve damage in the process. He would spend the next three years undergoing spinal surgery, multiple surgeries to each arm, and skin grafts. Haunted by nightmares, memory problems and paralyzed with depression, he started treatment with a hospital psychologist for Post-Traumatic Stress Disorder.
On January 31, 2004, while he and his roommate watched the Super Bowl on television, he took a turn for the worse. “They had cut more flesh out from under my arm and packed it with sponge, but they hadn’t gotten all the infection out. You could smell it soon as you came near me.” Feeling progressively worse minute by minute, Walter rang for help. “They finally got a doctor to take a look. To clean the wound he had to pull out the staples and he snagged an artery. Then his pager went off and he left the room.” Walter began to bleed out. “The guy in the bed next to me was a double amputee so it was hard for him to go for help, but when he saw what was happening he started hollering. Finally a nurse came in.”
When the nurse saw what had happened, she called for backup. They repacked the wound with dressing, changed the sheets and put Walter back in bed. Then they left. “I lay there feeling warmth seeping down my back and onto the mattress. We kept buzzing for the nurses but no one came.” He called his mother in Baltimore.
“I picked up the phone and I heard Walter on the line saying,’ Mom, I’m not going to make it. You got to get here. I love you,’” recalls Luvinia Blackston, who lives in Baltimore and is a retired surgical nurse. “It took me and Walter’s step dad close to two hours to get to the hospital. Route 29 from Baltimore to Silver Spring was bumper to bumper traffic so I drove on the shoulder the whole way. I called Walter’s sister and said call him and keep him on the phone talking until I get there. She asked what was wrong and I said, ‘Just call him!’ I was praying that the police would pull me over so I could tell them I needed an escort to the hospital, but no one stopped me.” When Luvinia got to her son’s hospital room she froze. Walter lay unconscious on his bed surrounded by a pool of his own blood.
His roommate had pulled himself into his wheel chair and gone out to the nurses’ station for help but no one had responded. “I wrapped a towel around my hand and pushed on the artery. The whole time I was screaming for help. My husband couldn’t take it. He went into the bathroom and threw up.” Once Luvinia got the attention of the medical staff, they went into overdrive. Walter’s bed was unplugged and he was rushed to the operating room, where he underwent surgery and received transfusions. “I pushed on the artery all the way to the OR. It was the only way to keep him from bleeding to death. While they were operating on him I waited outside, and a nurse came up to me and saw my arm covered in blood past the elbow. She said, ‘You should have worn a glove,’ and I said, ‘He’s my son. His blood is my blood.’” For the next 48 hours Walter remained in intensive care until he was stabilized enough to return to the unit. Luvinia stayed the entire time. “When he came around, he said, ‘Oh, Mom, I’m so glad you’re here.’ He had tears in his eyes.”
By 2005 Walter was quartered outside Walter Reed at Summit Hills apartments in Silver Spring where he lived with another soldier, a young sergeant who coped with his PTSD by going AWOL every chance he got. Three months later they were moved to Building 18, the hospital’s former student barracks, doubling up in a single room. “It was so small that the only way to get any privacy was to separate our bunks with the wall locker. The paint was peeling off the walls in strips. There was mold on the ceiling, mice, cockroaches. The bathroom was disgusting. You couldn’t go out alone at night because it was too dangerous. In the short time I was there two soldiers were robbed and beaten. Coming from Baltimore, I knew how to watch my back so I would sit in the lobby and talk to the guys, give them advice on how to protect themselves.”
Walter wrote a letter to the House Committee on Oversight and Government Reform about the state of the building but never heard back from them. “After two months I couldn’t take it any longer. I demanded that they find me another place to live.” He was relocated to an efficiency
at Knob Hill Apartments, another complex near Walter Reed. Two weeks after he moved in he attempted suicide. “I wanted to take myself out. I was emotionally drained. I felt that there was nothing left for me. I struggled for days but I couldn’t find a reason to keep on living. I took a bunch of medications and washed them down with alcohol, but I vomited everything up almost immediately.” After a second botched attempt, he gave up trying to kill himself.
In May of 2006 he was given three days to sign his Medical Evaluation form, but he hesitated. “I sought out a guy named Danny Sotto from the Disabled Veterans of America to explain the paperwork to me. Danny was a saint. At that time there must have been 600 soldiers at Walter Reed, all disabled and all being discharged, and we were clueless about what it all meant. Danny helped each and every one of us.” Ultimately Walter was discharged from Walter Reed and declared fit for duty, although he had been under almost daily treatment for his PTSD for over a year and a half, and had severely limited range of motion in his upper body. “The scarring was so terrible. The skin had healed like a web under both my arms but they only rated me 20 percent disability.” Once he was out on his own, the undiagnosed Traumatic Brain Injury (TBI) he received during the land mine explosion worsened precipitously.
“There were days I couldn’t remember who I was, where I lived or where I worked. I didn’t remember things I used to do or what I used to like to eat. When I was in Afghanistan I invented a 24-hour pager and got written up in a newspaper, and I have no memory of doing that at all. I’d wake up in the morning and feel like someone was holding me down just like after the explosion when I came to.” There was no job waiting for him as promised when he was called up, so he returned to Jessup, Maryland and lived on savings for as long as he could while waiting for his Veterans Disabilities to kick in, but he heard nothing for almost a year. “After that I borrowed from my family and friends. I lost my job, my house, my fianc#x00E9;e, my cars, my credit—but worst of all, I lost my mind.” There was a silver lining, however. While he waited, Walter was finally screened for TBI.
Feeling desperate, Walter went to the Veterans Administration in Baltimore for help, bringing photocopies of all his records with him. The benefits associate who saw him was not sympathetic. “She asked me if I couldn’t move back with my parents until this was all straightened out. I said, ‘Ma’am, I’m 47 years old. I can’t move back in with my parents. I need to get my life back.’” Walter demanded to see her boss. After hours of waiting he was ushered into another office where the Baltimore Director of the VA waited to see him. “I took off my shirt and said, ‘This is what I look at every day.’ She said, ‘I’m so sorry.’ And I said, ‘Do not be sorry. Help me.’” Two days later Walter received a 90 percent disability rating and a 100 percent unemployable rating which translated into $2,500 a month disability.
Arthritis in his back made staying in a cold climate impossible. Walter moved to Atlanta near a VA hospital and started carving out a new life for himself. Finances were bleak for a time, which was when The Armed Forces Foundation gave him money for his car payment. It’s still a battle. “I have blackouts. I don’t drive a car often. I forget everything. The VA gave me a Palm Pilot to record everything I need to remember, and I use it all the time. This life takes its toll; there are frustrations every day. I miss my family, but Maryland was too cold and too expensive to keep living there. I’ve lost it a couple times. I’ve thought about suicide. But I have my boys. I raised my oldest, Anthony by myself, and even though Corey has graduated high school and is now in college, I need to be here for him. When I first came back from Afghanistan and he came to see me at the hospital, I didn’t know who he was, my own son. I can’t let him down.”
Walter continues to take an increasingly proactive role in his mental health care. He sits on the Advisory Committee of a veteran’s hospital in Atlanta as an advocate for better care of veterans with PTSD and TBI. He is partnering with his church to start a “Veterans for Christ” program with a web site and the motto: “Veterans connecting and protecting.” He is also participating in the hospital’s pilot “Life Coach” program, a weekly one-on-one session with a social worker that addresses a wide range of issues. “We’ve talked about my problems with going out in public and fear of crowded places; about paperwork pending within the VA system; about managing my finances; about anything and everything. Sometimes we meet at the mall. It’s that informal.”
Walter’s attitude is hopeful, and he is determined to continue his recovery. “I just want to lead a fruitful life. To know how I used to be and to not be able to be that person again, ever, is frustrating. But I have to start from where I am now. It’s all on me. I used to sit for days and just look out the window, and I thought that withdrawing from people and breaking off relationships was normal considering what I had been through. Now I know it’s not. If I had one thing to say to vets like myself it would be, ‘We earned the right to be proud of who we are. Be the squeaky wheel. Dig down in your heart and get the help you need.’”
MEDALS
The Army Commendation Medal, Army Achievement Medal, 3 Army Reserve Components Achievement Medals, 2 National Defense Service Medals, Armed Forces Reserve Medal, 2 Non-Commissioned Officer Professional Development Ribbon, Armed Service Ribbon, Overseas Service Ribbon.
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AMERICA KEEPS ITS PROMISE
The Truth about Military Care of Warriors with Traumatic Brain Injury
By Christopher S. Williams, USAF, MC
Although the popular press and several recent reports suggest that the Department of Defense and Department of Veterans Affairs are falling short in the care of our warriors with invisible wounds such as Traumatic Brain Injury (TBI) and Post-Traumatic Stress Disorder (PTSD), nothing could be farther from the truth—America is keeping its promise. Just as important, never has Congress, the Department of Defense (DoD), and the Department of Veterans Affairs mobilized itself more briskly, delivered personnel, and appropriated resources to such a degree to deliver improved access to care for these “signature wounds” of the War on Terror. I will share a story with you that I believe illustrates the level of commitment.
On September 13, 2007, I deployed to a northern Iraq air base to command a small Air Force combat hospital caring for thousands of US Army, Air Force and contractor personnel. It was an honor to command this unit of splendid Air Force medics, but also a daunting task given the casualties we were seeing during the four-plus months we were there. Unfortunately, we witnessed firsthand the horrific injuries sustained from Improvised Explosive Device (IED) blasts. For most of us, the sights and sounds are etched indelibly in our memories forever; but for the wounded, they are not only etched in their memories but in the scars they bare. While I cared for over sixty traumas, there is one that remains most vivid.
In late October, a US Air Force member working with an Explosive Ordnance Disposal (EOD) team was critically injured with a “booby-trapped” IED device that was being disarmed. The explosion traumatically severed and destroyed his left arm at the mid-upper arm level. It caused severe injuries of a fractured face, destroying his left eye and injuring his right one. As you can imagine, he also suffered a Traumatic Brain Injury. He lived only because of the prompt and expert field care of a 19-year old Army medic who applied a tourniquet to his severed arm and was able to initiate administration of fluids in the field while awaiting helicopter medical evacuation.
Upon arrival at our hospital, it was obvious that there was no way to save his left arm, so after emergency resuscitation he was taken to surgery to complete the amputation of the arm and possible surgical exploration of his abdomen and chest. Once he was stable, he was promptly transferred to the Air Force theater hospital in central Iraq where otorhinolaryngologic (ENT) surgeons stabilized his multiple fractured facial bones, ophthalmologists attempted repair of his severely injured right eye (his left was beyond repair), and neurosurgeons could provide neurosurgical intervention if it became necessary. Unfortunately, despite multiple
eye surgeries in the theater hospital, in Germany, and back in the United States, his right eye could not be salvaged and he was left not only with an amputated left arm but totally blind as well. Fortunately, he recovered from the TBI without permanent effects.
In the ensuing time since being in Iraq and commanding the hospital where he was initially cared for, I was reassigned to my current position (I am a neurologist) as Senior Executive Director for Traumatic Brain Injury at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) in Washington, DC. However, I never forgot about this airman. During a trip to the University of Pittsburgh in September of 2008, I met retired Major General Gale S. Pollack, who served as interim USA Surgeon General in 2007. General Pollack is now the Executive Director of the Center for Ocular Regeneration and Vision Restoration at the University of Pittsburgh Medical Center, and shares with me a passion for caring for our wounded warriors. In our meeting she told me about a revolutionary vision device that I had only read about in a book, “The Brain That Changes Itself.” I did not realize that it was actually being developed by a company in Madison, Wisconsin. The device takes advantage of the innate neuroplasticity of the brain while utilizing a camera, small computer, and sensory portals applied to the tongue. The first person I thought about benefiting from this device was the young airman we had cared for.
The device works and is under careful evaluation and further development with the hope of obtaining FDA medical device approval in the next year or two. However, I immediately wondered if we could connect the airman to the company and provide DoD funding so he could utilize the technology while being a part of the evaluative process for the FDA request. With the help of the Air Force Reserve Surgeon, Colonel Dominec DeFrancis, I was able to track the airman down to Brooke Army Medical Center in San Antonio, talk with his case manager and connect with the technology company, Wicab, Inc., in Madison that is developing the BrainPort® vision device. As I write and relate this story, we are exploring ways to get this technology to him for evaluation and use. Although we have not completed the task, my experience to date is that DoD will do whatever is necessary to help wounded warriors, one by one, wherever, whenever. I believe that in the next several weeks, he will be evaluated and be using this technology.