The cartilage in his neck was also ruptured. While it has healed, Dave still has some slippage of neck bones which at any time could guillotine his spinal chord and perhaps cause paralysis. Contact sports like touch football became a fond memory. “I have a major loss of hearing in my left ear and some loss in my right ear. My vision is now different in both eyes. Consequently, sometimes when reading something on paper or the computer I occasionally miss what is written. The hole in my leg has healed. I have some cool scars on my face. Chicks dig scars; you can tell any story you want of how they got there.”
Dave left Bethesda to recover at Walter Reed Medical Center for the next two years. He could barely talk and went through months of intense speech therapy to learn how to recognize and remember words. Like Rob Kislow, who tested out different types of prostheses, he was asked to participate in clinical trials having to do with TBI. “I was asked if I would go through an experiment with a drug called X to see if it would help in my recovery. I had no idea if I had the drug or something else but I said yes. In the clinical trial, I had to go see some nurses to do weekly and monthly testing, and I was constantly taking different kinds of mental exams which forced me to think. That was a good thing. “
“In the meantime I tried reading, doing logic puzzles and playing Mahjong on a PDA. My best friend, Steve Smith, called me every day and we talked from one to three hours a day for eighteen months. Talking with Steve did a lot to get my mind working. Without him, I don’t think I would have recovered as much as I have.”
After getting his prosthetic skull he got a job at Walter Reed. “I started working with Mr. Kitt in the baggage room. Storing baggage was one of my responsibilities as a supply sergeant. This was a minor task in the Cavalry, but a major one at WRAMC with so many soldiers filtering in and out of the hospital.” After he worked there for about four months the job started becoming easy and he knew he was ready for the next step.
“I took over the supply room for the Medhold Company. They had no equipment accountability or ordering system, so I started building the systems to reclaim accountability of equipment and start the flow of office supplies. Before I got there you were lucky to get a pen, a notebook or printing paper. For example, we were supposed to get a new uniform issue once in Medhold Company, but when you were coming from the battlefield you got nothing like that. It took me over a year to get a new issue. That was because once in the supply system, the Brigade S-4 just kept things bottled up there in the bureaucracy. I convinced the S-4 officer to put this process in my hands, which he did. After I took over it wasn’t long before a soldier could put in for a new uniform and literally have the paperwork to go to the PX to get it the same day.”
A few months later, Dave worked with the Wounded Warrior program to return to the civilian workplace. His first job was as an unpaid intern at the Federal Highway Administration in Washington, DC. His hope was that an internship might turn into a full-time job.
“The first interview I went to was with Paula Ewen of the Federal Highway Administration. I told her that I did not see myself holding a stop and go sign on the side of the road, that I wanted to work for a logistic branch of the government. She not only offered me a position but grabbed hold of my arm as I left and told me she would not let go ‘til I said yes. I believed her and relented and it was one of the best decisions I made. I became a sort of personal assistant to her. If I can ever work again, she is the type of boss I want.” By far the biggest challenge Dave faced during this time were his headaches, constant migraines that kept him home for days at a time. “Once, I felt so guilty not going to work that I did not go back for six weeks. Paula called me at home and told me she understood that I was going through some bad times and to come back any time I was ready. I was not to feel any guilt about the time missed. She and the agency were there for me, not me there for them. The next day, I reported back to work.”
Dave retired from the Army in September 2006 with 30 percent benefits. He was approved for Social Security disability and received 200 percent from the VA.
Today he is attending Muhlenberg College. “Heather Bernard of the American Council of Education told me about Muhlenberg and helped me get into the school. My goal is to overcome some of my TBI issues so I can successfully re-enter the work force.” His first year was a resounding success. “I always thought that people would follow me to class protesting the war, or penalize me for having a conservative viewpoint. This is not the case at Muhlenberg. Professors and students want to hear your stories and show their appreciation and support regardless of politics. Because of the support of many professors I‘ve succeeded in my classes, with only one B, the rest A or A- and a 3.82 GPA. I feel it’s important to tell people my GPA and the courses I’m taking, not because I want to boast, but to clear up the fact that though some of us veterans were affected by TBI, we can still accomplish great things.”
Dave is optimistic about his future. “It would be easy to say, ‘I have done enough in thirty-five years to take it easy; certainly, I have earned this.’ But God has a purpose for me, to be a blessing to someone, and that takes work. Through all my experiences since I’ve been injured I have found it pays to be proactive and to push to rehabilitate myself. If nothing else I will have gained the satisfaction that I know I have lived a good life and framed my living to be a pleasure to my Lord and a blessing to others.”
MEDALS
Army: 2 Purple Hearts, Army Commendation Medal, 2 Army Achievement Awards, 3 Army Good Conduct Medals, 2 National Defense service Medals, Global War on Terrorism Service Medal, Non Commissioned Officer Professional Developement Ribbon, Combat Action Badge.
Marine Corps: Meritorious Unit Commendation, Good Conduct Medal, Sea Service Deployment Ribbon with one star.
24
THE MENTAL TRANSCEIVER
By Norman McCormack
Like other communications systems, our brains receive and transmit messages. As is the case with any transceiver, the human brain contains many electrical circuits—each devoted to a particular task or set of tasks. How clearly messages are received and sent out depends on how well our brain circuitry works. Disruptions (e.g. open circuits, short circuits, power fluctuations) interfere with both reception and transmission—in other words messages get garbled.
Unlike man-made transceivers, our brain circuitry does not rely on transformers, diodes, resistors and the like. The flow of electricity is modulated by chemicals called neurotransmitters. If the actions of these chemicals are disturbed, the electrical signal—the message—is interrupted.
The Norepinephrine Circuit
This drawing is of one of many neurotransmitter circuits in the brain. If this circuit malfunctions, electrical signals that rely on it are disrupted.
Disturbances in neurotransmitter circuits can result from physical injury, illness, drug abuse, or psychological trauma. For example, it is well established that the circuit connecting the thalamus (information clearinghouse), the amygdala (emotional memory, survival response) and the pre-frontal cortex (seat of reason) often malfunctions in those who have been exposed to severe trauma (such as military combat). This malfunction is in the nature of a short circuit. Instead of proceeding from the thalamus to the pre-frontal cortex and then to the amygdala, the signal is shunted directly from the thalamus to the amygdala, where the message is interpreted solely by emotion. This process—called emotional hijacking—frequently leads to inappropriate responses to the original signal.
Brain structures involved in emotional hijacking
Stimuli from the environment are interpreted by “unresolved” emotions stored in the amygdala. The prefrontal cortex is “locked out” of the loop. As Jonnei Compaz’s story demonstrates, a stimulus, the “smell of barbecue,” is “mis-interpreted as the smell of “burning flesh.” This “mis”-interpretation resulted in behaviors necessary to survive combat, but not appropriate to his hometown.
Troubleshooting brain circuitry is not as straightforward as it is with man
-made devices; oscilloscopes and digital VOMs are of no use to us. The “diagnostic tool” we use is behavior. If a person has trouble controlling anger, or avoids involvement in previously enjoyed activity, we can use these as crude measures of disrupted circuitry.
By exploring with someone how he or she interprets and responds to messages from the environment, we can “drill down” and focus on specific circuits. Once identified, we are then able to help people repair and re-energize disrupted circuits.
Sometimes it is necessary to use medication to help repair mental circuitry. Just as we may use a jumper wire to temporarily bypass a short in a man-made transceiver, medications help by giving us time to reenergize a neurotransmitter circuit that has been disrupted by trauma.
25
I’LL NEVER LEAVE YOU
The Story of National Guard Sergeant Jose Pequeno and His Mother, Nelida Bagley
“After Jose got injured I had to fight for a way to be close to my son. There were nights when I really did believe they were going to throw me out and then I would sleep in the waiting room. I had to prove myself.”
There is a lioness living in Jose Pequeno’s hospital room at the James A. Haley Veterans Hospital. Nellie Bagley is protecting her cub after he was returned to her from Iraq with a portion of his brain blown away, his left arm shattered and two shrapnel holes in his back. Since March 3, 2006 when she “got the call,” her fierce, almost unfathomably single-minded love for her son has been the driving force that keeps him alive.
“Back then I worked nights. I got home at 7 am but I couldn’t sleep that day. Around 1 p.m. there was a phone call. ‘We need to notify you that your son had an accident and is in surgery.’” But they couldn’t tell her any details so she hung up, called her daughter and Jose’s dad, and then kept calling Casualty Affairs every fifteen minutes. “They kept telling me that when they knew something I’d know it. It seemed like hours before they said,’ They’re flying him into Germany.’ When he got to Germany, they told me there was a severe injury to his head. I kept asking them,’ How bad is it?’ They kept saying,’ Until he’s getting cleaned up we won’t know the extent of the injury.’ I finally got to a nurse and begged her to tell me what was going on. ‘I’ll have a neurosurgeon call you’ she said.”
At two o'clock in the morning, Nellie received a call from the neurosurgeon. “‘I’m still evaluating your son. I’ll call you when I’m done. I asked,’ How long are you going to be?’ ‘I’ve got twenty minutes to go,’ he said, and I said,’ You’ve got twenty-two minutes. I’m his mom, for God’s sake.’”
Twenty-five minutes later Nellie got a call. “The same male voice said,’ Is Jose Pegueno your son?’ I said,’ Yes.’ ‘Such a beautiful son,’ he said. ‘What a terrible waste, a young man with such a life ahead of him, and he’s going to die.’ Right there, a piece of me just left. ‘You’re such a liar!’ I yelled. ‘Of course my son is going to make it.’ After that, I asked,’ Are you finished with your evaluation? Tell me exactly what’s wrong with my son. Please.’ And the surgeon said,’ He has a severe brain injury, severe bleeding; he’s lost the bottom two lobes of his brain.’ I started throwing things. My next-door neighbor came running, and I sat down and cried and said,’ I can’t do this.’” But she could.
In 2001 former Marine José Pequeno was the youngest police chief in the state of New Hampshire and the sole officer of Sugar Hill, population 600. He supported a wife and two school-age children as well as a preteen daughter from a former relationship. He ran five miles a day, hunted, fished and loved motorcycles and snowmobiles. The New Hampshire “north country” townspeople gave him a surprise going away party at the local meeting house when his National Guard military police unit deployed to Iraq in the spring of 2005. He’d be back in a year.
Almost exactly one year later, on March 1, 2006, just a week after his 32nd birthday, Jose was manning an Iraqi checkpoint. “Insurgents had blown up an Iraqi police station in Ramadi with a car bomb and Jose was there calling it in to the base,” Nellie explains. “They threw a grenade through the open part of his Humvee and it exploded directly behind him.” The blast blew Jose out the door. His driver was killed instantly, the gunner was shot, and Jose ended up half out of the truck so that the lower part of his body was still inside the Humvee but his head and parts of his brain were on the sand. The explosion had gone under his helmet. When medics arrived less than two minutes later they assumed Jose was dead and went to help the gunner. But they heard the gurgling sound of the “dead” soldier choking on his own blood. They cleared his airways and yelled “Sergeant P!” and Jose opened his eyes.
The first surgery was in Balad. The next few were at the Landstuhl Medical Center in Germany where Nellie would be told, for the first of six times in twenty-nine months, that Jose would die. The following day Nellie was flown to Bethesda Navy Medical Center along with Jose’s wife Kelley and his sister Elizabeth to meet her son. “There were so many tubes, wires and halos, I could hardly find a place to touch him, but I did and his body was warm. ‘You’re going to make it,’ I said. ‘I love you.’ At 3 a.m. Kelley had returned to Fisher House, the hotel where families of patients are housed, when a doctor came into the ICU room and asked to speak to family members. Nellie and Elizabeth were the only ones present at the time.
He took them into a conference room nicknamed the “Nutty Room” by families because it was where doctors told them the bad news. “There’s no way he’ll make it,” the doctor said, “and if he lives, the only thing he’ll be able to do is open and close his eyes. He’ll be a vegetable. I don’t give him two days, so be realistic and accept it.” Nellie was furious. “You’ve no right or power to make that call,” she shouted. “Go back and do your job.” Months later the doctor would tell Nellie that his encounter with her “Changed the way I dealt with families from that point on.”
Two weeks later Jose opened his eyes. One week later his breathing equipment was disconnected. He was transferred to Walter Reed Medical Center where he would stay for the next five months. It wasn’t long before Nellie gave up her job in North Woodstock, New Hampshire to be with her son twenty-four hours a day. There were questions about her presence at Walter Reed around the clock while Jose’s wife was living at the Malone House for patients’ families. “Walter Reed was the worst period of my life after Jose got injured. I had to fight for a way to be close to my son. There were nights when I really did believe they were going to throw me out and then I would sleep in the waiting room. I had to prove myself.” Meanwhile her son’s weight dropped from 205 to 126 pounds.
She quickly depleted her savings. She chose to exchange living in the home she was renting in New Hampshire for the temporary living quarters provided by the Army next to Walter Reed. “The first eight months I received $59 per day for expenses. I ate very little and used the money to pay my bills. I tried to keep up the rent on the house, but I got behind.” Elizabeth, 21 when her brother was injured, dropped out of college to help her mother care for him.” He is my brother, my father figure, my protector, He took care of me my whole life. How can I not take care of him now?”
After he transferred to Haley Hospital, part of the VA Polytrauma Rehabilitation Center in Tampa, Florida in August of 2006, Jose was retired from the military, and the $59 per diem stopped. For the next eighteen months, Nellie slept on a recliner at his side, showered and dressed in his bathroom and bought the skimpiest of meals at the hospital cafeteria. Whatever money she had came from veterans aid groups. But she was thankful because at Haley Jose had access to as many as twelve specialists in medicine and pain management, and ten people specializing in occupational, physical, vocational and speech therapy. Staffers convinced her to become a volunteer, and to write a newsletter for families like hers. Haley officials gave Elizabeth a paying job as an assistant in the nursing recruitment office. The hospital became their entire world.
On July 22, 2007 Jose was back at Bethesda Navy Medical Center for his first cranioplasty, but the pr
ocedure would fail when infection set in and his body rejected the plate. A second cranioplasty in April of 2008 would fail for the same reason. “It was one step forward and two steps back because everything had to come out, and each time we were at square one,” Nellie recalls. The surgeons at both Bethesda Navy Medical Center and Haley Hospital in Tampa, where Jose and Nellie returned to at the end of May, agree that a third attempt can come only after Jose has spent a full year infection-free, an almost impossible goal in the infectious environment of a hospital.
Yet Jose’s responses give her hope. His eyes move when he hears a familiar voice, made louder and clearer after he was prescribed a hearing aid for his left ear. He utters sounds that convey frustration, anger or love in answer to questions and conversation from his mother, his sister and particularly his 13-year-old daughter, Mercedes. “Mercedes spent a lot of time with him, and she would scold him,’ You need to hurry up and talk. You’re supposed to be my parent.’ You should have seen the look on Jose’s face. He positively beamed.”
Seventeen operations and two and a half years later, Jose was allowed to go home on weekends in a wheelchair to Elizabeth’s rented apartment in Tampa, ten minutes from the hospital. One evening in July 2008 he was lying on the bed watching television. “He was doing fine so I left for five minutes and then went back to check on him and there was blood everywhere. He’d pulled his feeding tube out. I can’t imagine how painful that must have been to do.” Nellie and Elizabeth called an ambulance and he was rushed back to the hospital. “I believe he was just frustrated and fed up with life,” Nellie says. “And I don’t blame him. He hadn’t had the luxury of dealing with the emotional part of himself.”
Hidden Battles on Unseen Fronts Page 16
