Science and promise, however, are not sufficient, as even the most effective treatments have no effect if they are not available in the clinic to individuals who need them. Making state-of-the-art treatments, such as evidence-based psychotherapies for PTSD, depression and serious mental illness, part of the treatment repertoire should be a national priority. The Department of Veterans Affairs is committed to leading the path in realizing the promise of evidence-based psychotherapies as part of its fundamental promise to honor and provide the best care for veterans. Truly, our nation’s heroes deserve nothing less.
Editor’s note: References for this chapter can be found on page 270.
31
A WOUNDED WARRIOR
The Story of Army Sergeant Nathan Toews
“I had second thoughts but I was so tired. I climbed out of the truck and slid down to a crouch, resting my back against the tire facing the inside of the perimeter we had set up. My last memory is standing back up to do something. That was when I was hit with the RPG.”
The supply convoy, made up of four now-empty tractor-trailer trucks and four up-armored Humvee gun trucks, wound its way back to Kandahar from the Musa Qala district where the supplies had been offloaded for Operation Mountain Thrust. Mountain Thrust was the largest Coalition offensive since the fall of the Taliban in 2001, a US-led operation of more than 2,300 US soldiers, 2,200 Canadians and 3,300 British, along with 3,500 Afghan troops and large air support. The goal was to quell the ongoing Taliban insurgency in the south of the country. Trained as a mechanic, Army Sergeant Nathan Toews was finally on a mission that might see some action.
“I was a gunner in my Captain’s Humvee. We drove for days, sleeping and eating when we could. We were targets of small arms fire now and then, but it was nothing more than a few sporadic gunshots and one incident when a car bomb was driven into one of our trucks and detonated. We didn’t sustain any injuries. I loved everything about it: the adrenaline rush from the constant threat of danger, the uncertainty of how things might unfold, living rough, sleeping on trucks, all of it.” After a few days they made it to their destination and dropped off supplies for the new forward operating base. Tired and hungry, they left the following morning for a multinational base set up near Kandahar.
It was mid-morning on June 13, 2006 when the convoy entered a small town in Helmand Province in southern Afghanistan, a hostile and Taliban-infested part of the country. Nathan was manning the second gun truck when a surprisingly large Taliban force sprung an ambush. Just seconds after the firefight began, one gun truck and two equipment trucks were disabled by mortar fire. Yet the team of mechanics fought back as if they were seasoned infantry. “I recall jumping up and down, screaming and cursing at my driver to get me into a better position so that I could return fire and help rescue one of our vehicles that had been cut off from us. We were engaged in combat from about ten in the morning till nightfall.” About halfway through the fight air support arrived in the form of four Apache attack helicopters, and for a short time two A-10 jets strafed a nearby village where the Taliban had taken up positions. Nathan’s unit formed a defensive perimeter on a nearby hilltop with what remained of the convoy. A British paratrooper unit was airlifted in to assist with holding the position until they could get the personnel who had lost their vehicles flown out.
At dusk the fighting stopped. Drained and exhausted from eight hours of combat, Nathan accepted a buddy’s offer to take his spot in the gun turret. “I had second thoughts but I was so tired. I climbed out of the truck and slid down to a crouch, resting my back against the tire facing the inside of the perimeter we had set up. My last memory is standing back up to do something. That was when I was hit with the RPG.”
Three years earlier, on January 20, 2003, after two years of junior college in his hometown of Kingsburg, California, Nathan had en listed in the Army. “I joined more or less to occupy myself while I attempted to figure out what I wanted to do with my life. To my surprise I almost immediately developed a sense of pride in what I had become a part of—pride in myself as well as my country.” He did his basic at Fort Knox, Kentucky, and then trained at Aberdeen Proving Grounds as a mechanic. His first posting was Fort Drum, New York with the 10th Mountain Division.
By June 2004, less than a year later, he was in Baghdad doing maintenance work on the 10th Mountains’ 2nd Brigade’s fleet of light wheeled combat vehicles “inside the wire.” He was twenty-one and hungry for action, but other than being part of one of the last units to actually drive the two-day trip from Kuwait to Baghdad (rather than being flown in), his tour of duty was unremarkable. He returned home with a few meager war stories about incoming fire and a handful of foot patrols during particularly “hot” periods such as during Iraq’s first democratic elections. “There were rough periods throughout the deployment, but I had made it home without getting injured and I was much more self-confident. I considered myself, I must admit, just about fearless. So as I neared the end of my contract I decided to re enlist so I could deploy a second time.”
He was assigned to Fort Irwin in southern California, and shortly after arriving heard about a deployment to Afghanistan. “I had not been stateside for a full year yet, so I had the right to miss the deployment, but I volunteered to go.” His unit deployed at the end of February 2006 and was stationed at a large military post near Kabul. “Something I wanted to do differently for my second deployment was to be more actively involved in the combat side of the missions.” He got his chance in late June.
The shrapnel from the RPG lacerated Nathan’s right thigh from his hip to his knee. His right wrist was blown out of the socket. Jagged shards pierced his right eye and lodged in his brain. “I don’t remember anything that happened after I was hit. Months later I was asking everyone,’ So how did I take it?’ You know because everyone wants to know,’ Did I cry? Did I freak out? Did I take it like a man?’” Nathan dropped straight to the ground but then propped himself up against the tire and tried to fire back even though his weapon was disabled. “Our body armor has a handle on the back behind the collar, and I was told somebody grabbed that handle and dragged me out of the line of fire. I was yelling, ‘My ears fucking hurt’ and coughing up a lot of blood from the head injury.”
While the rest of the convoy fought off a second attack, a British medic kept him alive until he could be evacuated. He was moved to the field hospital at Bagram, then Landstuhl Medical Center in Germany, and finally Bethesda Naval Medical Center in Maryland. His family was flown to Bethesda to meet him. His younger brother, Andrew, would remain by his side for the two and a half months he was there, through surgery after surgery.
Two weeks after arriving stateside Nathan was brought out of an induced coma. Doctors told his family to keep their expectations low. “There was no way to know what my mental condition would be. It was possible that I would wake up and have no memory of anything from my life or even be capable of speaking. While I was in my coma, I had vivid dreams, which I confused with reality. I was unaware of where I was, how I got there, or even what year it was. Most of all I was oblivious to my injuries, excluding my broken arm because I could see the splint.”
After the preliminary surgeries Nathan was moved to Walter Reed Medical Center. He gradually became aware of his injuries, a process the Walter Reed hospital staff call “self-discovery.” The metal fragments from the RPG blast had blinded his right eye. “But I didn’t know I’d lost my eye, even though they probably told me every morning since I had been there. I was so brain injured it hadn’t sunk in. So I went to an appointment with an ophthalmologist, and he said,’ I heard from your mom that you can’t see out of your right eye.’ And I was pissed. I said,’ What are you retarded? Of course I can see. Check it out. Check it fucking out!’ So he shines a light in my left eye and I can see the light, and then he shines it in my right eye and all I could see was red satin. And that’s how I found out.”
Shrapnel fragments had also fractured his skull and pierced his brain. More t
han a third of his skull had been cut out to relieve the pressure from the swelling. “When you are missing so much of your skull, your head is misshapen and the insides actually settle differently at night when you’re asleep. My head was all bandaged but finally one morning I woke up and got a chance to look in the mirror. I yelled,’ I need a doctor. There’s something wrong with my head.’”
Months later he found himself undergoing physical rehabilitation at the Veterans Affairs Polytraumatic Rehabilitation Center in Palo Alto, California. There were no guarantees as to how long he would be there.
“I arrived at Palo Alto about mid-August. I still couldn’t walk, was missing a large portion of my skull, and had a tube in my stomach. I asked one of the therapists how long she thought I would stay. She told me the average stay for a guy in my condition was a few years. Right then and there, I made it my mission to prove her wrong.” Within three weeks, he was running on a treadmill, eating normally and had completed all his testing which indicated that he needed no additional therapy.
“I was the first person who had previously undergone a craniotomy to leave Palo Alto without having a plate put in his head in place of the missing skull section.” The next step, a cranioplasty, was a minimum of six months away, assuming Nathan had no infections. Until he had his cranioplasty Nathan wore a helmet to protect his head. “I hated that helmet but I wore it. It was custom-made for me, and it looked like an old school football helmet.”
There was only one low moment during his stay in Palo Alto. “I don’t think I ever gave up hope that I’d get my vision back, and when I first arrived a doctor said that because I could perceive some light, it meant the optic nerves were still working and there was a chance I’d see again. Well, I took that and ran with it. Then a week later, doctors told me,’ Forget your eye. It’s gone for good.’ That night was the only time so far through this entire experience that I broke down; but I’m not a believer in wallowing in self pity or ‘woe is me.’ Getting mad at the world or how life has been unfair is just wasted energy. The military doctors put me back together. My philosophy has always been that I made my own choices and now I have to get on with the rest of my life.”
And so he did, but not without a few bumps along the way. He was permitted to go home for thirty days. He would experience daily migraines so severe he had to take anti-seizure medication in the thousands of milligrams. While he was home, he woke up one morning to find his left hand wouldn’t move due to the injuries to the right side of his brain. He was flown back to the East Coast to undergo outpatient therapy and surgeries at Walter Reed and then Bethesda Naval Medical Center. “Every day for a year I attended occupational therapy to strengthen my shattered right arm and to work on getting the use of my left hand back.” In February of 2007 Nathan had his cranioplasty to replace the missing section of his skull. This procedure carried a high risk and the plate would be removed if there appeared the slightest sign of infection. His “took” on the first attempt.
“A couple of weeks later my left hand started to work again. I was sitting in the old Company Area at Walter Reed, what is now the new Warrior Transition space, and I was trying to move my hand, and suddenly my thumb moved. Then I was able to clench my fist. I think the cranioplasty had equalized the pressure in my brain. I jumped up and ran down the hallway yelling,’ I can move my hand!’”
Nathan made a miraculous recovery but will have to deal with his wounds for the rest of his life. “I am no longer permitted to serve in the military, which is something I am still struggling to accept. My plan is to get into the field of working with service members who have similar injuries. I have yet to narrow it down to a more specific field. I want to be able to help soldiers and their families, if nothing more than to just share my experiences and be an example of how well someone can recover from such severe injuries. Such jobs require a degree. So the next step in my life is to get one.” Nathan enrolled at Dickinson College outside of Harrisburg, Pennsylvania as a freshman in the fall of 2008. He maintains a 3.5 GPA.
MEDALS
Bronze Star, Purple Heart, 2 Army Commendation Medals, 4 Army Achievement Medals, Army Good Conduct Medal, National Defense Service Medal, Afghanistan Campaign Medal, Global War on Terrorism Expeditionary Medal, Global War on Terrorism Service Ribbon, Army Service Ribbon, 2 Overseas Ribbons, NATO Medal, The Combat Action Badge.
32
FALLING THROUGH THE CRACKS
Why Time Is Running Out
By Lt. Colonel Cynthia Rasmussen
As I write this I am contemplating how to help the wife of a deployed service member who has been sexually assaulted. This is the second call regarding a sexual assault this week. The first woman had not told her husband that one of his good friends had assaulted her while he was away. What a welcome homecoming he will have. I find myself wondering how soon the divorce will come. (I bet those of you reading this are already saying to yourselves, “Oh she was just sleeping with him and now feels guilty so is going to accuse him of rape.”) Oh ye of little faith, think again.
Looking back over the last four years that I have been mobilized as a Combat Stress Officer and Sexual Assault Response Coordinator, I realize what an amazing opportunity I’ve had to make a difference. I admit that carrying on the behavioral health program started by LTC Susan Whiteaker and LTC Mary Erickson shortly after 9/11 for over 26,000 service members and their families can sometimes be overwhelming mentally, spiritually, and emotionally, but it has been worth it. The problem is immense.
One of my initial cases involved a whole reserve unit that was devastated by a seriously impaired command. These were amazing young men and women brought to their knees with suicidal and homicidal thoughts on a daily basis. There was the usual alcohol and drug abuse as they self-medicated. There were divorces and break-ups of longterm relationships, financial and job issues, isolation, weapon issues and homelessness, all within a single unit. I will never forget “Kevin,” at the unit’s family readiness picnic and stress management training, looking me in the eye and saying, “I want to go back and step on an IED and die a hero so my wife and son can get the money, because I cannot take living like this anymore.“
Then there is the service member, an NCO, who was served divorce papers while he was in Iraq. What was he to do? He was on a mission and responsible for lives and “bringing everyone home safe.” And when he gets home he better handle his domestic situation without any emotion, acting out, expressing his feelings, or self-medicating, or he will be the one punished. And we mustn’t forget the OIF/OEF Vets who are being discharged with diagnosed mental illnesses or who have been kicked out of the military due to inappropriate behaviors stemming from those mental conditions, and who now have little or no opportunity for good follow-up care or access to the benefits they so desperately need. They are often sent home to unsuspecting families who have no notion of how they have changed.
I cannot count how many times I have been to a unit’s homecoming from Iraq and seen service members walk off the plane to find that there is no one there to greet them. Or their “significant other” greets them with the keys to their apartment and the words “Goodbye, I am leaving.” For many other homecomers, their “significant other” or even their parents have spent all their money while they were deployed in theater.
One way for me to explain the state of our veterans when they come back home after deployment is by using the metaphor of a bridge. I look at the journey of a returning service member and his or her family as crossing a bridge. For many veterans the bridge is an obstacle course as dangerous—some say more so—as bridges they crossed in war zones. Instead of navigating cracks and holes created by an IED or a mortar, they must now confront new cracks and holes created by new enemies. These enemies can be fear, depression, loneliness, anxiety, anger, guilt, risky behaviors and frustration. The enemies can come in the form of “supportive US civilians,” who don’t really get it, employers, family and friends, and even the service members themselves. The journey is
fraught with possibilities of destruction as well as opportunities for amazing growth. And yet I wonder how many veterans stand at one end of the bridge and see it going “nowhere.”
If the service member and/or family member is “lucky” or meets the right people—knows the right “supply sergeant,” so to speak—they may miss the more subtle holes or cracks in the bridge and make it to the other side. On the other hand, if they fail to meet the person or persons who can guide them, or lack the inner resiliency to guide themselves, they will inevitably fall through one of the cracks or holes. The cracks represent the slower, more subtle changes that occur over time after coming home, such as “I don’t fit in,” “I don’t feel safe,” or “I have difficulty communicating now.” The cracks may occur because pre-deployment support systems may not be there or the veteran can no longer connect with those systems.
The cracks occur because once you don a military uniform you learn to live, function and survive using tools that are crucial to the service member/warrior, but do not work so well for the US civilian. Take anger. The physiological response to a perceived threat to self is fight or flight, responses that make sense in combat. But this isn’t the best way to function when the uniform comes off.
Take trust. We teach our warriors not to trust anyone or anything except other warriors, those close to them who talk, act and dress just like they do. Yet when the veteran takes off his or her uniform to return to civilian life, an environment where “I’ll watch your back and you watch mine” is considered only one of many ways to demonstrate trust, there can be relationship problems. Ultimately, for many veterans the cracks in the bridge to reentry include an inability to communicate, relate, empathize or feel. Feeling like a stranger in your own country, town and family can lead to withdrawal and isolation, self-medicating with alcohol and drugs, lashing out at others for no apparent reason, and having little or no tolerance for the mishaps of everyday life.
Hidden Battles on Unseen Fronts Page 20
