BROKEN BODIES/SHATTERED MINDS
A Medical Odyssey from Vietnam to Afghanistan
BROKEN BODIES/SHATTERED MINDS
A Medical Odyssey from Vietnam to Afghanistan
Ronald J. Glasser M.D.
Former Major, United States Army Medical Corp
Copyright © 2011 by Ronald Glasser M.D.
All rights reserved.
No part of this publication may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means—electronic,
mechanical, photocopying, recording, or otherwise—without prior
written consent from the History Publishing Company.
Published in the United States by
History Publishing Company LLC
Palisades, NY 10964
www.historypublishingco.com
SAN: 850-5942
Glasser, Ronald J.
Broken bodies/shattered minds : a medical odyssey
from Vietnam to Afghanistan/Ronald J. Glasser.
p. cm.
Includes bibliographical references and index.
LCCN 2011927256
ISBN-13: 9781933909486
ISBN-10: 1933909471
ISBN-13: 9781933909486 (e-book)
ISBN-10: 193390948X (e-book)
1. Soldiers--Wounds and injuries--United States. 2. Soldiers--Health and hygiene--United States. 3. Soldiers--Mental health--United States. 4. United States--Armed Forces--Medical care. 5. Vietnam War, 1961-1975--Health aspects. 6. Afghan War, 2001---Health aspects. I. Title.
UH215.G53 2011 355.3’45’0973
QBI11-600091
Printed in the United States on acid-free paper
9 8 7 6 5 4 3 2 1
First Edition
In admiration and respect for Dr. Michael McCue, arguably one of the finest neurosurgeons in America, who cares for the wounded of Iraq and Afghanistan through the Department of Defense Heroes Program and who edited these pages for content and accuracy—paragraph by paragraph and sentence by sentence—with a surgeon’s scalpel.
CONTENTS
Foreword
Forty Years of War
The Late Great 1968/Welcome to the Army
Zama/The Wounded
The Medics/Then and Now
America’s Wars/An Autopsy Report
Med-evacs and Gunships/A Short and Deadly Technical History
The Changing Face of Military Medicine
Teleconferencing/More Than Six Degrees of Separation
All the Toms/Iraq 2004
Shell Shock/The Shattering of Minds
The Wars Within
Multiple Deployments/Brains at Risk
The Bleeding Wars
IEDs/Blasts that Kill and Maim
Traumatic Brain Injuries/PTSD/The Invisible Wounds
All the Jakes/Adrift in Afghanistan/2010
That Deadly Sense of Privilege
All the Carries and Priscillas
Bullets of Grief/A Prescription for Prevention
“Is My Junk All Together?”
Chronicles/Reduxing Vietnam
Epilogue
Acknowledgments
Glossary
References and Recommended Reading
Index
FOREWORD
In a country that over the last forty years has grown more distant, becoming less involved and less concerned about its military, Dr. Glasser’s newest book is both a cautionary tale as well as a powerful redemptive work. Expertly crafted, there are sections of this book that could be used by active duty personnel to teach past military history—both successes and failures—as well as become a primer on current strategy and tactics, including the liturgy of the ever-changing, ever-more-deadly, and evermore-challenging wounds of war.
The connections with our past wars, particularly between Vietnam and our current wars, are valid on factual grounds. We never had enough troops in Vietnam and we do not have enough troops in Afghanistan. We never sealed the borders in Vietnam and we cannot seal the borders in Afghanistan. We never had a real exit strategy in Vietnam and we clearly do not have an exit strategy of any merit or validity for Afghanistan. We trained a South Vietnamese Army that lasted a year. The Iraqi Army will last a few months, the Afghan Army a few weeks.
Dr. Glasser writes with a quiet elegance, factual precision, and emotional restraint that make this a book of great power and greater substance. It will enlighten, amaze, and trouble you—and it is a book America needs now, more than ever.
—Lt. General Harold G. Moore, U.S. Army (Retired)
1.
FORTY YEARS OF WAR
Why write anything? For those who aren’t there, it’s like it isn’t happening, and for those who are, it’s like it doesn’t count. But there have been 1.9 million soldiers and marines deployed to Afghanistan and Iraq over the last decade, with over 5,000 killed, some 300,000 wounded, another 250,000 diagnosed with PTSD and over 300,000 with traumatic brain or concussive central nervous system injuries, along with amputees approaching levels not seen since our Civil War. These are by any measurement or comparison truly enormous numbers. You’d think that so many wounded, if not dead, would be hard to ignore. But they are.
Yet, these numbers do count, not only to the families of those killed and wounded, but also to the nation. The Iraq and Afghanistan wars have become a 3 trillion dollar war that we can continue to ignore or simply write off. There will be both a moral and economic reckoning before these wars are over and we all finally do go home. And that is what this book is about, that reckoning—the physical, mental, and psychological costs of these wars, those real and those invisible wounds, the anguish and persistent suffering. Unlike all our other wars, the real legacy of Iraq and Afghanistan is not the graveyard but the orthopedics ward, the neurosurgical unit, and the psychiatric outpatient department.
This is a book about forty years of war. It is written from the bottom up rather than from the top down. These are the stories of the soldiers and the marines who actually did and still do make the fight, and those doctors, nurses, and medics who are there when they die and then simply turn around and go on to try to save those who have somehow managed to survive. It is not a book of memoirs or even remembrances, nor is it a book of narrative non-fiction; these stories are no more and no less than the truth. Everything in this book happened. All the numbers and facts are real.
But war is a brutal business. So in places I’ve changed unit designations in the hopes of protecting those we have once again sent out to the Edge of Empires. In “All the Toms” and “All the Jakes,” the real Tom and Jake asked me not to use their names. I interviewed both a number of times. They not only survived their deployments, they survived intact. Tom is now in Special Forces and Jake will soon be leaving the Marines.
Yet, because of the confusion caused by the Army’s and Marine’s multiple deployments, I merged Tom’s and Jake’s stories with those battles and firefights they had heard about or those fought by other squads or platoons in their company, regiment, or brigade in order to give a clearer understanding of a history that had so quickly overtaken both the strategists as well as those making the fight. What is unchanging and unchangeable is that those things Tom and Jake saw and experienced were exactly the same things that were seen and experienced by every soldier and marine I talked to or interviewed. There is a terrible democracy to war.
The wounds though, those mangled arms and lost legs, the burns and penetrating head wounds, the transected spinal cords, the grief and the d
epression, the traumatic brain injuries, the blindness and the pain, all speak for themselves. As for the dead, we still have our poets:
You think their dying is the worst thing that can happen.
Then they stay dead.
2.
THE LATE GREAT 1968/WELCOME TO THE ARMY
During the decade of the Vietnam War, the Selective Service System swept up some 20,000 draftees every month! Over 4 million troops were sent to Southeast Asia to fight, to die, and be wounded in Vietnam, Laos, and Cambodia. Whatever has been written or said about Vietnam, there was a regular harvesting of young men and little else before it was over.
By the time I was drafted in the summer of 1968—the year that I completed my medical specialty training and ended my military deferment—the Army was not only running down, but running out of virtually everything, including physicians. The chief of the county hospital where I had finished my training as a pediatrician wanted me to stay on at the hospital to care for the pediatric patients of the county’s indigent population. He actually sent a letter to the Pentagon, through our Senator, asking for an additional two-year deferment for me.
The next week, he received a certified letter from the Pentagon that said right up front, “Absolutely not … in case you haven’t noticed we have a war going on and every citizen, including every physician, is expected to do his duty.” As it turned out, that wasn’t quite everybody.
The 101st Airborne, The 82nd, The First Air Cav, The 25th Division, The 9th, The Americal, and the 173rd Airborne Brigade, because of deferments given for being in school, in the National Guard, having asthma, having a bad back, being flat-footed, almost anything that a family could get a doctor to document, were made up of eighteen- and nineteen-year-old blacks from Cleveland, Detroit, and Cincinnati, Hispanics from East Texas, and poor southern whites. Virtually every Field, Company, and General Grade Officer was from a small town of less than 7,000.
There were few soldiers in Vietnam from families of wealth, power, prestige, or privilege. There was actually a time in early 1969 when the Marines (that had been since their beginnings a volunteer outfit), because of deaths and injuries, were running out of trigger-pullers—and sergeants in induction centers across the country would walk down the line of new draftees and every third one, tap them on the shoulder and say “Marine” … “Marine” … “Marine.” At the time, that was pretty close to a death sentence and the draftees knew it. There were some, though, who viewed the military as a stepping-stone to a political career. Again, they were mostly from the South—and there weren’t very many of those.
In early 1967, Secretary of Defense Robert McNamara lowered the IQ standards for induction into the military, giving the Army over the next three years an additional 100,000 new draftees each year. They were called “McNamara’s One Hundred Thousand.” Many of these soldiers couldn’t read, and the military had to print comic books with pictures rather then printed copy to get these draftees through basic training.
The least jarring reason for lowering IQs was that the Army simply needed trigger-pullers as cannon fodder; the most cynical was that it allowed the ongoing college deferments to continue, despite the ever-increasing demands for more and more troops on the ground. Three years after the program began, and only after the resignation of McNamara, the low IQ induction program was stopped when it was discovered that these soldiers were killed or wounded at three times the rate of drafted personnel with standard IQs. Even the Army didn’t want their troops killed or wounded just because they couldn’t quite figure it out or get it right.
But Vietnam was that kind of war—full of all kinds of stupidity, obfuscations, nonsense, suffering, and death. It seemed after a while to be a war that no one could really understand and very few were able to explain. It did seem though that Vietnam went on for so long because it wasn’t the kids of those with power and political clout or even the policy makers who were going to ’Nam, but someone else’s kids. That kind of thing always makes it easier to start a war, and definitely makes it easier to keep one going even as it begins to fall apart.
I received my orders to report to the Medical Student Detachment at Fort Sam Houston, San Antonio, Texas, for six weeks of basic training on or before August 12, 1968. I had gone home to Chicago to say goodbye to my parents before leaving for the Army. It was right after the brutal clash between the police and the peace-activists at the National Democratic Convention. The anti-war riots had continued not only in Chicago, but across the country. On my way to the airport there were still National Guard units out on the streets who had used their 50-caliber machine guns to shoot out street lamps just the night before.
I had no idea why we were in Vietnam. I think that at the time it had to do with something that had happened in the Gulf of Tonkin—one of our destroyers that had been attacked—or it was the domino theory of stopping the communists before they took over all of Southeast Asia, or maybe it was just to show the Russians that we really meant business. During my two years in the Army I never did figure it out, nor was it ever really explained to me or anyone else, from company commanders to the grunts pulling the triggers. What I was sure of was that it didn’t have much to do with the Viet Cong or the North Vietnamese drifting across the Pacific on rafts to attack California.
But I do remember thinking that day driving to the airport, looking out at the military road blocks on State Street, that despite all the pronouncements of military success in winning over the hearts and minds of the South Vietnamese people, that some clearly weren’t yet convinced. For better or worse though, the war was finally on everyone’s mind. It certainly was on mine.
I took a commercial jet from Chicago to San Antonio, unaware that the stresses of Vietnam were already forcing the military to begin cannibalizing medical units and hospitals across the world to find enough physicians for ’Nam, as well as the hospitals in the Evacuation Chain and the large military hospitals in the States. From the airport in San Antonio, a bus took me and other new medical draftees and soon-to-be officers onto the base at Fort Sam to begin basic training. The song on the radios in Texas was Pete Seeger’s “Waist Deep in the Big Muddy and the Big Fool Says to Push On.”
I entered the Army six months to the day after the start of the Tet Offensive, when the Viet Cong overran some 125 U.S. bases, occupied the U.S. embassy in Saigon, and took over the northern South Vietnamese city of Hue. It would take months of brutal fighting to retake all the bases, as well as Hue itself. Some 90,000 Viet Cong were killed in the fighting. After the Marines retook Hue, you could stand on the east bank of the Perfume River and look out over the city on the west bank and not see a wall left standing that was over three feet high.
I remember a sergeant in the 101st Airborne who had been shot through the chest telling me that after his unit took back their base camp in the Central Highlands they had put up a sign near the entrance to the rifle range “45 VC Killed down Range … Go Airborne.” But he also understood that if the enemy could make it to your rifle range something had gone terribly wrong, no matter what kind of sign you put up.
The Military Command in Saigon called the turning back of the Tet Offensive and the recapturing of the main U.S. bases in the south a “great military victory.” But it was not lost on anyone that if the Viet Cong could pull this kind of thing off once, they could certainly pull it off again.
We were clearly paying a very high price for that kind of “success.” By the time I left Fort Sam, the number of U.S. troops killed in Vietnam since Tet had doubled. Since the first deaths of three advisors to the South Vietnamese Army in 1959, the total numbers had reached over 25,000.
At Fort Sam, the pressure was put on those of us with permanent duty station orders for bases outside of the Continental United States—but not Vietnam—to either voluntarily extend an extra year, or have our orders changed to ’Nam. Those with orders for stateside medical facilities were to keep their orders and the usual two-year military commitment.
I had order
s for the military hospital at Camp Zama, Japan, to serve the children of the dependent military population as well as government and contract Department of Defense personnel. The carrot was that a three-year tour allowed you to bring along your family as military dependents and at government expense. The stick, of course, was getting killed or wounded serving elsewhere.
About half of us who had arrived at Fort Sam already had orders for Vietnam. There were a few specialists, mostly orthopedic and cardiovascular surgeons, but the majority of those with orders for ’Nam were right out of medical school, with an internship in internal medicine or surgery. They were sure to be in a battalion aid station or out in the bush with the troops. In a very real way, they were the expendable ones and everyone knew it.
The Army is not a democracy. If a company commander believed that his troops would perform better if they had a real doc with them rather than medics, then the docs went out with the patrols, getting shot at just like everyone else. What none of us knew at the time was that the combat troops protected their doctors even better than they protected themselves.
From that first day at Fort Sam, you didn’t have to ask who had orders for ’Nam. They were the ones who had a real seriousness about them—if not yet a sense of doom, at least a kind of patina of fear. They didn’t joke about the unbelievable military nonsense, like the map-reading course that started out with a poster showing a map under the heading, “This is a Map.”
Those of us without orders to Vietnam actually stayed away from them, telling ourselves that it was best to leave them alone, but really because we had no idea what to say or what to offer. They were the ones who had clearly lost, even though there was a general rumor going around that only three or four docs had been killed in ’Nam.
The chances of getting killed as a physician were small. But if it was you, it was 100 percent. That much was clear to all of us. But as a surgeon with orders for one of the military hospitals in Germany said, “They don’t have to kill you. Did you ever see a one-armed surgeon?”
Broken Bodies, Shattered Minds: A Medical Odyssey From Vietnam to Afghanistan Page 1
