But brutal statistical logic also predicts that as survival rates increase, so do the scope of amputations as well. In World War II, 7.0 percent of soldiers with amputations had multiple limbs lost. That rate increased to 16.8 percent in Vietnam. In Iraq fewer soldiers lost limbs, since we could stay mounted in armored vehicles in the city. But in Afghanistan, the Engineer’s pressure-plates hidden in the dirt were very effective. The survival rate of those that made it to Kandahar was up to 99 percent, but the multiple amputation rate also jumped to 30 percent.
Fye lost his leg in May of 2011 because that’s when it seemed like everyone lost a leg. The greatest percentage of amputations, 42 percent of the total, were simple transtibial losses, a lop-off at the shin. Fye might not have known it at the time, and his doctors may not have identified him as such, but Fye was the typical case in every way. The height of the Surge, landmine–actuated, one leg, below the knee, and a fight to save the other.
WHEN HE ARRIVED in San Antonio and underwent his first surgeries, Fye was so pumped with medications that he was racked by hallucinations. Dwarves walking around his hospital room. A guy with a large afro jumping outside his window, even though Fye was on an upper floor. Streetlights turning into people and then back. A small part of his brain knew that such things could not be real, and so if the doctors gave him enough painkillers that he saw them, then he must be in rough shape.
They gave him an Alzheimer’s medication for the pain. He never got the name of it, but when that didn’t work, they put him on methadone, a synthetic heroin used to treat junkies. As the worst of the pain receded, he backed off the high before he could get hooked, and gradually, ever so gradually, the hallucinations passed. Fye’s teeth hurt, because he had clenched his jaw when the blast hit. His vision was blurred, and his ears rang for weeks.
Fye spent nearly three months as a patient in the hospital, far longer than the average stay at BAMC. The Center for the Intrepid in San Antonio specializes in out-patient orthopedic and rehabilitation services, not long-term in-patient hospital care, so he received a demoralizing parade of short-term roommates arriving fresh from theater. They came at all hours, sometimes in a rush, sometimes silently materializing in the middle of the night, woozy from surgery and combat. One leg gone, one arm gone, maybe two legs clean. A unit flag tacked to the wall, a stream of well-wishers and first sergeants and family and cards and flowers and then, all of sudden, discharged while their stitches were still pink and tight, off to rehab, quick to a prosthetic and learning to walk. The young men and visitors came and went, the old men with bad hips stuck around, and still Fye lay in his bed with his dwarves and dancing streetlights.
Fye never got used to the hospital. He never got used to shitting in a bedpan; visitors always walked around the curtain at the worst time. It took him two months to get a shower. It was all unsatisfying sponge baths until a nurse remembered that there was an old roll-in shower on another floor that had been turned into a closet. The staff unpacked it, and it had a bench you could sit on, and when Fye finally got under the water he realized it was his first shower since Kandahar. No shower at Walter Reed, no shower in Germany or the KAF Role 3 hospital, no shower at COP Robinson, only a solar bag in a wooden box at Mushan.
There were other trials to endure. The blast that took his leg had scrambled his thoughts, but Fye had not been officially diagnosed with a Traumatic Brain Injury, and he wasn’t sure he ever would be. Until he was off pain medication, testing him would prove little, and in any case, he didn’t need a test to know how bad his short-term memory was; every day the nurse would ask if he had had a bowel movement, and he’d have to check the bedpan to know the answer.
The EOD warrior, the invincible bomb defuser qualified to take on the Engineer, reduced to overcoming the hurdles of bedpans and handicapped showers.
Even when he moved into the one-floor home Nicole had purchased in a nearby suburb, Fye never felt like he was making progress at his daily appointments. Only surgery yielded obvious results, and so he found himself settling into a pattern: two months of painful grueling stasis, surgery on a foot plate or his nubbin, a marked jump in ability, followed by more disheartening months of fruitless therapy until he went under the knife again.
Fye’s body fought him every step of the way. Phantom pains in his missing leg, or “zingers,” as the doctors called them, shocked down his leg and shook his body. He developed Heterotopic Ossification, the disruptive and unhelpful formation of bone at sites of massive trauma, on the nubbin on his left leg and on his ankle and tibia on his right. HO is frustrating because it is haphazard; either new hard bone spontaneously erupts in the middle of soft tissues or the fractured bone grows painful spikes that push into surrounding nerves and muscles. For reasons that doctors do not fully understand, HO is more prevalent in patients who experience brain trauma at the time of their amputative injury, and so HO has been the particular scourge of combat veterans since World War I. The government and media have dubbed Traumatic Brain Injury the “signature wound” of the post-9/11 wars, but IEDs have created epidemics of other afflictions as well. HO was previously classified as “infrequent,” but the latest research shows that it affects over 60 percent of amputees from Iraq and Afghanistan. The interior barnacles on Fye’s nubbin made it painful to wear a prosthetic leg, and an eruption of tiny needles poking through the skin of his right shin were sharp to the touch. He knew he was lucky, though. One fellow soldier at BAMC had HO growing around his femoral artery; his X-ray looked like a flowering tree in full bloom.
And at least the HO was caused by an actual physical phenomenon. No, the worst were the uncanny sensations that had no name.
“They’re bizarre,” Fye told me.
“What do you mean?” I asked him.
At this Fye visibly shrank into his chair and paused and looked away.
“I don’t really want to do it because I’ll probably get it back now,” he said. “I don’t even want to talk about it really.”
“What could be so awful?” I said. I didn’t mean to press, but I had no frame of reference to even know what he was alluding to.
“You know when your toes get crossed?”—here he demonstrated with the index and middle finger of his right hand, binding them up—“I could feel that. I can’t see it, but I could feel my muscles, in my mind. I could feel there was a foot there. It was so weird. I could feel it, and I couldn’t get my toes uncrossed. It was weird, it was so weird, and it would last like that for a whole day at a time.
“So you just do this,” he said, and tapped the end of his nubbin with some urgency. “You tell your body, this is as far as it goes, you train your mind, tell it, ‘I can’t feel my crossed toes because this is all there is.’ And I can feel everything. The nub is awesome.”
But sometimes that didn’t work. Once the toes on Fye’s right foot could move, he hoped to do mirror therapy to fix the uncanny feeling. The medical techs could put his right foot in a mirrored box, and he would watch as they crossed and uncrossed his toes, and finally, he heard, relief would spring from the ether on his left. Hopefully, some day.
A certain family-wide cabin fever set in: Nicole had no time for outside work and home-schooled the four children. Dan left the house only for BAMC. The tedious grind, every day the same struggle, was like a never-ending deployment. At least when he went to Iraq or Afghanistan, his family knew they only had to endure until a specific date marked on the calendar. Now Fye fought the effects of the Engineer every day, no relief in sight.
Cut off from his old unit and the EOD brotherhood and daily rhythm of the war, he spent much of his time on Facebook, watching videos of other men’s tours, desperate for news from those who were still at Kandahar and Robinson. He discovered that the Engineer had been busy, and the next three EOD team leaders at Mushan—his replacement, a second Air Force tech, then a Navy guy—all got blown up themselves and had to be medevac’d. He stayed in touch with some of the Special Forces guys from the task force, and he stayed in
touch with Pete Hopkins, the medic who first attended to him, started the tourniquets, bagged his leg.
Fye was Hopkins’s first real trauma. Over the next year, Hopkins would do over a hundred more.
FROM MUSHAN TO Taloqan to Perotsi, Pete Hopkins was a traveling medicine man.
He was first trained as an emergency medical technician—an EMT like a firefighter or ambulance runner back in the United States—at Fort Sam Houston, adjacent to BAMC.
But he became more than that. He started IVs and pushed fluids and morphine and fentanyl, and his scope of practice grew as the Army docs taught him new skills. Cricothyrotomies, better known as crikes, better known as an emergency definitive airway, often confused with a trake and the movie Playing God, where David Duchovny pokes a ballpoint pen through the guy’s throat right below the Adam’s apple. Needle chest decompressions, also known as NCDs, better known as that scene in Three Kings where Ice Cube and George Clooney fix Mark Wahlberg’s sucking chest wound by sticking a release valve in his rib cage.
Not that Hopkins got those valves; he always had to improvise with a catheter.
He was allowed to do crikes and NCDs and more, things that would make a stateside EMT jealous, but his skills were still focused on combat trauma. So when he arrived at the village and treated locals in the interest of spreading some of those Gallieni oil spots of stability, it never proved sufficient for the Afghans or provided closure for him.
He was supposed to do simple work within a limited scope of practice, but reality never cooperated. Kids would show him infected chai burns, or a young man would pull up his kameez and reveal that an IED had blown off a leg and the tip of his penis, or the old man of the village would come to him and say, “I think my hip is broken,” and point to a desiccated compress prescribed by a local medicine man attached to the side of his ass. Hopkins may have been limited, but the medicine man was a charlatan, and Hopkins would unglue the cloth cast and find lesions or maggots or worse. And parents would bring their children and say, “He broke his wrist five years ago,” and the boy would still be wearing a cast made out of pink fiberglass insulation and a T-shirt from some American cancer awareness 5K run. By then, the wrist would be fused and discolored and as crooked as a mesquite tree. Hopkins couldn’t break it and reset it, and the only Taylor Spatial Frames were at KAF, so he did nothing. But he still thinks about it sometimes.
Hopkins also thinks about the old man and his son. The old man had an abscess on the back of his head, and Hopkins cleaned it and packed it with gauze and started an IV. The physician’s assistant Hopkins worked with called for an antibiotic called Rocephin, and it had to be given every twelve hours. So Hopkins told the son to bring his father back twice a day, to get the abscess cleaned and receive more antibiotics. The son returned with his father for a day or two, but then not again for over a month. By the time they did come back to see him, the old man was hallucinating. Hopkins took off the bandage, the same dressing he had applied a month before, and saw rotting tissue falling away from the man’s white skull. The abscess had dug an open-pit mine from crown to neck. Hopkins was helpless, and the young man was furious that the Americans refused to heal his father. The Gallieni oil spot spread no more in that village.
Sometimes the Afghans came to him at COP Robinson. Local laws and culture said that as a man, Hopkins could treat the men and the boys and the prepubescent girls but not the women. At his tiny fire base in Mushan and Taloqan there were three female soldiers: a cook, a psychological operations spook, and an EOD technician. None of them could treat, so the men and children had their chai burns cleaned and dressed, and the women watched and went home with unknown ailments hidden under their robes. One day, a husband and wife arrived with massive injuries. The man had taken shrapnel to the abdomen, and the wife was hemorrhaging on the ground. But the husband would not let Hopkins near her, so while he was treated and flown out on a medevac, relatives drove his bleeding wife to Kandahar. The trip would have taken all day. Hopkins thinks about them too.
At a local madrassa was a unit of Afghan National Civil Order Police (ANCOP) commandoes. ANCOP was organized to be a more reliable, literate, and disciplined national police force, and this unit was to be the elite of the elite. Hopkins treated innumerable stabbings and gunshot wounds in the unit, all either self-inflicted or one cop stabbing another, shooting another. In the foot, in the hip, in the jaw where the bullet settled in the upper cheek. They were always friends who shot each other, he was assured.
One day Hopkins was patrolling through a village, and they saw an old man baking naan at the ANCOP School Checkpoint, the same checkpoint from which Fye launched his last mission. They called it the School Checkpoint because NATO had built a beautiful modern school there a few years before but it had been converted into a military compound. There was a fire pit off to the side, and the man built the fire in the dirt and then pulled his bowl out of the dirt and mixed the bread dough and then put it on the fire. Hopkins knew too much about germ theory and transmission of disease, and he saw that the dough and the dust were one. They might as well be kneading it with their feet, Hopkins thought. At that moment he swore he would never eat it again, not the naan nor the local meat that hung on hooks in the open air of the bazaar for days, nor anything else that he had not seen grown and washed and cooked. But then a few days later, when chasing a gunman through a village, they burst into a house and interrupted a family at dinner. The patriarch invited them in to eat, and they had to stay, because it was polite, and because of Gallieni’s oil spots. So Hopkins and his platoon leader and the gunner sat and drank tea and ate a roasted sheep and naan bread, kneaded in dirt that was full of nothing but infection and disease and bullet lead.
After four decades of conflict, war is just part of this culture, Hopkins thought, down to the dust on the ground.
He took a doxycycline antibiotic every day after that.
Hopkins eventually got wise to the cycle. A new American unit would arrive, and the locals would ask for anything and everything, to test the new group. Then the Americans would set up KLEs, Key Leader Engagements, to see what they could do for the tribes in the interest of raising their own internal statistical metrics, to show leaders back home that the Surge was working. And then the Afghans set up their own KLEs, to agree on what wells and crop assistance and medical aid they could get from the Americans. Everyone got what they wanted, money and Surge metrics, and then the war continued.
Hopkins learned other lessons about Afghans the hard way. He eventually realized he had to ask what medications they were already taking, since the medicine man at the local bazaar prescribed everything from daily vitamins to Viagra.
He learned from his physician’s assistant how to use Narcan, an opioid antagonist, to block the effects of heroin. Unlike the long-term management drug methadone, Narcan is a way to immediately interdict narcotics in the bloodstream. The Afghan cops ate poppy on patrol, picking the buds off stalks as they walked by, and they took opiates to celebrate after every battle. Hopkins would recognize the pinpoint pupils and push Narcan on them, and afterward they got violent as they came down.
And he learned that gratitude for his work would never trump safety; one day at COP Robinson he would save a child’s life, the next he would see the family in the market and they would not acknowledge his existence. The privacy of the aid station allowed a gratefulness not possible in a public space with unknown eyes watching.
Hopkins learned things about himself as well. He was a trim and focused thirty-year-old in Afghanistan, but military service was never a foregone conclusion. A childhood bone disease had destroyed his knees, and when he was fourteen he had extensive surgery to rebuild them with plates and screws. Over the course of a decade, before 9/11 and after, he tried three times to enlist. But the Army didn’t want him. Those rebuilt knees disqualified him, they said. By the late 2000s, though, the Army had trouble meeting their recruitment goals and they lowered their standards. So Hopkins snuck in on his fourth try,
an armful of medical data in hand saying he was fit for duty. Eventually, after Afghanistan, he would run a marathon.
Hopkins would come to decide that it was Fye’s injury that solidified the new course of his life. In his twenties he worked as a debt collector at a call center in Buffalo and bartended on the side. He was going nowhere, and he knew it, but saving Fye validated all those attempts to enlist. You never really know what you can do until you do it, he thought. Fye’s injury was his first chance to prove that he wouldn’t freeze up, that he could do emergency medicine.
It was different than EMT training. They are always unresponsive in training, Hopkins realized, but in real life they talk to you. They’re alert, rational, as if they aren’t lying in pieces in a smoking crater.
When Fye got hurt, it was the first time he had ever heard the “Medic!” call. It was only a few weeks into his tour, so he had never before left his place of relative safety between the platoon leader and the machine gunner and sprinted into the dust cloud. Like a relay race, running from man to man, checkpoint to checkpoint, along the single path clear of IEDs to reach the patient.
And he learned things about his fellow soldiers. He learned that wars are fought by children. It wasn’t like the movies. He was thirty, and the average infantry soldier was a decade younger. They looked more like Zack Efron than Mark Wahlberg, he thought. When they were injured, he could gauge how much pain they were in from their talkativeness, where their mind went.
At first it was all business. But then, the more pain, the more they talk about their wives and kids or high-school girlfriends. That’s when you want to get the morphine onboard. Because eventually they stop talking. That’s the worst, except when they never start talking at all; those are the ones you lose.
After Fye’s incident was over and he was safely home, Hopkins learned how close they had come to not transporting him to Kandahar at all. The medevac took so long to arrive because of a miscommunication. Over multiple radio calls between Hopkins’s platoon and the rescue operations center, his report of “bilateral amputation” had been converted, telephone-game style, into “bilateral lacerations.” The medical operations center had actually turned the rescue mission off; helos don’t fly for scraped knees. The bird that eventually picked up Fye wasn’t even a real medevac bird. That’s why the robotic flight crew ignored him, didn’t treat his wounds as they went. They weren’t medics. The helo pilots had just been in the air and happened to overhear the radio traffic, including the original call for help. They understood the mistake and had disobeyed orders to go get Fye. If the human pilot of that bird had been less stubborn, the golden hour would have been long past by the time Fye made it to KAF, and he could well have been one of the 1 percent.
All the Ways We Kill and Die Page 12
