Exhausted Medical Teams at Landstuhl

By Matthew McAllester, Staff Correspondent - Newsday

September 27, 2004

LANDSTUHL, Germany -- The medical team that accompanied the soldier on the Thursday morning flight from Iraq had worked the whole way to keep him alive, his body burned and lacerated by the fire and metal of a roadside bomb.

They were low on oxygen by the time the green military ambulance reached the front door of the hospital.

"Get me more O2," shouted out a visibly upset nurse, Maj. Pat Bradshaw. She had been up and working for 28 hours, ferrying the wounded out of Iraq.

"She's stressed," said Capt. George Sakakini, a physician in charge of the team that greets the wounded. He watched from the curbside through the early-morning drizzle, keeping an eye on his highly trained squad of doctors, nurses and chaplains. "Someone's trying to die on her."

Full green oxygen tank in place, its contents filtering into the unconscious man's lungs, the team lowered the soldier on his stretcher to the ground. His scorched face was a painter's palette of the colors of pain: yellow, mauve, bright red.

In the intensive care unit, nurses quickly worked to make sure his wounds were as clean as possible. An infection could kill him. A couple of rooms over, more nurses worked on another young soldier, also unconscious, burned and sparring with death. Another roadside bomb victim. Dabbing gently, they spread thick white antimicrobial cream on the raw flesh of his forearms. Twenty percent of his body was burned.

It was an average morning at Landstuhl Regional Medical Center, which has become the American military's museum of pain and maiming, doubt and anger. The planes from Iraq land every day, sometimes two or three of them.

Like his staff, who brim with frustration at what they see as the irresponsible disinclination of the American people to understand the costs of the war to thousands of American soldiers, the hospital's chief surgeon feels that most Americans have their minds on other things.

"It is my impression that they're not thinking about it a whole lot at all," said Lt. Col. Ronald Place. As he spoke, the man who has probably seen more of America's war wounded than anyone since the Vietnam War sobbed as he sat at a table in his office.

First stop for injured

Nowhere is it less possible to escape the horrors of the war in Iraq for American soldiers than Landstuhl. Nestled among the tall trees of a forest on the outskirts of this small town in southwestern Germany, the largest American military hospital outside the United States is the first stop for nearly all injured American personnel when they are flown out of Iraq or Afghanistan. Dedicated and compassionate doctors, nurses and support staff push aside curtains of fatigue and what the hospital's psychologists call "vicarious trauma" to patch up and tend to soldiers before they fly to the United States for longer term care.

This month politicians focused on the unwelcome tally of the 1,000th American soldier to die in Iraq. Landstuhl has its own set of figures, numbers that flesh out the suffering occurring on the battlefields of Iraq and in homes across the United States.

Since Sept. 11, 2001, more than 18,000 military personnel have passed through the hospital from what staff refer to as "down range": Iraq and Afghanistan. Of those, nearly 16,000 have come from Iraq.

Last month, 23 percent of those were casualties from combat, slightly higher than most months; the rest had either accidental or disease-related complaints.

Thirteen have died at the hospital.

Each day, an average of 30 to 35 patients arrive on flights from Iraq. The most on a single day was 168.

More than 200 personnel have come in with either lost eyes or eye injuries that could result in sight loss or blindness.

About 160 soldiers have had limbs amputated, most of them passing through the hospital on their way home to more surgery.

And it's not just their bodies that come in needing fixing. More than 1,400 physically fit personnel have been admitted with mental health problems.

Then there are the Pentagon's figures that touch on all casualties from the war in Iraq: 1,042 dead; 7,413 injured in action, including 4,026 whose injuries have prevented them from returning to duty. In Afghanistan, there have been 366 injuries and 138 deaths.

One other number tells a slightly different tale, a story of selflessness in the face of suffering: one third. That's about how much money surgeons at Landstuhl make compared to what they could make if they chose to work in the civilian world.

"There is nothing more rewarding than to take care of these guys," said Place, the skin around his eyes reddening with the tears that he failed to hold inside. "Not money, not anything."

Every day starts in the same way at Landstuhl. The staff get up early to greet the buses and ambulances that come from nearby Ramstein air base, where the planes from Iraq touch down as early as 6 a.m. Most soldiers can walk off the buses, with broken bones or noncombat illnesses. But those who come in ambulances, like the two blast-injured soldiers, go straight to the ICU.

On Thursday morning, the 20-bed ICU was a busy, but not rushed, place. As so often these days, the staff there were dealing with the effects of roadside bombs rather than bullets. That means taking care of scorched, lacerated bodies that may have less obvious internal injuries.

Col. Earl Hecker sat outside the room where nurses were applying the white antimicrobial cream to one of the burned soldiers. Twenty-seven years old, Hecker remarked, looking at the patient's notes. (Hospital officials were not able to get these patients' consent to be named or photographed because of their medical conditions.)

Hecker, at 70, is a few generations older than his patient. A surgeon who had retired from the Reserves but recently rejoined, he has forsaken his private practice in Detroit for now to help at Landstuhl, working past his assigned 90-day tour to stay nearly 150 days.

This experience "has changed my whole life," he said, his jovial demeanor fading to introspection. "I'm never going to be the same."

The day before, Hecker had been taking care of an 18-year-old soldier who, thanks to an Iraqi bullet, will forever be quadriplegic.

Hecker sat gazing through the window at the burned soldier and thought of the kid he had sent off to the States the day before. "Terrible, terrible, terrible," he said, staring into the distance. "When you talk to him he cries."

A month ago, Hecker took four days off to fly home to see his family. He needed a break. They went out for dinner at a nice restaurant. Hecker realized during dinner that he was suddenly seeing the world differently. He looked around at the chattering people, eating their fine food, drinking good wine and he thought to himself: "They have no idea what's going on here. Absolutely none."

He doesn't think people want to see it. He thinks the nation is still scarred by Vietnam and would prefer not to see the thousands of injured young men coming home from Iraq.

"I just want people to understand -- war is bad, life is difficult," he said.

Maybe it was the stress, maybe it's because Hecker has no military career to mess up by speaking out of line, but it just came out: "George Bush is an idiot," he said, quickly saying he regretted the comment. But then he continued, criticizing Bush as a rich kid who hasn't seen enough of the world. "He's very rich, you'd think he'd get some education," Hecker said.

"He's my president. I'll follow him in what he wants to do," he continued, "but I'm here for him." Hecker leaned forward and pointed through the glass at the unconscious soldier fighting for his life 2 yards away.

'It's just not right'

Not all of the staff can get away with criticizing their commander-in-chief or his decisions, but many use more opaque ways of communicating their unease.

"It's not right," said Maj. Cathy Martin, 40, head nurse of the ICU, when asked how she felt seeing so many soldiers pass through her unit. She paused. "It's just not right."

She declined to elaborate on what exactly she meant. Comments such as Hecker's about the president can lead to severe consequences for those with careers ahead of them. But Martin did add: "People need to vote for the right people to be in office and they need to be empowered to influence change."

What she did feel comfortable saying, echoing the head surgeon, Hecker and others, was that people back home just don't get it.

"Everyone's looking but no one's seeing," added Staff Sgt. Royce Pittman, 32, who works with her. "I had no idea this was going on. ... What we see every day is not normal. There's nothing normal about this."

In private, some hospital workers said they wished they could openly air their feelings about the war. And if reporters could somehow quote people's facial expressions, a number of those staff members would probably be facing disciplinary hearings. Only one staff member interviewed expressed solid support for the war.

"I do believe, I truly do believe that those that are fighting and defending for liberty and freedom ... that that is a truly worthy cause," said Maj. Kendra Whyatt, head nurse of inpatient orthopedics.

Is it all worth it? the head surgeon was asked. "That's not for me to say, but I'll be here for them," Place said.

The staff do talk among themselves, said Maj. Stephen Franco, chief of the clinical health psychology service at the hospital. He recalled one doctor's comments after attending a memorial service for a young soldier who had died. "I wish some of the lawmakers could attend some of these more often so they can think a little more about their decisions," Franco recalled the doctor telling him.

But like all the staff in the hospital, politics comes second to healing with Franco. He has a lot of it to do.

"It's probably the biggest challenge to mental health [in the military] since Vietnam," said his boss, Col. Gary Southwell, chief of psychology services.

Psychological wounds

Soldiers come in carrying guilt about leaving their unit behind, haunting visions of seeing friends dying, nightmares, frayed nerves and deep anxieties about their future, Franco said. Place noted that for a single man facial disfigurement, for example, can be particularly traumatizing. Who's going to want someone with a face like this? the young men wonder.

Franco and his colleagues -- the number of psychologists and psychiatrists has doubled since the Iraq war began, reflecting large staff increases throughout the hospital -- make a point of visiting all new patients to see how they're doing.

"We provide assurance, look to the future," he said. "We're careful not to sugarcoat anything."

Franco doesn't attempt quick miracle fixes for traumatized soldiers, most of whom are flown to the United States after a few days. "When your world is rocked like that it's not a smooth process necessarily to get that to make sense," he said.

On Sept. 18, Army Sgt. 1st Class Larry Daniels' world was rocked. So was his wife's.

With other men from his platoon, Daniels was standing on a bridge over a highway near Baghdad International Airport while an Iraqi contractor fixed a fence by the side of the road. Daniels, 37, was waving Iraqi vehicles past the three American Humvees while the contractor worked as quickly as possible to fix the wire fence.

An orange and white Chevy Caprice, a type of car usually driven as a taxi in Baghdad, veered toward the soldiers. It exploded; a suicide car bomb.

"I felt my body went up in the air," said Daniels, in his Texas drawl. "I was upside down looking back at where the car had been and landed on the ground. Three seconds later it hit me what happened."

Lying on the pavement, Big Daddy Daniels, as his men call him, had the presence of mind to keep ordering his soldiers around, even though he couldn't move. Another unit arrived soon and ferried the survivors to safety. Two were dead.

Two days later, Daniels was flown to Landstuhl. Both of his arms have multiple fractures. Steel pins and thick casts keep his bones in place. Part of his hand is missing. And as he puts it, he's got "holes from my ankle to my ear." The doctors have taken some of the shrapnel out. Some fragments are still there.

Wife's opinion has changed

Daniels is an experienced, professional soldier. He's been in the Army for 17 years. His dad was a draftee in the Vietnam War. He can trace his family's military history back to the Civil War. So perhaps it's not surprising that he says he wishes he were still in Iraq with his men.

His wife, Cheryl, has had enough. While the staff at Landstuhl move the injured on, usually after five days, the families of the wounded have to face up to the long-term consequences of the violence in Iraq. Many are embittered.

From a military family herself, the mother of two had been changing her mind about a lot of things even before her husband became so badly injured that he can't do even the most basic of tasks for himself.

She supported the war and voted for Bush. Now, she says, she wants to pull the troops out of Iraq. "I will vote for Kerry. Not because I prefer Kerry over Bush but because I don't want Bush back in office."

Her 12-year-old son has been saying he wants to go to West Point. Her 8-year-old daughter wants to be a military veterinarian. She's stopped encouraging those ambitions.

Speaking alone, without her husband, she said she knew that the Army wasn't going to like what she had to say. Like Hecker, she hasn't got much to lose by speaking her mind, which she did, calmly and thoughtfully.

"I don't feel we have any business being there," she said Friday. "I think this is an area of the world that has been fighting for thousands of years, and I don't think our presence will change anything. If anything, we've given them a common target to focus on. Rather than fight each other, they're fighting us. I don't see why my husband has to lose two soldiers or question why he's here or see his other guys that are hurt. The minute we pull out, things will go back to the culture that is established.

Cheryl Daniels is looking at a tough future. She has to parent her kids, hold down a job at Fort Hood Army base in Texas, where the family lives, and finish the management degree she is studying for at night. Soon her disabled husband will be home, and she finds it hard to believe, as the doctors have told her, that "in a year or two he's going to be back to normal. I can't see that right now because he's got nerve damage in his arms."

She doesn't feel that her country, her military, is giving her enough support. She had to pay her own way to Germany and her own way back. The Army was doing almost nothing for her, she said.

"I feel like we've paid our dues," she said. "And I'm done."