Casualties of war

LANDSTUHL, GERMANY – In a corner bed of Room 205, Spc. Yancie Baker waited for his transport flight back to the United States and wondered about life with one eye.

“My left eye’s gone,” the 25-year-old Fort Lewis, Wash., soldier said. “It’s life. As long I ain’t dead, right?”

Six days earlier, on a narrow street in the Iraqi town of Mosul, a car bomb triggered by a detonator exploded as the 114th Calvary’s Stryker Brigade drove past. Baker’s vehicle, the last in the long convoy, was the only one hit. His injuries brought him to Landstuhl Regional Medical Center, the largest American hospital outside the United States.

More than 17,000 soldiers have been treated at Landstuhl since the war on terrorism began in 2001. Medical workers only half-jokingly refer to it as Europe’s Emergency Room.

The soldiers who arrive here are in some ways lucky. About 5,000 soldiers wounded in Iraq have come through the hospital’s doors; only 13 have died.

But for the other 4,987, life changed.

“It’s easy to forget there’s a war going on when you’re far away from it,” said Maj. Ronald Krogh, a medical service officer from Seattle. “We see these soldiers every day. Many of them are in their 20s. It’s a powerful reminder of the price of war.”

Baker is among the walking wounded in the war on terror. His injuries will not kill him, but he likely will not be a soldier again in Iraq, or return to his unit. In that way, he thinks, the roadside bomb that exploded that quiet morning stole more than his eye.

“I want to go back over there,” he said. “I want to finish business.”

Two floors below him, with a chill still lingering in the morning air, a pair of Army buses rumbled to a halt in front of the hospital. A row of stretchers and a crowd of nurses and medics waited for them. The soldiers wore fresh burns that had begun to scar, leaving uneven patches of skin where goatees and sideburns had been. Bandages covered their hands and arms, obscuring tattoos. Many were hooked to IVs to ease the pain.

There is no better place to study the effects of bullets and projectile explosions than Landstuhl. Dozens of studies are under way, including those examining the destruction of tissue by high-velocity bullets and new advances to prevent scarring after burns or explosions. The studies benefit from the most comprehensive data collection program ever enacted by the U.S. military in wartime.

“It is a fascinating place to work,” said Dr. Ronald Pace, the hospital’s chief of surgery. “But it is also very sobering. It has made me more patriotic to see the horrors our soldiers are going through. Their feeling of loyalty to fellow soldiers and Marines and their willingness to go to war – it’s just truly remarkable.”

Pace worked at Harborview Medical Center in Seattle, which serves trauma victims from across the Northwest. But even that can’t prepare surgeons for what they see at Landstuhl, he said.

“At Harborview, I saw car-accident victims and gunshot victims who were hit by low-velocity rounds,” he said. “Here, our car accidents are tank rollovers. And the guys have been shot by high-velocity rifles. The amount of tissue destruction is far different.”

Barbara King, an operating room nurse from Dupont, Wash., spent two months at a mobile hospital in Iraq. Now, she handles infection control at Landstuhl.

In Iraq, she saw firsthand the tissue destruction inflicted by the high-velocity bullets – far greater than the damage from a handgun, for example.

Sometimes the bullets go straight through. Other times they tumble through the body, severing arteries and causing massive blood loss, King said. In one case, King’s team pumped 40 units of blood into a soldier – about 10 times the amount circulating in the human body. The soldier lived, she said.

The mobile surgery center was light and Spartan. Heavy plastic sheets covered the floor. The operating room had two tables, which looked like military litters, she said, but had cachement areas for blood and fluids. She watched a stream of young men come through the operating room.

“They’re healthier, and they can typically bounce back quicker,” she said. “But if it’s the wrong injury, it doesn’t matter.”

Her 29-year-old son is a helicopter pilot at Fort Bragg, N.C. He has not been to Iraq, but he is scheduled to go next year, if the conflict continues. At times, King said, she saw his face in the young men who came through the operating room.

“When I look at those kids, I think about my son,” she said. “I know there’s a mother somewhere else. If you think about it too much, it’ll cripple you as a nurse.”

But the war exacts a toll on other caretakers as well.

Medical staff often stop by the office of Chaplain Eric Holmstrom for counseling. Many have trouble sleeping at night, he said, or suffer a loss of appetite.

Often the stress is compounded by the fact that they are thousands of miles from their families in the United States. The sense of loneliness can make the trauma they see even more difficult to cope with, he said.

“Sometimes, it’s the relative youth of the victims, sometimes it’s the nature of the injuries,” said Holmstrom, an Army reservist called up last year. “It’s good to be here, but it’s also hard to be here.”

In the physical therapy room, Lt. Shane McDonald, from Pullman, led his patients through often painful exercises to prevent scarring from their injuries. A reservist, he received a call in January telling him to report for duty in one week.

“I dealt with more gunshot wounds here in the first three days than I saw in my first four years in practice,” said McDonald, 34. “I had never seen what someone looks like after they’ve survived an explosion. That was a little tough. But I’m a much better physical therapist because of it.”

McDonald said he was surprised by the sheer number of casualties arriving each day from Iraq.

“You hear about the fatalities on television and in the newspapers,” McDonald said, “but you don’t hear much about the injured. I wasn’t quite aware how many soldiers are getting hurt.”

Back home, McDonald has a wife and a 5-week-old son. His wife flew to Germany to give birth so he could be there. But this month, his family returns to Pullman, and McDonald will track the first year of his son’s life through e-mails and photos and letters.

“When I see what these guys have gone through, I feel a little selfish sometimes to be missing home,” he said. “I’m not getting shot at here. I don’t have sand underneath my feet. My patients have experienced more trauma than I’ve seen in my career. But they are so motivated to do what they need to do that I’m affected by that, in a very positive way.”

In the ophthalmology department, Dr. Todd Hess hustled from one patient to the next. In addition to caring for the wounded from Iraq, the hospital also handles outpatients – both soldier and civilian – from the nearby Army and Air Force bases.

Hess’ department has dealt with more than 200 soldiers who lost an eye in the Iraq conflict. Many were not wearing protective eyegear, either because it was uncomfortable or because it affected their vision, Hess said.

The eyes are relatively unprotected, Hess said. “You can’t put Kevlar over the eyes. And so we’re seeing a lot of patients with open-globe eye injuries.”

Hess said the patients typically were stoic about their injuries. Many asked to be returned to their unit.

“They really aren’t reacting to the injury yet,” Hess said. “Most of them are very matter-of-fact about it. I don’t think it really sinks in until later that they no longer have an eye.”

Baker, the Fort Lewis soldier, lost an eye and won a Purple Heart. Like almost everyone here, Baker can draw a line from Sept. 11, 2001, to his presence here at the hospital.

He remembers that on the day of the terrorist attacks, he stopped in a gas station in Mobile, Ala. “You won’t believe what just happened,” the clerk told him.

The next day, Baker signed up for the Army.

He said he felt a duty to serve. Besides, he added, “I didn’t have much going on back home.”

He spent more than 10 months in Iraq without a scratch. He was slated to go home in October, though soldiers joked that the end of the tour of duty had become a moving target itself, as insurgents stepped up attacks and tours were extended this spring.

On the morning of the explosion, his convoy moved through the narrow streets of Mosul on patrol. Typically, the drivers tried to avoid parked cars, a popular way for insurgents to strike. The last in the line, his Stryker followed the others past a small car.

He remembers little of what happened. A moment before the explosion, he laughed at something a buddy said. Then he turned as the car burst into flames.

The Stryker absorbed much of the shock, and Kevlar and body armor protected his head and chest. But the explosion scorched his face and hands, and sent a piece of shrapnel into his eye. He remembers heat and color – white and red. Somehow he stayed conscious.

“It felt like my arms were melting,” he said.

Two days later, he arrived at Landstuhl.

As he sat waiting for the plane home, he held an unlit cigarette in his right hand. It trembled slightly. A thick gauze patch covered his eye socket. Burns traced his face and arms, and in places, his skin had begun to peel. His thoughts remained with his unit.

“The Army changed me,” he said. “I’m hoping they let me go back.”

A visitor asked what he’ll do if he can’t return to his unit.

“I don’t really know,” he said. “I guess I’m not really sure.”

In front of the emergency room, the late-afternoon sun slanted across the line of waiting medics and nurses and stretchers. Around 5 p.m., the last pair of buses arrived for the day. Those soldiers who could walk into the hospital did so. The rest were gently lifted on stretchers from the back of the buses, and then, one by one, the nurses rolled them up a small ramp, past the sliding glass doors, and into the fluorescent light of the hospital.