Best Hospitals 2007
Trying to make a life
After a battlefield injury, endless challenges
Adams survived and was soon transferred to Walter Reed. When Summer first saw him there, he peered at her through his bandages and gave a thumbs up. But painful decisions loomed. Doctors could remove the shrapnel, along with part of Adams's brain, leaving him more impaired. Or they could leave it in and take their chances. Summer didn't hesitate: Leave it in, she said.
Early studies indicate that head injuries like Adams's are a frequent byproduct of the Iraq war. Michael Xydakis and John Casler, military head-and-neck surgeons, have gathered data that show about 1 in 5 soldiers injured in Iraq and Afghanistan and airlifted to Landstuhl over a 14-month period was treated for injuries to the face, neck, or throat below the helmet. During the first eight months of this year, the Defense and Veterans Brain Injury Center at Walter Reed treated 355 patients from Iraq and Afghanistan with traumatic brain injury, known as TBI. Depending on its severity, TBI can result in headaches, sleep difficulties, decreased memory and attention, irritability, and depression. Patients do recover, but more serious brain injuries often mean long-term problems.
Adams sustained "significant brain damage," says Yolanda Reyes-Iglesias, his neurologist at the VA Medical Center in Miami. The shrapnel in his cerebellum affects his speech and coordination. The damage to his frontal lobe affects his mood swings and memory, as well as his ability to solve problems, plan events, and behave in an appropriate way socially, causing his laughter at awkward moments.
Soldiers like Adams and his men must deal with two big bureaucracies: the Pentagon and the VA. "Medical holdover," or med hold, as soldiers call it, was intended to make sure no one leaves the military until medical problems are stabilized. "We want to return them to the level they were at," says a senior Army medical official. "The idea is, 'We broke it, we fix it.' " Although wounded soldiers receive their active-duty pay while being treated, many are assigned to bases far from home. About 23 percent of the roughly 14,600 reserve soldiers who have entered medical holdover are still there; the average number of days spent in med hold is 136. Aware that many soldiers want to heal closer to home, the Army recently initiated a community-based program. Still, many soldiers express frustration. VA Secretary Principi acknowledges that a young soldier can "get stuck in a netherworld" while the Army tries to determine whether he is fit to stay in the military. "We should not be holding them up unnecessarily," Principi says, "for prolonged periods of time."
Limbo. During his time on medical holdover, Jason Recio has been bounced back and forth between Walter Reed and Fort Stewart and Miami for treatment and convalescence. Over the past 16 months, he's had at least 18 surgeries; his shattered right leg is made up of metal and cadaver bone and grafted muscle and skin. Recio, however, feels so limited that he says now he wishes he had decided to have his leg amputated, an option he and his father say may yet be their preference. "There's something to be said for having your leg," he says, "but I'm 23, feeling like a 60-year-old. I want to cut my losses."
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