Iraq War’s Signature Wound: Brain Injury

Traumatic brain injuries are the signature wound of the Iraq war, a byproduct of improved armor that allows troops to survive once-deadly attacks but does not fully protect against roadside explosives and suicide bombers.
by Jordan Robertson

PALO ALTO, Calif. — Lance Cpl. Sam Reyes bears scars from three horrific attacks in Iraq, but his most debilitating wound cannot be seen.

He recovered from the chest wound delivered by a machine gun-toting insurgent and the bullet wound to his back that came during an ambush. He survived the severe burns and broken ribs inflicted by a suicide bomber who struck a lightly armored 18-wheeler he was riding in – an explosion that killed 12 of his fellow Marines.

One injury initially went undetected. It continues to cripple him long after he arrived home with a clean bill of health.

Reyes suffered a traumatic brain injury in the truck explosion. The blast sent a powerful shock wave through his brain tissue, bursting blood vessels and smacking his brain against the inside of his skull…

“I thought I was a mess-up, just damn near dumb,” Reyes, 22, said about the mysterious fogginess that plagued him long after his physical wounds healed. “I thought I was just a failure at this. I was recognized before as being the best. I knew my stuff real well. It made me feel like I wasn’t a Marine no more.”

Doctors say traumatic brain injuries are the signature wound of the Iraq war, a byproduct of improved armor that allows troops to survive once-deadly attacks but does not fully protect against roadside explosives and suicide bombers.

So far, about 1,000 patients have been treated for the symptoms, which include slowed thinking, severe memory loss and problems with coordination and impulse control. Some doctors fear there may be thousands more active duty and discharged troops who are suffering undiagnosed.

“People who were hit by lightning, a lot of energy goes through their systems and their brains are cooked,” said Dr. Harriet Zeiner, a neuropsychologist at the VA hospital in Palo Alto. “A lot of that happens in (improvised explosive device) blasts. Your brain is not meant to handle that energy blast going through it.”

The injury, a loss of brain tissue, shares some symptoms with post-traumatic stress disorder, which is triggered by extreme anxiety and permanently resets the brain’s fight-or-flight mechanism.

Battlefield medics and military supervisors often fail to spot traumatic brain injuries. Many troops don’t know the symptoms or won’t discuss their difficulties for fear of being sent home.

“Most of us are used to the Vietnam War, where people didn’t trust the government,” Zeiner said. “That’s not going on here. A lot of these guys want to go back, they want to go help their buddies.”

The most devastating effects of traumatic brain injuries – depression, agitation and social withdrawal – are difficult to treat with medications, said Dr. Rohit Das, a Boston Medical Center neurologist who treats injured troops at the VA Boston Healthcare System.

Certain symptoms, such as seizures, can be treated, but after that “we just draw a blank,” Das said, adding that doctors are just beginning to cope with the mounting volume of brain injuries as the war drags on.

“We’re just unlocking the secrets of the brain,” he said. “And when they have memory problems, leg weakness, arm weakness – there’s no quick fix for that. We’re probably decades away from regrowing brain tissue. Once you lose that, it’s permanent.”

In Reyes’ case, the Purple Heart recipient didn’t recognize his father and closest friends when they picked him up at the airport. His math and reading skills had deteriorated to a child’s level.

A machine gun operator in the war, he taught recruits while healing at Camp Pendleton, but was relieved of the position after he started to forget the differences among weapons.

After his injury was discovered, he was sent to the Palo Alto VA hospital, where his treatment includes exercises to improve his speed and attention and to control his angry outbursts.

But his memory may never fully recover: He’ll watch half of a movie before remembering he has already seen it multiple times. He forgets basic tasks without Post-it note reminders and alerts programmed into his cell phone.

He feels “like I’m back to a little kid,” he said. “I’ve got to go through the whole process. It’s frustrating, depressing and very overwhelming.”

The spike in traumatic brain injury cases is forcing the Department of Veterans Affairs to expand its treatment. The VA operates four hospital trauma centers specializing in treating traumatic brain injuries, and is creating 21 smaller regional facilities, said Secretary of Veterans Affairs R. James Nicholson.

“This is very high priority,” he said. “It’s a very serious injury to those young heroes that suffer it. We’re pulling out all the stops.”

The patients need a combination of psychiatric, psychological and physical rehabilitation that can be difficult to coordinate in a traditional hospital, Nicholson said.

In troops with brain injuries, the loss of brain function is often compounded by other serious injuries.

Eric Cagle, a 26-year-old Army staff sergeant from Arizona, lost his right eye and was paralyzed on his left side when an IED exploded under his patrol Humvee two years ago.

A concussion he sustained in the blast left him with a brain injury that makes math difficult and triggers inappropriate outbursts. He feels its symptoms caused his divorce.

Treatment has improved his outlook, he said. He’s been using a wheelchair, but took his first tentative steps last year. He wants to study forensic science and hopes to work in an FBI crime lab.

“I’m getting part of me back here,” he said in Palo Alto. “I’m getting my life back.”