- Garth Stewart lost his foot in Iraq, in a mine blast
that showered his blood and flesh on his buddy and left Stewart writhing
and screaming on the road, smoke rising from his wound.
-
- Andrew McCaffrey's right hand was blown off by a grenade
in Afghanistan. A Special Forces medic tackled him and knelt on his stump
to stanch the bleeding as they waited for the medevac helicopter.
-
- Scott Barkalow's legs were shattered in Afghanistan when
a mine detonated beneath his truck. As he lay shivering in the snow, knowing
the pain would come, he looked down to find his right leg missing below
his knee.
-
- War maims as well as kills. The war on terrorism is no
different. Among the hundreds of shattered young soldiers being carried
from the battlefields of Iraq and Afghanistan are dozens whose arms or
legs, sometimes both, have been blown off completely, or shredded and then
sawed off in surgery.
-
- Until recently, the military worked to ease these soldiers
into medical retirement.
-
- But now, many reject retirement and work their way back
to active duty. The Army, in what doctors describe as a sea change, is
using high-tech artificial limbs and rehabilitation techniques developed
in the past few months to help them get there.
-
- Spc. Stewart, wounded April 5, already is back on active
duty at Fort Benning, Ga., with his buddies of the mortar platoon, headquarters
company, 1st Battalion of the 15th Infantry Regiment, 3rd Infantry Division,
themselves just back from Iraq.
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- "You don't whine about it," Stewart, a gangling
21-year-old from Stillwater, Minn., said of his war experience.
-
-
- Psychological effects
-
- Whether from land mine, bomb or rocket-propelled grenade,
combat wounds that result in limb amputation are not medically or psychologically
simple to treat.
-
- Explosions shatter and sever legs and arms. They char
flesh and drive debris deep into the soft tissue that remains. Unattached
muscles, nerves and tendons dangle. Red-hot shrapnel sometimes punctures
torsos below waist-length body armor, ripping bowels and bladders. Concussions
bruise skulls and brains. Soldiers thrown into the air are injured again
when they hit ground.
-
- There is psychological trauma, too, involving the shock
and horror of being wounded, and fear and depression about the future.
Often, soldiers feel guilty because they have survived while their buddies
were killed in combat.
-
- "When they get here, it's like a beehive swarm"
of specialists working on them, said Dr. David Polly, who until recently
was chief of orthopedic surgery and rehabilitation at Walter Reed Army
Medical Center in Washington.
-
- "Do not kick me out for this," Sgt. McCaffrey
grunted to his commander as the medevac chopper lifted him, with a bleeding,
bandaged stump, from a dirt road in Afghanistan on July 1. "I ain't
done yet."
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- McCaffrey, 31, from Massapequa, N.Y., works out in the
rehab gym at Walter Reed. He is past the point when he couldn't bear to
look at his stump. He fits a self-designed strap on his artificial arm
and yanks it to keep his carbon-fiber limb tightly attached while he's
doing pull-ups.
-
- McCaffrey is a Special Forces soldier, a Green Beret,
and it is to that demanding specialty that he is desperate to return. He
has taught himself to put on a heavy rucksack, rappel down a rope, field-strip
weapons and shoot from his left side. He works intently, a wad of tobacco
tucked behind his lower lip. He spits the juice into an empty Cherry Coke
bottle. Pushing the limits, McCaffrey has broken his electric arm twice.
-
- "I worked for 10 years to get to this level,"
he said, speaking of his fitness peak before he was wounded. "I won't
accept for it to be taken away."
-
-
- The meaning of home
-
- It is hard to explain such drive to civilians. Parents,
wives and children may figure enough sacrifice has been made. Time to hang
it up and do something less risky. Time to come home.
-
- But home to these soldiers may be their small combat
units, where honesty and responsibility take on real, everyday meaning
and the violence of war melds friendships into bonds difficult for outsiders
to comprehend.
-
- "It's their known world," said Joseph Miller,
chief prosthetist at Walter Reed.
-
- Among civilians, the amputees draw stares. Not so in
the refuge of the platoon, the company, the battalion. "When you're
around a bunch of guys who've been in combat, it's not such a big deal,"
said Pfc. David Jatich, 19, one of Stewart's buddies at Fort Benning.
-
- That's a powerful draw, especially for badly wounded
soldiers.
-
- Being around "guys who've been there" was the
idea behind a series of secretive visits to Walter Reed's battle casualty
ward by two of the Army's most senior officers: Gen. Eric Shinseki, recently
retired as Army chief of staff, and retired Gen. Fred Franks Jr., who commanded
the armor and infantry of VII Corps, the victorious ground combat force
in Desert Storm.
-
- The two highly decorated soldiers would come to Ward
57 and chat with the patients, many of whom were irritated at yet another
visit from the brass "who usually don't have a clue," in the
view of one amputee.
-
- Then Shinseki would slide off his shoe to reveal his
partially amputated foot, and Franks would roll up his pant leg to reveal
his artificial leg. The two generals would describe their horrific wounds
in Vietnam and how they'd managed to return to full and productive lives.
-
- "It's not what you don't have, it's what you've
got -- competence as a soldier, determination and motivation," Franks
told them. "Find the steel inside yourself and go on."
-
- But not everyone can go back on active duty.
-
- "If they'd let me go do what I do with the leg like
this -- yeah, I'd go back," said Barkalow, 41, a Special Forces sergeant
wounded Feb. 19. "My wife ain't going to like hearing that."
-
- While Barkalow struggles through rehab at Walter Reed,
his wife, their 9-year-old stepdaughter and 8-year-old son are at home
in Dickson, Tenn.
-
- Like many amputees, Barkalow carries little evident bitterness.
"I lost a leg, but I feel whole," he said. "I understand
people get hurt and die in war." Toward God and President Bush, he
added, "I don't have a hard thing to say."
-
- What's hard, Barkalow and others acknowledged, is rehab.
"You're in pain much of the time," he said.
-
- Rehab was once designed to enable amputees to drive a
car to the shopping center. Now, some amputee soldiers insist on being
able to climb steep inclines at 10,000 feet in waist-deep snow, carrying
90-pound rucksacks at night, under fire -- as they were doing in Afghanistan.
-
-
- Researching pain
-
- For a soldier with an above-the-knee amputation, walking
on level ground can require two or three times more energy than for someone
with two sound legs. For an amputee with an artificial leg, walking downhill
on loose gravel is a challenge therapists and technicians are just beginning
to address.
-
- There is little to instruct surgeons how to prepare the
stump for that kind of activity, nor is there any guide for therapists
to use in helping to rebuild muscles and stamina.
-
- "We're trying to push the envelope," said Chuck
Scoville, chief physical therapist at Walter Reed. "We don't know
what's possible."
-
- A few months ago, the Walter Reed staff began using a
sophisticated computer program to scan an amputee's stump and design a
socket that will fit tightly and comfortably without binding or chafing
under heavy use. Advances in electronic sensors and miniature, lightweight
computers and motors are boosting the performance of artificial legs, feet,
arms and hands.
-
- But amputation hurts, and often for a long time. Many
amputees feel stabbing, cramping or burning pain in their missing limb.
Doctors use nerve blocks to help patients cope. Pain is "a huge issue"
and not well understood, said Dr. Jeff Gambel, Walter Reed's chief of inpatient
rehab.
-
-
- Hard at work
-
- Six months after the mine blast felled him on a Baghdad
highway, Stewart strides across Fort Benning at dawn, heading to the gym
for a workout. His shorts flap above his stump and a shiny metal leg and
plastic foot. His exuberant 6-foot-5-inch frame angles over the landscape
at a pace that would force some people into a trot.
-
- Rumor says his outfit will go back to Iraq in April.
Stewart, not yet healed, works methodically and relentlessly to regain
full function. It's a race with an outcome still unclear.
-
- "There is a pain issue," is the most he will
say about his private ordeal.
-
- How hard to push patients in pain, soldiers who have
already given so much? How much hope to hold out to someone desperate to
be back with his buddies on active duty? When is enough, enough?
-
- Surgeons, therapists and psychologists wrestle with such
questions every day.
-
- "We talk about expectations," said Polly, the
orthopedic surgeon. "Clearly a guy who lost an arm and two legs isn't
going back on active duty. We have a limited capacity to replace missing
limbs.
-
- "But we are always excited when a guy exceeds our
expectations."
-
- - David Wood can be contacted at david.wood@newhouse.com
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