Amputees Returning To Duty
Therapy Gets Troops Back To Their Units

By David Wood
Newhouse News Service

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.
"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."
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
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