That was at the Naval Medical Center. For two years now Jason has been treated at the Palo Alto VA Hospital — one of four specialized centers for rehabilitation of the huge numbers of brain injured troops. The program uses intense, individualized physical and mental rehabilitation. Dr. Harriet Zeiner is a clinical neuropsychologist in the hospital’s polytrauma unit. “Every hour of the day something is done,” Zeiner says, “And we're very careful to keep within the envelope of what someone is capable of doing and pushing it just a little.”
Angel Gomez is learning to walk again. Frank Sandoval is struggling to eat on his own. Most of the patients treated in the brain rehabilitation program go back in the community, but about 10 percent wind up in nursing homes or other long-term assisted living facilities on a permanent basis.
Jason Poole already is living in his own apartment — even taking driving lessons in a simulator and starting remedial reading classes at a community college — as he continues the rehab. “Motivation isn't usually an issue,” Zeiner says, “Awareness that you're not gonna be that same person is the problem.”
Poole says he accepts that he will always have difficulty with speaking and memory. “From the day I was born I've always been happy,” Poole says. “I know I got blasted and basically I came alive, you know, but basically it's just that I'm still happy.” Thousands of other vets are facing the same challenge of accepting their new selves.
© 2006 MSNBC Interactive
Alec did not perceive a problem. “I thought there wasn't anything wrong with me,” he laughs. “Everybody else was screwed up.” Dr. Henry Lew of the Palo Alto VA Hospital says it is a very common scenario. “You don't see shrapnel or bullets or open injuries,” Lew says. “But the inside of the brain has been damaged to a point that it affects the daily function.”
Veterans Affairs psychologist Harriet Zeiner says that often people will think a brain-injured vet is depressed or suffering from post-traumatic stress. “It's really important,” Zeiner says, “that individuals out in the public know that it's entirely possible for someone who's been in the combat theater to have a head injury and not know it.” Geiss finally had his problem diagnosed. He's been through months of rehabilitation, but he still has occasional emotional outbursts and memory problems.
“Sometimes, a new memory will stick in there, like, I don't know why,” he says. “And then other times — there's nothing.” Before the war, Geiss ran a construction business. Now, even though he looks fine, he knows that he can't do that again. “The hardest thing,” he says, “is to tell yourself you're not fine. You're not... It's real hard to keep everything together when you're not together yourself and you don't even know that something is wrong.”
Like thousands of other returning Iraq vets, Alec Geiss faces an uncertain future, because of a hidden wound.
THE SIGNATURE WOUND OF THE IRAQ WAR
Many troops in Iraq with brain injuries may be returning to duty. That’s right -– they’re not getting treatment –- not even getting a break –- but going right back into the field. We've been reporting on the enormous numbers of brain injuries among Iraq vets for the past two nights. (Read part one here; part two here.) I'll reiterate the numbers and the reasons below. We could not fit this aspect of the story in these two reports, so I want to point it out here.
According to the VA doctors who run the rehabilitation programs for brain injuries, when troops are wounded in the field they are evacuated immediately if they have any obvious wounds. But the signature enemy weapon of this war has been the roadside bomb – the IED. The human brain is the consistency of gelatin and the force from the explosion shakes it ferociously. Many thousands of troops in Iraq have felt the blast of an IED. If they are knocked unconscious, according the VA docs, they too are evacuated to a field hospital for evaluation. But if they are not and if they do not complain of a problem, they remain on duty.
Specialists in brain injury know all too well that people can suffer brain problems without losing consciousness. One of the most frightening aspects of brain injury is that brain-injured people often lose the ability to know something is wrong.
Dr. Harriet Zeiner, a VA psychologist and brain injury specialist, was recently on a conference call with medical officials at several military treatment facilities including hospitals in Iraq. "One of the things commanders are trying to determine," she says, "is that after someone has been exposed to five and six concussive blasts are they still battle ready? Frankly, that floored us. You could have very significant effects from one exposure, and now they're trying to figure out if people who've been exposed five and six times should be going back into battle."
To follow up on those comments, I called the Pentagon several times to request an interview with someone who would explain the policy of what field commanders do to determine if troops are suffering brain injury, and what is the policy for returning them to duty. My requests were denied repeatedly.
But beyond that problem, as we have been reporting, the toll of brain injury in this war is enormous. Almost 18,000 troops have been wounded according the Department of Defense. The VA doctors say that two-thirds of them have been injured by IED blasts and two-thirds of those exposed to blasts suffer some brain injury -- ranging from a mild concussion to permanent damage. Brain injuries -– thousands of them –- could be the legacy of this war just as much as post-traumatic stress and problems from exposure to Agent Orange persisted among many of the troops who served in Vietnam.
© 2006 MSNBC.com