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When Dr. Andy Moser, an assistant professor of clinical physical medicine and rehabilitation at the IU School of Medicine became lead polytrauma physician at the Roudebush VA hospital in Indianapolis, his main priority was to help injured Iraq and Afghanistan war veterans regain control over their lives.
Veterans such as Portray Woods.
During a routine patrol in Iraq in 2004, U.S. soldier and Fort Wayne, Woods, an Indiana native, sustained severe injuries when his Humvee triggered a roadside bomb. The blast tore off his right arm and delivered a blow to Woods’ head hard enough to cause a serious brain injury and send him deep into a coma. Even if Woods were to wake up, doctors doubted that the former high school athlete would ever walk or talk again.
Yet after emerging from the coma and working with doctors and therapists at the newly opened polytrauma clinic at the Roudebush VA Medical Center in Indianapolis, Woods relearned to walk and talk. “They helped me out,” he said, “and I got better.”
Today, the 37-year-old Woods works part-time at Roudebush, greeting visitors at the front desk. He’s one of the tens of thousands of Iraq and Afghanistan war vets who’ve sustained life-altering injuries including lost limbs, brain damage and concussions, and suffer from mental disorders such as post-traumatic stress disorder (PTSD) and depression. To care for the record number of veterans with multiple injuries and, especially, brain trauma, the U.S. Department of Veterans Affairs created a network of polytrauma sites across the country.
The Roudebush polytrauma facility, which opened in 2006, is under the direction of Dr. Andy Moser, an assistant professor of clinical physical medicine and rehabilitation at the IU School of Medicine. The facility serves active duty troops and veterans from Indiana, Michigan and Illinois. The 26-member staff includes rehabilitation doctors, nurses, and physical, speech, recreational and occupational therapists.
The 11-bed unit has so far treated 15 inpatients suffering from injuries to body and mind. “They’re not just broken physically,” said Alix Walker, a physical therapist at the Roudebush facility. “They’re broken mentally and emotionally, too.”
Among the physical injuries treated by doctors at the Roudebush facility, concussions and more severe brain injuries are the most common. (According to recent reports, as many as 360,000 Iraq and Afghanistan veterans have sustained brain injuries.) Many such injuries are caused by 155-mm artillery shells hidden under asphalt and triggered by cell phones. Beyond shrapnel wounds, soldiers are damaged by the bomb’s concussive shock of compressed air that explodes upwards and rattles the brain. Arteries tear, brain tissue swells. And multiple explosions are not uncommon, said Roudebush polytrauma manager Andy Brown. “You get hit by one to drive you another way, so they can blow you up again.”
The resulting head injuries are often catastrophic. One Iraq veteran struck in the head by a rocket-propelled grenade that did not explode sustained an open-wound brain injury. He arrived at Roudebush virtually unable to speak or understand others. Susan Toler, the polytrauma facility’s lead speech pathologist, asked the patient to identify pictures of household objects. She had him read single words, then paragraphs. Twice a day, five times a week, Toler worked with the determined soldier, followed by seven months of outpatient care. Slowly, painstakingly, his speech returned.
To treat head and brain injuries and other physical trauma, the Roudebush polytrauma facility features a gym with state-of-the-art rehabilitation equipment including treadmills and a vestibular therapy area to treat patients with balance problems—a common consequence of traumatic brain injury. The facility also has computers to help brain injury patients hone their mental skills.
Patients battling physical injuries are often also beset by mental disorders such as PTSD, depression, and what doctors call “hypervigilance”—an un-abating edginess that, while necessary on the battlefield, disrupts life at home. Veterans suffering from hypervigilance might compulsively scan a crowded room for danger or, spotting road debris while driving, imagine a bomb and veer suddenly away. Overpasses could be wired. Potholes are perceived as a menace.
Having lived on an emotional razor’s edge for so long while in Iraq or Afghanistan, many combat vets have trouble adjusting to treatment. Some recoil at the touch of a staffer’s hand. One patient, the Roudebush staff recalls, dived for cover when an object fell to the gym floor.
Roudebush therapists use a variety of therapies and techniques to treat war-related mental disorders, including deep-breathing exercises and “grounding,” which involves having patients rub their faces and describe what they see and hear in the moment. To confront and cope with the intensity of their war experiences, patients are encouraged to recount them. In the telling, some become angry. Often there are tears. For those who have seen fellow soldiers killed, there can be underserved feelings of guilt, said Heidi Knock, a polytrauma clinical psychologist. “Why was it their buddy and not them?”
Polytrauma patients are, for the most part, disciplined and motivated. Some, still recovering from severe wounds, even talk of wanting to rejoin their units, said Moser. “They see their fellow soldiers almost as brothers.”
Still, the program logs many no-shows. Some vets miss appointments because they are seeking work. Others, because of their brain injuries, simply forget; those patients are provided palm pilots or smart phones to program reminders. Other soldiers don’t show up until their lives are virtually falling apart, or not at all. According to a Rand Corporation study released last year, nearly 20% of military service members who returned from Iraq and Afghanistan reported symptoms of PTSD or major depression. Yet only a little more than half had sought treatment. Many feared it would hurt their military careers. Knock sees another reason. Combat veterans have a warrior’s mentality, she said. “They see needing help as a weakness.”
Each March, select patients from the polytrauma facility fly to Aspen, Colorado to ski and snowmobile. The idea is to show disabled veterans what they can accomplish if they try. Assisted by ski instructors, brain-damaged vets, amputees and blind vets all participate.
Portray Woods, who has been on the trip four times, balked when first asked. “I was scared,” he said. But he’s always had a good time. Woods, who in addition to his artificial arm has a prosthetic left thumb, says he went rock-climbing.
Greg Brooks sustained a brain injury from an anti-tank mine in Iraq in 2005. Despite a balance disorder that requires him to walk with a cane, he’s been to Aspen twice. “I wouldn’t have imagined I could ski with the balance I have, but I did,” he said. He admits he fell a few times, adding: “Who doesn’t?”
Mike Whelihan, adjutant of the Indiana chapter of the Disabled American Veterans, which helps sponsor the trips, praises the VA for making the commitment to men and women wounded in Iraq and Afghanistan. “The VA’s put their money where their mouth is,” he said. “We in Indianapolis here are so blessed to have this unit in town.”
Former patients are grateful, too. One was so appreciative of physical therapist Alix Walker that the person penned these words in a letter to The Indianapolis Star: “Not only has she helped me through my physical pain, but she has helped me deal with my emotional scars left by my tour in Iraq. She has put a personal touch to her physical healing which has shown me there is still hope for humanity. Alix has changed my life.
Woods says “thank you” to the people who helped him each time he reaches out to other vets from Iraq and Afghanistan. When they walk through the front door at Roudebush, the man at the front desk takes each aside and relates his story. Just as the polytrauma staff encouraged him, Woods urges on his military brothers.
“Keep your head up,” he says.
