Tuesday, December 29, 2009

Shock Waves: an article by Bethany Vaccaro about her brother's brain injury resulting from a blast in Baghdad | The American Scholar

Going to war brings with it the very real possibility of dying. When my brother Robert left for Iraq in September 2006, our family feared that his commitment might demand what is often called the highest price. Before he left, I imagined what it might be like as the sister of a dead soldier to tell everyone that he had laid down his life in such a contentious struggle. I pictured the flag-draped coffin, the article in our local newspaper, the murmuring friends and neighbors filing through to praise the dead hero. Always a realist, I prepared myself for his death as the worst possible outcome. I failed to conceive of any scenario that could rival the bitter finality of his dying.

I soon discovered that giving one's life can come in more than one form. For my brother, his life as he knew it was taken on January 14, 2007, in Baghdad, when an EFP—an explosively formed projectile device—detonated outside his Army Humvee, sending a shock wave through his brain, severely injuring him without leaving a mark on his body. Robert escaped death, but has paid a price almost as high. Today, he is back from war, 25 years old, brain-injured, and disabled. My brother accepted this risk when he signed his military contract in 2002 through the ROTC program at the University of Rhode Island. Although my family didn't sign an agreement or contract, we have discovered that we are as bound to his commitment as he is himself. Before my brother's injury, the phrase traumatic brain injury, or TBI, meant very little to my family. Now it defines our daily existence. The ongoing process of rehabilitation since his injury has tenaciously enmeshed each one of us, altering our plans, our family structure and interactions, our ideas about life and sacrifice, and most resolutely our belief that if he would only make it back home, everything would be okay.

My brother's injury occurred in the early hours of the morning in Baghdad, as his platoon was finishing a 10-hour shift of route clearing. He was a mechanical engineer and a second lieutenant, in charge of 25 men. Their assignment was to find and dismantle or detonate IEDs (improvised explosive devices) and other explosives that litter the roadways in Iraq. His convoy was nearing an Iraqi checkpoint when his vehicle, the third in line, was targeted by an EFP. The explosion catapulted the vehicle into the side of a building. The force of it blew a hole in the side of the armored Humvee, sending a chunk of metal into the driver's head, killing him almost instantly. My brother was in the passenger seat, and it was the force of the explosion rather than metal that penetrated his head.

After he was wounded, Robert's brain began to swell and the pressure inside his skull skyrocketed. He was taken into surgery as quickly as possible, where a large part of the skull on the right side of his head was removed to allow his brain to expand unencumbered. The pressure continued to rise, and a second surgery to remove even more of the skull was necessary before he left Iraq. It was almost a week before he was stable enough to be moved to the Landstuhl Regional Medical Center in Germany. During this time, my family did little besides sit together and pace around the house, waiting for the phone to ring with an update on his condition. We didn't fully grasp the severity of his injury. We weren't told at the time that he was awarded his Purple Heart in the middle of the night after he was wounded, because doctors feared he wouldn't live until the next day.

Once Robert was in Germany, the Army flew my father out to be with him. It was only then that we understood the gravity of the situation. As his body began to awaken, my brother was kept in an induced coma, allowing his brain to rest. When they finally tried to bring him out of it, he would not wake up.

I am one of five children spanning 14 years. Robert, the eldest, and I were lumped together for much of our childhood, being the closest in age to each other. Although he is 18 months older, I have always acted like the eldest. My mother says he didn't talk until I did. I distinctly remember explaining to him how to pronounce "Hallelujah." Because we were homeschooled, much of our schoolwork was done together. We did our English and history lessons as a pair, as well as all of our science projects—I dictated the steps of the scientific method while he scribbled ferociously into a notebook that would later prove indecipherable. We didn't stay particularly close. He moved into his own sphere when he joined ROTC in college, while I studied philosophy and kept to myself. I could tell he relished being in the traditionally masculine world of the military, where he could perform and deliver, unlike at our university, where he struggled to get through his required courses. Occasionally, he would let me go out with him and his ROTC buddies. I would sit back with my pint of beer and listen to their rapid banter, chuckling where I thought it was appropriate, as they fired movie quotes at each other. I liked watching him laugh and gesticulate. Like our father, Robert would laugh until his eyes watered—with an exuberance that seemed a long time coming after the hesitations of his childhood.

My parents have organized their lives around their children, creating a force field that continually draws us home even as we have grown up. The night we learned of Robert's injury, the rest of us were at our house in Kingston, Rhode Island, where we had spent most of our lives. We were sitting on the floor of the kitchen tie-dyeing T-shirts when the phone rang. A crackly voice told us he had been in an explosion and was going into surgery for head trauma. They would call again in two hours to let us know how it had gone. We gathered in our living room, stunned and unsure of what to do with ourselves. My father stood in the center of the room, slowly rocking back and forth on his feet. When he moved, the imprint of his shoes was chiseled into the carpet as clearly as if he had been standing on clay. He finally sat down, dragging an armchair tight into the circle of chairs and couches. It was not a time for sitting on the other side of the room. I knew my parents were praying, clinging to their lifelong faith, but I only waited for events to unfold and eventually sat at the kitchen table coloring fairies and dragons with my siblings to pass the hours. Every instant seemed like it could be the magical moment—surely now he is gone, or now all is well.

The phrase head trauma meant very little to me that night. I wondered to myself if my brother had perhaps lost an ear or an eye. The possibility of cognitive changes never crossed my mind. I was only vaguely aware of traumatic brain injury as the so-called "signature" wound of the Iraq war, something that is largely due to the increasing sophistication of the explosive devices used by the insurgency. I learned later that the Defense and Veterans Brain Injury Center, which operates out of Walter Reed Army Medical Center, had treated 1,803 cases of TBI stemming from the Afghanistan and Iraq conflicts as of November 2008, while cumulatively their sites had recorded 9,100 cases of this injury. I was completely unaware of the large advocacy and support networks, such as the Wounded Warrior Project, that exist to rally for the treatment of severely injured service men and women, the influx of whom our government has proven sadly unequipped to handle. I didn't know that it is still an uphill battle for many families to receive the kind of care that this incredibly complex injury needs in order to maximize recovery. This was the world we were about to enter that night, although we couldn't have been more ignorant of its existence.

As soon as my brother was moved to Bethesda Naval Hospital in Maryland, my parents began the arduous task of attending to him. I never saw a hint of hesitation in them, even through the long months of care, as everything else in their lives took a distant second place. They were unflinchingly proud of Robert, as they had been when he joined the Army, decided to volunteer for deployment, and ultimately left for Iraq. My parents saw his wartime role in crisp black and white. They were not angry, like I was. Any political context for his actions and what had happened to him collapsed into the overarching fact that he is their son and was in need.

The day my mother prepared to leave for Bethesda, she told us she might stay the whole week. She was sure we could mind each other (two of my brothers were still being homeschooled), the house, and our grandmother for that amount of time. It would be hardest on my nine-year-old brother, who had never been separated from both his parents at once. But we were all eager to rally and pitch in, snapping into an automatic mode that propelled us through our daily routines. My mother was gone for the better part of four months, my father for six months. They would rotate, depending on my father's university work schedule, and were often not home for more than three days at a time. But even when they were home, my parents were present in Rhode Island only in body. Their minds and all their energies were concentrated on a single hospital bed hundreds of miles away.

More ...

http://www.theamericanscholar.org/shock-waves/