TOPICS > Health

Healing the Wounds

December 3, 2003 at 12:00 AM EDT


SUSAN DENTZER: B.J. Jackson walks a bit awkwardly. But in many respects, it’s impressive that Jackson, a 22-year-old Iowa National Guardsman, is walking at all. Jackson, shown here with his wife Abby, was attacked while riding in a humvee in Baghdad last August. He lost the lower third of both legs, and now walks with prosthetics.

B.J. JACKSON: The only thing I remember is yelling for my wife and my kids.

SUSAN DENTZER: Jackson still has difficulty speaking due to damage to his vocal cords. He wears a hat to cover burns on his head.

B. J. JACKSON: I was told a phosphorous land mine went off underneath the vehicle, an RPG [rocket-propelled grenade] hit the side of the vehicle, and there were guys in three buildings on each side firing AKs. I lost both my legs below the knee, and 60 percent body burn on my hand, arm, and my head and lower back, and lost my legs due to the burns.

SUSAN DENTZER: Army Maj. Lanier Ward is another of the wounded. Last June, the humvee he was riding in was attacked with a remote-controlled bomb.

MAJ. LANIER WARD, U.S. Army: I began to move out of the vehicle when my arm fell essentially in between my legs. At that time, I just had a couple of pieces of skin and muscle that kept the arm attached. And so the mind can do some incredible things. I picked up my arm with my left hand, and I moved to the other side of the vehicle. At that time, I gave out of gas.

SUSAN DENTZER: As the violence rages on in Iraq, the number of injured U.S. military personnel continues to rise. Approximately 1,900 have been wounded since the war began last March. The experiences of Jackson and Ward shed light on ways military medicine has changed from past wars. It’s also built on techniques developed during those conflicts.

Roughly 660 patients to date, that’s about one-third of those wounded in Iraq, have been brought here to Brooke Army Medical Center in San Antonio, Texas. It’s the Defense Department’s premier burn treatment center. And that makes it the right place to bring patients who’ve both been severely burned and suffered serious orthopedic injuries to their arms and their legs.

Dr. Mark Bagg is chief of orthopedic surgery at Brooke, and the Army’s top consultant on orthopedic surgical issues. He says one change is the type of wounds that have resulted from use of new lightweight body armor. Called the “Interceptor” and produced by point blank body armor, it consists of layers of a material called Kevlar backed up with special ceramic plates.

DR. MARK BAGG, Brooke Army Medical Center: The body armor is a jacket, a vest that covers the chest, the abdomen, the back, and the spine. The good news is they’re surviving their injuries, we think, because of the body armor. The bad news is that there are some very devastating injuries to the extremities as a result of their surviving the initial blast.

SUSAN DENTZER: In fact, nearly three-quarters of wounds from the Iraq conflict are serious arm and leg injuries, like Jackson’s and Ward’s. To date, there have also been about 70 amputations.

Personnel wounded in Iraq have benefited from two enhancements over previous wars. One is the availability of more sophisticated medical treatment provided close to the battlefield. Another is a so-called “evacuation chain.” It allows the wounded to be cared for in stages, as they are moved gradually back to the United States. It also keeps hospitals along the chain from being overwhelmed by the volume of injured.

After his humvee was attacked, Jackson was flown almost immediately to an Army combat hospital in Kuwait, where his legs were amputated. Lanier Ward was taken to a so-called “forward surgical team” just minutes away by helicopter.

MAJ. LANIER WARD: I had lost an artery within my arm, and I had lost a large amount of blood. The team, the forward surgical team continued with saving my life along with saving my arm, and they were able to get the initial — they removed a vein from my leg and placed the vein in my arm, and this is in a very forward location.

SUSAN DENTZER: After their initial surgeries in theater, Ward and Jackson were flown to the Army’s regional medical center at Landstuhl, in Germany. Within several days, they were brought back to the United States.

Along the evacuation chain, their wounds were repeatedly cleaned out and dead tissue removed, in surgery similar to this shown here. That’s the way to prevent a potentially fatal infection until the wounds can be closed and so-called definitive care provided back in the United States. At Brooke, Ward underwent additional surgery to reconstruct his arm, including extensive repairs to muscle, skin and bone.

DR. ROMAN HAYDA, Brooke Army Medical Center: How much are you using your hand at this point?

MAJ. LANIER WARD: For smaller functions I can actually utilize it, open refrigerator doors, picking up some items.

SUSAN DENTZER: Ward’s doctor, orthopedic trauma specialist Roman Hayda, says additional surgery lies ahead.

DR. ROMAN HAYDA: We’re still in a very active phase of treatment. What we’re faced with now is that now that we know that the fracture has healed and there is no sign of infection, he’s developed a lot of abnormal bone formation in the muscle tissue. And so, we are at the point where we’re considering going back in surgically to excise that bone and then release some of the scar that is blocking motion in his elbow, which will improve motion there.

SUSAN DENTZER: For his part, Jackson spent 47 days in the intensive care unit at Brooke, all but one week of it under heavy sedation.

SUSAN DENTZER: What was the first point at which you were conscious enough to realize that you had lost both your legs?

B.J. JACKSON: When I first woke up I seen the casts, but it didn’t really set in until they cut the casts off. I looked at my sutures and the burn on my leg to see how they were healing. It was pretty hard at first, but I had a lot of support.

SUSAN DENTZER: Army Lt. Col. Alfredo Montalvo is a psychiatric clinical nurse specialist. He’s helped care for Jackson during his stay at Brooke.

LT. COL. ALFREDO MONTALVO, Army: When a person experiences a burn injury or an amputation, life is going to change for that person. Most people undergo something called the grieving process, and the first stage of the grieving process is shock and disbelief.

SUSAN DENTZER: What’s the rest of the process?

LT. COL. ALFREDO MONTALVO: Depression, anger, existential questions — “why me?”– And finally, acceptance. It isn’t that smooth. Sometimes they may jump back to anger, depression. There’s good days, there’s bad days.

SUSAN DENTZER: Jackson’s wife Abby says her husband’s moods have followed that pattern.

ABBY JACKSON: He does a lot better than I would expect anyone to do. He has good days and bad days, but in return, I have good days and bad days. So he’s done really well.

LT. COL. ALFREDO MONTALVO: I saw his spirits soar when he was able to walk. That was a big turning point that I saw. “I can walk. I will walk again.”

SUSAN DENTZER: Along with other military amputees, Jackson has benefited from recent improvements in prosthetics. He demonstrated the set he’s now wearing — his third and most sophisticated to date.

B. J. JACKSON: They’re really easy to put on and take off. It’s a flexor foot. It’s a high-energy foot, so when you step and start to walk, it springs your foot forward. When you’re an amputee, you use more energy to walk than folks that aren’t. This leg gives you a little push. Most of the time, unless I’m really sore, I have my pant legs down, people can’t even tell that I’m amputated.

SUSAN DENTZER: Jackson now spends several hours a day working with physical and occupational therapists at Brooke. For now, he, Abby, and their two daughters stay at a special residential facility on the Brooke campus. They plan to return permanently sometime soon to their home in Des Moines, Iowa.