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Healing by degrees, Troops burned in war find recovery a painful journey, both in mind and body

SAN ANTONIO — While making a turn in his lumbering, 7,500-gallon fuel tanker in a night convoy through Taji, Iraq, last fall, Spc. Justin Burgess swerved to avoid a roadside bomb.


Too late — a fireball erupted outside the truck cab.

http://www.marinecorpstimes.com

By Deborah Funk
Times staff writer


“I just knew I had to stop the truck. … The tanker was full of fuel, so it takes quite a while to stop,” Burgess said.

As he focused on wrestling his big rig to a halt, the next few moments became sheer terror.

“I heard my passenger scream. I was like, ‘What is he screaming about?’ I thought it was over. Then I look over and I see him on fire — then I see myself on fire.”

The cab door had melted shut, so Burgess went head-first out the window and rolled in the dirt.

“I could see my hands and the skin was hanging off. … I could see it hanging off my face,” said Burgess, with the Army Reserve’s 660th Transportation Company out of Cadiz, Ohio.

The bomb that destroyed his truck Sept. 18 marked the first night of a long journey for the 21-year-old reservist from Columbus, Ohio — one that is far from over.

He was whisked to a combat support hospital, then picked up by a medevac helicopter, where he passed out and did not come to until he was half a world away.

Like other service members who suffer burns in Afghanistan, Iraq and elsewhere, Burgess was taken here, to begin months — if not years — of painful treatment and recovery.

Army Lt. Col. (Dr.) Evan Renz, assistant director of the Defense Department’s only burn center, tells patients and their families that they will know the burn team for at least a year.

“It’s a long-term adjustment,” Renz said. “It’s physical, spiritual, mental — all of it.”

Burns are complex wounds. Destroyed skin leaves the body more vulnerable to infection. Heart rate is elevated. Sunlight is felt much more keenly.

“You need more calories. You break things down quicker, you go through electrolytes,” said Army Maj. Louis Stout, chief nurse of the burn intensive care unit, housed at Brooke Army Medical Center.

Hospitalization can be lengthy, lasting just over a day for each percentage point of total skin surface that’s burned. Outpatient rehabilitation can take months, if not years. Routine tasks such as shaving become painful chores.

Burn patients undergo multiple surgeries to remove shrapnel, dead skin and tissue, transfer healthy skin to cover the burned areas and remove scar tissue that restricts movement of their joints or mouths, or pulls at their noses, ears or other burned areas. Some require orthopedic surgery, too.

“It’s not uncommon to have two dozen operations,” Renz said.

‘It’s going to blow!’

With third-degree burns over 40 percent of his body — along with shrapnel wounds — Sgt. Joe Washam has undergone more than 10 surgeries already.

“I quit counting when I was waking up screaming in pain,” said Washam, who needs more reconstructive surgery on his hands and face.

Washam has been at the center for a year, arriving badly injured from explosions at a suspected chemical weapons warehouse in Baghdad on April 26, 2004.

He’d had a bad feeling about that mission. “It was noon, in the middle of the day, and the street was empty when we showed up,” said Washam, who was assigned to the Iraq Survey Group, a U.S.-led outfit that searched for suspected weapons of mass destruction in Iraq in 2003 and 2004.

A team went in to scour the building while Washam waited in a Humvee nearby. Suddenly, he heard screams from inside: “It’s going to blow! It’s going to blow!”

He dropped into his Humvee to grab his protective mask, but before he could get it on, a wall of flame engulfed the vehicle.

He ran away from the flames as explosions rocked the building. Fire burned into his face, back, buttocks and legs and melted his neoprene gloves to his hands. As Washam reached for his 9mm pistol, “the skin on my hands started to peel,” he said.

He and other wounded soldiers were put into a Bradley fighting vehicle. When Washam sat down and saw blood pouring from the side of his buttocks, he realized he’d also taken shrapnel; the pain from the burns had overwhelmed everything else.

An Iraqi ambulance that had rushed to the scene took Washam to a local hospital, where Iraqi doctors stabilized and prepared him for medical evacuation.

Washam passed out in the Iraqi hospital and does not recall his evacuation, the combat support hospital or Landstuhl Regional Medical Center in Germany, all stops en route to intensive care at the burn center in Texas.

“I woke up in ICU,” he said.

Burns to the hands are about the most difficult to work with from a rehabilitative standpoint, because of the complexity of motor skills the hands perform: holding a pen, picking up a paper clip or zipping up pants, Stout said.

Washam still fights that fight, wearing gloves to protect his damaged hands as he works out in the burn center’s occupational and physical therapy room.

A constant struggle

The main goal of occupational therapy is to battle scar tissue and regain as much function as possible. Patients exercise for hours a day to stretch scar tissue and prevent it from restricting motion, said Army Sgt. Kim Platt, an occupational therapy technician.

Along with building strength, patients try to regain the control required to drive a car, fire a weapon or just thread a nut and bolt. They are taught how to be their own therapists; seeing a professional once or twice a day is not enough, Platt said.

Washam does pull-ups to stretch the scars on his arms; Burgess shoots baskets. Both use a multifunctional machine to simulate a variety of actions, from driving a car to using a screwdriver, and do other exercises to regain function.

Burgess has recovered a good deal of strength in his hands, which were burned down to the tendons. He’s also regaining movement in some finger joints, but probably will not get it back in all of his knuckles, he said.

His facial burns restrict how far his mouth will open. He loves the hospital cafeteria’s hamburgers, but must mash the buns to fit them between his lips and teeth.

He talks about future surgeries: lip, nose and eyelid release, probable surgery to smooth scars on his young face and one or two more surgeries on his hands. He guesses he’s had 20 surgeries so far, but like some other patients, he’s stopped counting.

Discomfort is constant, a reminder of the severity of their injuries. On a scale of one to 10, most patients say the pain of being burned is off the scale.

“When I was first burned, I blew 10 out of the water and kept going,” said Army Reserve Staff Sgt. Tony Covell of the 182nd Transportation Company out of Traverse City, Mich.

Covell was riding in a 5,000-gallon fuel tanker that folded in on itself when a roadside bomb exploded Sept. 6 near Baghdad. He suffered third-degree burns to his face, hands, arms and legs.

He’s had eight operations and needs more, but his pain level is down to about a two on the one-to-10 scale, he said.

Psychological scars

Burn patients’ wounds are not just physical; they also have emotional pain to confront.

“A lot of people who get facial burns have to figure out who they are,” Covell said. “Their identity is taken away. Everybody has to learn to deal with it in their own way, and the people around them need to be supportive.”

Strangers often stare at people scarred by burns, especially when the scars are on the face or some other visible part of the body.

Burgess said sometimes he just stares back.

Washam told of a young woman who mistook his burned face for some sort of mask at a Halloween party last fall.

Having such a noticeable health problem — and being concerned about how others perceive them — is a key difference between burn patients and those with other chronic conditions, said Army Lt. Col. Danny Davison, a psychiatric clinical nurse.

Burn scars, with their potential impact on self-esteem, carry a higher probability of post-traumatic stresslike symptoms, Davison said.

He screens and treats patients for PTSD, depression and other mental health problems such as nightmares, anxiety or anger.

The most common problem is difficulty sleeping. Burgess takes a drug to help ward off nightmares, which may make him flail and further injure his hands.

But he still has bad dreams, he said, often waking up to an imaginary explosion.

Marine Corps Sgt. Luis Aranda, 22, also doesn’t sleep well. He catches four to five hours of shut-eye at night and then naps a few hours during the day.

He always feels discomfort, which turns to plain pain when he exercises, such as bending his arm against resistance supplied by occupational therapists such as Maj. Lynn Burns.

Aranda has no nightmares, but now and then when he watches television and sees a car fire or an explosion, his mind flashes back to his last patrol.

“I see it happen,” Aranda said.

He was vehicle commander and assistant squad leader on a patrol outside Ramadi, Iraq, on Feb. 22 when he stopped to check a suspicious-looking box on the road — a well-placed decoy for an improvised bomb that exploded a few feet away, sending shrapnel slicing into his hand and arm and burning his right arm and leg.

After that, “everything seemed like slow motion,” he said.

The power of family

Family support is vital to burn recovery, experts said.

“We can provide the best care in the world,” Davison said. “However, when they wake up, they want to see their mother, they want to see their wife, they want to see those individuals who are important in their life.”

When he arrived at the burn center Sept. 20, Burgess’ mother was already there. She stayed for two months before returning to Ohio. His grandparents also came and stayed until late in the year, when he could feed himself.

“My grandma and grandpa … they fed me lunch and dinner every day,” Burgess said.

Aranda’s family arrived Feb. 25, and his father was still there more than two months later. His mother returned to El Paso, Texas, to care for Luis’ younger brother, but she drives back to San Antonio for weekend visits.

Washam had dated Jennifer, who would become his wife, for four months when he left for Iraq.

After his injury, she huddled with her father and Joe’s family at the hospital.

“It was very emotional,” Jennifer said. “The hardest part was, he couldn’t talk to me.”

Jennifer transferred her job and elementary education studies to San Antonio. “I came down here because I needed him as much as he needed me,” she said.

She helped tend his wounds at night when she got off work. She has been tough on him in rehab, making him do tasks himself.

They were married Oct. 16 and keep an apartment near the hospital campus.

“If I didn’t have Jenn around, I’d be lost,” Washam said.

As an infantryman, he had two plans for how he would return from war: “A-OK, or with a flag draped over my coffin.”

“When I woke up in my hospital bed, for almost a month I was pretty pissed off to be alive,” Washam said. “If I didn’t have her ... I’d still be angry. I would be a train wreck.”

Uncertain futures

As the troops heal, their futures are uncertain.

Burgess studied accounting at the University of Toledo in Ohio before deploying, and talks of picking up his studies.

Covell, a carpenter, worked for a construction company and did residential work on the side prior to his deployment. His employer wants him back, but the extent of his limitations is unknown, and he must work indoors to protect him from the elements, he said.

Aranda wanted to be a Marine since grade school. Now he plans to get out and try something in public safety — a firefighter, paramedic or emergency medical technician — closer to his El Paso home.

As a fallback, he says he’ll study criminal psychology. The Washams have postponed family plans until they see how Joe can earn a living. He takes classes at a community college and thinks about teaching.

Washam would love to stay in the military if he could — and would return to Iraq, he said.

The odds of that are slim; he passed the function test on the M-16 rifle, which made him “ecstatic,” but he can’t do push-ups, climb a rope or even venture out in sunlight. Being unable to rejoin his comrades on the front lines, he said, is “frustrating.”

Washam is coming to terms with likely leaving the military, and is now eagerly looking ahead.

“With what I’ve already dealt with and overcome, the healing process, letting frustrations go, having people care about me … it lets me know that no matter what, I can get over anything,” he said.

“I’m very grateful to be alive. I’ve learned to live every day like it’s my last.”