Before the flash and burst of heat spiraling up toward him, Robert “B.J.” Jackson was behind the wheel of a Humvee on a boiling hot August day in Baghdad. He screamed for his wife and kids, grabbed for his legs and then all went blank.
One and a half months later he woke up in an Army hospital bed in San Antonio. Below his knees, his legs were gone. His face, scalp, back and arms were burned. He could barely see, hear or talk. His memory was shattered; his thinking hazy. He ached everywhere.
But that was a year ago, and today he has a life to get on with–a life medics at first didn’t think the young Iowa National Guardsman would ever experience again.
From Vietnam War amputees, he has learned that he probably would have died if he had suffered similar wounds in that war, and that has deeply touched the tall, 23-year-old redhead.
“I was left here for a reason,” he said softly in the kitchen of his just-purchased home in Des Moines. A baseball cap covers a bald spot left from the blast.
Like Jackson, many of the more than 7,000 soldiers wounded in Iraq are alive despite major injuries from a guerrilla war marked by rocket-propelled grenade attacks and remote-controlled mines on roads and in trees. There are mines stuffed with glass, nails and dirt and bombs that mangle, blind, burn and leave behind a deafening shock.
Yet the soldiers are surviving, military officials explain, because of better medical technology, transportation and use of medical staff on the front lines, and new Kevlar helmets and body armor that stop bullets and flames that otherwise would be fatal.
A few more than 1,000 U.S. servicemen and women have died in Iraq.
“This 7-to-1 ratio of wounded to killed has to be an all-time record,” said Michael O’Hanlon, a scholar at the Brookings Institution in Washington, D.C. For many of the nation’s wars in the last century, the ratio was 3 to 1, he added.
The first burn patient that Maj. Louis Stout dealt with from Iraq stunned him.
“He should have been dead. You could see how badly his arms and head were burnt,” said Stout, head nurse for the intensive care unit at the burn center at Brooke Army Medical Center in San Antonio.
Because the soldier wore armor, however, he had few burns, and he survived, Stout said.
Yet these life-saving successes have a trade-off.
Many soldiers suffer amputations, extensive surgery and brain trauma from horrific wounds. And that creates challenges for those who struggle to heal them as well as for the men and women who must learn to live with damaged bodies.
Despite all of her son’s suffering, Giselle Garriga of Rochelle, Ill., says she is deeply thankful that Gabe, 20, a member of the Illinois National Guard’s 333rd Military Police unit, is alive. To help him, she has lived for the last year on the grounds of Brooke Army Medical Center in a home for families of seriously ill soldiers.
Badly burned by gasoline in a military accident last year on an Iraqi highway, Gabe Garriga was given less than a 1 percent chance of survival by physicians at one point. Now he has markedly improved. But he faces another year of care at the hospital.
“He wasn’t supposed to make it, so I see this as a miracle,” said his mother, thumbing through a photo album of her son’s medical progress with him sitting at her side. “Without the care of the people here, all of the technology wouldn’t have meant anything.”
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How much of a difference the new technology and measures are making in saving troops’ lives is a question the military cannot answer precisely. That’s because there is no single database. Instead, injury records are kept separately by the various armed services and military hospitals, a situation the military is trying to remedy with a central medical registry.
Without such records, it is too early to reach any conclusions about injuries and survival rates, said Col. John Holcomb, who directs the Army Institute of Surgical Research in San Antonio. The institute is the military’s major research source on combat trauma.
Accelerated fighting
The fighting in Iraq also has taken a brutal turn in the last six months and that may change the medical results, he added.
Yet Holcomb, a trauma surgeon and veteran of the Army’s 1993 clash in Mogadishu with Somali tribesmen, agrees that troops’ care and protection has markedly improved.
During the Vietnam War, it took up to a month to transport a seriously injured serviceman back to a major military hospital in the United States, he said.
Now, someone hit by a roadside bomb north of Baghdad can be in a hospital bed in the U.S. three days later.
The difference is that the Air Force has planes that are virtual emergency rooms.
As soon as soldiers are wounded, military physicians in Iraq are in touch with facilities such as Brooke Army Medical Center, discussing treatment and evacuation plans.
While Dr. Steven Wolfe, a burn specialist at Brooke, was discussing two burn victims in Iraq with colleagues one day last week, the hospital’s five-person traveling burn team was preparing for a trip to the military hospital in Landstuhl, Germany, to get the two victims.
The team was expected to arrive at the same time as the victims did from Baghdad and have them on a plane to Texas within hours. It was the team’s third trip to Germany last week.
So, too, much improved body armor and helmets have made a difference.
“I know a medic who was hit [by bullets] eight times, and I have no question that this guy would have been dead wearing a regular flak jacket,” Holcomb said.
The life-saving vest is a 16-pound combination of fragment-proof fabrics and bulletproof ceramic plates worn by every soldier and Marine assigned to Iraq.
To Charles Scoville, manager of Walter Reed Army Medical Center’s Amputee Patient Care Program, the armor that protects troops’ torsos has been salvation for many.
It is a major reason soldiers today suffer wounds to the core of their bodies at half the rate as in the Korean War, which is the last time such records were kept, Scoville said.
But the result of that protection, he said, is that they are treating more wounds to the still unprotected parts: many more head and neck wounds, and twice as many amputees as in Korea, he said, noting that his figures are based on data from all of the services.
From their work with the wounded, researchers at Walter Reed, near Washington, D.C., have found that nearly two-thirds of the soldiers treated there from Iraq and Afghanistan have suffered some form of mild brain injuries, said Dr. Deborah Warden, national director of the Defense and Veterans Brain Injury Center.
Survival rate affects numbers
In Vietnam, about one of five wounded soldiers suffered such injuries, she said.
One reason for such a high number today is that soldiers are surviving injuries that used to be fatal. But researchers also point out that the technology for screening these kinds of injuries didn’t exist during the Vietnam War.
Over the years, physicians treating soldiers for life-threatening injuries also often overlooked these kinds of problems.
This situation persists, military officials said, despite recent efforts by the Veterans Affairs Department and military hospitals to keep an eye out for the symptoms. In some cases, soldiers’ absent-mindedness or mood swings are written off as stress-related when they are really biological problems.
In the case of B.J. Jackson, who needed three complete blood transfusions after he was injured, doctors’ immediate concern was simply keeping him alive.
When he awakened from his long, medicated sleep his vocal cords were so damaged, he could not talk. He could not write with his right hand because of burns and broken fingers. And he had problems with the nerves in his left arm from shrapnel.
As Jackson later learned, a rocket-propelled grenade had hit his side of the Humvee moments after a mine went off underneath it.
He lost at least 50 pounds in the first months of his recovery. He couldn’t hold his children, Brilynn, 3, and Hailey, 2, when they came to see him. Nor could he make himself understood. It was not an easy time.
But from the day he woke up, his wife, Abby, an outgoing and positive 21-year-old, was on hand. She had left her daughters with her grandparents and gone to San Antonio, determined to stay with her husband until he could return to Des Moines.
She was there nine months.
Heroic devotion
For Abby Jackson, a third-year nursing student at Mercy Medical Center’s School of Nursing in Des Moines, her husband became her patient. She dressed, fed and washed him. She cared for his wounds and helped with his rehabilitation. She spoke for him, translating his gasps and whispers.
One of the few spouses on hand, she soon became a favorite at the hospital because of her upbeat manner.
“He didn’t have a lot of bad times, not around me. I didn’t let him,” she said. “I said, `We are together, and we’ll always be together.’ And I just set high expectations for him.”
For sure, he did well.
“He just got up and started walking the first time we put a prosthesis on him, and he was like a little kid learning to make his first steps,” recalled Delbert Lipe, a prosthetist with Hanger Orthopedic Group, who worked with Jackson.
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Five months after the blast in Baghdad, Jackson did something that he at first considered impossible. He went skiing in Colorado with a group of disabled Vietnam veterans. Only a month before, he could barely stand for 10 minutes on a new set of legs for a Purple Heart ceremony at the hospital.
Despite his fears, Jackson, who had never skied before, had a great time. Abby Jackson kept falling down, but her husband didn’t.
Yet along with his daily victories, he can rarely put aside what happened to him. He still has terrible dreams about losing his legs. He has anxiety attacks and wide mood swings.
He has gone through six sets of legs and undergone 27 operations for his wounds.
Except for those wounds and his work with other seriously injured soldiers, he also remembers little from day to day.
“Abby will tell me something, and I’ll say I don’t remember. But we’ll both laugh it off,” he said.
Thinking about a career, he underwent vocational training tests in Des Moines, paid for by the VA, and discovered after testing that he suffers from brain trauma as a result of the blast that took his legs.
He doesn’t make much of the finding, however, saying he would return to the VA in a year for new testing to learn whether the trauma has faded.
For the time being, he is working as spokesman and Iowa coordinator for the Coalition to Salute America’s Heroes, an organization that helps severely wounded and disabled soldiers from the Iraq and Afghan conflicts and their families.
Helping others helps him
The job is a twist for a typically shy person who was doing home repair work before being called up and who can still barely lift his voice. But he said he enjoys visiting bed-ridden soldiers at military and VA hospitals and trying to inspire them. That was the kind of therapy that he said worked best for him.
“I tell them I have two prosthetic legs, and I went skiing five months after my injuries,” he said as he adjusted his legs and stood up for a minute to stretch.
So, too, he is not shy about wandering through a mall with his daughters, wearing shorts so that his legs–one of them covered with large Sept. 11-themed stickers–can be seen. If people ask, he tells them he is proud to have served his country.
“I’m lucky,” he said, speaking after a long pause. “Two explosions and being able to have a wife to handle it so well.”