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Injured Iraq veterans battle a new enemy
By Anita Manning, USA TODAY
RICHMOND HILL, Ga. — Even though he's in pain every day, it doesn't seem to occur to U.S. Army Capt. Jonathan Pruden to feel sorry for himself.
The bones in his right foot were shattered by a bomb in Iraq. He has no feeling in his left leg below the knee. He can get around on crutches, but that irritates his leg and shoulder injuries, so he spends 90% of his waking hours in a wheelchair. But, if you ask him, he'll tell you how much better off he is than the other guys.
"A lot of guys in my unit and other units are more severely injured," he says. "They've lost limbs, their eyesight. Unfortunately, it seems like hundreds of guys are coming back now that are paralyzed. I'm fortunate."
Pruden, 27, was driving an unarmored Humvee that was caught in a roadside bomb attack in Baghdad on July 1, 2003. He took 173 pieces of shrapnel and one AK-47 round that passed through his left knee. A piece of shrapnel the size of a golf ball shattered his shoulder blade and lodged near his spinal cord. His arms and legs were shredded.
He doesn't remember feeling pain at the time, but as he tried to maneuver the vehicle, he realized his legs didn't work. He couldn't see, couldn't hear and couldn't feel his left arm.
"I saw a spray and thought it was the hydraulic line on the truck, but it was the artery on my leg," he says. "I started yelling to get a tourniquet. I was bleeding out."
Pruden is among more than 12,000 American military men and women injured in Iraq since combat operations began in March 2003, according to the Department of Defense. About half sustained injuries serious enough to prevent their return to duty. Many of them, such as Pruden, are treated initially in combat hospitals or by doctors on the field, then sent to the U.S. Army hospital in Landstuhl, Germany, where injuries are stabilized and assessed. From there, they may go to one of several specialized military hospitals in the USA for treatment that can take weeks to months before returning home to continue recovery.
'Improved survivability'
Soldiers in Iraq are surviving wounds that in earlier wars would have been fatal, thanks to a variety of factors, including body armor, more efficient evacuation of the wounded. On-field emergency medicine specialists and advances in medical technology and training, says pain management specialist Lt. Col. Paul Pasquina, chief of physical medicine and rehabilitation at Walter Reed Army Medical Center in Washington, D.C. This "improved survivability on the battlefield" poses challenges for the injured soldiers and for their doctors, he says.
The injuries coming out of Iraq are complex, says Larisa Kusar, a staff doctor at the VA Medical Center in Minneapolis, one of four "polytrauma centers" operated by the Department of Veterans Affairs. (The others are in Tampa, Richmond, Va., and Palo Alto, Calif.) The centers care for patients with two or more injuries, at least one of which is life-threatening.
Doctors still have a lot to learn about what causes and relieves pain, but medical knowledge of the subject has advanced significantly in the past decade, Pasquina says, and today there are medications designed to treat pain caused by a variety of sources.
"When you have a severe extremity wound, particularly from a blast injury, more often than not you have pain from soft-tissue injury, bone injury and nerve injury," he says. "So you have to approach it from different directions."
Doctors on the battlefield can use a narrow tube to deliver anesthesia to a wounded limb, deadening the nerves that cause pain but leaving untouched the ones that control muscles, Pasquina says. Other anti-pain weapons are epidural anesthesia, patient-controlled delivery of pain medicines such as morphine, and a variety of oral medications such as opioids, anti-convulsants, anti-depressants, muscle relaxants and anti-inflammatory agents.
"While there's no cure for pain," Pasquina says, "we're very optimistic with our patients to find a pain level that is tolerable, and that's what we shoot for: pain that does not interfere with their functional goals, their activities of daily living."
A fight to save his legs
Pruden first received care at a battalion aid station set up on a former soccer field in Baghdad, then was carried by helicopter to a field hospital in Kuwait, where doctors worked to save his legs. Next, he was sent to Landstuhl, where he had "three or four surgeries," he says, and then to Walter Reed, where he spent two months and had eight more operations.
He has had 18 operations in all and is on convalescent leave, awaiting discharge from the Army. He still has shrapnel in his body, including a piece that is visible under his left eye. He takes two doses of OxyContin and Percocet when needed every day, which controls most of the pain, and tries to divert his mind from the rest of it by reading, watching TV, traveling and taking part in disabled sports activities. Mainly, "I just live with it."
At Walter Reed, he was given a difficult choice: have his right leg amputated or try to rehabilitate it. "The doctor said, 'If it was me, I'd take it off,' " Pruden says. He decided to try to keep it.
"Now we're dealing with the consequences of that decision," says physical therapist Mike Parsons, looking on as Pruden does leg exercises during a therapy session, one of three each week. "Functionally, he might have been better off with a prosthetic."
Pruden says he can put weight on his left leg and can even drive with a specially outfitted left-side gas pedal, but any weight on the right leg is painful. Amputation remains an option. "Sometimes I debate the long-term usefulness" of the leg, he says. "I know a lot of guys with prosthetics who are doing pretty well. They're able to walk and even run on those, so it's something to consider."
The future looks bright
In the tidy, attractive home Pruden and his wife, Amy, 25, share, there is little visible accommodation to disability. The coffee table that used to be in front of the couch is gone, leaving room for the wheelchair, and Pruden's hand crutches stand nearby.
They are covered in camouflage tape, which Pruden applied before he went turkey hunting a couple of weeks ago at a military base near here. He went with a friend from Paralyzed Veterans of America, which sponsors sports programs, including hunting and fishing on military land. The camo tape worked: Pruden bagged a gobbler.
Taking part in activities that engage his mind and body is a form of therapy for him. "When I was out there turkey hunting, I didn't feel it," he says of the pain. "But I did later." The experience cost him days of recovery.
Amy has tried in vain to persuade him to take it easier. "He wants to be able to do a lot more than he's able to do," she says. "He's very active. It just stays at a painful level because of all the things he does."
The couple met as students at Appalachian State University in Boone, N.C. Pruden, who grew up near Asheville, attended college on a four-year ROTC scholarship and was commissioned as an officer in May 2001, the same month he and Amy were married.
A former emergency medical technician and volunteer with the local rescue squad, Pruden started his military career as a medical services officer, then a platoon leader and headquarters executive officer before switching to infantry. Stationed at Fort Stewart, Ga., he was "consumed by my job," going in before dawn and working until 9 or 10 p.m. The couple didn't see much of each other.
But when that bomb exploded, there was no question about what was most important in his life. "I wasn't concerned about my leg being gone. I wasn't concerned about dying. My big concern was I wanted to see my wife again; that was my overriding thought. I've got to see Amy again."
Now, they're together most of the time. The couple is planning a move to Florida this month. The new house, a few doors from Amy's parents' home in Gainesville, is being outfitted with wider doors and wheelchair ramps. Pruden plans to go to the University of Florida in the fall for a master's degree in political science.
Having negotiated the military medical bureaucracy, he says he'd like to work with other disabled veterans. "There's so much out there for people, especially vets with disabilities," he says. "There are a lot of good folks out there who want to help."
Injured Soldiers Returning from Iraq Struggle for Medical Benefits, Financial Survival
By BRIAN ROSS, DAVID SCOTT and MADDY SAUER
Oct. 14, 2004 -- Following inquiries by ABC News, the Pentagon has dropped plans to force a severely wounded U.S. soldier to repay his enlistment bonus after injuries had forced him out of the service.
Army Spc. Tyson Johnson III of Mobile, Ala., who lost a kidney in a mortar attack last year in Iraq, was still recovering at Walter Reed Army Medical Center when he received notice from the Pentagon's own collection agency that he owed more than $2,700 because he could not fulfill his full 36-month tour of duty.
Johnson said the Pentagon listed the bonus on his credit report as an unpaid government loan, making it impossible for him to rent an apartment or obtain credit cards.
"Oh man, I felt betrayed," Johnson said. "I felt, like, oh, my heart dropped."
Pentagon officials said they were unaware of the case until it was brought to their attention by ABC News. "Some faceless bureaucrat" was responsible for Johnson's predicament, said Gen. Franklin "Buster" Hagenbeck, a three-star general and the Army's deputy chief of staff for personnel.
"It's absolutely unacceptable. It's intolerable," said Hagenbeck. "I mean, I'm incredulous when I hear those kinds of things. I just can't believe that we allow that to happen. And we're not going to let it happen."
The Department of Defense and the Army intervened to have the collection action against Johnson stopped, said Hagenbeck.
"I was told today he's not going to have a nickel taken from him," he said. "And I will tell you that we'll keep a microscope on this one to see the outcome."
Hagenbeck also pledged to look into the cases of the other soldiers ABC News brought to the military's attention, including men who lost limbs and their former livelihoods after serving in Iraq.
"When you're in the military, they take good care of you," said the 23-year-old Johnson. "But now that I'm a vet, and, you know, I'm out of the military — not so good. Not so good."
Johnson had been flying high last September, after being promoted from Army private first class to specialist in a field ceremony in Iraq. Inspired by his father's naval background to join the military after high school, Tyson planned a career in the military and the promotion was just the first step. But only a week after the ceremony took place, a mortar round exploding outside his tent brought him quickly back to Earth.
"It was like warm water running down my arms," he said. "But it was warm blood."
In addition to the lost kidney, shrapnel damaged Johnson's lung and heart, and entered the back of his head. Field medical reports said he was not expected to live more than 72 hours.
With the help of exceptional Army surgeons, Johnson survived. As he recuperated, however, Johnson faced perhaps an even greater obstacle than physical pain or injuries — the military bureaucracy.
Part of the warrior ethos, the soldier's creed of the U.S. Army, is to "never leave a fallen comrade."
"And it doesn't just pertain to the battlefield," Hagenbeck said. "It means, when we get them home they're a part of the Army family forever."
But Johnson now lives in his car. It is where he spends most of his days, all of his nights, in constant pain from his injuries and unwilling to burden his family.
Stories like Tyson Johnson's are not unique.
Many of the severely wounded soldiers returning from Iraq face the prospect of poverty and what they describe as official indifference and incompetence.
"Guys I've met, talking to people, they'd be better off financially for their families if they had died as opposed to coming back maimed," said Staff Sgt. Ryan Kelly, who served as a civil affairs specialist for the Army while in Iraq.
On July 14, 2003, the Abilene, Texas, native had been on his way to a meeting about rebuilding schools in Iraq when his unarmored Humvee was blown up. A piece of shrapnel the size of a TV remote took his right leg off, below the knee, almost completely, Kelly said.
Kelly attests to receiving excellent medical care at Ward 57, the amputee section of Walter Reed, but said he quickly realized that the military had no real plan for the injured soldiers. Many had to borrow money or depend on charities just to have relatives visit at Walter Reed, Kelly said.
"It's not what I expected to see when I got here," he said. "These guys having to, you know, basically panhandle for money to afford things."
Perhaps as a sign of the grim outlook facing many of these wounded soldiers, Staff Sgt. Peter Damon, a National Guardsman from Brockton, Mass., said he is grateful for being a double amputee.
"Well, in a way, I'm kind of lucky losing both arms because I've been told I'll probably get 100 percent disability," he said.
Damon, a mechanic and electrician, lost both arms in an explosion as he was repairing a helicopter in Iraq. He initially woke up in the hospital worried and anxious to learn that both forms of livelihood were taken away from him.
"Now what am I doing to do?" Damon said, faced with the prospect of supporting his wife, Jennifer, and two children. "I can't do either, none of those, with no hands."
The military fails to provide a lump sum payment for such catastrophic injuries. And Damon still has not heard from the military about what they plan to give in terms of monthly disability payments.
The last time Damon asked about the payments, he was told by the military that his paperwork had been lost.
"And then when I went to go back to inquire about it again, just to ask a question, I just wanted to see if they had found my paperwork, I was told I had to make an appointment and to come back five days later," he said.
A thick book of federal regulations specifies the disability rate based on how many limbs were amputated and precisely where.
The percentage rates were set during World War II.
Jennifer Damon said the shock of her husband returning with no arms has been replaced by the fear of destitution, as well as a frustration over her husband's final discharge. Like his disability benefits, Peter's release is being held up by the lost paperwork and unanswered phone calls.
"It's hard to understand," she said. "I mean, I need him more than they need him right now. It's been a long time. You've had him for a long time. I want him back."
Staff Sgt. Larry Gill, a National Guardsman from Semmes, Ala., wonders whether his 20 dutiful years of military service have been adequately rewarded.
Last October, Gill injured his left leg when on patrol during a protest outside a mosque in Baghdad. A protester threw a hand grenade which left Gill, a former policeman, with leg intact, though useless. He received a Purple Heart from the military, but no program, plan or proposal of how to make a living in civilian life.
"It's not fair, and I'm not complaining," Gill said. "I'm not whining about it. You know, I just, I just don't think people really understand what we're being faced with.
Gill expects he will have to sell his home, the dream house he and his wife, Leah, designed and built, where they raised their children.
"I've never questioned my orders," he said. "I've slept with rats and stood in the rain and wondered why I was standing in the rain, and, you know, for my children to have to do without based on a lack of income from me, it's frustrating."
Leah Gill agreed. "I just don't feel we should have to uproot because of an injury that he received while he was serving the country," she said. "It shouldn't come down to that."
Gill and the others in Ward 57 have had their pictures taken frequently with visiting politicians.
"Where are the politicians? Where are the generals?" he asked. "Where are the people that are supposed to take care of me?"
Help and care will be forthcoming, promised Hagenbeck.
"There in fact was a plan," he said. "But again, it was not integrated in a seamless fashion that it needed to be. And that was not even, really, to be honest with you, recognized probably until sometime about a year ago. And these soldiers actually brought it to our attention about the transition problems."
The military would do a better job of taking care of their own, Hagenbeck said, though the system in place was often unwieldy, outdated and inadequate.
"Oh, there absolutely has been problems in the past," Hagenbeck said. "And they're in — even with some of our soldiers today. Some missteps have been made. And they have not been taken care of the way they should have been taken care of."
To help these neglected soldiers, Hagenbeck said, the military created an advocacy program this past April called Disabled Soldier Support System, or DS3. The network is set up to fight for a soldier's benefits and entitlements, ease transition to civilian life, and deal with any other problems facing a disabled soldier, according to Hagenbeck.
But still there are soldiers like Johnson who fall through the cracks.
His mother, Willie Jean Johnson, worries her son may hurt himself.
"He's not going to say anything bad about the Army," she said. "I have never heard him say anything bad about it. But you can see the hurt in his eyes. You can see the hurt from his heart in his eyes."
Johnson said he usually keeps to himself, preferring to protect his son from seeing him in his current state. "I'd rather be to myself than to flare at somebody else and, you know, and hurt someone that I know I really love," he said.
One year after nearly being killed in combat, the Pentagon has yet to send Johnson his Purple Heart medal.
The Pentagon collection notices, however, arrive without fail.
As to Kelly's discovery that he and his wounded comrades had to beg and borrow to pay for their loved ones to visit while they recuperate, Hagenbeck said a new policy went into effect this weekend to alleviate part of the problem.
"There was no system in place to support them in their needs. And I'll be honest with you, until it came to our attention, to people that were paying attention, and then those that wanted to help, that obstacle was there," Hagenbeck said.
Incredibly, these soldiers remain dedicated to the military despite all they have endured.
"Even though the way I'm being treated, you know, as a vet, I'd still go back in," Johnson said. "I would."
"I love being a soldier," Kelly said. "I don't regret what happened. If I had to go back to Iraq knowing that there was that chance of losing my leg, I'd do it. Because that's what the nation asked me to do."
Jessica Wang contributed to this report.
Following the airing of this report on PrimeTime Live, Congressman John Dingell (D-MI), a former infantryman, wrote a letter to the Pentagon demanding a progress report on the recently implemented Disabled Soldier Support System and further assurance that all wounded and disabled vets would be financially and otherwise assisted in making the transition to civilian life. "I am astonished by this story and disappointed," Dingell wrote, "that we are failing to fulfill our nation's duty to care for our injured veterans."
One of John Crawford's least favorite assignments when he was a soldier in Baghdad was standing guard at a gas station where shortages and long lines kept everyone on edge.
"We were all sitting in the most oil-rich country in the world, and even when people could get gas, it was overpriced fuel trucked in by Halliburton from Kuwait and Saudi Arabia," Crawford writes in his terse, gritty, new memoir, "The Last True Story I'll Ever Tell: An Accidental Soldier's Account of the War in Iraq" (Riverhead Books, $23.95). The book jumped to No. 12 last week on the New York Times best-sellers list for nonfiction.
"The whole thing (at the gas station) was a joke," Crawford writes, "but it directly affected our lives on a minute-by-minute basis."
One night, Crawford and Stephen Mitchell, who were both students at Florida State University in 2002 when their Florida National Guard unit was sent packing to fight in Iraq, were bored out of their skulls during a 10-hour vigil at the gas pumps. Mitchell persuaded Crawford to take a joy ride on an abandoned, ancient, rusty motorcycle that had a sidecar.
"He said it would be just like Indiana Jones," Crawford, 27, said recently over a light beer and a late lunch. "He talked me into it. You'll do anything to break the boredom."
The two took off down the unlit street into the darkness. Then they realized the brakes did not work. They were stuck on a runaway motorcycle tearing through the night in one of the most dangerous places on Earth.
"The Americans act like kids, basically," Crawford said. "And the Iraqi people thought of us as big children."
Yeah, but they're big kids with really big guns.
"The Last True Story I'll Ever Tell" is packed with eye-witness accounts of the follies, fears, frustrations, bitterness and gutsy triumphs of American foot soldiers on the ground in the Iraqi war. Crawford's tell-all, rawly honest memoir has also stirred up a lot of national media attention for the polite and rather serious-minded small-town boy from Palatka.
In August, Crawford was interviewed live on Comedy Central's Emmy Award-winning "The Daily Show" with Jon Stewart, who couldn't stop raving about the book. National Public Radio's Terry Gross devoted a "Fresh Air" program to him. The New York Times editorial department gave Crawford half a page in a recent Sunday edition to write an article about his return to the States.
"Um, I'm doing an interview with Wisconsin Radio in a few minutes, and then I'm supposed to fly to Washington to do 'Hardball,' but I'm waiting to see what happens with the hurricane (Katrina)," Crawford said during a recent phone conversation. "My life is really kind of surreal right now."
Military history
Crawford hails from a family with a long history of military service, going back as far as the Civil War. His father flew a chopper for Special Operations in Vietnam, and Crawford grew up hearing war stories from those days.
"I think there's been a Crawford fighting in every major war America has ever been involved in," he said. "I'm sort of like the character Lt. Dan in 'Forrest Gump' whose grandfathers and great-grandfathers kept getting shot in wars."
After he graduated from high school in 1996, Crawford immediately joined the famed 101st Airborne. He spent time in Panama and was stationed at Fort Campbell, Ky.
When he finished service with the Airborne in 1999, at the seasoned age of 21, he headed straight to Tallahassee and enrolled in classes at Tallahassee Community College. Crawford, who read "The Iliad" at 10 just for fun, was ready for a formal education.
"I signed out of the Airborne at midnight and was in class (at TCC) the next morning," he said.
Ironically, for a guy with a bestseller on the New York Times list, he struggled to make a C in his freshman composition class at TCC.
"I was off spinning these raunchy fiction stories with dialogue, and that's not really what my professor wanted," Crawford said. "About halfway through the semester, I caught on to what she wanted. I had to play catch-up just to get a C. I was happy to get that C."
The experienced soldier signed up with the Florida National Guard because he figured it would be an easy way to pay for tuition at FSU, where he transferred and selected anthropology as his major.
Heck, Crawford figured, after surviving Airborne, how hard could it be playing weekend warrior?
In the fall of 2002, Crawford got married and took a honeymoon cruise over Christmas break. Aboard ship, the day after Christmas, he went to check his semester grades from FSU via e-mail.
What he got instead was an invitation from Uncle Sam. It was one he couldn't turn down. He and his fellow Florida National Guard members would soon be conducting apartment raids and other deadly business in Baghdad's urban war.
The tour of duty was supposed to last three months. It dragged on for more than a year.
"I was planning to enroll in a master's program at FSU, instead I took a vacation to Iraq," former machine-gunner Crawford said.
The ancient city turned out to be a hellhole - and that's not even including having to deal with the sweltering heat while wearing 100 pounds of combat gear or the threat of being blown to pieces by car bombs.
"Baghdad stinks," Crawford said. "There's constant water in the street. There's no one to pick up the trash, so it all piles up outside. ... All the American toilet paper was clogging the Baghdad sewer system. It wasn't built to take it, so there's backed-up water everywhere and kids playing in it. Baghdad is just a dirty place."
Confusion was another constant. The American soldiers didn't speak Arabic. The locals existed on rumors or no information about what was going on. The electrical brown-outs were unpopular, and the Iraqis blamed the Americans for not restoring power.
"They said Saddam had the electricity in Baghdad back on two months after the first Iraq War," Crawford said. "It'd been two years after the start of the war when I was there, and the greatest nation on Earth couldn't even keep the lights on. It's understandable they're upset."
During his downtime, Crawford borrowed a buddy's laptop computer and began writing vignettes and stories about what he was seeing during the occupation. An embedded journalist from The Nation noticed him typing and struck up a conversation. That chat later led to Crawford getting an agent and landing a book deal with Riverhead Books, which is part of the mega-sized Penguin Group publishing house. But first he had to make it back to Florida after his year of living dangerously.
To sleep at night, while the sniper fire popped and bombs exploded outside his window, Crawford began eating Valium pills like candy. By the time he did get home to Tallahassee in 2004, he realized he had become addicted to the drug. He kicked it cold turkey on the bathroom floor.
Readjusting to civilian life was tricky.
"It's like being at a party and going into the bathroom for 15 months.," Crawford said. "When you come back everything has changed. What happened to the party? All the people that were there at the party have moved on. They're not having the same conversations as they did when you left. Everything has changed."
The extended tour also put a strain on his marriage. It's the one subject he wouldn't talk about and would only say "it's private."
Meanwhile, Crawford had a book to finish.
"I had written a few chapters in Iraq and had sent them off," he said. "I came back and, sort of, you know, got drunk for a couple of months. Then one day you wake up, and you realize you've got a little under three months to write a book. You've got to pay back the advance if you don't finish it. I figured I was in pretty rough shape. So I actually just sat down and set out a schedule. Every day I had to write so many pages. That's how I did it."
Iraq as a bar fight
"This book is brilliant," avid reader Berry Bowman said when he telephoned the Democrat unprompted with no other reason than to rave about "The Last True Story I'll Ever Tell."
"This guy is the real deal," Bowman said. "He gives it to you straight. He has a style. He's direct. He's not didactic. He tells you the way it is without having a political agenda. Anyone who wants to know what's really going on in Iraq should read this book."
Crawford said the reaction has been positive from his National Guard buddies who are featured prominently in the book.
"When they heard I was writing a book, they all wanted to know if I was
writing a 'super liberal' book," Crawford said. "The ones I've talked to so far
said they liked what I wrote."
"I had the privilege of serving with Spc.
Crawford in Iraq," D.G. Rosenthal wrote in a review of "Last True Story" he
posted on www.amazon.
com.
"His book tells it exactly like it was, with no holds barred. It covers everything from our supplyinadequacies, to command mismanagements, to the reality of the war that the media never took the time to cover. Crawford is a natural author, an expert at weaving an engaging story that grips the reader firmly and swiftly."
As far as Crawford's personal feelings about the ongoing war in Iraq, he put it best when he was on "Fresh Air" with Gross by saying:
"I liken it to getting in a bar fight. Occasionally, you know, you get drunk and you get in a fight because you think some guy's eyeballing you in the bar. And you wake up in the morning, and you say, 'Wow, that guy didn't deserve that at all.' But the morning is the time for regret. If you do it in the middle of the fight, then you still wake up feeling bad, but you got beat up, too."
For now, in addition to making the rounds on radio and TV chat shows, Crawford is speaking on college campuses around the country.
Oh, yeah, he's also working on finishing that longtime-coming degree from FSU - if only he can stay out of a war this time.
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