Reconstructing Lives — A Tale of Two Soldiers (NEJM)

http://content.nejm.org/cgi/content/full/355/25/2609?query=TOC

Volume 355:2609-2615 December 21, 2006 Number 25

Reconstructing Lives — A Tale of Two Soldiers
Susan Okie, M.D.

Jason Pepper can't see the deer and wild turkeys that feed in the pasture in front of his new home, an hour's drive from Nashville. But when he sits and smokes on his front porch, he likes knowing they're out there — and even more, he savors the silence. Pepper, who was blinded by a bomb in Iraq in 2004, completed a rehabilitation program for blind veterans last year at the Edward Hines, Jr., Veterans Affairs Hospital in Illinois, learning to find his way using a cane and a personal global positioning system (GPS) device. With this device he was able to travel alone by public transportation into downtown Chicago. By moving to the country, Pepper has given up that independence: his wife or her brother must drive him to his college classes and other appointments. But to Pepper, a former Army combat engineer still struggling with disabling headaches, episodic anxiety, and other sequelae of the blast that blinded him, damaged his brain, wounded both arms, and destroyed his sense of smell, it seemed more important to escape from the sounds he associates with danger and combat.

"I want the quietness, the serenity of knowing that I'm in the country," said Pepper, a powerfully built man in his late 20s. "You don't have the hustle and bustle of all the traffic. You don't have the honking of horns, the sirens. You hear gunshots, but it's target practice or hunting." He grinned. "The crickets get kind of annoying."

Pepper and another soldier, David Emme, were profiled in the Journal last year while they were undergoing treatment and rehabilitation at Walter Reed Army Medical Center in Washington, D.C. As sergeants in the U.S. Army serving in Iraq, both had been wounded by improvised explosive devices and had traumatic brain injury (TBI), which has been called the signature wound of this war. Both also had symptoms of post-traumatic stress disorder (PTSD). Among more than 22,600 U.S. soldiers wounded in the conflicts in Iraq, Afghanistan, and other locations as of November 4, 2006,1,2 blasts have been by far the most common cause of injury, and 59% of blast-exposed patients at Walter Reed have been found to have a TBI.3 As thousands of brain-injured veterans come home to recover and rebuild their lives, medical experts have expressed concern about the challenges of providing them with continuing medical care and vocational and emotional support, especially because cognitive and psychological aftereffects of TBI can predispose them to falling through the cracks of the health care system. Officials in the Departments of Defense and Veterans Affairs (VA) have planned for what they term a "seamless transition" from military medicine to the VA or civilian health care. To see how two transitions are going, I recently revisited Sergeants Pepper and Emme.

<snip>

"We should screen for brain injury and mental health issues — there's such a high percentage of both" in returning veterans, said Representative Bob Filner (D-CA), who is likely to become chairman of the House Committee on Veterans' Affairs. "They talk about the seamless transition, but there is no such thing. The proactive approach is just not part of their culture."

"I give the military and the VA credit" for creating programs to treat brain-injured veterans, "but there are not enough of them, and I think that's the bottom line," said Gene Bolles, an assistant professor of neurosurgery at the University of Colorado at Denver, who treated soldiers wounded in Afghanistan and Iraq at the military's Landstuhl Regional Medical Center in Germany from 2001 to 2003. "The best thing the military could do is to recognize that this is a serious problem, help them get jobs, and give them the disability that they deserve."

Source Information

Dr. Okie is a contributing editor of the Journal.

Interviews with Jason Pepper and Harriet Zeiner can be heard at http://www.nejm.org

http://content.nejm.org/cgi/content/full/355/25/2609?query=TOC