Casualty of War

Newsweek The War in Iraq

Casualty of War

Iraq: A Marine's Experience of Brain Injury

Damaged brains are emerging as the singular injury of the Iraq conflict. A soldier's story.

Sam Reyes remembers nothing of the suicide bomb attack on a highway outside Fallujah that nearly killed him on the morning of Sept. 6, 2004. Perhaps it's just as well. When medics arrived at the site of the attack, which left 12 Marines dead, they found Reyes sprawled on the road in desperate condition: his arms, back and head were pierced by shrapnel; his left arm was ripped open to the muscle; his stomach and spleen had been sliced; his ribs were broken, his face was badly burned and his tongue had been cut in half.

In the helicopter on the way to a military hospital in Baghdad, the medical team had to defibrillate his heart to keep him alive. Over the next 18 months, during an agonizing recovery, the young Marine gunner underwent several operations and lost 45 pounds. Although his physical wounds have largely healed—save for scattered scars across his forehead and his sense of taste, which has yet to return—the bomb blast left Reyes, now 21, with a less visible, but devastating injury to his brain. Like many Iraq vets who survive the concussive force of an improvised explosive device, or IED, Reyes is now sometimes unable to recognize his friends or family, to recall what he just read or heard, to concentrate or to read faster than the average second-grader. " I feel kind of odd when I see people and they say, 'Oh, you don't remember me'," says Reyes. "And I say, 'No, I don't.' They'll say, 'Remember, we did this and that when we were younger.' And I go, 'Oh, yeah.' It kind of makes me feel bad."

Like more than 1,700 military personnel wounded in Iraq and Afghanistan in recent years, Marine Cpl. Samuel Reyes Jr. is suffering from traumatic brain injury, known in military jargon as TBI, which leaves survivors unable to perform the most basic cognitive functions. According to officials at the Walter Reed Army Medical Center in Washington, TBI affects more than 25 percent of bomb-blast survivors like Sam Reyes, making it the signature injury of the Iraq war. In fact, military officials say that were it not for advances in body armor, helmets and drastically improved battlefield medicine, the majority of survivors being treated for TBI would not have even survived their injuries as recently as the first gulf war 15 years ago. The increasing number of TBI survivors and the vexing limitations they face has become an enormous challenge for both military medicine and for the Department of Veterans Affairs, which will treat these survivors for life. "In the military, the question is 'are you battle ready?'" says Dr. Harriet Zeiner, a clinical neuropsychologist for the VA in Palo Alto, Calif., where Reyes is being treated. "Our criteria at the VA [are], are you going to be able to hold down a job, sustain a relationship, get married, have kids or do you have something that's going to impair you?"

For Reyes, and hundreds of others suffering from TBI, the answers to these questions are still far from clear. The diffuse but debilitating symptoms of traumatic brain injury—which sometimes are not apparent until months after the bomb blast—can leave veterans with festering psychological problems and anger that often lead to failed relationships and careers, substance-abuse problems and the inability to adapt to civilian life. Many TBI patients, like Reyes, are also suffering from posttraumatic stress syndrome (PTSD), a psychological condition affecting many combat veterans and other trauma survivors that is marked by flashbacks, nightmares, anxiety and irritability. The combination of TBI and PTSD, says the VA's Zeiner, "is pretty deadly." Reyes suffered damage to the frontal lobe of his brain, the area that helps a person calm himself after a stressful or frightening experience and where problem-solving takes place. When Reyes becomes anxious, he quickly escalates to a state of agitation. It's not uncommon, says Zeiner, for those suffering from TBI and PTSD to "either drink themselves into a stupor," in an effort to self-medicate, or to become agoraphobic, afraid to go out where they may have to contend with overwhelming stimuli.

In the months after his injury, Reyes tried over and over again to qualify for combat duty and return to Iraq. The first three times, he wasn't strong enough to run and do the pullups required to demonstrate his fitness for duty. On the last two attempts, Reyes passed the physical tests, but knee pain, stomach problems and the increasing effects of the brain injury kept him confined to barracks at Camp Pendleton, near San Diego. While other members of his unit, the First Marine Division, Second Battalion Fox Company weapons platoon, returned from Iraq in October 2004 and went back to work at Camp Pendleton, Reyes lived in limbo for nearly a year. "I never had to get dressed. I didn't have to go to work," says Reyes. "They wouldn't want me to have a 'brain-injury moment'." He spent his days in the barracks watching movies and playing videogames to make the time pass and seeing a doctor for his memory problems and nightmares. He began to drink heavily. In June 2005, Reyes was examined by a civilian doctor who recognized signs of traumatic brain injury, and he was transferred almost immediately to the VA's specialized brain-injury unit in Palo Alto.

At the Palo Alto center, one of four VA facilities around the country with a specialized TBI unit, Reyes began the frustrating process of retraining the damaged memory center of his brain. All the brain-injury patients in Palo Alto are issued handheld computers, which the staff jokingly calls "brain prosthetics." Reyes sets the alarm on his twice a day in order to remember to check his to-do list. He began keeping a journal to try to spur his memory. Another device, a Franklin electronic dictionary, pronounces words to help rebuild his vocabulary while reading. It recently took Reyes a month and a half to read "Jarhead," the memoir of a Marine sniper. Before his injury, he says would have read the same book in a day or two. In his lighter moments, Reyes, who hopes to attend college on the G.I. bill, quips that Dr. Seuss's "Green Eggs and Ham" is about his speed now.

The brain damage also has painful emotional consequences. His family members were shocked that he often couldn't remember their faces. Sometimes a voice will help him remember. Other times an object can prod his memory. One buddy gave him a football to remind Reyes of his high-school football career in Houston, where he grew up. Tossing the football can bring back specific memories of plays he used to run and hits he made. Other times, it's harder to remember. If a therapist reads him a two-line story about a mom and dad going to the store and the purchases they made, he'll say, "Who went to the store?" Reyes says, "It gets kind of annoying." When he watches movies, he tends to forget by the end what happened in the beginning.

Soon after he arrived at the brain-injury center, Reyes's doctors began trying to convince him to go for treatment at the VA's PTSD center in nearby Menlo Park, where Vietnam veterans work side by side with active-duty Marines and soldiers, trying to find ways to deal with the lingering trauma of their respective wars. At first, Reyes resisted, worried that his fellow Marines might think he was weak. Meeting the other men in the PTSD treatment center had a big impact on him. "Some of them are real tough, big guys, real smart, and that made me feel better. It showed me I wasn't the only one in the whole world who would have it." Reyes says his fellow Marines who haven't gotten help are suffering. "I tried to let some guys know who I thought could use help, and they said, 'Nah, I don't need that. I take sleep medicine and I drink, so I'm doing pretty good'." Although the Marine Corps is sending some mental-health workers into the field, Reyes says he didn't have any discussions about combat-related stress. He got a brochure about PTSD at one point, but says it didn't explain the symptoms. "It scares me that all these guys could be just like me, having the same problems, and they're getting ready to ruin a whole lot of their life."

As the population of wounded Iraq veterans increases, the military is also trying to raise awareness about TBI, especially the less severe cases like Reyes's, which can easily be misdiagnosed or overlooked in the chaos of battlefield medicine. The Defense Department is developing a training course for medics to teach them how to screen for TBI in the field. Any injured combatant who has lost consciousness is a candidate for TBI diagnosis. The military is also making plans to station a TBI expert at medical facility in Germany where the U.S. wounded are first evacuated after leaving Iraq. "I'm sure people do get misdiagnosed , says Dr. Warren Lux, deputy director of the Defense and Veterans Brain Injury Center at Walter Reed. "That is why we are trying to get education out there."

For now, the 6-foot-3 Reyes fills his days with volleyball and basketball, group-therapy sessions, meditation and recreational therapy at the VA's Residential Rehabilitation Program in Menlo Park. Being so close to the civilian world has exposed him to painful criticism of the war. "It kind of hurts that I lost a lot of friends and I got injured," he says. "I guess that's what freedom of speech is for." Someday, he hopes the Iraqi children who once enthusiastically greeted Reyes and his fellow Marines will appreciate their sacrifices. In the meantime, Reyes is working on putting his own life back together. Later this year, he plans to marry, and before long, to attend college. First though, he wants to learn once again to recognize his family members, especially his beloved 5-year-old brother who dressed up as a Marine for Halloween in honor of the injured big brother who struggles to remember his name.

With Martha Brant and Karen Breslau

John Clark for Newsweek; Reyes, shown here at the VA facility in Menlo Park, Calif., still has trouble reading and remembering; John Clark for Newsweek; Reyes, shown here at the VA facility in Menlo Park, Calif., still has trouble reading and remembering