Healing War's Wounds

Hey, have any of y'all seen the crocodile that got my arm?" U.S. Army Maj. Anthony Smith hoists his prosthetic hook, tied to a paddle, as he floats down Idaho's Salmon River in a large blue raft, manned by a cackling crew of fellow amputees. Momentarily rattled, a group of rafters resting onshore stare as Smith's boat glides by, before someone on the beach points down the rapids and yells, "He went that-a-way." Smith, digging his paddle back into the water, growls with mock pirate glee. "You should see what happens when I'm in a restaurant and I say to the waitress 'Can you give me a hand?' "

He can laugh now. It's the surest sign yet of the progress he's made since April 24, 2004, when Smith, then a captain with an Arkansas National Guard unit stationed near Baghdad, was struck by a rocket-propelled grenade. The three-foot-long missile lodged in his right hip, exploding as Smith's commanding officer rushed to help him. The blast cut Smith's rescuer in half. It blew off Smith's right arm and ripped open his abdomen, destroying one kidney and shredding his intestines, and shattering his femur and right hip. Heat from the explosion burned his retinas and melted his dog tags into his chest. As Smith staggered to his feet, insurgents opened fire, shooting him four times. By the time medics reached him minutes later, Smith had "flat-lined." Finding no pulse or respiration, they loaded him into a body bag and put his name on the list of those KIA, killed in action. Only as a soldier was preparing to zip shut the bag did she notice an air bubble in the blood oozing from Smith's neck wound. "They said, 'Hey, this guy's still alive'," Smith says.

Two and a half years later, Smith recounts his own resurrection in vivid detail--not because he remembers (he was in a coma for six weeks), but because he has pieced the story together from conversations with his wife, Jackie, and the dozens of doctors who labored to save him. Smith has endured more than 30 surgical procedures to reconstruct his abdomen, the remains of his right arm, his burned face and the gaping wound in his hip, now painfully infected. He must be constantly monitored for signs of traumatic brain injury that may have resulted from the force of his skull's slamming against the inside of his helmet.

Though Smith's tale of survival is extreme, it is no longer unheard of. Thanks to advances in combat medicine and body armor, more than 90 percent of the 20,000 U.S. forces wounded to date in Iraq and Afghanistan are surviving their injuries. (In Vietnam, that figure was closer to 75 percent.) That is encouraging news, to be sure, especially as the U.S. body count in the Iraq war approaches 2,600. But it also presents a huge challenge for the military as this sizable population of wounded veterans returns to society, bearing complex disabilities that will require lifelong care.

To address the problem, the military has adopted a holistic mind-body approach, deploying a fleet of experts ranging from orthopedic surgeons to therapists to work on the wounded. Doctors insist on group therapy to help cope with the guilt that often dogs survivors who have lost--or left--comrades on the battlefield. Of special concern are the service members, like Smith, classified by the Pentagon as "severely injured"--having lost limbs or eyesight, or suffering burns, paralysis or debilitating brain injuries that will not emerge fully in some cases for years. "Technology has advanced to the point where we can salvage patients who would not have survived before," says Lt. Col. John McManus of the Army's Institute for Surgical Research in San Antonio, Texas. "The bigger test is psychological. Can we restore a life worth living?"

The Pentagon has recently begun testing more experimental methods, rehabilitating wounded service members with extreme sports designed to build muscle--and self-confidence. Early next year the Center for the Intrepid, a privately funded $45 million rehab facility featuring rock-climbing walls and an indoor surfing tank, will open on the grounds at Brook Army Medical Center in San Antonio, offering lifelong privileges to those wounded in Iraq and Afghanistan. At BAMC, wounded soldiers are encouraged to get moving as soon as possible, a strategy that promotes independence and wards off depression. Learning to accept their disfigured bodies is "an immense emotional challenge," says Dan Blasini, a case manager at BAMC. "They want to know 'Am I a man? Is someone going to love me?' This isn't exactly the stuff you expect the Army to talk about, but this is what's on everyone's mind."

Patients who work out regularly, lifting weights and yanking pulleys from their wheelchairs, often with burned and mangled limbs, are rewarded with all- expenses-paid outdoor expeditions. It was just such an invitation that brought Smith, two other wounded service members and their wives to the Salmon River last month. They were the guests of Sun Valley Adaptive Sports--one of several private nonprofits consulting with the Pentagon. On the week's agenda: white-water rafting, paragliding, rock climbing and horseback riding. With the group is Erik Schultz, a backcountry sports enthusiast who was paralyzed in a skiing accident eight years ago. During his darkest depression, says Schultz, friends "literally dragged me" on a camping trip. After a week in the wilderness, "I was bursting with self-confidence. Things didn't seem that hard anymore." He hopes that his presence in a wheelchair, fly-fishing from a rocky beach and whooping his way down the river, will help "demystify" disabled life for the wounded service members.

Free from their hospital routines, and the weight of their wounds, Smith and the others spend their days splashing like kids. U.S. Marine S/Sgt. Damion Jacobs, who lost his right leg below the knee to an IED near Fallujah six months ago, removes his prosthetic and props it in the sand like a coffee table; he leans against it while watching the show. Jacobs plans to take his Marine Corps physical and return to active duty. Army Spc. Andrew Soule, an intense, dignified 25-year-old who has emerged as the star of BAMC's rehab program, says that before his injury, he wasn't "much of an athlete." A year ago Soule lost both legs and suffered a severe arm injury in a bomb blast in Afghanistan. Now he kayaks, hand-cycles and surfs. On the first day of the river trip, one of Soule's carbon-fiber prosthetics is fractured. He tosses the limb aside and, for the next five days, kayaks legless, dragging his body over rocky beaches, even climbing stairs, with his arms. "People have this tendency to overreact," says Soule, who left Texas A&M after 9/11 to join the Army. "They don't know how much you can do for yourself."

Even Soule is amazed by how far he has come. As he lay tourniqueted on the ground last year next to the wreck-age of his Humvee near the Pakistani border, waiting for a helicopter to rescue him, Soule's squad leader leaned over him and instructed the young soldier to repeat over and over, "I'm going to live. I'm going to live." It's a lesson he carried with him, down the Salmon River and beyond.