The Heroes, The Healing

On American streets, amputees offer the most public and visually jarring testimony of war. The human eye, drawn to symmetry and startled by its absence, cannot help but scan voids where legs or arms once swung, while the mind wonders how it happened. But there are other injuries, some far worse than amputation.

Of the wounded, more than 20 percent have suffered traumatic brain injuries, called TBIs. As the roadside bomb, or improvised explosive device (IED), is the signature weapon of this war, the TBI has become its legacy, says Dr. George Zitnay, a neuropsychologist with some 40 years experience treating brain injuries. Zitnay, 67, has described brain injury as an "invisible epidemic," a plague the public knows little about or is unwilling to face. Zitnay believes this is because brain injuries carry heavy stigmas. "You get a brain injury in this country, you keep it quiet because here we value intellect so much," Zitnay says. "It's a very frightening thing to think about the psyche, to think about the mind. If you were brain injured, would you want people to know about it?"

After the Gulf War, Zitnay helped found the Defense and Veterans Brain Injury Center, now the military's premier brain injury program. The fate of Vietnam veterans pushed him to do it. Many of them, he says, returned with brain injuries that went undiagnosed and untreated. "They ended up in prisons and hospitals, on the street, undergoing divorces," Zitnay says. He sees some of the same things happening to Iraq vets today. "So many of these troops get redeployed so often. Their time in the war zone gets extended, their exposure to blast injuries is high. When they come back, we're not really screening them for concussions or other types of brain injuries. Often in people with mild or moderate concussion, it doesn't show up right away."

Mild brain injuries generally don't permanently impair a person's ability to function. More important, nothing is lost of the victims' essential nature -- they remain who they were before injury. In more severe cases, the victims become violent, forgetful, manic. In the worst cases, the body returns from the war alive, but the victim does not. The old self is obliterated, fragmented, lost in furrows of gray matter that medical science does not fully understand and cannot repair.

Staff Sgt. Jason Welsh is slim and tall, his brown hair buzzed short, his face smooth and boyish. A black-ink tattoo spreads across his right forearm, a warrior angel he got while stationed in Germany. Another tattoo, a ring of flame, circles his left elbow. Both his parents served in the Army, and Welsh joined not long after high school. He wanted freedom, but with boundaries. "I didn't want to depend on anyone," he says. "I wanted to go out on my own, and the Army was the easy way to do it." He went to Iraq first in 2003 as a mechanic, found it disappointing. Afterward, he re-enlisted as an infantryman.

Welsh returned to Iraq in late 2005 with Bravo Company of the 2-6 Infantry, 1st Armored Division. The division deployed to Ramadi, the seething Sunni city wedged against the banks of the Euphrates River west of Baghdad. Welsh commanded two riflemen and a machine gunner. His unit patrolled garbage-lined streets renamed in desire and homesickness after young female celebrities, Route (Britney) Spears, Route (Jessica) Alba. The men skirted puddles of sewage, kicked in doors during raids, battled insurgents as temperatures needled toward summer. Once, he watched Iraqi soldiers throw down their weapons and flee under fire from insurgents. It was all an education. Welsh loved it.

The young sergeant had never been hit by fire. He was on patrol one night, steering his Humvee at the head of the column, his platoon leader, a translator, a roof gunner, and a 19-year-old medic named Nick Crombie riding with him. Crombie was an energetic kid, new to the unit, so eager to please he made mistakes in his excitement. But Welsh could work with that. He put Crombie in the back, had him sit where he could pass out Gatorades during the patrol. It was a Wednesday night in June, a night like any other. Then the truck burst.

An unarmored Humvee weighs about 5,200 pounds. Many Humvees used on combat patrols in Iraq are augmented with steel plates and bullet-resistant glass that weigh an additional 3,000 pounds or more. The trucks are wheeled rhinoceroses, stout and tough. The blast that injured Welsh pulped his armored Humvee. It blew off the wheels, doors, the trunk, everything but the seating area. The platoon leader, the translator, and Crombie were killed, the roof gunner seriously wounded. Shrapnel carved them apart. But not Welsh. His injuries -- the broken neck and face, a damaged knee -- were caused by the blast concussion itself or from the force of it whipping his body against the truck. He doesn't know how he survived the flying metal. "It's as if I took a bowlful of Doritos and threw them at you, and somehow they all went around you and missed," he says.

By Thursday, the day after, Welsh was in the U.S. military hospital in Landstuhl, Germany. On Friday, he landed in Washington, D.C. He remembers blurry scenes from the journey, scraps of dialogue. "I woke up, and I was really violent," he says. "I was strapped down, and I didn't want to be. They stuck something in me, and I went down. I think I was on a plane." It may have been during his journey to Germany, or his way back to the States. Such experiences are not uncommon for seriously injured soldiers who've been drugged. Welsh's first coherent post-blast memories begin at Walter Reed.

Walter Reed Army Medical Center in Washington, D.C., is a sprawling collection of buildings, some of them nearly a hundred years old. The grounds are green and tree-lined, lending the feel of a college campus -- except for the shotgun-slinging guards at the main gates. Walter Reed has treated U.S. wounded since World War I. It is not the sole military hospital in the nation; marines are often shipped to the National Naval Medical Center in Maryland, and some soldiers fly to Brooke Army Medical Center in San Antonio, Texas -- but Walter Reed remains a critical hub for soldiers returning from Iraq.