Sgt. Wells's New Skull

Brian Mockenhaupt, Esquire
Personal Story: Sgt. Wells's New Skull

He goes to war and wonders what it will be like if he gets hit. Will he be tough, maybe heroic? Will he piss himself? How bad will it hurt? He isn't sure when, but at some point the thought shifts from the possible to the inevitable. When he gets hit. Because now he's sure it's going to happen.

This is how it goes.

The dreams come first. Every night he huddles on the rooftop with his squad and the grenades rain down. They aren't wearing their body armor, just T-shirts. He tries to cover his men with his arms, but he can't protect them. He's helpless. And the grenades keep falling.

After he's sent out to pick up what's left of the suicide bomber, still smoking and too hot to put in the body bag, that dream is joined by this one: He lies in bed, waiting for sleep, and hears something down on the floor, scratching, sliding. There's the bomber, a head and a torso, just as they'd found him, crawling toward him in the darkness.

Staff Sergeant Brian Wells has been in Iraq ten months. This is getting old. Time to go home.

But he stays, we all stay, because that's the Army and that's war.

On April 23, 2005, First Lieutenant Dan Hurd, Wells, and his squad are preparing for a foot patrol in a village just west of Baghdad, searching for weapons caches. With a cockeyed smile, Hurd tells Wells he might want to keep his distance from him today. "I dreamt last night I blew up on a dismounted patrol," he says. "I saw my wife speaking at the funeral."

Wells laughs. "I have horrible dreams every night," he tells Hurd. One bad dream is no big deal.

A few hours later, just before sunset, they're outside a metal shop, near an artillery round they've just found. That's a win for the day, one less roadside bomb. Hurd and Wells are standing with Captain Scott Shaw, the company commander, talking about finding some cover. No sense staying out in the open. And now Hurd is watching Wells fall. He didn't hear the bullet snap past his right shoulder, but a second later, with Wells already unconscious and halfway to the dirt, he hears the shot.


Now he's yelling.


The soundtrack of war would probably bore you. Mostly you'd hear bullshitting and bitching. But sometimes you'd hear long rips of machine-gun fire and explosions so loud, they box your ears and rumble in your chest. That's exhilarating. So that's war, you'd say with a greedy, giddy smirk. And sometimes you'd hear something that shoves your guts into your throat. A sharp, short, desperate cry.


Shaw is yelling, too.

"He's dead! He's dead!"

Now all sound is drowned out by gunfire as the platoon rakes an apartment building four hundred meters to the northeast, which everyone figures is the origin of the shot. If there's a sniper in the building, this should keep him from firing again. The racket builds in coughs and spurts. Every four rounds, the rifles and machine guns spit out tracer rounds that glow red as they zip through the air at a half mile a second.

Dust is rising around the apartment building as bullets pulverize the concrete. Someone calls out a target. Brown car. The gunmen are leaving in a brown car. Across the canal to our front, maybe two hundred meters away, a gray sedan comes into view and the gunner on my Humvee starts firing, throwing rounds across the canal, blowing out the back windows of the car, which stops. I'm standing outside the truck, using the open armored door as cover, with my rifle raised to my eye. My ears ring from the machine gun barking beside me. Through my scope I track the driver. Easy shot. He's getting out of his car now, hesitating, terrified. He's back in and speeding away, clearly not the gunman. I lower my rifle. But I could have killed him, and no one much would have cared.

The platoon's medic is off that day, so the job falls on Specialist Scott McCarthy, an infantryman trained as an EMT. Every day that he's the assigned medic, he prays no one is hurt on patrol. He joined the Army to shoot guns and kick in doors, not to be responsible for saving his friends' lives. He's eating Tostitos and salsa on the hood of a Humvee when Wells is shot. He hears the call and sprints around the corner with the aid bag, a mobile ER packed with thirty pounds of IVs, morphine, splints, airway tubes, and bandages.

Panic crowds his thoughts. Oh shit. Oh shit. Oh shit. There's Wells, lying on his back, eyes closed. Shaw is kneeling beside him, shielding his body. "Get down," he tells McCarthy, not wanting another soldier dropped by the sniper. "He's dead." McCarthy hears him, but not really. He doesn't hear much at all. Everything's foggy, quiet, far away. Oh shit. Oh shit. Oh shit. He lowers his ear to Wells's mouth and feels breath. "No he's not!" he yells. "He's alive!"

The bullet struck the edge of his helmet, just above his left ear, punched through the layers of Kevlar, split the top of his ear, and drove into his skull, shooting fragments of bullet and bone into his brain. Blood seeps from the wound and congeals in a pool in the dust. McCarthy slides his fingers to the back of Wells's head, feeling for an exit wound, but there isn't one. Thank the helmet for that. Without something to slow down a tiny cone of metal traveling at nearly two thousand miles an hour, Wells wouldn't need a medic, might not have a brain left in his skull. As it is, the bullet has done plenty of damage. Before putting a piece of gauze over the entrance wound, McCarthy sees bits of brain mixed in with the blood. It looks like greasy sausage.

There's a half dozen people working on him now. Cutting off his web gear and body armor. Loosening his boots. Sticking his arms with IVs. McCarthy kneels behind Wells, cradling his head, squeezing it, really, with his left hand clamped over the wound. Our interpreter, Sala, who must be sixty-five but walks with us in the heat every day, is crouched by McCarthy. "Wells! Wake up!" There's pain in his voice. "Wake up, Wells!" And soon he does. His body shifts. He moans and mumbles.

The Black Hawk is fifty feet overhead and thwacking madly, covering us in a wave of dust. The pilot sets down on a soccer field and a knot of soldiers shuffle to the bird, taking turns as stretcher bearers. McCarthy trips and falls to his knees but is up again, his blood-soaked hands never leaving Wells's head. They load the stretcher, shut the door, and the bird rises. We watch it disappear, headed for the Green Zone, and we wonder if Wells is dead.

At the Combat Support Hospital, a ten-minute flight away, the ER team drives a six-wheel John Deere Gator to meet the helicopter, the sides of its small bed folded down to receive the stretcher. For a moment no one is holding Wells down, and his left arm flails and snatches the bandage from his head.

Neurosurgeon Major Michael Rosner is the realist on call at the hospital. Before he starts the four-hour operation, he gives his initial assessment: Wells is going to die. Rosner has been doing surgery in Baghdad for the past three months. He is always busy. And when a neurosurgeon is needed, the patient usually isn't doing too well.

The bullet caused a massive skull fracture, but what's killing Wells right now are the bone fragments and shrapnel that tore through the torcula, the cluster of vessels at the base of the brain that drains blood from the head. In wars past, doctors wouldn't have bothered. Battlefield triage necessitates putting resources and manpower where they'll save lives. Even in the Baghdad CASH in 2005, with an operating room better equipped than those at Walter Reed hospital in Washington, Rosner is expecting death. And if Wells does live, he'll be a vegetable. "We're going to operate, but I'm not too optimistic," Rosner tells Alpha Company's First Sergeant, Terry Sutton, who's just arrived at the CASH. "I'm not sure he's going to make it off the table."

If you're lucky, the wispy thread that's your life goes on for a while. If you're not, then this is how your story ends. Twenty-five years old with a wife, a little boy, a little girl, and a bullet in your brain. You don't figure it'd be like this. Maybe you'd take a hit and grit your teeth and curse as they patch up your bloody arm. Or there'd be a flash and the lights would go out for good. But not like this, not in between.

Yet here he is, a million miles from East Wenatchee, in Washington's Cascade Mountains. He joined the Army so he wouldn't spend his days making pizzas and smoking pot. After seven years he's hung on to his irreverence and his playfulness, but he's also grown into a military asset, a fast-thinking, self-aware, tactically sound leader who's respected and trusted by his men. And he loves it. He loves this job. It's so much fun. Back at Fort Drum in upstate New York, where we were training for Iraq, we watched his combat acrobatics. He would jog forward with his M4 and dive into a somersault, pop up and fire three rounds into a target, barrel-roll to the left and fire three more, roll again, and stop on his back, firing upside down. Just like the video games. God knows he plays enough of those. Sometimes when he's on patrol, or moving in to raid a house, he sees an image of himself, as though he's at the controls in a first-person shooter.

But in video games, you respawn when you're shot in the head.

Rosner posts Sutton outside the operating room so he can watch through a window near the door and relay updates to the guys in the waiting room. There's Wells, stretched out on a table four feet away. The doctors quickly shave his head, mark incision lines with a Sharpie, slice into his skin, and peel back the flaps. The cranial saw is whining now as they lower the blade into bone. They pull the piece off and there's his brain. The nurse comes to the door. They're in the occipital lobe now and the damage is extensive. This could affect speech, balance, sight, and hearing. Again Sutton is told it doesn't look good.

The surgical team cuts out a softball-sized chunk of skull to give Wells's brain room to swell, cleans out the shrapnel and bone fragments, and puts a tube in his head to drain the blood. Sutton expects delicate, subtle movements. Instead he watches Rosner probe the cavity with metal instruments, and at times with his fingers. "He's a little rough with his brain," Sutton thinks. "I hope he doesn't do any more damage."

Somehow, Rosner keeps Wells's brain and body from shutting down on the table. Colleagues will later speak of the surgery with awe, saying it's the most difficult case of its kind. With his head sewn up, he's wheeled upstairs to a room he'll share for the night with two Iraqis, a baby and a man who seems to be held together by stitches, hundreds of stitches. Iraqis don't often end up in American hospitals, so chances are we had something to do with their wounds.

The entourage of brass troops in, and our brigade commander, Colonel Mark Milley, says a prayer over Wells and pins on his Purple Heart while he's still alive. When they've gone, McCarthy and Staff Sergeant Carlos Santos, who has worked with Wells for four years, are alone with him. His eyes are black. His head's wrapped in a turban of gauze. On a blanket pulled up around his bare chest, a large note urges caution with the patient; his brain is unprotected. What the hell do I say to him? McCarthy wonders. He spent so much of the night worrying. Now the worry shifts to anger. He leans in close. "We're going to get that motherfucker for you," he says. "We're going to find him."

We don't.

As McCarthy is pledging vengeance, we're surrounding the apartments, a cluster of four three-story buildings. The whole company is out tonight. The breaching squads move through the shadows and into the stairwells. They stack in four-man teams outside the doors. My watch shows midnight. All of the apartments are quiet. One glows with the flicker of a TV. In the hallway, whispered commands. "Go." The racket starts at once. Pounding on the sheet-metal doors. If there's not a hasty answer, the breach man kicks in the door. Flashlight beams bounce around inside the apartments. "Get down! Get down!" Children wake and scream. Women wail and men plead. Mister, mister, please. The cries start anew with each floor the teams ascend. The answer is mostly the same. Get the fuck down. Shut the fuck up.

Soon all the apartments are cleared and searched, the men hustled outside to be interviewed. There are no gunmen here, no rifles. But there is a story: In the late afternoon, two masked men came to the apartments and roughed up some residents, ordered them to keep quiet and out of sight, then broke into an empty third-floor flat. A short while later, residents heard a single shot and saw the men speed away.

Tit for tat. That's the way the insurgency goes. You kill them one day, they kill you the next.

Back at camp, after the raid, I stand in the darkness outside our rooms smoking cigarettes with a friend, Staff Sergeant Raul Davila, one of Wells's fellow squad leaders in 1st Platoon. "Our luck ran out today," he says. "Ten months of good luck and it ran out." He's right. Our luck has been absurd. IEDs that blow up late or not at all. Bullets and shrapnel that miss by inches. A car bomb that detonates against a Humvee but no one is seriously hurt. We knew this day was coming.

I lie in bed, staring into the dark, at an image of Wells on a table, doctors crowded around. He was riding in my truck today, telling me about his daughter's birthday party the night before, how his son threw up in the movie theater. I want to pray for him, to give him something, but I don't know what. You can't end this here. You're too good for this. I want to talk to my wife, because I still can.

In the morning we find out he's lived through the night. He did better than some. Kevin Prince, from Plain City, Ohio. Anthony Davis Jr., from Long Beach, California. Aaron Kent, from Portland, Oregon. They all died in Iraq on April 23. Who knows how many were wounded. Throughout the war the average has been about sixteen a day. Deaths run just over two a day.

The communications blackout, prohibiting calls or e-mails home, has been lifted. So his wife now knows. Michelle knows.

When it comes, you're not expecting the call, or the knock on the door. But really, you are. When my wife heard cars pull in late at night as she lay in the dark, when the neighbors were supposed to be gone, she knew. They're here. And the day the UPS deliveryman knocked on the door, that time she was sure.

Michelle is at her sister's in Toronto. She expected a call from Brian by now. The worry is always in ebb and flow, and right now it's rising. When her phone does ring, it's a 315 number, the Fort Drum area code. The caller is from Casualty Affairs. Here it comes. He says her husband's been injured, and the crushing weight lifts a little. Maybe he hurt his back or bumped his head. Then he tells her he's been shot, in the head, and she crumbles.

Linda Wells, Brian's mom, knows before she even knows. Her migraine starts on Friday, around the time Rosner is pulling off her son's skull, eleven time zones away. This is her first migraine in eight months, and the worst ever. As the Army is calling the house, leaving messages, she's at the hospital with Brian Sr. getting a shot of Demerol. When they get home, before they can punch play on the machine, a family friend calls with a message from Michelle.

Brian Sr. stands up straight, rigid. "What? Shot?"

The drugs are gone, as though she hadn't had the shot. The headache gnaws and the room spins. Brian Sr. phones family. Linda collapses.

Wells leaves Baghdad for Germany hours after his surgery, but once he's airborne, his cranial pressure spikes. The plane lands in Balad, Iraq, and doctors cut out another big chunk of his skull. Now he's missing most of the left side of his head. But the bone isn't thrown away. Instead, after both operations, doctors slit open his belly and slide the pieces in above his abdominal muscles, where they'll stay clean and nurtured by blood, until it's time to rebuild his skull.

Three days after the shooting, Wells arrives at the National Naval Medical Center in Bethesda, Maryland, the heat and dust and sewage stink replaced by polished floors and the whiff of antiseptic. Lieutenant Colonel Rocco Armonda, the hospital's vascular neurosurgeon, ups Wells's sedation, putting him into a coma, and wraps his chest in a cooling vest that chills his blood. This slows the metabolic rate of his brain, reducing swelling and giving the blood vessels time to reroute themselves around the disrupted area. Armonda operated on troops for a year in Iraq and has handled dozens of cases at Bethesda. He's never seen a head-trauma patient survive an injury this severe.

Michelle is there within hours. When the doctor gives her the rundown of his injuries, just before letting her in to see him, she nearly vomits. There are bullet fragments still in his brain, and the swelling has bent and crunched his brain stem. He may not be able to see or speak. He may not know who she is. That's if he wakes up. Right now there's no activity on the left side of his brain and very little on the right.

And then she's with him, for the first time since his two weeks of leave in December, she's with her husband and she barely recognizes him. It's him, yes. That's his face. That's his flame tattoo, rising up his right forearm. But he's so swollen. His hands, his arms, his face—they're all fat and puffy. At least he's not alone anymore. She reaches for him and caresses his skin.

"I'm here," she says.

Linda and Brian Sr. arrive later that day. So begins the hospital vigil.

They touch him and play music and read him the celebrity news from trashy magazines. They tell him how the guys are doing in Iraq. They sing to him. They pray and they weep. And he does nothing. He doesn't smile or moan or twitch.

They learn the language of the monitors, the reassuring beeps and dings that say everything's fine, and the beeps and dings that signal alarm. Within days, they're fluent. Their eyes fix on the tiny screens, making quick note of the numbers every time they enter the room. Heart rate. Blood pressure. Core temperature. Oxygen levels. Intracranial pressure — that's an important one. They watch the monitors as they speak to him. Maybe the sensors will say what his body cannot, that he really does hear them.

Being in his room, even though he's lying there limp, can be a refuge from the rest of the hospital. That's a horror show. It's all wrong. Those people shouldn't be here. They're young, they're strong, they're healthy. At least they were. Now they're missing arms, legs, and eyes. They're burned and broken. And what's going on inside their heads, that's a whole other mess. Michelle and Linda had read about the wounded, they followed the news. But they had no idea it was this bad. Some of them don't even have family coming to visit. At night, as Linda listens to the beeps and dings that say her son is still alive, she hears screams down the hallway. This time it's a boy missing half of his face. He wakes not knowing where he is or why his face is gone.

During the days there's a different sort of shouting as the neuro team moves from room to room, checking on the head cases. Eventually it's Wells's turn. The team comes in and Michelle leaves. She can't bear watching this. But Linda stays because she needs to see something, anything, a sign her boy's still in there. The doctors pound his chest, jab his sternum, and yell. Brian, wake up! Sergeant Wells! They bend his fingers back, scrape the bottoms of his feet, and poke under his fingernails. Nothing.

The doctors have been asking Michelle if she's thought about the future. They don't have to ask. That's all she thinks about. What if he's not who he was? What if he doesn't know me or the kids? What if he can't walk or speak? What if he never comes back? They ask if she and Brian have talked about situations like this, what he would want. Yes. He would never want to live like this.

To counter the doctors' prognosis, there are the other families. They migrate to one another for support. And the ones who have been at the hospital for a while, who know the routine of hope and despair, they can read the faces of the new arrivals, the newly despondent. Listen, doctors told me my son had two days to live, the mother of a marine sniper tells Michelle. And now look at him. He's out of his coma and starting to talk.

On Wells's fifth day in the ICU, his left arm jerks. Doctors tell his family that's nothing to get too excited about because the movement wasn't prompted by a command. On a scale of 3 to 15, the Glasgow Coma Scale rates a patient's ability to open his eyes, obey commands, and speak understandable words. Wells is a 3. He can do nothing. But this offers no indication of how badly his brain is damaged. The coma was induced with drugs to regulate his body functions and prevent more swelling. Until he wakes up, it's anyone's guess.

They're weaning him off the sedation now, and his eyes flutter and open, just barely. Somewhere in the second week, Michelle puts a video recorder to Wells's ear and plays a scene of him with his four-year-old son, Terje, at a park. Terje is climbing a rope to the top of a wooden jungle gym. Wells hovers close by, waiting to catch him. "I'm going to do it, Dad. I'm going to do it on my own," Terje yells, and hauls his little body over the top. "I did it, Daddy. I did it by myself."

Bam. Wells opens his eyes, nearly all the way.

"That's your little boy," Michelle says, sobbing. "You have to be here for him. You have to come back and show all these doctors they're wrong."

Wells doesn't come back yet. His eyes are open more often now, but he looks at nothing in particular. The family keeps the same routine, telling stories, showing pictures, and reading e-mails from family and guys in Iraq.

The brain isn't resting; it's figuring out how to work again. Imagine a circuit breaker deep in the base of the head. Trip that breaker and your brain's power grid needs time to come back online. If you're knocked out briefly, say, by a punch, your brain might flip the power back on in seconds. But the more severe the trauma, the longer it takes to reestablish the connections. If some of the transmission lines are damaged beyond repair, the brain searches out alternate routes for its messages. So the mind emerges from a fog that becomes less patchy, revealing more pieces of the world it knows—faces, sounds, smells, pain. The process can take weeks, months, or years. Some never come back. For Wells, the emerging begins with an arm jerking, his eyes fluttering. He sleeps less each day. He shrugs his shoulders and moves his head. He flinches when poked. He squeezes Michelle's hand randomly. She holds up his thumb and pleads with him, coaches him. "You need to do this. Do you hear me?"

And then, in the middle of May, after he is moved from Bethesda to Walter Reed, Wells gives a thumbs-up when prompted by doctors, so they know his brain can understand a command and send a message to his hand to execute the prescribed action. Once, after a nurse readjusts his catheter and leaves the room, Michelle asks him if that hurt. He raises his middle finger. And a few days later, when Michelle asks if he wants her to read him a letter from our battalion commander, he holds his hand near his crotch and tosses it back and forth, mimicking masturbation. Wells is alive.

On May 24, a month after he is shot, doctors discover that Wells can see, and nurses are now using pictures to ask him questions. This one shows a human body. Are you in pain now? He nods. Yes. Where? Stomach and head. How much pain? Seven out of ten. What can I do to help you? Do you want meds? No. Wells points to a picture of a family. Your wife and mother are here. No. He shakes his head slowly, side to side. Now Michelle understands. You want to see the kids, don't you? Michelle asks. Wells nods yes and tries not to cry. She has been worrying about this. It needs to happen. He needs it and the kids need it. But their invincible father will be lying here, tubes stuck in him everywhere, unable to talk. Are you sure? she asks. Yes.

The kids come the next day, after a meeting with a child psychiatrist to prepare them for what they'll see. Wells wants a kiss from Terje, but his son balks, nervous he might hurt his dad. Instead he hands him a Hot Wheels car, pulls out another for himself, and the two play on the bed, rolling cars across the covers. "My dad's really sick, isn't he?" Terje asks Michelle. "Yes," Michelle says. "But he's getting better with our love and the doctors' help." Rachel, who's ten, stands beside the bed, holding Wells's hand, and smiles sweetly when she gets three squeezes, their sign for "I love you." Later, Michelle and Rachel walk through the hospital, surrounded as always by the wounded and the limbless. "Why couldn't he have been shot in the leg and lost his leg or something?" Rachel asks. Michelle wonders that all the time.

Wells doesn't even know why he's in the hospital. His stomach hurts so bad, it must have something to do with that. He doesn't know there are two pieces of skull in his belly, only that his gut aches like he can't believe. He knows his wife is Michelle. He knows he has two children. He knows his birthday is November 28, that he's from Washington State and Michelle is from Canada. And that's about all. The memories are scattered in tiny shards. Do you remember being deployed? Michelle asks. No. Do you remember what you do for a living? No. She tells him he was a soldier, one of the best there was. She shows him a picture of us from Iraq, on patrol on Halloween, wearing fake mustaches. He's crying now, nodding as she points to each of us. He knows us, but he doesn't know the picture. Where is he, and why is everyone holding weapons? Michelle tells him he injured his head in Iraq, and that's why he's having these problems. It will all come back, she says. This just takes time. Your mind is protecting you from things you don't need to remember yet.

He's trying to mouth something to her, but she can't understand. Can you write it down? He scrawls it on a board: "Please don't forget about me."

Michelle is crying again, for what must be the hundredth time this week. "I could never forget about you," she says. "You've had my heart in your back pocket since the day I met you, and it'll be there forever."

He's confused and teary for the rest of the day, and Michelle has no trouble reading his lips. "Don't leave me here," he says over and over. "I'm scared."

He dreams of Iraq without knowing why. There is violence and pain. People are dying and he can't save them. He dreams of explosions and awakens frantic, feeling for his legs. So many explosions. That must be why he's here, an IED. Every morning he mouths the same questions to Michelle, having forgotten the answers. Why am I here? What happened to me? She treads lightly, giving him little bits. She tells him he was shot, but not by a sniper. She doesn't want him to know it was so personal, that someone had tracked him in his sights and fired a single shot.

A few days later doctors insert a speaking valve into Wells's trachea tube, allowing air to brush against his vocal cords. In a quiet, raspy voice, he speaks: "This hurts," he says. His next words set Michelle to crying again. "I love you, my wife." Then he says he wants food, and he wants out of the hospital. And soon he wants to hear more about his life before, his life as a soldier. Michelle mentions his friends still in Iraq and now he's distressed. He's crying. "They all have to get out of there before they die," he says. "They have to get out of that shit. They don't want to be like me. I can't save them from here."

He's lost 35 pounds since he was shot, down to 135 by early June. He pukes a dozen times a day because the section of brain that controls equilibrium was damaged, making him constantly nauseous. When he sits up, he vomits. The injury tweaked his vision, so he sees everything in double. An eye patch helps but leaves him with no depth perception. He's eating soft foods now, but still has some food pumped directly into his body. The tube in his stomach has coiled, so it's been replaced with a tube inserted into his intestines. Doctors have put another tube through his nose and down into his stomach to suction off bile and gases, part of what's making his stomach hurt so much. He's already yanked out that tube once when no one was watching him. The skull pieces were hindering his movements and have been removed. Instead of bone, doctors will rebuild his head with plastic. Wells is fine with that. Anything to get rid of the pain in his gut. The trachea tube is out as well, so he's breathing on his own, and there are no more worries about him drowning from fluids slipping into his lungs. But there's still the risk of a brain infection or the shrapnel that's still in his head shifting and causing a seizure and further brain damage.

In late June, a few days after our platoon returns from Iraq, Wells is loaded into an ambulance for a four-hour ride to the Hunter Holmes McGuire VA Medical Center in Richmond. There he's reunited with some of his friends from the neuro unit at Walter Reed. Eddie, a marine sniper, shot in the head, and Joe, hit with an IED in Mosul while riding in a Stryker armored vehicle. A chunk of shrapnel hit his forehead and plowed a groove through his brain. They all floated for days in comas but survived. Now, at the rehabilitation hospital, they learn how to live again.

They're a sad-looking lot, heads caved in like deflated basketballs. Wells is the furthest along of the three, already talking and starting to walk. Joe can't do either and doesn't seem motivated to improve, so the therapists partner him with Wells, who, everyone agrees, is absurdly good-natured about his situation. This is the first time Wells has actually seen Joe's face. At Walter Reed, before Wells could lift his head, he'd seen only Joe's feet. On their second day of therapy, when Wells rolls into the room, Joe smiles for the first time. For a while, Wells is the only patient in the neuro ward who can talk, and he talks to Joe, all day long, rambling on about anything. Joe's first word, several days later, is Brian.

The nausea is under control now, so Wells throws up less, and the feeding tube is gone. When his stomach hurts, it's usually from eating too much, which he does often, whenever he can. He spends hours a day in therapy. He walks, supporting himself on parallel bars, and works with a speech therapist, stumbling over some words and going blank on others. In a mock apartment inside the hospital, he makes the bed, dresses himself, and uses the bathroom. He's sent down to the little store for ingredients and makes pizza and Caesar salad in the apartment's kitchen. He tries, and tries again, until he gets it. This is the soldier in Wells. He doesn't want to say he can't do it, doesn't want to disappoint the therapists. Someone tells you to do something, you do it.

He's healed enough now to be released on weekend passes, and Michelle takes him to see Wedding Crashers, pushing him in his wheelchair to a handicapped spot near the front. He's wearing his eye patch and his hockey helmet. He loves the movie and just being out of the hospital, doing something normal. But people stare, and he feels like a cripple. In the hospital, being damaged is the norm. Not out here.

And then the doctors tell Wells he's done being a patient, no more living with the damaged. The day they come home, on a warm August afternoon, we throw a little party at their house in Watertown, just outside Fort Drum. A red-white-and-blue banner hangs outside the house: welcome home brian. you're our superman. we love you and we miss you. There's beer and cupcakes inside. He tells us he'll have to go back to Iraq someday, to find the piece of his head and ear that were shot off. If there's an upside to this, he says, it's that he can wear his favorite hat again, a fitted baseball cap that had shrunk a bit. Now that his skull is smaller, the cap fits just fine.

There is relief in being home, but this is matched by anxiety and uncertainty. Wells needs help with everything. He can't shower or use the toilet by himself. He can't get a snack or a glass of water. He can barely dress himself and can't tie his shoes. He teeters when he walks, and Michelle worries constantly that he'll fall and smack his head, or that Terje will throw a Hot Wheels and hit the soft spot.

In September they return to Walter Reed for the cranioplasty surgery to replace the missing section of skull. I'm alerted to this by a text message from Wells: "B gets his new head September 16!"

Humans have been drilling into skulls to relieve pressure for thousands of years, holes that doctors once covered with gold hammered flat and slipped under the scalp. But even in recent years, the process was a patchwork, with surgeons making a template on the operating table from the patient's exposed skull. The fit wasn't precise, the replacement pieces weren't strong, and patients were in significantly more danger, both from being under anesthetic for up to eighteen hours and from increased risk of infection.

Wells's implant is fashioned in a small lab, more Star Trek than hospital, on Walter Reed's ground floor. Stephen Rouse, director of the hospital's 3-D Medical Applications Center, starts with two-dimensional CAT scans of Wells's head, showing the exact outline of bone and the missing piece of skull. Rouse converts the scans into a three-dimensional image and pastes a mirror image of the right side of Wells's skull over the hole, giving him dimensions for the implant.

The 3-D image serves as a blueprint for the stereolithography apparatus, a six-foot-tall metal box in which a laser etches models from liquid epoxy resin. Rouse uses the technology, originally developed for industrial applications, to crank out plastic skulls, femurs, and organs. In the machine's Plexiglas-walled chamber, a platform rests just below the surface of the pool of yellowish light-sensitive resin. Following the blueprint, the laser dances across the resin, which hardens when hit with the beam. With each pass, the platform drops .125 millimeters, another layer done. Again and again the laser passes over the resin. A day later, the model is finished. The platform rises and an exact replica of Wells's skull—with the same huge hole stretching around the whole left side—emerges from the vat.

In most other hospitals, surgeons don't really know what they're dealing with until they crack open a patient's chest or saw off his skull. At Walter Reed, they know exactly what they're getting into. Before Colonel Leon Moores opens Wells's skull, he holds his pseudo-skull in his hands, turning it upside down and sideways, studying the hole and planning his attack.

Rouse crafts another piece of resin matching the missing piece of skull. This is built up with modeling wax into the precise shape and checked against the skull model for final adjustments. The piece is used to make a plaster mold, which is filled with polymethyl methacrylate, a plastic mixed into a putty. Within several years, doctors hope to make these implants from hydroxyapatite, the building block of our bones. Over time, bone cells would invade and alter the bioactive implant, which would slowly become natural bone, leaving the skull whole again. But for now, the plastic is the best thing going, and harder than bone. Encased in the mold, the implant cures in a pressure cooker for twenty-four hours, and then Wells's new head is ready

Nurses wheel him into the operating room on a Friday morning, and Michelle paces and fidgets and waits. Colonel Moores, a former infantry officer and now chief of neurosurgery at Walter Reed, slits open Wells's scalp and starts peeling back the flap. In the five months since the skull pieces were removed, the skin and scar tissue have fused to the dura, a millimeter-thick protective sac that envelops the brain. Moores runs his knife between dura and scalp, much as you might skin an animal or clean a fish. But this is much, much slower, a millimeter at a time. Delicate work, and the risks are severe. The dura is also fused to the brain, already injured and prone to bleeding. A wrong move with the scalpel can cause a hematoma, stroke, or seizure.

And there's the ever-present threat of infection, a risk multiplied if Moores pierces the dura.

For more than an hour, he works at Wells's scalp, gently tugging it back, exposing the rim of bone around the giant hole in his head. The skull model sits nearby for reference. Of more than a hundred cranioplasties the Army has performed since the beginning of combat in Afghanistan and Iraq, this is one of the biggest, so big it's done in two pieces.

Moores and his team set the sterilized implant pieces. Sometimes the skull has grown in the time between the scans and surgery, so the bone must be shaved. But here there's a perfect fit, just like the model. The implant won't actually touch the brain, and while there's always a danger of rejection, that hasn't been a problem in the operations performed thus far in the war.

Using a half dozen titanium plates a centimeter long and three millimeters wide, Moores joins skull to implant, fastening the bridges with titanium screws anchored in bone and plastic. He runs sutures through holes in the implant and into the dura, pulling up the sac. This will prevent blood clots from forming between the dura and the plastic. He pulls the sutures slowly, over many minutes, to keep from tearing the delicate brain tissue that clings to the dura. Moores also runs sutures through the temporalis, a fan-shaped muscle that normally runs from the cheekbone to the side of the skull. This is cosmetic. Wells's jaw would work fine without it, but the side of his head would look dented.

Three hours down and Moores is done. The scalp flaps are pulled up and stapled shut. Wells has his new head.

As he recovers in his room, a visitor stops by, someone he's never met. "I can't believe you're sitting here and you're talking," Dr. Rosner says. Finished with his time in Iraq, Rosner is now stationed at Walter Reed. "You weren't looking so good last time I saw you," he says.

Being back at Walter Reed, now that his mind is fully awake, Wells sees what Michelle saw in those early days. So many wounded. The two walk through the hospital, and they know people are staring at them. Michelle remembers seeing wives taking their wounded husbands out to dinner and feeling so jealous because her husband was in a coma. It's not really jealousy, she says, but hunger. Wanting something so bad. And she can see it on their faces when she and Brian pass. Why can't that be my husband? Michelle knows. She knows how greedy you get. You just want him to wake up, and he does. So then you want him to see and speak and walk. And when he does all that, you want your life to be the way it was, before the war, or at least before that phone call.

Wells sees Joe before leaving for home, and he's sliding. Joe already had his cranioplasty. He was walking and talking. But a spinal-fluid infection moved to his brain, he contracted pneumonia, and a virus he brought back from Iraq is thriving in his weakened body. His eyes are closed. He's unresponsive and can no longer breathe on his own. He'd come so far, and now here he is, back in the ICU, where he was six months ago. In fact, he's in Wells's old room. Michelle looks at Joe and thinks how easily that could have been Brian. Still could be. What if he gets an infection or the shrapnel moves? Wells is wrecked. Helpless. He can't save Joe.

If they could just switch places. He'd do that in a second. He knows he could make himself better. Joe just doesn't have the same drive. But Wells could do it. Just look at him. He's already done it. He'd take it for Joe. He'd go through this again.

At home, one wall of his living room is devoted to the military. There's a picture of Alpha Company from its first Iraq deployment, and another of the ship Wells's great-grandfather served on in World War I. On a narrow shelf are nine twelve-inch action figures depicting soldiers through America's recent wars, an American flag folded into a neat triangle, and a half dozen coins he's received over the years in recognition of achievements. The two most recent additions to the shelf almost pass unnoticed. The first is an empty 7.62mm shell casing, given to Wells by one of our friends who worked as a sniper in Iraq. The casing, from one of his kills, is inscribed in black marker: for those who have fallen, not forgotten. haji suppository. Not far away on the shelf is a small misshapen wad of metal, the largest piece of bullet Rosner pulled out of Wells's brain.

There will be no more additions to the shelf. Wells will be medically retired from the Army this month. When he was barely out of his coma, the Army started the paperwork for his medical-evaluation board, which decides whether soldiers are still fit for duty. By the end of last summer, the Army's decision was made. He can no longer perform his duties as an infantryman. This has been his life. He was a soldier. He planned on making it to Special Forces and retiring as a sergeant major. For a while after his injury, he thought about staying in and maybe working as a physical therapist. At least he could wear the uniform every day. But now he's done with the Army. He feels chewed up and cheated, abandoned by this Army he loves. His unit at Fort Drum has been great. Checking in on the family, calling Washington to unsnarl red tape, finagling an extension for their government housing. But the Army, he never figured it'd be like this. He starts talking about life after the military and stops, already tearing up.

"I got kind of patriotic," he says. "I kind of got suckered into that, brainwashed a little bit."

He has his moods now. People think he's doing great when they see him chasing his kids around or drinking a beer at a party. But he calls himself mildly retarded, and that angers Michelle. He's joking, but he means it, too. Now he's disabled. He feels disabled. Once he has his eye surgery and the patch can come off, he'll at least look normal. And that's what he really wants. Michelle's response is immediate and always the same. "What does normal mean, anyway?" she says.

Wells knows. Along with being able to tie your shoes and remember what someone told you five minutes ago, normal means people not noticing him when he walks through the mall. Kids ask why he wears an eye patch. He tells them his eyes are too strong. If he didn't wear it, he could see right through them. A woman at the hospital asks if he was shot in a hunting accident. So he wears hats when he's out. He says he's not embarrassed; he just doesn't want people to be nervous around him.

He used to support the war all the way, before he saw how many were getting wounded, what it meant to be wounded. Being in the Army is dangerous business. He knew he might die. His uncle Michael, Linda's older brother, died in Vietnam. So he knew. But still.

"If I had the choice to go back or have never been there, I'd fucking have never been there, because I'd be normal," he says.

"You get to know all these people because they're hurt, and that's the only reason you know each other. So it sucks."

A few days after his cranioplasty, Wells visited Arlington National Cemetery with a group of wounded soldiers from Walter Reed, the friends he never wanted. Guys like Bobby, who lost a leg to an IED, who always says Wells has it so much worse than him. Wells says the same about Bobby. There's always someone in more pain. He and Bobby sat in wheelchairs at the Tomb of the Unknown Soldier and watched the lone guard walk back and forth, twenty-one steps each way, back and forth. A few visitors came to shake their hands, thanking them for what they've done and wishing them speed in their recoveries.

Wells and Bobby couldn't see it from their wheelchairs, but down the hill and through a thicket of trees, the dead are making a final assault on the virgin land of Arlington. The rest of the cemetery feels quiet, tranquil, with tourists walking the rolling hills, through stands of mature trees. But in Section 60, where most of the new arrivals are sent, there is work to do. Three separate crews dig in the mud, lowering concrete vaults into the ground, ready to receive bodies now en route. The Iraq and Afghanistan vets are clustered together in a few rows of headstones. Before them a grassy field, waiting to be filled, stretches east, toward the Pentagon, the Potomac, and beyond.

From Esquire magazine, March 14, 2007. Copyright © 2006 by Brian Mockenhaupt. All rights reserved.

Posted on BrainLine January 30, 2009.