Unseen Wounds

NewHour host Jim Lehrer tackles the question: How do service members return to their lives after surviving an explosion or helicopter crash and sustaining TBI?

[Next, Iraq Wounded] Now returning home from Iraq and recovering from a different kind of injury. Susan Dentzer of our Health Unit has the story. The Unit is a partnership with the Henry J. Kaiser Family Foundation. [patriotic music] The occasion was a Memorial Day observance at a Veteran's Administration Hospital in Richmond, Virginia. Patient's listened to an Army band from their wheelchairs or gurneys, then U.S. Senator George Allen spoke. Now this Memorial Day we do pay tribute, of course, to the fallen, and we also, though, in my view, ought to remember our living heroes. Some of you all here today are some of those still bearing the burdens and scars from your service to the nation. One of those bearing scars was retired Army Chief Warrant Officer John Sims, but Sims' scars aren't visible. Since he's a recovering brain injury patient, they're inside his head. Sims was a Maryland National Guardsman and an airline pilot in civilian life. Last year, he volunteered to join the Army's 101st Airborne Division as a maintenance pilot in Iraq. He was aboard a Black Hawk helicopter on his first flight into Iraq when the chopper crashed. One of the guys that dragged me out of the airplane said that when he got there my helmet was already off, and I'd already hit my head on the instrument panel and fallen forward enough to crush the cyclic stick under my body with all the armor I was wearing. Now Sims is among a growing number of service members returning from Iraq with traumatic brain injuries. The wounds have been caused by a range of factors, from crashes like Sims' to motor vehicle accidents to blast injuries from explosive devices or rocket propelled grenades. Thanks to new body armor, many of those who once died in such attacks are now surviving them. But along with their other wounds, like missing limbs, many have brain injuries, as well. Sims, who's 51, was lucky. Severe brain injuries like his can kill or leave victims permanently disabled. But Sims is recovering, though he'll probably never pilot a plane again. Brain injury survivors can benefit from a growing understanding of how much a wounded brain can heal. A damaged brain can forge new neural connections to replace those lost by a blast, a bullet, or a concussion. But that process doesn't always happen spontaneously. So brain injury survivors like Sims often need special care to spur the growth of those connections and to help them recover speech or other functions they may have lost. We asked Sims to help us reconstruct his recovery and the long road back that brain injury patients travel. After his accident on April 4, 2003, Sims was flown to a combat field hospital, then on to a U.S. Navy hospital ship anchored in the Persian Gulf. Neurosurgeons operated to stem bleeding in his brain. My wife got the word from the doctor. "He's got this, that. He's broken this and that." "Our prognosis is that he'll be dead in the next day or two." But, on April 21, still alive and in a coma, Sims was brought here to Walter Reed Army Medical Center in Washington, D.C. It's the home of the Defense and Veteran's Brain Injury Center. A network of military veterans and community programs. Dr. Deborah Warden, the center's director, says it was created with three goals in mind. One was to provide care for the injured person, the soldier, the veteran, to provide clinical research, the understanding about what is the appropriate care to give, and also to give focused educational interventions to the survivors and to their family members, as well. We asked Warden to show us how Sims' brain had been injured in the crash. She told Sims that he'd suffered a closed brain injury. That's different from a penetrating head wound, in which the skull and protective tissue around the brain are pierced. But Warden explained that these closed injuries can still be devastating. Since the brain floats within the skull, it moves at a different pace from the skull under the extraordinary forces of a crash. The brain can also twist around on a much smaller brain stem. Together, those movements stretched Sims' brain and its billions of neurons, or brain cells. Communication fibers that make up part of the neurons where stretched or chopped in two, like a garden hose sliced down the middle, Warden said. Among other things, those injuries impaired Sims' so-called executive functions. Those are the abilities to organize one's thoughts and work. There was also some localized, or what we call focal injury, to this part--sort of the left, frontotemporal area. That's the area of the brain that involves speech. Sims' brain was badly bruised there, and had bled inside the skull. Sims spent two weeks in this hospital ward at Walter Reed, most of them in a coma. He told Warden that he remembered nothing of that period. My memory cuts out about a day before the accident. I remember the day before pretty well, but I don't remember briefing for the mission. I don't remember preparing for the mission. I don't remember anything of the mission. The other pilot that I was flying with, neither one of us remembers exactly which one of us was flying the airplane at the time of the accident. By early May of last year, Sims had emerged from his coma, and was ready to start rehabilitation. He was transferred to the McGuire VA Medical Center in Richmond, another institution in the brain injury network. Dr. Timothy Silver, McGuire's Chief of Physical and Rehabilitative Medicine, told us Sims was in an agitated state, typical of brain injury patients. They don't really understand what's going on to them and why folks are gathering around them. They're threshold for stimulation is very low. If you come in and you turn the lights on, they may use foul language or whatever agitated type reflexive behavior will come out of them. Clinical Nurse Specialist, Marian Baxter, told us Sims also experienced post traumatic stress, including flashbacks to the crash. If you ask John now, he couldn't tell you what happened in the accident. But when he first came to us in this agitated phase, he was crying out about the helicopter and about the accident and trying to save people. It was definitely not usual. During our return visit to the VA, Speech Pathologist, Micaela Cornis-Pop, told Sims that the bruise on his brain left him with an inability to understand or formulate language. You were trying to tell me a word or sometimes a whole sentence, but you were not really aware that you were only using the sounds of English and not necessarily the words of English. You might have picked from this orange and told me that it is an orange, or you might have told me "tum" or something that was not an English word at all. Sims has no memory of that period, so Cornis-Pop showed him the exercises he performed to help him recover his speech and thinking skills. John, will you please show me where the clock is; show me the clock. Very good. And show me the cookies. Very good. Sims' VA caregivers told us that by the time 7 weeks had passed, he was a new person. His memory had returned, and his speech was close to normal. By the end of June, Sims was well enough to leave the VA, but not to return home, so he came here to Charlottesville, Virginia, to stay in a group home like this one with other brain injured patients. The home is part of Virginia NeuroCare, a community reentry program that was Sims' last stop on the Defense and Veteran's Brain Injury Network. Sims also worked part-time in a used bookstore Virginia NeuroCare operates to help patients recover thinking and work skills. It's our job to come in here, locate the book, get it out, bag it up, fill out the proper shipping paperwork, and then have one of the supervisors check it and take it down to the post office to have it moved off. Sims explained why that was good therapy for him. After you've been in a hospital for a while being treated for a while, being able to get into a situation and be in control-- even if it's a minor thing like getting the book on the shelf--doing that for the afternoon left you with a basic, positive feeling about the way the day went. Sims needed any positive feelings he could muster. Dr. Daniel Slater, his physician at Virginia NeuroCare, told us Sims was depressed. He prescribed Zoloft, and antidepressant. Some say as high as 60 percent of our patients have depression. It's pretty natural to think, "Where's my life going after I leave this place? After such a huge change?" I had miserable feelings when I first got here because I didn't know exactly what was happening. I had spent my entire adult life working and flying, and because of my injury I was permanently grounded. I didn't know what condition I'd be under, lifestyle, income, or anything like that, or what I would do for continuing or replacement employment or anything like that. Sims finally left Virginia NeuroCare last December and came home to northern Virginia. His wife, Violetta, left for Europe soon after to care for her sick mother. Now, 15 months after the crash, Sims feels grateful for having survived. When I run into the people that I used to work with at the airline, I say, "Hey, I got my ticket, and I open it up and the destination was a crash, but I got a little coupon that went along with it that says 'hey, you get to go home anyway," So, to me, that's a winner. For now, Sims is retired and temporarily living on three-quarters of his former pay. He still has trouble remembering names and performing the math that as a pilot he once did routinely in his head. He's looking for a new job, but so far hasn't had much success.
Posted on BrainLine January 26, 2009.
Broadcast on The NewsHour with Jim Lehrer, July, 16, 2004. Courtesy of MacNeil Lehrer Productions. All rights reserved. www.pbs.org/newshour.