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The Lasting Wounds of War

"We're saving more people than should be saved, probably," Lt. Col. Robert Carroll said. "We're saving severely injured people. Legs. Eyes. Part of the brain."

Carroll, an eye surgeon from Waynesville, Mo., sat at his desk during a rare slow night last Wednesday and called up a digital photo on his laptop computer. The image was of a brain opened for surgery earlier that day, the skull neatly lifted away, most of the organ healthy and pink. But a thumb-sized section behind the ear was gray.

Staff at the 31st Combat Support Hospital in Baghdad, the Iraqi capital, move a patient into position for a CT scan. (Dana Smillie For The Washington Post)

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"See all that dark stuff? That's dead brain," he said. "That ain't gonna regenerate. And that's not uncommon. That's really not uncommon. We do craniotomies on average, lately, of one a day."

"We can save you," the surgeon said. "You might not be what you were."

Accurate statistics are not yet available on recovery from this new round of battlefield brain injuries, an obstacle that frustrates combat surgeons. But judging by medical literature and surgeons' experience with their own patients, "three or four months from now 50 to 60 percent will be functional and doing things," said Maj. Richard Gullick.

"Functional," he said, means "up and around, but with pretty significant disabilities," including paralysis.

The remaining 40 percent to 50 percent of patients include those whom the surgeons send to Europe, and on to the United States, with no prospect of regaining consciousness. The practice, subject to review after gathering feedback from families, assumes that loved ones will find value in holding the soldier's hand before confronting the decision to remove life support.

"I'm actually glad I'm here and not at home, tending to all the social issues with all these broken soldiers," Carroll said.

But the toll on the combat medical staff is itself acute, and unrelenting.

In a comprehensive Army survey of troop morale across Iraq, taken in September, the unit with the lowest spirits was the one that ran the combat hospitals until the 31st arrived in late January. The three months since then have been substantially more intense.

"We've all reached our saturation for drama trauma," said Maj. Greg Kidwell, head nurse in the emergency room.

On April 4, the hospital received 36 wounded in four hours. A U.S. patrol in Baghdad's Sadr City slum was ambushed at dusk, and the battle for the Shiite Muslim neighborhood lasted most of the night. The event qualified as a "mass casualty," defined as more casualties than can be accommodated by the 10 trauma beds in the emergency room.

"I'd never really seen a 'mass cal' before April 4," said Lt. Col. John Xenos, an orthopedic surgeon from Fairfax. "And it just kept coming and coming. I think that week we had three or four mass cals."

The ambush heralded a wave of attacks by a Shiite militia across southern Iraq. The next morning, another front erupted when Marines cordoned off Fallujah, a restive, largely Sunni city west of Baghdad. The engagements there led to record casualties.

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