By Christian Davenport
Washington Post Staff Writer
Saturday, February 4, 2006
Brian Radke was celebrating his 31st birthday at Walter Reed Army Medical Center when he chomped into a grilled cheese sandwich and bit something that was neither grilled nor cheese.
It was sharp, round and hard as a BB, and it had dislodged from his throat.
"Shrapnel," the Army specialist told his wife that December morning, after he'd spit it into his palm.
"There's my birthday present," Nova Radke remembered him saying.
When U.S. service members or civilians such as Bob Woodruff of ABC News are injured or killed in Iraq, official accounts often blame roadside bombs and improvised explosive devices, or IEDs. But many times it's the searing hot, sharp-edged, comes-in-all-sizes shards of metal and debris known as shrapnel that actually cause the wounds.
Walter Reed is full of soldiers whose bodies are riddled with shrapnel. Many carry around the fragments doctors have left inside them to work their way out over time. Removing embedded shrapnel, doctors say, can do more harm than good. And the body can "tolerate it fairly well," said Col. Russell Martin, the general surgeon consultant to the Army surgeon general.
With IEDs a leading cause of injury, the Iraq war is producing a generation of veterans who not only have scars and prostheses for limbs but also whose skin seems as bumpy as Braille and looks as if someone dotted it with black marker. Some carry so much metal that they set off detectors at airports. Magnetic resonance imaging machines must be avoided because the magnetic force will yank the metal right out of them.
Glance at Radke's pockmarked face, and you can see the pieces doctors left behind. Run your fingers over his throat, just above where the body armor stopped, and you can feel them.
In October, the Humvee that Radke, a member of the Arizona National Guard, was riding in was hit by an IED in Iraq. He said surgeons removed from his body more than 100 pieces of shrapnel, which he keeps as souvenirs. The rest have begun to emerge on their own. There were the splinters that burst from his face like blood blisters, the quarter-size piece a doctor yanked out of his neck with tweezers and the one he coughed up that had come loose in his throat.
Shrapnel wounds have been part of combat for more than 200 years, since Henry Shrapnel, a British artillery officer, designed an explosive canister that sent metal balls flying during the Napoleonic wars.
"It has probably become the single best man-killer, barring a nuclear weapon," said Dale C. Smith, chairman of the Department of Medical History at Uniformed Services University of the Health Sciences.
Shrapnel often comes in metallic scraps that get scattered at terrifying velocity in an explosion. But during a blast, anything can become a dangerous projectile. Martin has pulled out bits of rock, glass, wood -- and once, even a part of a circuit board that he presumed came from the cell phone used to detonate the bomb.
He saves much of the shrapnel he removes from patients because, he said, it's helpful for them to see "the actual fragment of metal that caused the scar." But shrapnel has also become a highly sought-after souvenir of the Iraq war. "Usually when I offer it to them, they're all over it," Martin said.
As for the pieces he leaves behind, it can take weeks or years for them to surface.
Sometimes, they never come out.The Reality of War's Danger
The first piece of shrapnel that Army Spec. Bryan Anderson saw was in a charred Humvee that had just been rocked by a roadside bomb in Iraq. It was a vicious-looking scrap of twisted metal, six inches long and one inch thick, with so many razor-sharp edges it couldn't be picked up without a glove.
He just stared at it in horror, he said, wondering what something like that could do to the human body. That's when he realized how dangerous the war was. "This [expletive] is serious," he remembered thinking.
His fellow soldiers had the same reaction and placed the piece of shrapnel inside an Army command center "so people could see what we were up against," he said.
A few months later, a bomb hit Anderson's Humvee. Shrapnel sliced through the vehicle and into his body. He lost his legs and his left arm and became the war's fourth triple amputee treated at Walter Reed, according to a hospital spokesman.
Anderson, 24, of Chicago, who is learning to walk on prosthetic legs, estimates he has about 100 fragments of shrapnel inside him. Many are visible under the skin.
The pieces in Radke's face resemble hard pimples. "That's what the ones in my face feel like," he said. "Once you can feel it, you want it out of there."
They itch, he said, and he spends so much time clawing at his peppered arms and face that his wife tells him constantly to stop.
Several pieces have come out, which didn't really hurt, he said. But there was a fair amount of blood and the troubling fact that the last person to hold the piece of metal was most likely the insurgent responsible for his injuries.'Something You Don't Forget'
For Army Capt. Jason Scott and the soldiers under his command, shrapnel was more than a deadly force; it became a grisly souvenir.
Thirty-five IEDs exploded on the supply route Scott's unit patrolled, and the soldiers commemorated each one they survived by collecting shrapnel from the crater. Scott kept 15 pieces, each labeled with the date and location of the explosion, in a box next to his bed. They came in varying shapes and sizes, but all were spiked with sharp edges.
His collection was "kind of a macho thing, to some extent," said Scott, 28, of Chicago. "If you survive an IED blast, it's something you don't forget."
And there were unwritten rules, he said: "It was a memory of the event, so you wouldn't collect shrapnel from an IED you had nothing to do with."
Then, in October, Scott saw a flash, like a kid's sparkler, out of the corner of his right eye. He knew immediately what it was. Shrapnel tore through the Humvee door, severed his right arm, shattered his left and ripped gouges in his face and body. He was blinded in his right eye.
At Walter Reed, doctors showed him an X-ray. He could identify his pelvis and thigh bone right away. But what were those little dots floating throughout the picture, he asked. Shrapnel, the technician said.
Amazed, Scott started counting, but there were too many.
"I stopped at 10," he said.
He doesn't know what happened to his collection of shrapnel. He hopes it was shipped back to the States with the rest of his stuff because he has a piece the doctors saved that he'd like to add to the collection. It's no bigger than a nickel, but it ripped through his left arm. He keeps the fragment by his bed at the hospital and occasionally looks at it in wonder, he said: "How could something so small cause so much damage?"
Radke has a shrapnel collection, too. Not the pieces that stuck out of his body armor like knives in a dart board, but the ones the doctors removed from virtually every part of his body that wasn't covered in Kevlar.
Radke, who was back in surgery again this week, asked the doctors to hold on to them, he said, because, like the scars that line his face, legs and arms, they are reminders of the war "and of what I went through, how close to death I was and how far I've come."