Walter Reed's World of Hurt, Hope

By Susan Levine
Washington Post Staff Writer
Wednesday, April 5, 2006

Solomon Montgomery wakes up early on workdays. Hours before dawn, the first thing he does is pray.

He prays for the soldiers he will try to help that day, whose bodies were ravaged during attacks in Iraq. He prays that their families find comfort and courage. And with no end to the bloodshed in sight, he asks God for support. "Lord," he says, "give me the strength to do my job."

At 7 a.m., he reports for duty at Walter Reed Army Medical Center. The war remains ubiquitous in the operating rooms, some of which are set aside for the returning wounded, and on the wards, where amputees begin coming to terms with their new realities. Montgomery, a physical therapy assistant with the bulk of a former defensive end, works in a ball- and mat-filled space where, hour after hour, he challenges and cheers on brain-injured soldiers not much older than his own teenager.

So many have arrived in the past three years -- so many continue to arrive -- that they have transformed the hospital's routine. The staff has been redeployed, programs created, a special military company activated just for the injured. "This has become our normal," a nurse explains. But the cumulative effect of nearly 4,900 patients, including 1,458 battle casualties, has done more than change the institution. It has deeply affected the hundreds of doctors, nurses and therapists who work there -- who have been inspired by the resiliency and motivation of the individuals in their care, yet shaken and exhausted by the magnitude of loss.

Since the first soldier was admitted March 28, 2003, nine days after the invasion of Iraq, Walter Reed has confronted damage of daunting proportion: limbs blown off, guts blown open, brains devastated by piercing shrapnel or by concussive explosions, or maybe all that and more. The youth of the wounded elicits sadness, even tears. The veteran staff members look at these patients and see their sons and daughters. Their younger counterparts see siblings, friends.

"That's always my worst nightmare, that I'm going to take care of someone I know," says Capt. Matthew Hueman, a 31-year-old surgical resident whose West Point class has suffered casualties in the war.

Six thousand miles from the actual mortar fire, grenades and roadside bombs, it amounts to a different kind of combat fatigue.

At the start, they expected that the transports of casualties would taper off quickly. But three times a week, the white buses from Andrews Air Force Base still turn off Georgia Avenue NW through the hospital's main gate. They pull slowly up the looping drive to where a double line of gurneys and a small company of gown-clad escorts wait, and then each bus's back door swings open, revealing the litters of patients. Some soldiers are only 48 hours off the battlefield. The most critically injured are unloaded with so much medical equipment they are scarcely visible beneath it.

A pause to lower a litter, convey charts and untangle tubes, and then the new arrival is whisked inside, under the Walter Reed banner proclaiming "We provide warrior care" and on to a triage room.

That pause is all Michael Wagner needs to say, "Welcome home."

Over the past 2 1/2 years, the chief of the hospital's Medical Family Assistance Center estimates that he has greeted hundreds of patients, as well as thousands of family members. His first weeks, he struggled to find the right words. "This guy's missing a leg. What do I say to him?" he wondered. Until he understood: "They're not legs, they're not arms. They're human beings."

These days, the psychologist talks to spouses and parents with a gentle bluntness.

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