What I Faced After Iraq

By Kimberly Dozier
Sunday, September 30, 2007

On May 29, 2006, a 500-pound car bomb was remotely detonated on a Baghdad street as the U.S. patrol that my CBS television crew was filming approached it. The explosion killed two of my colleagues -- Paul Douglas, a cameraman, and James Brolan, a sound man -- as well as James A. Funkhouser, the 4th Infantry Division Army captain we were following, and his Iraqi interpreter, "Sam." The bomb -- one of five that exploded in Baghdad that day -- blew burning shrapnel through the rest of Funkhouser's patrol. Six soldiers were wounded. So was I, critically.

Since then, I've learned more about how the medical profession puts injured troops back together again than I ever wanted to know. I've also learned that surgeons like the ones who've helped me heal need more information -- and quickly -- about how to deal with the kinds of traumas that troops are suffering today. Because there are only going to be more of them.x

The other soldiers scrambled to keep us safe and patch us up as best they could. I knew that the chaos was an everyday occurrence in Baghdad. What I didn't realize then was that the kind of blast injuries I had suffered to my arms and legs are also common. More than 20,000 U.S. troops -- about four out of five of those wounded in Iraq and Afghanistan -- have suffered what are called "extremity war injuries."

Quick treatment by medics on the ground, coupled with rapid evacuation to nearby hospitals and advances in the science of trauma surgery, have enabled more injured troops to survive in Iraq than in any previous U.S. conflict. In the Vietnam War, the survival rate hovered around 76 percent. By contrast, about 90 percent make it home from Iraq.

While this is great news, it also means that many more of the injured survive long enough to develop a host of rarely seen side effects. And unfortunately, doctors haven't had the resources to figure out how best to treat them -- nor the resources to track the thousands of wounded to figure out which of the treatments that they tried are working. But this information could make the difference between life and death, or between a life of severe disability and one of manageable limitations, for thousands today and many more to come.

In the days and months after the first series of lifesaving trauma surgeries that I underwent at combat hospitals in Baghdad and Balad, my doctors had a host of debates at my bedside: whether to amputate my right leg; how much dead muscle tissue to cut away; how to fight a multi-drug-resistant infection common to injured troops from Iraq and Afghanistan; and how to treat the strange and painful excess bone that can sprout at the site of a break as bones heal from blast injuries.

The blast shattered both my thighbones (one splintered in three places), burned away flesh from my hips to my ankles and sent shrapnel deep into both legs. More than half of my blood drained away through a nicked femoral artery; my heart stopped twice on the operating table in Baghdad.

Two days after the bombing, my right leg was nearly black. It looked as though the circulation had been cut off and the tissue had started to die. Luckily for me, the surgeons at Landstuhl Regional Medical Center in Germany, where I was flown within 48 hours of the bombing, decided not to amputate immediately but to watch and wait a few more days.

A decision on whether to amputate a badly damaged arm or leg often rests on little more than a surgeon's best guess as to whether the limb has a viable blood supply and enough working sinews and muscle tissue to survive. Each time surgeons gamble in this way and win, they learn more about how to judge which tissue is viable. A database of the records of hundreds of amputation decisions and their outcomes would allow doctors to look for patterns that might reveal which characteristics of tissue damage indicate that a limb can be saved -- or not.

A couple of weeks later, after surgeons at National Naval Medical Center in Bethesda had pared away the dead, burned muscle tissue in my upper right leg, I developed an infection of Acinetobacter baumannii. There's some debate about how this bacterium enters the wounds of those injured in Iraq and Afghanistan. Early in the Iraq conflict, doctors thought that it's blown into open wounds from the soil by the force of the bomb blasts. But some limited medical studies have now traced it to hospital infections at U.S. military facilities in Europe.

However it first enters the body, Acinetobacter can multiply to dangerous levels when a person's immune system is compromised by blood loss or massive tissue damage. Only one antibiotic is 90 percent effective against it, and that drug can be toxic to the kidneys. That was the problem I had, forcing me to choose between losing my kidneys or going off the drug and hoping that my body would fight the bacteria on its own.

I did the latter, and survived. But that took another measure of luck. And doctors shouldn't have to rely on luck to win battles against Acinetobacter. If they had a large database of cases, they could figure out when exactly the infections tend to flare up in wounded troops -- on the battlefield or during later care -- so that they'd know better when to begin treatment. Doctors also need safer drugs that can keep the infection in check.

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