What I Faced After Iraq

By Kimberly Dozier
Sunday, September 30, 2007; B01

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.

Even as my own infection was clearing up, I developed another problem common to extremity war injuries: heterotopic ossification. Surgeons don't know why the body does this, but when it heals bones that have been broken by a blast, it often goes a little haywire, laying down so much bone that it looks as though a coral forest is sprouting from the site of the break into the muscle. The only way to treat this is to wait for the extra bone to stop growing (up to nine months), and then to cut through the muscle and chisel it out -- a bloody and painful surgery. I had it in February.

Before the Iraq war, doctors had seen limited cases of heterotopic ossification, but usually only when bones were crushed or injured in something like a motorcycle accident, or in patients who had sustained severe head trauma. Only recently have there been enough patients with the problem to make it possible -- and important -- to conduct the kind of large studies that could reveal, for example, whether drug treatments or a course of radiation delivered while the wound is new would stop the excess growth.

The American Academy of Orthopaedic Surgeons has been pushing for Congress and the president to fund several initiatives, including the two-year-old Orthopaedic Extremity Trauma Research Program, a competitive grant program that has already sponsored small-scale research on all the problems I've mentioned. It has been championed by one of my surgeons, Andrew Pollak at the Maryland Shock Trauma Center.

Both Congress and the Defense Department agree that this program and a similar research proposal from Brooke Army Medical Center are important to limiting disability and improving quality of life after severe extremity war injuries. Yet funding for this research has been stalled. "We funded [traumatic brain injury] research, and amputee research," one House staffer told me, "and assumed that meant extremities were included." But apparently they weren't, so the staffer said that supporters have gone back to the current defense budget to try to find a way to pay for the research.

My own recovery, which was completed this spring, came faster than expected, thanks especially to private physical therapy several days a week. But I could have healed faster early on if I hadn't had to deal with the Acinetobacter infection, and I could have returned to walking and running normally months sooner if not for the spiky bone that had grown into my muscle.

Like me, future victims of extremity war injuries will desperately need the kind of knowledge that could be gained from adequate research.

I imagine that some readers might say, "Haven't we spent enough on the war in Iraq? Won't these injuries stop if we get out?" But roadside bombs and car bombs have proven too cheap, too easy and too effective for future adversaries to ignore. Blast injuries like the ones that I suffered -- and that thousands of U.S. soldiers and Iraqi citizens have suffered -- are here to stay. We need to know how to fight them, for the sake of everyone in the bombers' path.


Kimberly Dozier is a Middle East-based correspondent for CBS News. She is on temporary assignment in Washington.

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