FRIEND OF MINE, an orthopedic surgeon at Walter Reed Army Medical Center, called recently and asked me to come out to the hospital to speak to five men who had lost their limbs in military training accidents in Saudi Arabia.
They were soldiers who had suffered blast injuries from explosives, and their limbs had been blown off or had been so damaged and infected that the limbs had had to be amputated. One young man had lost an arm and a leg.
My friend called because he and I had talked earlier about the need for the severely wounded to talk to disabled men who had suffered the same kind of disability years ago and were now successfully using prostheses and living normal lives.
The wounded will soon be returning from battle. Do we know what being wounded really means in terms of what it does to the soldier's physical and mental being? Do we fully comprehend the long-term consequences to the soldier who has been wounded and to the nation that will be responsible for caring for this wounded man the rest of his life?
Some of us vets disabled in past wars were talking the other day about soldiers injured in the Middle East, sharing our terror at the thought of what they will have to go through. We know that a man or woman can get used to being handicapped, but those newly wounded won't know that.
Thinking about casualties -- an antiseptic word that can mask a horrible reality -- isn't pleasant for any of us. But if we at home are prepared to understand better what these young men and women have been through, and what they're going to go through, we can help them -- and ourselves as well.
Physical wounds come in many categories. You hear about the soldiers who hope for the "million-dollar wound" -- the one that does not kill, disfigure or disable but is serious enough to get the soldier out of the fighting and all the way home.
There are other wounds so slight that the soldier is back in the fighting within days, weeks, or months -- a Hollywood-style romantic version of heroes at war. A red badge of courage.
Make no mistake. Any wound, at the time it happens, is an experience for the individual that is both unsettling and scary ("That was close -- I could have been killed") but also exhilarating ("I'm alive!") and transcendental ("I am different forevermore").
There is another category of wounds that most people, soldiers especially, don't even want to think about. These are the wounds that change a man's life for the rest of his days. These are the wounds that bring out the primal fears that go to the most basic level of man's id. I am speaking of wounds that irrevocably maim the body: amputation, blindness, paralysis, disfigurement, deafness, muteness and worse.
And there is no more devastating blow to the human psyche then to be transformed in microseconds from a healthy robust human being into a cripple. The fear of being disabled is ingrained in us. We are brought up to pity, fear and loathe the cripple. Literature, movies and folklore often reinforce this. From our earliest begin-nings, the cripple has been an outcast, a burden on society. Even in America, a country proud of its stance on equality, the handicapped person has been a second-class citizen whose demands for job opportunities and accessibility to public buildings were only codified into law in 1990.
So yes, there is fear in becoming handicapped, a fear as old as human history. Imagine what happens to that fear when it becomes reality. First and foremost is the terror of the physical damage. Second is the mental anguish of trying to cope with this horrible thing that has happened to you. And third is the foreboding of what is to come. The unknown.
There has been much in the media about casualties that will come during the war with Iraq, especially if we move, as seems increasingly likely, into full-scale ground warfare. Death in battle we can understand. It is final. But what does the word wounded mean? It is, in a way, less than death but it is also more. The Japanese have a saying: "Death is as light as a feather but duty is as heavy as a mountain." We can bury the dead, but our duty to the severely wounded is an obligation to be met for a lifetime.
Whether it is a hundred wounded or a million, the total numbers are of small import if you are one of them. Each man who becomes wounded begins that painful and arduous journey by himself. The journey begins when the bullet strikes, the shrapnel tears, the explosion burns, or any of the multitude of weapons in the world reach to take out the soldier.
On Jan. 11, 1968, near Chu Lai, Vietnam, I was walking, early on a glorious morning, along a trail through an abandoned village next to the South China Sea. I passed through a gate and stepped on a "Bouncing Betty" land mine that bounded up out of the ground and exploded with a tremendous blast a few inches from my left hip.
I was thrown violently through the air. When I threw my arms out in front of me, I saw in shocked amazement that my left arm was gone from above the elbow. A white splintered bone jutted out of a bloody stump of tangled and torn flesh. The flesh on my right arm had been blasted away from the elbow to the hand, and I could see both bones glistening white against bloody pulp.
Thus my journey began. I was medevaced by helicopter back to a surgical unit where I was given immediate treatment. My heart stopped. I came to in excruciating pain. I was half-crazed with anxiety and fear about all that was wrong with me. I was helpless, I could not move, there were tubes in all my openings, I could not talk, I was miserable, sick and hurt. And I was scared. It was a lonely place and time. In the intensive-care combat ward where I lay, other men beyond my drug- and pain-filled haze were moaning, and some were dying. This was as close to hell as one could come.
And so it went as I was "stabilized" and then moved from hospital to hospital out of the war zone and back to the United States -- "The World," we called it. At Fitzsimons Army Medical Center near Denver we really began the process in our minds of accepting our disabilities and learning how to function. It was easier for us wounded to adjust in the large military hospitals because the medical corps tended to group categories of disabilities together. There were a lot of amputees at Fitzsimons in Ward 5 West. We went through pain together, rehabilitation, learned from each other how to do things, gave each other mutual support through the rough times and encouraged each other to try things. When we got well enough we sneaked out of the hospital and tried out The World -- got drunk, chased women, raised hell.
We learned together -- the amputees, the spinal-cord injured, the disfigured, the blinded -- and we supported each other.
These were tough times for families. The first time they arrived at the hospital and came up to the ward to visit their son or brother or father or husband was always a shock. You could see it in their faces no matter how gallant and brave they tried to be. There were some divorces, Dear John letters to men from wives who could not deal with a handicapped husband.
The situation was unfair to the families. A combat ward takes getting used to. Men with disfigured faces walk down the hall with two or three pedical grafts (rolls of the individual's own skin being moved to cover wounded areas) swinging from their face and neck. Legless amputees hoist themselves up with overhead bars above their bed. Other amputees are scattered in the ward, spinal-cord injured pushing their wheelchairs along the hall, catheter and urine bags hanging off to the side. Blind men feel their way along the wall. Men whose jaws are wired shut have a pair of wirecutters on a cord around their necks so that if they start to throw up they can cut the wires to keep from choking to death. Men in body casts lie immobile on their beds. Deep repulsive wounds are healing from the inside out and the smells can be bad at times.
The war was on, and every once in a while a friend would arrive from the battlefield. I remember how shocked I was one time to see one of the men in my platoon arrive in the ward. He had lost both legs above the knee. There were so many amputees in the hospitals. I wondered why.
One tenet of modern warfare holds that weapons that maim are actually more effective then weapons that kill because the wounded create a greater drain on the country. More resources are required to care for the wounded then for the dead: more medical staff, medicines, hospitals, transportation, rehabilitation staff, equipment and centers, prosthetic appliances. Emotional and psychological factors can also affect the morale of citizens and soldiers. The wounded can sometimes have a more lasting terrorizing effect on the people around them than the sorrow that comes from burying a war's dead.
What sort of casualties should we expect among survivors? An analysis conducted for the Army on high-velocity gunshot wounds showed that if you got shot in the head, there was a 90-percent chance you would die; there was a 70-percent fatality probability for chest wounds and a 60-percent fatality rate for belly wounds. If you got shot in an extremity there was a high probability you would survive.
Another report found that about 70 percent of all surviving casualties, whether wounded by gunshot, fragmentations, blast or what have you, would have extremity wounds.
This explains why I saw so many amputees in the hospital. It also explains why the Department of Veterans Affairs has in its care such a large proportion of amputees in relation to other types of war injuries: The amputees are the ones who survive getting wounded.
The ugliness of being wounded and the aftermath is far outside the normalcy most of us are used to. But it needs to be understood by all of us at home as a normal course of events in war, no more, no less. Nor should we let these ugly facts lead us to pity, because that is the last thing that we, the disabled, want. What those wounded in the Persian Gulf will want most is an even chance to start their lives over again.
Regardless of the type of disability, there is life after becoming disabled. After all the trauma, fear, pain, emotions, depressions, anger and just being crazy gets out of the system, the spirit rebuilds itself. Soldiers are, for the most part, normal healthy well-adjusted individuals and they will heal from their wounds and get on with their lives.
They will go back to their communities, enjoy their family and friends and contribute to their country. This transition will be aided by the fact they will be American veterans, and America takes better care of its combat-wounded veterans than any other nation I know of, and I've seen many. The Department of Veterans Affairs spends about $30 billion each year on programs that include providing each disabled veteran for the rest of his life with a compensation check, health care and prosthetic appliances. Other benefits will include vocation rehabilitation training for a new career, perhaps an automobile grant and adaptive equipment to enable him to drive. It may never be enough, but it's a substantial downpayment on the debt a nation owes to those who have sacrificed for it.
One final thought. Who is a soldier but a man who fights for his country? Our enemies are soldiers who fight for their country. They will kill us as we will kill them. Our weapons will maim and disable them, as their weapons will maim and disable us. These men are not evil, they are not subhuman. They are sons, brothers and fathers, even as we are. They have dreams, even as we do. And their wounded will be with them, as our wounded will be with us. When the war is over, we must remember that.
Frederick Downs is the author of two books on his experiences in Vietnam, "The Killing Zone" and "Aftermath." He is director of the DVA's Prosthetic and Sensory Aids Service. He was awarded the Silver Star, four Purple Hearts, the Bronze Star for Valor and the Vietnamese Gold Cross of Gallantry.