An update from Kim Dozier

Mon, 06/08/2009 - 11:04am

The more I hear from Kimberly Dozier of CBS, the more impressed I am. This is from her commencement address at Wellesley College. She is talking about being hit by a car bomb a few years ago in Baghdad:

Now I was lying there on the ground, didn't know what was wrong with me. I'd lost most of my blood, I had shrapnel to the brain, both eardrums were blown out, both femurs shattered and there was burning shrapnel studded in my legs from my hips to my ankles.

Now they say your true nature is revealed at a time like that. I immediately started alternately asking questions... and then a bit later, bossing my poor besieged rescuers around. I'm O positive. I have extra bandages. They are right here. Do you need them? You don't need them. Is my helmet on? If my helmet is not on, I think you should put my helmet on because I can hear some ammunition burning off and that's not good if it hits me. The poor guy is trying to put tourniquets on me and probably thinking, Lady, that is the least of your problems....

I had to do physiotherapy. Now because they hammered titanium rods through my legs, and I had a head wound. Some bizarre things happen with  these injuries. Bones overheal. My bones were overhealing with like flakes of coral bone that were going into my joints and fusing them. There was one way to fix this, otherwise they would fuse and I would walk like a peg leg for the rest of my life. I had to pick up my legs, and crack the knees, and break the flakes of bone. They would have to give me extra painkillers and it still hurt like hell. You would scream through gritted teeth. They had to lock mom in the waiting room, behind two closed fire doors, to allow this to take place.

My dad, meanwhile, knew this had to be done, would stand next to me, hold my hand and listen to me scream. Both of them are just absolute love, just different ways of expressing it."

A lot of people have suffered similar agonies in recent years, but Kim does a good job of capturing it.

PAUL J. RICHARDS/AFP/Getty Images

Thomas E. Ricks | Permalink | | Comments? Login or register
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Minds vs mines

by Walking Wounded on Tue, 06/09/2009 - 1:18pm

Paradoxically, some (like Dozier) who suffer open-skull wounds recover better than those who suffer TBI blast/concussion alone; perhaps because of brain swelling relief, and other differences in treatment.

In an 'economy of force' mission and a 'suck it up, battle mind' culture, an internal 'silent wound' is often going to get '3 hots and a cot', and sent back on line. Rapidly returning wounded to duty is the original military medical mission. In this war, turnaround for a 3-day return to duty is the stated goal. The numbers on that are a frequent talking point; mission accomplished!

The cascade of Traumatic Brain Injury nerve cell-death occurrs hours and days after injury, defying a quick field assessment. Traffic trauma and civilian sports injury don't begin to tell us what happens after primary blast, shrapnel, tertiary fall or vehicle crash, and hypoxia from lung injury, blood loss, shock, smoke inhalation, surgery; some or all of the above, from one event.

Supposedly our troops were to be getting 100% pre-deployment testing, for objective assessment of closed head wounds. TBI effects overlap/amplify with PTSD; both tend to be denied by the injured, and later by the med boards.

Maybe a FP reader in the medical services can tell us something about how the pre-post testing program is going? It's my suspicion that TBI remains a major force-level issue, and a veteran care expense that is hugely under-estimated and therefore underfunded.

Check out "Operation Helmet" and listen to Doc Bob's take on the poor service commitment to brain injury prevention. Football went to fitted padded helmets decades before even parachute troops, and still leads the military in taking concussion care measures. How can that be?

Virtually every college football program was using pre and post testing at the team (ie platoon) level to determine if a player is fit to return to contact play. Any loss of consciousness is indication of injury that must be assessed. The odds of serious sequalae (reduced memory and 'executive function' judgement, delayed epilepsy etc.) go up with repeat neuro injury, as studies of boxers, football players (and parachute troops) have shown.

It would be a real shame if all we're learning about how to reduce TBI cell damage and enhance neuro recovery is allowed to drift away. TBI is the most common disabling unjury for even civilian Americans under the age 45 or so, and the rate peaks for young men, even without combat service.