Hidden Battles on Unseen Fronts

by Patricia Driscoll

  During his first evening at the Landstuhl ICU, Brent started running a fever. “His eyes and skin were starting to look rather yellow. Within thirty minutes his liver started shutting down, and his fever spiked to 107. The doctors were preparing to take him into surgery later in the day, but instead operated immediately.” Brent almost died. “The Landstuhl surgery was a low point for me because Brent had lost so much blood, and the medical staff wouldn’t guarantee anything. I was afraid we would lose him.” But after two more surgeries he was actually stable enough to be flown stateside. After the family had left the hospital and Brent was on a gurney, General Pete Schoomaker, Chief of Staff of the US Army who happened to be at Landstuhl, presented Brent with the Purple Heart.

  Kathy was taken to the airbase to fly home with Brent. “The flight home was excruciating. Brent’s temperature rose again and the doctors were watching his pressure, the bleeding on the brain and his fever. He would have gone to Walter Reed but every bed in the ICU was full so they took him to Bethesda.” Over the previous eight weeks, 1,927 soldiers had been wounded. On January 10th doctors lifted the induced coma and Kathy could finally talk to him. Bethesda Navy Medical was followed by more weeks of procedures at Walter Reed as doctors worked to save his left arm and reconstruct his face. Six feet tall, Brent lost half his body weight. “So much of his recovery was determined by the amount of pain he was in,” Kathy remembers.

  Almost as lethal as the blast that destroyed his truck was the condition that now developed inside Brent’s body: heterotopic ossification, or HO. Brent’s body formed bone around his wounds instead of tissue. It grew in painful lumps on the ends of his legs and his injured left arm, making it impossible to use his prosthetics. Uncontainable, it pushed the plates in his elbow through the skin. Besides the heterotopic ossification, Brent had sores from his braces and infections from his skin graphs, and ringing in his damaged left ear.

  Five months after he was injured, Brent and Kathy moved to Brooke Army Medical Center in San Antonio. Brent was terribly weak from lack of exercise, but he gamely began the physical therapy he was sent there to do. Yet as daunting as his physical recovery was proving to be, emotional healing proved to be equally as challenging. “As the physical parts of his body healed, then it was time for his mental healing to begin. While he was in rehab at Brooke he was diagnosed with clinical depression, not PTSD. I thought it was because of all the pain medications he’d been on. When I mentioned to his caregivers that I thought he wasn’t depressed but had PTSD, they were surprised to hear that I would think that. But it was so clear. He was having sleepless nights, nightmares; there were days when he’d be in a constant state of anxiety.”

  By May 2005 he had become an outpatient, living with Kathy in a two-room suite at the Powless Guest House and driving an electric wheelchair, a far cry from his huge 1999 Ford F-150 truck with 13inch lifts and tractor tires, but better than being pushed around by his mom. “I knew it was hard on him to be so dependent on me, but I also knew I was his best and very often only advocate.” Brent was also struggling with memory loss and chronic headaches from his TBI. But he gradually gained his strength back so that in July he was able to move back home to Arizona.

  Once home, Kathy and Brent found that living in the same house was difficult. Brent was alternately angry and depressed, often mixing his pain medications with alcohol. “It was his little girl, Celeste, that kept him going,” recalls Kathy. “And his nieces and nephews. You know children are so spiritual, whether Brent had legs or not couldn’t have mattered less. They’d come into the house and ask,’ Where’s Uncle Brent? How’s he doing?’” In September Brent moved into a ground level, two-bedroom condo in Tempe with his cousin, Jason. In the fall of 2007 the Armed Forces Foundation gave Brent $125,000 toward a down payment on his own house ten minutes away from Kathy.

  Brent continued to struggle to regain his independence. “It took a while before he could travel any distance without having a panic attack. To travel by airplane was very difficult.” In October 2005 the men of the 1st Battalion, 5th Regiment had a reunion to celebrate their homecoming from a year-long tour of duty in Iraq at the Greater Takoma Convention & Trade Center. Brent had been the first of the 160 in his company to be seriously injured, and he wanted to go.

  “I remember it took four days before he made his flight. Between the effort it took to even get to the airport and the anxiety of dealing with checking in, dealing with his wheelchair, prosthetics, security, the actual flight and the number of people at the airport, it was all very stressful. I had to keep changing his flight. On the fourth day I finally accompanied him to the airport and helped him get checked in and waited at the gate with him to board before leaving. This was one of his first trips by himself, and it was a very important step for him to make.”

  Kathy became so wise and well known as Brent’s mother that she was asked to work with the Military’s Severely Injured Program to help other wounded soldiers and their families make the transition back into their communities. She took the job. “To witness the things these brave soldiers cope with as they recover from their wounds is beyond the imagination. To undergo surgery after surgery like Brent has is beyond my comprehension. Yet he wakes up every day with a renewed determination to move on, and I believe that ability to overcome what life has dealt him is because of his faith and belief in God, family and country. Brent was once asked by a reporter if he regretted his service and the loss of his legs. He replied, “How can I compare the loss of my legs to millions having freedom. The job is not done, and we should stay until it is.” Brent continues to struggle with his PTSD, yet he says he would reenlist in a second if he could. His friends say that Brent isn’t in denial about what has happened to him, he just doesn’t let it define him.

  MEDALS

  NCO Professional Development Medal, Iraqi Campaign Medal, Operation Iraqi Freedom Medal, Global War on Terrorism Medal, Combat Service Medal, 2 Good Conduct Award, Army Achievement Medal, Army Accommodation Medal, Purple Heart, Bronze Star, Combat Infantry Badge, Expert Marksman Badge, Expert Infantry Badge.

  28

  FAMILIES OF HONOR

  By Dr. Mary Car-Blanchard

  In a split second, the lives of Marine Jose Pequeno and Army Sergeant Brent Bretz were changed forever. Few people may realize that the lives of the soon-to-be family caregivers were changed forever as well. Traumatic Brain Injury (TBI) and Post-Traumatic Stress Disorder (PTSD) have an insidious ripple effect on the entire family. With a lack of community services, it is extremely common and almost a “given” that adult patients will be returned to their spouses, parents, siblings, extended family, significant others or friends. These are regular people with regular lives that change abruptly as they become instant caregivers. As the mothers and sister in these accounts found out, their roles and lifestyles were no longer the same. Like other parent caregivers of adult children that experienced TBI, Nellie and Kathy learned that although needs and issues may differ from person to person and change over time, they do not abate.

  Traumatic Brain Injury is a catastrophic event. It can happen at any time and certainly does not wait until a military member’s or caregiver’s life is in perfect order. Life has its ups and downs, and it seems like all we can hope for is a balance over time. TBI does not wait for an up, down or balanced period. TBI does not consider marital satisfaction, family dysfunction, caregiver coping skills, caregiver income or dependent children. It does not wait for your bank account balance, blood pressure or coping skills to be at their best. TBI can occur at any time, regardless of how prepared or unprepared a loved one is to become a family caregiver.

  When a Traumatic Brain Injury occurs in the family, everyday life is in an upheaval. Who will stay with the patient, who will pick up the kids at daycare, who’s making dinner? Loved ones take a crash course in Traumatic Brain Injury, hospital care and military systems, at the same time they are experiencing a wide range of deep emotions. Will he live? I shouldn’t have let her enlist? W
hat am I going to do? Is he receiving the best care? Please don’t die…

  As a person recovers from TBI, it becomes apparent that they have changed. Because TBI can change the way a person thinks, acts, moves, behaves or feels, loved ones experience a unique kind of grief, the concept of grieving a loss without death. Loved ones are challenged to grieve the “person they knew,” while at the same time getting to know the new and different characteristics of the person. This is not the same man I married… Dad, it’s me… He used to have such a good sense of humor… Why are you doing that? It’s not appropriate to say things like that… You used to play with the kids… I used to know you cared. Why don’t you act like you used to? I miss that person…

  Depending on the severity and types of injuries, caregiving can range from direct supervision to hands-on total care. Are you prepared to change your spouses or adult child’s diaper—every day? What about trach care (a breathing tube in the neck)? Can your back handle all of the lifting? Does a wheelchair fit through your doorways or do you need an accessible house? Can you get your loved one in and out of a car? Is your boss understanding? Who cares for him while you work…or need a break?

  With all of the new responsibilities, it is common for caregivers to have problems adjusting to their new responsibilities, especially while still grieving. Caregivers most frequently report feeling depressed, anxious, fatigued, overwhelmed, self-doubting and physically stressed. Caregivers with lots of support, funds, respite care, and hands-on help usually report feeling better. In fact, some caregivers report adjusting to caregiving quite well. Indeed, the caregiving experience appears to depend on a multitude of factors and to be unique and complex.

  Caregiving has been shown to be more stressful on spouses than it is on parents. A stay-at-home mom may suddenly find herself needing to be the primary breadwinner. Sex lives may change. Divorce is not uncommon. His childish immature behavior turns me off. This is not the same man I married. How am I going to care for him and financially support us?

  It is speculated that parents return to the role of taking care of their child, but that is not to say that it is easy. As Kathy found, the love, care, concern and worry of a parent is always there, but not all adult children with TBI realize or even want to realize that their lives have changed and that they need help. She received negative responses to her concern over her son’s partying and prescription medications. I don’t see your name on the bottle. I’m going out partying with my friends….

  Further, some family caregivers, such as Nellie, may experience secondary traumatization. They are traumatized by hearing or seeing what their loved one has gone through, and as a result feel a string of negative emotions. Face it, mothers pray that their children return safe from duty. It is any mother’s worse nightmare to be told “Your son has been injured,” or worse. Not only did Nellie have to process the circumstances of how her son was injured, but also how he had changed. She had the total firsthand shock of finding her son’s attempted suicide. These are the things that are not supposed to happen.… How much can anyone take…

  The strength that caregivers need to make decisions is clearly demonstrated, in different ways, by Nellie and Kathy. Traumatic Brain Injury affects everyone differently, but changes in behavior, thinking skills and personality, such as poor impulse control, lack of insight or empathy and poor decision-making can cause the most caregiver stress. Kathy found herself being responsible for her son, who was not behaving responsibly when it came to partying. For Kathy it was too much to stand by and watch Brent’s behavior and choices. She said, “I will not stand around and watch you do to yourself what the Iraqis couldn’t.” Caregiving circumstances are different for everyone, and it is certainly not a failure to say, “I cannot do this,” and to get help from someone else.

  In addition to a full spectrum of emotions, the experience of caregiving for a loved one with TBI brings about changes in roles, child rearing, family decision-making, financing and careers. It is estimated that about one half of family caregivers have to give up their jobs to care for their loved one with TBI. After a year or more, many do not have enough money to take care of the person anymore. This was the reality for Nellie, as her savings were quickly depleted and she chose to give up her house. Her daughter Elizabeth left college to help and got a job at the hospital where Jose was being treated. Like so many families, they would do anything for their loved one.

  The accounts of Nellie, Elizabeth and Kathy are not isolated incidents. Does it need to be so difficult? Can more be done to help them? The reality is that there is indeed a lack of support services, community services, affordable respite care and financial support for military members or veterans with TBI and their caregivers. However, the reality also is that more and more soldiers are returning home with TBI and Post-Traumatic Stress Disorder each day. These men and women unselfishly dedicated their lives to protect the citizens of the United States and our country. In turn, are they receiving the best from their fellow-citizens and country?

  29

  DELTA FORCE DOWN

  The Story of Special Operations Sergeant Bryan Lane

  “Before I could take a breath, four of our guys were down. It was dark, chaotic and fast. Then a large explosion and the next thing I know I’m blown up into the air by the blast. I came down on my elbow. I couldn’t feel my right arm; I thought it was gone.”

  On February 5, 2005, around 2 a.m. in a Baghdad slum, an Army SpecOps team broke through the door of “House A,” surprising an extended family and other adults who were sleeping. It only took seconds, well before the Iraqi interpreter started demanding names, for the soldiers, seasoned from months of night raids like this, to recognize that the target they were looking for wasn’t there. Someone called in to say they’d taken down the house and it was quiet. The unit got orders to check the place next door, “House B.”

  Bryan Lane was in his second tour of duty in Iraq, after he’d also served a tour in Afghanistan. “We’d deploy for four months at a time, then get sent home to decompress for six months, then deploy again. “We’d go out every night from 11 p.m. to 4 a.m., doing missions and then get out before the sun came up. We’d sleep all day, watch videos, work out and then go out again. We’d had only two nights without going on missions before the night I got injured. It was brain-busting alright.”

  In “House B,” the insurgents waited until the Americans were halfway through the rooms before opening fire. They’d had plenty of time to arm up and position themselves for the ambush. It was close, dark and almost impossible to maneuver. “Before I could take a breath, four of our guys were down,” recalls Bryan. “It was chaotic and fast. There was a large explosion and the next thing I know I’m blown up into the air by the blast. I came down on my elbow. I couldn’t feel my right arm; I thought it was gone. I had other injuries—wounds to my groin area and leg—but I had no idea how bad they were. I knew my arm was bad. I got up, walked out of the house into the back courtyard and sat down against a wall, and that’s where my buddies found me.”

  Bryan grew up in Bakersfield, California, the son of an alcoholic father. “In my family I was the peacemaker. But I was always crazy about the military. I always saw myself as a soldier.” After he graduated from high school he went first to Sacramento and then to Los Angeles with big ambitions, but no money or job.

  “I thought I could do anything. My plan was to be a bodyguard and hang out with celebrities, but surprisingly, no one was hiring 18year-olds with zero experience. I ended up working for a company that sold Internet Service Providers—‘ISP Investments.’ It was like a scene out of the movie Boiler Room, a complete scam which took me months to realize, but I made a lot of money because I was great at selling.” He quit two weeks before the company was raided by the FBI. After a series of short-term jobs he’d had enough, and joined the Army determined to qualify for the “RIP”: Ranger Indoctrination Program. Sure enough, by 2000 he was training as a sniper, part of the Second Ranger Battalion out of Fort
Lewis, Washington.

  “We were the last Ranger battalion to deploy to Afghanistan. They sent us straight to Kandahar and then to an outstation right on the Pakistan border. In 2002 Afghanistan was nothing like Iraq. It was a much less complicated war and the Afghans were actually pretty good people.”

  There were only ten trained snipers, so Bryan bounced around from outstation to outstation as a “battalion asset.” “There was generally very little to worry about on those sniper missions. We could shoot more accurately and farther than anyone, and the Taliban weren’t exactly crack shots.”

  His first stop in Iraq was the city of Fallujah in Al Anbar province. He arrived at the end of February 2004, just weeks after insurgents had captured four Blackwater contractors, beaten them to death, lit them on fire, and then hung their burnt corpses on a bridge over the Euphrates. “It got violent. We were supporting the First Marine Expeditionary Force under General Conway, doing some raids but mostly acting as a ‘Force Multiplier’.”

  Against the ground commanders’ better judgment, the Marines were ordered by the Joint Task Force to conduct an aggressive assault against the insurgents beginning April 3. American units, 2,000 strong, laid siege to the city with the aim of retaking it. Army SpecOps worked independently but also as part of the major campaign. They were so good at what they did that “when we took down a former General who had worked with Saddam, he complimented us on our professional behavior. In less than a minute we had him. With no noise, no lights, no shots fired, he simply woke up and there we were in his bedroom. He was shocked.” Although at heart a humanist, Bryan became hardened in battle. “We were taking photographs of dead suicide bombers who we would identify later. There was one terrorist who had been shot many times but had somehow managed to drag himself from a hallway to the kitchen where I found him laying on the floor, blood all over the place, still alive. I could hear his labored breathing, and I remember thinking as I took his photo,’ I don’t care about this guy. This doesn’t mean a thing to me. He was a suicide bomber; I hope he stops breathing soon.’”