Broken Bodies, Shattered Minds: A Medical Odyssey From Vietnam to Afghanistan

by Ronald Glasser M. D.

  I remember seeing Max in the intensive care unit, his stilloozing stumps up on blocks, his left arm completely gone at the shoulder, tubes running into his chest and what remained of his abdomen. His story, like so many stories in ’Nam, was simple enough.

  The First Air Cavalry had begun to chopper in troops to replace the Marines who had put up a three-month-long resistance against North Vietnamese regulars during the battle for Khe Sanh in the northern Central Highlands of Vietnam.

  The Marines had survived dozens of assaults, constant mortar and artillery fire, and a whole host of frontal attacks. Finally, after enduring enough casualties from B-52 raids and hundreds of fighter-bomber sorties along with their tons of high explosives, white phosphorous, and napalm, the North Vietnamese simply gave up and disappeared back into the jungle. In reality, the Marines had survived on our immense firepower and the fact that our military would not let the base be overrun. But it had been a very close call.

  Two companies of the First Air Cavalry were to be the Marines’ replacement. Max, a Southerner with political ambitions, had volunteered for the military first as an American, second as a Southerner, and third as a potential politician who had been told by his mentors in Georgia that a military background could not hurt an aspiring politician. You do make your choices and you do take your consequences.

  The story of the loss of both his legs and his left arm and parts of his lower abdomen has become a bit confused over the years. What we heard when he first arrived at Zama was that when he was jumping out of the chopper at Khe Sanh, a grenade clipped to his web gear got caught on one of the door jambs and the pin was pulled as he left the open doorway.

  Either he’d forgotten or hadn’t been in ’Nam long enough to learn that you have to tape down the lever arm on your grenades, or you run the risk of the pin inadvertently being pulled out as you moved through the jungle or, in Max’s case, as you exited a chopper.

  Apparently Max was able to get his web gear down around his knees before the grenade exploded.

  There were discussions among the surgeons and the nurses as to whether or not it might be better to just let him die. But he survived and eventually was sent on to Walter Reed, and after a few years at Reed he went back home to Georgia.

  Three decades later, the story changed when a trooper, on the same chopper as Max, came forward. He said that he was behind Max in the chopper when they both jumped out of the doorway and that he had dropped a grenade that he was holding in his hand when he’d hit the ground. It was his grenade that had rolled forward and blew up under Max. So it wasn’t really Max’s fault. It was the stupidity or carelessness of war itself. I am sure that the new explanation for the loss of his three limbs was of some comfort to Max. Heaven knows there was little enough comfort for anyone in that war. But that was what Vietnam was like—filled with confusing stories, outright lies, terrible decisions, bizarre unexplainable and unexpected results, distortions of the truth, foolishness, stupidity, courage, bravery, and in more cases than anyone would be willing to admit, a kind of dazzling grace. And nowhere was that grace more clearly seen than in the medics.

  4.

  THE MEDICS/THEN AND NOW

  Who do you ask if there is a disaster? If there is a tornado in Alabama you don’t ask the people in Florida what happened …

  —Conversation: Wounded Medic, Surgical Ward, Camp Zama, Japan

  Back in late 1969, Life Magazine had a pictorial covering the medical evacuation chain, from the battlefields of Vietnam through the battalion aid stations, all the way to Japan, and from Japan on to the States. For some reason that still baffles me, and it certainly surprised every physician in the military who saw the magazine, the editors and photographers of Life had picked a young white officer, as I remember a college graduate from some eastern university, with a minor hand wound. It might have hurt. You could see that much on the face of the young lieutenant in the photograph as they carried him off the chopper. But it definitely wasn’t reality.

  The country clearly had no idea what was really going on then, anymore than it knows what is going on now. If Life Magazine was willing to present fiction as fact, then there was truly no way out of the mess. It would just go on forever. I remembered thinking about why the editors hadn’t picked someone with a penetrating head wound, a transected spinal cord, or no face? I understood, as did everyone else at Zama, or at the Burn Ward at Kishine, or the Neurosurgery Unit at Drake, that this war was a lot more ferocious than anyone was willing to admit, much less acknowledge, and a lot more devastating than a hand wound.

  What happened in Vietnam and what was presented in Life Magazine as the truth has been trumped by an even more insidious silence, or rather disinterest, for both Iraq and Afghanistan. We don’t have pictures of any kind of injury. For our latest wars there are not even pictures allowed of caskets coming home, the C-5As that bring the wounded in from Iraq and Afghanistan have been ordered to land at Dover Air Force Base in Delaware only at night. Our past President did not attend military funerals, and there was a moratorium on medals given out for courage and bravery, as if to downplay the dangers as well as the desperateness of the fighting. What is hoped for is that out of sight will be out of mind. And for the most part the silences have worked. We were told to just go shopping and basically to leave the fighting and the wars to someone else.

  The truth was that back in Vietnam, no one, including the editors of Life Magazine, was seeing the whole thing. Vietnam, like all wars, came in pieces. In a very real way, everyone saw only their part of it, and that alone made it easy to dismiss what was really important. You could see what you wanted and parse whatever you saw any number of ways and no one could really say you were wrong. It was the old “You were given the wrong information”… “You didn’t get the full picture”… “You talked to the wrong people”… “You don’t understand the long-term goals” … “You’re not a team player”… “Give it a chance, it will work.”

  But it did seem to me at the time that if you really wanted to know the true costs of a disaster, you had better ask those really involved, and better still, those actually paying the price. And those were clearly the ones I saw at Zama, and today those landing at Dover, and the ones being carried off the med-evac C-5 at Andrews yesterday, today, and tomorrow.

  So, Life Magazine aside, I realized after a month or two at Zama that the whole war was coming to me and not just the war, but the price we were paying for that war. Out of those two years came the book 365 Days, which was nominated for The National Book Award. But back then, what I found baffling, and still today find so amazing, is that what I discovered and wrote down that was actually taking place, was during the time when we were all reading in the stateside newspapers that America was going to hell and that it was impossible to get an American teenager to act responsibly, listen to authority, to do what was asked, or for that matter to care about anyone but themselves.

  You would have thought then that it would be a hopeless task to get them to kill themselves for something as vague as duty, or to run through mortars and machine gun fire for anything as subtle as concern. But during the first five hours of what was to be called “Hamburger Hill,” fifteen medics were hit and ten were killed. There was not one medic left standing. The 101st had to bring in combat assault medics from two other companies during the firefight and by nine that night, every one of those medics too, had been killed or wounded.

  At the time, the Army psychiatrists at Zama called it a simple matter of roles. Soldiers and marines fight and die for each other, while medics growing up in the hypocritical adult world of Salinger’s Holden Caulfield, and placed at the heart of a war that even the dullest of them eventually found difficult to believe in, much less die for, were suddenly tapped, not for their selfishness or greed, but for their grace and wisdom, not for their brutality, but for their love and concern. The medic begins after a very short time to think of himself as a doctor as well as a savior. The fact that the units returned the medic�
�s concern with their own wholehearted respect and affection made the whole thing work. In a world of suffering and death, Vietnam became a Walt Disney true-life adventure, where the young were suddenly left alone to care for the young.

  That was then…

  Graham was eighteen years old when a tracer round skidded off his flack vest and triggered a grenade in his webbing. He struggled for a moment to pull it off and then, according to the other medic working with him, he jumped out of the aid station, and kept running, with the grenade bouncing against his chest until it went off.

  Webb had been in ’Nam only three days when he got into his first firefight. The 3rd Platoon working out ahead had killed three dinks near a bridge. A few hundred meters farther they found a small arms cache with four AK-50s, a couple of RPDs, and a Smirnov attack rifle. They waited for the rest of the company and then they all moved out through the waist-high grass. You could feel trouble coming; up and down the line, the troopers switched their weapons to automatic and shifted their rucksacks so they could drop them more easily. The machine gunners began carrying their weapons at port arms instead of across their shoulders. The grenadiers loaded their M-79s with canister rounds. Up ahead, fifty meters away, was a thick tree line. The only sound was the company moving through the grass and an occasional tinkle of loose gear. Webb was walking with the Sergeant.

  “Thirty meters,” the Sergeant said softly, “we’ll get hit inside of thirty meters.”

  “Sooner,” a trooper offered drily. Twenty meters farther, the firing began. Even as he hit the ground, Webb saw three figures tumble over in front of him. Within seconds, the whole field was exploding. Automatic fire cracked and snapped through the dry grass. An RPD hidden off to the right began firing and caught a squad trying to move off that way. Two other machine guns opened up on the left. Seeing where they were falling, the VC began skipping rounds into them.

  Behind and overhead, Webb could hear the gunships thumping their way toward them. The Vietnamese stopped firing as the first loach, small and agile, swept in over their heads. A moment later, a Cobra swung in. Everybody was popping smoke grenades. Webb got to his knees and, seeing a trooper dragging a body toward a nearby rise, shook off his rucksack. Taking his helmet off and leaving it on the ground with his M-16, he got to his feet and began running toward them with his aid kit. He made ten meters before they got him: a clean straight round that caught him under his swinging left arm and came out the other side of his chest.

  This is now…

  Johnson was twenty-two years old when the firefight broke out. It started with an IED that disabled one of the Humvees, killing the driver and severely wounding the machine gunner. The IED blast was followed by an attack where a dozen Taliban began to fire at the platoon from across an orchard. Two more marines were hit and dragged behind one of the stone walls near the road. Johnson picked up the medical kit and started to sprint towards the wall when a round hit him in the neck. Unable to stop the bleeding, he was dead a few minutes later—

  5.

  AMERICA’S WARS/AN AUTOPSY REPORT

  We rely on things, an enormous number of things. In the Second World War there were B-17s and B-24s, B-26s and B-29s, along with P-38 Lightings and P-51 Mustangs. The Navy had over thirty-six different kinds of ships in its fleet firing over two dozen different guns of some twenty different calibers. Our army went ashore at Normandy with dozens of types of trucks and tanks. Over 1,667 tons of bombs were dropped by 279 B-29s in one night, causing the firestorm of Tokyo that led to the destruction of over 300,000 buildings and approximately 125,000 deaths. And of course there were our atomic bombs.

  There are military historians who have commented that our ultimate victory in World War II was not so much a victory based on tactics and strategy as it was on the unfolding industrial might of the United States. General Fred C. Weyand, Chief of Staff of the Army, in his 1976 analysis of the Vietnam War said much the same thing, though in decidedly starker terms:

  War is Death and Destruction. The American way of war is particularly violent, deadly and dreadful. We believe in using “things”—artillery, bombs, massive firepower—-in order to conserve our soldiers’ lives. The enemy, on the other hand, makes up for his lack of “things” by expending men instead of machines, and for that suffers enormous casualties. The Army saw this happening in Korea, and we should have made the realities of [the Vietnam War] obvious to the American people before they witnessed it on their television screens. The Army must make the price of involvement clear before we get involved …

  Nowhere is this understanding of technical and industrial power as an element of winning our wars more dramatically and clearly explained than during the questioning of an unrepentant captured German officer by an American captain following the breakthrough of the German lines surrounding the 101st Airborne at Bastogne during the Battle of The Bulge in late 1945. Clearly irritated by what he considered the arrogance of the German officer, the captain challenged the German that if the Wehrmacht was such a superior fighting force, what were he and his men doing in an American prisoner-of-war camp? The Germans earlier in the war had used their own technology, advanced equipment, and industrial might in the form of Ju-87 Stuka dive bombers and Tiger Tanks to win their own victories. They understood the advantages of “things”.

  “Well,” the officer answered in perfect English, “We set up our guns. And you Americans sent a tank down the road and we destroyed it. Then you sent another tank down the same road and we destroyed that tank. Then you sent a third and fourth tank that we destroyed. Unfortunately, we ran out of ammunition before you Americans ran out of tanks.”

  The German officer’s professional arrogance was appropriate and in a way accurate, but his unit had been defeated and he was taken prisoner, whatever the reasons. Still, a post-World War II study documented that when Americans fought the German Army, if troop numbers were equivalent on each side, the Germans, despite having less and inferior equipment, often won or inflicted a disproportionate number of Allied casualties.

  But our reliance on things didn’t work all that well in Korea. Despite round-the-clock artillery barrages, the Chinese were willing to take enormous casualties as they drove the Eighth Army and the First Marine Division back from the Chosin Reservoir all the way down the North Korean Peninsula into South Korea. There were reports that some units of the Chinese Army attacked with only pitchforks and axes. It was only the daily strafing runs by U.S. fighter planes that kept enough soldiers and marines alive to allow what were left of the First Marine Division and the Eighth Army back to the safety of South Korea.

  Still that reliance on things continued on into Vietnam. Only then it was B-52s, C-130s, F-105s, and F-86 sabers, and helicopters, lots and lots of helicopters. There were gunships and slicks, med-evacs and Cobras, loaches and the twin engine Chinooks. And yet, after ten years of fighting with 58,000 of our own troops killed and another 400,000 wounded, we had to pack up and go home.

  There is a recorded conversation held in Hanoi during the peace negotiations preceding our withdrawal from Southeast Asia: “You do know,” explained an American officer to the Vietnamese negotiator, “that you never defeated us on the battlefield.”

  The North Vietnamese colonel pondered the remark for a moment. “That may be so,” he answered carefully, “but it is also irrelevant.”

  If Korea was the template of what can truly happen in a poorly thought-out war, where wishful thinking and industrial might replaces reality, Vietnam became the poster-child for the rest of the Twentieth Century and the beginnings of the Twenty-first.

  Senior Lieutenant Colonel Nguyen Hu An, Deputy Commander of the B-3 Front and Commanding Officer of the 66th North Vietnam Regiment explained his professional assessment of our war in an interview thirty years after the first major battle between regular forces of the North Vietnamese Army and the technologically-advanced United States Air Mobile First Air Cavalry using the new tactics of vertical envelopment.

  The battle o
ccurred deep in the Ia Drang Valley in the forested jungles of the Central Highlands near the Cambodian border during the second week in November of 1965. More than 234 troopers of the First Air Cav were killed and more than 250 wounded during the four days of the battle. The North Vietnamese paid a much higher price of over 3,500 killed and an unknown number wounded.

  We had never fought the Americans and were curious about this use of helicopters, which our troops, because of the thumping noise, called tractors with propellers. During the battle, I sat out on the mountain and watched how the helicopters and aircraft were used in this new kind of war. It was very interesting.

  What Colonel Hu An quickly grasped was that the North Vietnamese forces could not match the massive firepower of the Americans. He understood that any prolonged battle with the Americans, who could bring in ever-increasing fire power in the form of long-range artillery, helicopter gunships, napalm, fighter-bombers, and saturation B-52 raids, would always tip the scale of victory in their direction, no matter how hard or how bravely the North Vietnamese fought.

  Colonel Hu An and other Vietnamese officers realized that the only way their units could survive a firefight, much less a battle, with the Americans was to get in close and “grab the Americans by the belt buckle,” and not let go. It was clear that to give up distance during an attack or firefight was in essence to lose the battle. The strategy and the tactics would have to be to get in close and stay close, whatever the initial costs.

  What the Vietnamese had learned would become painfully clear over the remaining years of the Vietnam War. The American units might pound them, but the Vietnamese could—by picking the time and place of their battles—get in close to offset the offensive firepower and then withdraw as quickly as possible after initial contacts. This made up for being outgunned, while bleeding the Americans at their own game.