But this absence of practical record keeping isn’t an anomaly in the military. As yet there isn’t a standardized medical database that chronicles or catalogs the casualties or fatalities of Iraq and Afghanistan. But during a 2010–2011 deployment in Afghanistan, Colonel Michael D. Wirt, a brigade surgeon with the 101st Airborne Division, created a unique, multilayered database that tracked wounded soldiers with remarkable detail. In this database, Wirt included criteria like “increased or decreased risk factors—whether the victim was wearing larger or smaller body armor, whether a bomb-sniffing dog was present, when a tourniquet was applied” when he listed casualties and deaths during war. He also “mapped where on the human body bullets most often struck.”24 Wirt’s work was unique in that the information he added to basic medical record keeping was not only meticulous but also incredibly detailed. His database was intended to build a narrative, and to potentially solve problems.
But for the US military—or even each individual branch—to keep such meticulous track of all their deployed servicemen and women would take an incredible amount of manpower and hours. The MWD program, at minimum, would require an across-the-board change in regulation in the way records are maintained and shared up and down the chain of command, from the veterinarians, to the handlers, to the kennel masters, to the program managers.
By the time he was deputy commander at Blanchfield Army Community Hospital, Wirt told the New York Times in 2012, “If you don’t take data and analyze it and try to find ways to improve, then what are you doing? . . . A consolidated database with standardized input consisting of mechanism of injury and resulting wounds, classified by battle and nonbattle injuries, would be something you could actually use.”25
Were the MWD program to maintain something like this, they would be setting a kind of military precedent. But its potential value for soon-to-be deploying handlers, at training facilities like ISAK at the Yuma Proving Ground, could be quite high. Knowing the details of how handlers are getting wounded or killed would be exceptionally useful. Knowing, for example, the type of IED, its size, where it was buried, how deep, how many of them. But the information, if available, is not shared, and the few people who are trying to correct the problem believe it may be impossible to shake up the system enough to inspire real change or true transparency.
Even so, there are worthy lessons to be learned.
Part III
Eight
Wounds and Healing
Thousands of our men will soon be returning to you. They have been gone a long time and they have seen and done and felt things you cannot know. They will be changed.
—Ernie Pyle, Brave Men
Usually [dogs] are quick to discover that I cannot see or hear. Truly, as companions, friends, equals in opportunities of self-expression they unfold to me the dignity of creation.
—Helen Keller
They made it into Baghdad on a Monday night. It was already very late by the time Army Captain Cecilia Najera’s flight from Tikrit landed. Najera was uneasy about this trip, but when she looked down she was contented. Her partner, a black Labrador retriever named Boe, whom she called her “little shadow,” was close beside her.
Lieutenant Colonel Beth Salisbury, commander of the Camp Liberty Stress Clinic, was there to pick them up. Najera and Boe climbed into the vehicle. Salisbury looked and sounded exhausted as she briefed Najera on what they would be walking into that night.
Earlier that day, May 11, 2009, Army Sergeant John M. Russell, a patient, had walked into the clinic and opened fire on fellow servicemen, patients, and staff, killing five people and wounding three others.1 Russell, who was on his third deployment, had been escorted to the clinic that morning, not by his own choosing but on his commander’s insistence. Russell had been exhibiting alarming behavior, openly expressing thoughts of suicide. In fact, he had already been to the clinic on four separate occasions and, only three days earlier, his commander had disabled his weapon by removing the bolt so that it couldn’t be fired. But once at the clinic he became belligerent and was told to leave.
Just one hour later, he fought with the soldier placed as his escort and took his weapon, an M16 rifle, and forced the man from the car at gunpoint, intending to return to the Stress Clinic.2 The soldier had alerted military police but by the time they tried to warn the clinic’s staff, it was too late. When the police were on the phone with the clinic, the officers said they had heard shots being fired on the other end of the phone line.3 The Washington Post and the New York Times called it the deadliest incident of soldier-on-soldier violence since the invasion of Iraq in 2003.4
Najera and Boe weren’t in Iraq to find bombs or drugs, or work
patrols—this dog team was there as part of a new Army initiative. An occupational therapist, Najera had deployed to Iraq with the 528th Medical Detachment Combat and Operational Stress Control Unit, where she had been previously stationed at Contingency Operating Base Speicher. Boe, her partner, was not a traditional war dog, but a combat-trained therapy dog.
It was just pure coincidence that Najera and Boe arrived in Baghdad on the day of such a tragedy; their plans had been made long ago. Najera and Boe had visited this clinic before, and they knew the people who had been inside during the attack. Which was part of why Najera was uneasy, scared even. She was not only unsure of what she and Boe were about to encounter, but she was at a loss to think of what she could do to be of any real help. The people in this clinic weren’t just soldiers, they were therapists and doctors, health-care professionals just like she was. What could she possibly say, she wondered, that would make a difference to any of them?
“I’m not sure that they’re going to want to talk to you,” Salisbury warned her as they drove, as if reading Najera’s mind. The clinic, she said, had been inundated with offers of support, but she doubted any outsider would be able or even welcome to do much for her staff. Not tonight at least, she said. It was too soon.
The military police had sealed off the clinic as a crime scene, so the staff was in the small adjacent building that housed the commander’s office. Najera and Boe waited in the hallway with the others who had come to lend their services—chaplains, a social worker, other mental health-care providers. They stood in silence until a sergeant emerged from the room where the clinic staff had gathered together. She addressed the group in the hall. “No one on staff wants to see anyone,” she said and told them all to leave. Najera turned to shuffle out with the others, but then she heard the sergeant’s voice again. “Ma’am?” The woman was addressing Najera. “You and Boe can come in.”
Inside, the clinic staff sat without speaking. Their eyes were red and raw—from crying or exhaustion, Najera couldn’t tell. She simply nodded at the group, slipped into a chair, and unclipped Boe’s leash, so the dog could have range of the room. Boe wove her way in and around the chairs, sniffing and greeting people as she encountered them. The sergeant who had invited them to stay called Boe over to her and kept the dog next to her, patting her large black head.
Once or twice someone would break the silence. One of the younger staffers, a woman, wanted to talk about what had happened. But after she spoke the group went mute again. It had been a long day for Najera and for Boe, the dog was tired, and they hadn’t planned on working straight from the plane so Najera hadn’t dressed Boe in her vest—a signal to the dog that she was in work mode. So being tired herself after a long day of traveling, Boe plopped down in the middle of the room with little grace, releasing a heavy, grunting sigh.
A few people chuckled at this, some small smiles showed, even if briefly. And Najera felt reassured. The dog had just done what probably every person there had wanted to do, and though it was a mild kind of relief, for the smallest of moments the tension broke and the room lightened.
Between 2007 and 2011, there were eight dogs who made up the very first Combat and Operational Stress Control (COS
C) dog therapy teams: Boe and Budge, Zeke and Albert, Butch and Zach, Apollo and Timmy.5 They were the first therapy dogs ever trained and deployed to combat theater in Iraq and Afghanistan.
Hatched in 2007, the idea to deploy COSC dogs evolved after those working with wounded soldiers at the Walter Reed Army Medical Center began to notice that the service dogs, assigned to help wounded soldiers get used to prosthetic limbs, were just as integral to each patient’s emotional recovery as to their physical recovery. Cases of animal-assisted therapy for people recovering from severe injuries or trauma were well documented. So why did soldiers have to wait until they were wounded to benefit? Why, these therapists wondered, couldn’t this kind of restorative interaction be applied preemptively in a combat theater?
The Army partnered with America’s VetDogs (a nonprofit started by the Guide Dog Foundation for the Blind) and developed a program that would bring skilled therapy dogs into the theater of combat.
The idea was progressive but simple: the dogs would become part of the combat stress control units, attached to occupational therapists who would also receive additional training so that they could become therapy-dog handlers. The COSC units were mobile, meaning that they traveled from FOBs to PBs, essentially acting as a rotating or even door-to-door resource, bringing stress and trauma relief to servicemen and women in the combat zone. The dogs were intended to serve as an adjunct, an icebreaker so to speak, to the therapy their handlers—and the units they served—were already offering deployed service members.
In many ways, the COSC dogs required much of the same kind of predeployment preparedness training that being a military working dog necessitates. The dogs had to be exposed to the elements in which they would be working—the different kinds of terrain, the feel of ear muffs and goggles, live gunfire, explosions, the sound of large military aircrafts, helicopters—so that they could become used to them. Unlike MWDs, the COSC dogs had to be adaptable to multiple handlers and fill different roles. Their demeanor was of the utmost importance: these dogs had to have close to the perfect temperament to be effective in this demanding job.
In December 2007 the first two COSC dogs deployed to Iraq. They were a pair of matching black Labs: Special 1st Class Budge and Special 1st Class Boe.
Boe was a quiet dog, lumbering and sweet, with a molasses-mellow temperament. As an occupational therapist who’d volunteered to be a COSC dog handler, Najera saw the difference Boe made with her patients almost instantly. Boe wasn’t just popular with the soldiers, but with command as well. While Najera had anticipated resistance to the idea of therapy in the theater of war, the stigma of which still looms large, she found that with Boe, her presence was not just accepted, but welcomed with enthusiasm.
Still, Najera tread lightly, never forcing Boe on anyone. The dog was gentle enough that Najera could often let her roam off the leash. The dog had a knack for seeking out reluctant and withdrawn soldiers who might be too shy or traumatized to ask for help from another soldier.
Boe did not just help soldiers who were deeply affected; she also helped others with more mundane problems. At one point during their tour, Najera noticed that Boe had gained quite a bit of weight from all the treats she had been given. Najera realized that a soldier who liked to visit Boe had also been gaining weight—it was slowing him down and he was having a hard time finding the energy to motivate himself to exercise. So Najera used Boe as a way to engage him, never really directly addressing his weight issue. Instead she made it about Boe. Pretty soon, the soldier was taking Boe out on runs a few times a week—he decided they would lose the weight together.
Boe was effective in even more subtle ways. Najera began to see soldiers put their hands on the dog without any prompting, and then, finally, begin to open up about their problems. Others simply liked being around the dog, approaching her because they just wanted to hug her before they continued about their day.
Captain Cecilia Najera poses with her COSC dog Boe while they served together for 15 months in Iraq in 2009.
When they started their duties in Tikrit, Najera and Boe made regular visits to the combat support hospital. It was a US military facility but the staff there treated Iraqi civilians as well—anyone who was injured as a result of the war, even insurgents. While in the hospital Najera was always careful not to approach Iraqi patients with Boe, conscious of the cultural differences between the way Americans and Iraqis regard dogs. In Iraq, dogs are generally considered unclean and not kept as pets; in urban areas, dogs run wild in the streets.6 (The stray dog population reached epic proportions in 2010, and after a spate of attacks on residents of Baghdad, the Iraqi government took action and deployed some 20 teams of veterinarians and police to shoot or poison the dogs. They killed upward of 58,000 stray dogs in three months.) But Najera and Boe made so many trips to the hospital together that the civilian patients and their visiting families grew familiar with the dog team, sometimes even smiling or laughing when Boe passed by.
There was one young patient Najera would notice, a young Iraqi girl around 12 years old. According to the story Najera was told, the girl’s parents were both insurgents who had been killed during a raid by US forces. The girl was badly wounded during the fight, shot after she herself apparently reached for a weapon. The bullet that hit her in the abdomen went into her small intestines, wreaking havoc on her insides and exiting her colon. She had a colostomy bag and was for many months confined to her bed. She was so frail and small that the girl appeared many years younger than she actually was.
Each time Boe passed by, the girl stared out from her bed, watching with large dark eyes. Najera assumed the girl was afraid of the dog. So when one of the nurses approached her and said that she thought the girl would really like it if Boe visited her bedside, Najera was surprised and somewhat reluctant. The nurse insisted. The staff had been giving their patient Play-Doh to occupy the long stretches of confinement to her bed; each time the girl would fashion the clay into small, brightly colored dogs.
Those first visits Najera took it slow, keeping the dog at a distance. The girl would smile. Najera did tricks with Boe, like “sit,” “shake,” and “lie down,” and the girl laughed. It took a few weeks, but finally she reached out a cautious hand and touched the dog to pet her. As she recovered over the six months of her hospital stay, the girl was eventually able to get up from bed. Not long after, she took to walking Boe up and down the hallways. When she was with Boe, the girl seemed genuinely happy.
The night of the shooting at Camp Liberty clinic, there had been a forecast for a huge sandstorm. Najera and Boe had been lucky to catch their flight over to Baghdad. Their stay was extended another week because of some other transportation delays. Initially, Najera was frustrated that she and Boe were unable to find another flight back to Tikrit, but later, she felt grateful. There were five memorial services held that week for the clinic staff, and she and Boe attended each one. That was when the tears came. Those were some very long and challenging days for the COSC dog team—there were no breaks. She and Boe worked straight through the day and into the night. It was the hardest week of their 15-month deployment. Najera felt that she and Boe were meant to be there to help in the aftermath of such a tragic event. That’s why she and Boe were in Iraq.
No one is entirely sure why John Russell snapped that day at the Liberty Clinic in Baghdad, or what drove him to kill five people. According to a 325-page report published in October 2009 investigating the incident, he’d been exhibiting erratic behavior for weeks and threating suicide.7 When this mental break occurred, Russell was just six weeks from finishing what was his third deployment to Iraq. While his rampage was unprecedentedly deadly, he was far from the first soldier to crack under the strain of combat.
Since the Iraq and Afghanistan wars, post-traumatic stress disorder (PTSD) is so prevalent among US servicemen and women that it has earned classification as an outright epidemic, reaching catastrophic numbers in the m
ilitary. Of the soldiers, Marines, airmen, and sailors coming home from Iraq and Afghanistan, one in five will return with PTSD, adding up to 300,000 so far. (About 380,000 who deploy to these two wars will suffer from a traumatic brain injury.)
Untreated and unaddressed, PTSD frequently leads to volatile behavior and suicide. The recent rate of suicide among active-duty service members, as well as among recent veterans, is rampant. Currently, every 80 minutes a veteran takes his own life. From 2005 to 2010 a service member committed suicide once every 36 hours. The 1 percent of Americans who have served in the US military represents 20 percent of the country’s suicides.8 “Suicide,” as journalist Tina Rosenberg reported in September 2012, “is now the leading cause of death in the Army.”9
The symptoms have been the same war after war: records dating back to the ancient Egyptians tell of warriors and soldiers who were psychologically wounded by the battlefield. The Romans and Greeks also noted similar, damaging phenomena after combat.10
In later eras, there was an agreement among the symptoms soldiers felt when they had been damaged by war—anger, anxiety, depression, obsessive thoughts of going home, insomnia, loss of appetite, heart palpitations, and bouts of fever. In the seventeenth century Swiss military doctors called it “nostalgia.” The Germans and the French had words for it that meant “homesickness.” And the Spanish termed it estar roto, meaning “to be broken.”11
During and after the Civil War, such afflictions took on the name Da Costa Syndrome after a doctor, Jacob Mendes Da Costa, made a clinical study of it with 300 soldiers, publishing his reports in 1871.12 Afterward, though, it became better known as “soldier’s heart.” During World War I, physicians fashioned the term “shell shock,” originally coined by Captain Charles Myers in 1915 to describe a syndrome in which physical and neurological ailments were thought to be a direct result of the force of a blast, a literal shaking of the brain. Within a year, though, many of these same symptoms—treacherous headaches, ringing in the ears, memory loss, feelings of being disoriented, an inability to sleep—were exhibiting in soldiers who had never suffered a blast. Instead military physicians determined that this was not shell shock but rather a break in nerves, or “neurasthenia.”13 During World War II the syndrome became known as “combat fatigue.” In Vietnam the condition was notorious for violent flashbacks and was believed to have been compounded by the poor reception servicemen received upon their return home. To make matters worse, men who reported feelings of depression, paranoia, sleeplessness during wartime were thought to be fainthearted, or cowardly would-be deserters looking for some way out of their soldier duties. This attitude persists today and is still an obstacle to effective treatment.
War Dogs Page 20