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Coming Back: Battling the Invisible Wounds of War
Military men and women now are returning with brain injuries that would have been fatal in earlier times. Here's how the nation's warriors and the medical teams that treat them are fighting these unseen battles. By John Pekkanen
Comments () | Published September 12, 2011
In combat in Iraq, Justin Bunce was where he wanted to be. Then shrapnel from an exploding IED broke his leg and ripped into the right frontal part of his brain. Photograph by Chris Leaman.

Justin Bunce struggles into the conference room dragging his left leg, using a cane, and looking as if he’d rather be somewhere else. He sits at a long table with members of a Traumatic Brain Injury medical team at National Naval Medical Center in Bethesda, awaiting their questions as part of his intake evaluation.

Bunce, 27, appears distracted. Despite lots of medications, he’s often unable to concentrate. He has had short-term-memory loss ever since an improvised explosive device (IED) planted in the wall of a cemetery detonated while he was on foot patrol in the Iraqi city of Husayba, near the Syrian border, in March 2004.

Shrapnel riddled his body, broke his leg, and ripped into the right frontal lobe of his brain and his right eye, leaving him effectively blind in that eye. At the time, he was a lance corporal in the Marine Corps, which he had wanted to join since his freshman year at Centreville High School in Fairfax County.

“What’s the toughest branch of the service?” he had asked his father, Peter, an Air Force colonel and career military man.

“Physically, it’s the Marines,” his father said. “There’s not even a close second.”

From then on, Justin Bunce never wavered. He became a workout fanatic and played rugby in high school so he could become a great Marine. Part of an elite unit in Iraq, he was one of the first Marines to engage in night fighting. “When I was in combat in Iraq, I was on cloud nine,” he says. “I was where I wanted to be.”

Following his first Iraq tour, during which he survived many firefights, he was called up for a second—which turned out to be his last.

After his injury, Bunce wound up at National Naval Medical Center in Bethesda. When he learned that the commandant of the Marine Corps was coming to pin a Purple Heart on him, he resolved to be at his best.

He asked his dad to shave him and put a Marine Corps uniform shirt on him. When the commandant entered Bunce’s room, Bunce shifted his legs off the edge of his bed, pulled himself up, and, straining to maintain his balance, stood at attention as the commandant pinned on his medal.

• • •

His hair trimmed short, wearing a robe, and with a black patch covering his right eye, Bunce asks for a cigarette as he sits down at the table for his intake evaluation in March of this year. He knows his request won’t be granted.

He looks up when Dr. David Williamson, a neuropsychiatrist and director of the Inpatient Traumatic Brain Injury Program, enters the room. Bunce reaches over with his right hand to clasp the doctor’s hand and says, “Aye, laddie,” mimicking Williamson’s Scottish accent. Williamson, a civilian, smiles and withdraws from the room.

The initial impetus to create the Traumatic Brain Injury (TBI) unit—usually referred to simply as 7 East, for its location in the medical center—arose in 2005 after the Marines entered Fallujah and suffered some traumatic brain injuries during the intense fighting there. Four years in development, the unit opened in early 2009. The 7 East team has experts in neuropsychiatry and neuropsychology as well as speech, physical, recreational, and occupational therapy. The unit is the only one of its kind anywhere; with just six beds, it can accommodate only a small percentage of those in need of it.

This troubles Cheryl Lynch, founder and executive director of American Veterans With Brain Injuries. Her son Chris, an Army paratrooper, suffered a near-fatal brain injury when he fell 26 feet in a training accident in 2000. Since then, Chris has seen countless doctors in his search for treatment for his mood swings, violent outbursts, and bouts of bizarre behavior, which sometimes grew destructive when he was prescribed the wrong medication. His mother says her son’s treatment at 7 East has significantly improved his behavior.

“The expertise Dr. Williamson and the staff at 7 East provides is unique—they are making a big difference with Chris,” she says. “But this level of care should be available in all our Department of Defense health-care systems for all returning servicepeople with TBIs. The country owes them that.”

TBIs have been called the “signature” injury of the wars in Iraq and Afghanistan. They frequently happen when metal fragments from high-energy explosions penetrate brain tissue or when blast waves traveling at 1,600 feet per second hit the brain, rupturing blood vessels and tearing tissue. Bunce likely suffered from both.

A 2008 RAND Corporation study found that 20 percent of the 1.6 million US military personnel who had served in Iraq and Afghanistan since 2001—320,000 in all—had suffered some form of combat-related brain injury, including TBIs, depression, and posttraumatic stress disorder (PTSD). These numbers make clear that the cost of the wars will continue long after they have ended.

“Our mandate and area of expertise is to understand and treat these injuries,” says Williamson, who received his psychiatric training at the Johns Hopkins School of Medicine and the University of London. “The sad fact is that the wars are driving an increased knowledge of brain injury. Because of the body armor they wear and the rapid intervention and evacuation, many soldiers who would have died in earlier wars now survive potentially lethal brain injuries.”


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  • Bot

    So glad to see you doing what you do so well.

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Posted at 12:09 PM/ET, 09/12/2011 RSS | Print | Permalink | Comments () | Articles