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Coming Back: Battling the Invisible Wounds of War
Comments () | Published September 12, 2011

In response to questions from Army captain David Lee, a psychiatric intern, Bunce, slouching in his chair, describes his family and background. As he talks, his head sometimes slumps forward and he nods off.

“How well are you sleeping?” Dr. Lee asks.

“I hardly sleep at all,” Bunce says. He reports pain in his head, neck, back, and limbs and can’t sleep at night.

Even when he doesn’t nod off, Bunce’s short-term memory is so compromised that he often forgets the questions Lee poses.

“Could you repeat that?” he asks several times.

One day in October 2004, seven months after his injury in Iraq, Bunce was driving to Gettysburg to meet members of his Marine unit home on leave when he lost control of his car. Knocked unconscious in the one-car accident, he suffered additional brain damage. Doctors asked his father to be ready to make a decision about taking him off life support because they held out little hope for his recovery. Justin has no memory of the accident. It’s possible he suffered a seizure.

His father didn’t know that Justin, despite the brain injury and only one functioning eye, had gotten behind the wheel to drive. He thinks his son was motivated to see his Marine buddies because, like many injured servicemembers, he wanted to rejoin his unit and redeploy to Iraq, an impossibility given his combat injury. For a time, Justin refused to take prescribed drugs because he felt doing so would diminish his chances of returning to duty.

At the Hershey Medical Center after the accident, Justin suffered a severe infection that antibiotics eventually brought under control, but not before it had caused additional loss of brain tissue, especially in the right hemisphere. When Williamson examined Bunce’s brain scans from before and after the car accident, he concluded that the accident and infection had caused more extensive damage than the IED explosion.

Before coming to 7 East, Bunce lived for more than a year in a group home in the Shenandoah Valley for people with disabilities, but he says the place did him no good: “There was no therapy there—everything was outsourced.”

Besides short-term memory loss, the trauma to Bunce’s brain caused paralysis in his left arm and leg and produced personality changes that remain unresolved.

“Most of Justin’s right frontal lobe is gone, and part of his left frontal lobe is gone as well,” Williamson says. “This is a very severe traumatic brain injury that causes him to have chronic problems with attention, memory, impulsivity, organization, and, on top of that, bad judgment as well as personality and behavior changes.”

His father says that on many occasions Justin has stepped into the street without looking for oncoming cars. He often acts as if the normal restraints that govern social behavior have been stripped away.

• • •

During his intake interview, Bunce fixates on an attractive medical student sitting across the table from him. He stares at her and asks if she’s available. She politely fends off his advance. After more edgy banter, Bunce realizes that his efforts are going nowhere.

“You’re very distracting and I can’t stop looking at you,” he tells her. “Could you please move from that chair so you won’t be in my line of vision?” She moves a few seats away.

His approach to women remains unchanged. A few days later, he tries to hit on a female chaplain in an elevator.

Later in the interview, he asks for the numerical code that opens the exit door from 7 East, presumably to get out to buy cigarettes. Dr. Lee refuses.

“I will haunt your dreams,” Bunce tells him in a heavy voice leavened with a trace of humor. He seems to enjoy making idle threats. A few days later, agitated after again being denied a cigarette, he tells members of the staff that he plans to stage a “bloody coup” and take over 7 East. He’s joking, but there’s an edge to his humor. He really wants cigarettes, he says, “because I need the stimulation of nicotine to wake up.”

As the intake interview proceeds, Bunce’s head droops again; he struggles to stay awake and remember the questions. Then, toward the end of the interview, the subject of movies comes up and he begins quoting lines from his favorite movie, The Big Lebowski.

Suddenly alert and animated, he laughs and repeats more dialogue from the film. It’s almost as if he’s a different person.

As Bunce leaves the conference room, someone mentions a line from the movie. Bunce turns and corrects him, then proceeds to recite the dialogue from an entire scene.

Despite the extent of his brain injury, Bunce is oriented to time and place and is aware of his surroundings. He comes across as an intelligent person with a sharp sense of humor and excellent verbal skills. Williamson attributes Bunce’s ability to verbalize so well to the fact that he’s right-handed, which means his language abilities reside in his left brain. If he had the same amount of damage to his left brain as to his right, Williamson says, he would have lost most of the language ability he now has. The fact that Bunce thinks, talks, and functions as well as he does is a testament to his and his brain’s resiliency.

“Considering what has happened to him, I got a lot more of Justin back than I ever thought I would,” says his father. “His judgment is lacking, but he can still love and laugh.”


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