Remember the wounded

Maybe a tragedy as bad as the soldiers dying in Iraq are the wounded who survive. Today's medics can save many who would otherwise have died. So guys are surviving with one to four limbs missing, with their faces shot off, deaf, blind or otherwise incapacitated and helpless. Here are two articles about this hell of the war:

1. Forget the War? Many Can't by Bob Herbert

Specialist Fourth Class Hugo Luis Gonzalez knows that he will never be the same. He can barely see now. The sight in his right eye is completely gone, and he sees only faintly with the left. The damage from the head wound he suffered plays games with his moods, and there are glitches in the tape of his memory. "We got ambushed," he said softly. "I have to say I was very, very, very blessed that night. The angel of death put his cloud over my body. But I am alive."

Specialist Gonzalez is one of many thousands of American troops who have suffered disabling wounds in Iraq. Their harrowing ordeals do not get much attention. For most Americans, these troops - many of them armless or legless, or paralyzed, or horribly burned - are out of sight and way out of mind. Jennifer Aniston's marital woes are viewed as a much more compelling story.

On CNN's "Reliable Sources" on Sunday, there was a discussion of "Iraq fatigue," the idea that viewers, readers and editors are tiring of stories about the war and the number of deaths. But despite the fatigue, the war continues to force itself on us, with jolting developments like this week's terrible death toll for American marines.

Specialist Gonzalez was wounded in an attack that erupted in the 1 a.m. darkness of the first day of summer in 2004. He was on patrol in a "bucket," a Humvee that was open in the back like a utility truck, and not armored. Everybody understood that the vehicle was dangerously vulnerable to improvised explosive devices, so a system was devised to rotate the troops who rode in it. It's fair to think of this as a roadside version of Russian roulette. "It was a whole experience to prepare that vehicle to go out," said Specialist Gonzalez, "because you knew that if something happened, you were definitely going to get it. We put as many sandbags as possible on the floor, hoping those sandbags might save your life." I asked if he had done anything else to prepare. "Oh, yes," he said. "Pray. And then you take a big breath when you go out of the gates to start the mission. You inhale at that moment. And when you come back from the mission, then you exhale."

On that morning, Specialist Gonzalez had to be carried back from the mission. The "bucket" took a direct hit from an I.E.D., and a furious gun battle with insurgents broke out. Fragments from the blast ripped into Specialist Gonzalez's head. "I remember trying to get down and calling for a medic," he said. "I lost consciousness on the floor." Emergency surgery was performed in Baghdad, and then Specialist Gonzalez, who is 32, was flown to Germany and eventually to the Walter Reed Army Medical Center here. A portion of his skull was temporarily removed because of the swelling of his brain. It has since been restored, and he is still being treated at Walter Reed.

I interviewed Specialist Gonzalez on Tuesday in the quiet, air-conditioned offices of Disabled American Veterans, which is helping to prepare him for the transition to civilian life. He sat rigidly on the edge of a sofa, his left hand clinging to the knee of his wife, Any, who is 27. They were married last February. "She has to be my eyes now," he said.

I asked Specialist Gonzalez if he had ever become depressed during his ordeal. "Yes, I did, sir," he said. "Actually, I've been getting more depressed lately than in the beginning." After a pause, he said, "Frustration makes me sad sometimes. And I have mood changes. From very happy to kind of sad from one moment to another. And I've become judgmental. Criticizing others. I do that most of the time. Even Any. People have pointed it out to me." His ability to concentrate has deteriorated, he said. "I have to accept it. My room is like a whole map where I keep big chart boards to remind myself which day I went to the gym, which bills I have to pay, so I don't pay them again."

These are the kinds of sacrifices some Americans are making because of the war. If we're already sick of hearing about the troops getting killed, there's not much hope left for increased attention to those who are wounded. Specialist Gonzalez said his chief worry, the concern that keeps him awake at night, is what lies in wait when he finally leaves the hospital and returns - newly married and without many of the tools he previously took for granted - to the "real world."


2. We should recognize and honor all sacrifices for America by John Wheeler

Eleven years ago Lewis B. Puller Jr., winner of a Pulitzer Prize for the book "Fortunate Son" on his experiences as a Marine platoon commander who was severely wounded in Vietnam, took his own life. Puller had lost both legs and the use of his hands in the war. On May 11, 1994, he finally succumbed to stump pain, to frustration at his inability to grasp objects and to depression, which he had fought for 25 years.

We were close friends, and I can attest that Lew fought his troubles to the end. Despite his disability, he had just completed a trip to Hanoi to pick school sites for the Vietnam Children's Fund. The first school was named for him.

Wounds like Lew's -- from what is now called an improvised explosive device -- are more frequent in Iraq than they were in Vietnam. With protection around vital organs, the rate of wounded Americans having amputations is 6 percent -- three times the rate it was in Vietnam. Also, because of the angle from which such explosive devices strike, about one in five of those evacuated to Landstuhl Regional Medical Center in Germany has head or neck injuries; many have brain damage, breathing and eating impairments, blindness, or severe disfiguration.

Thanks to forward surgical teams, in mini-hospitals close to battle, the ratio of wounded to killed is 8 to 1 in Iraq, up from 5 to 1 in Vietnam. Surgeon Atul Gawande wrote in the New England Journal of Medicine about one Iraq case, "Injuries like his were unsurvivable in previous wars. The cost, however, can be high. The airman lost one leg above the knee, the other in a hip disarticulation, his right hand, and part of his face. How he and others like him will be able to live and function remains an open question."

Lew's case shows the need for recognition, support and encouragement for these wounded, especially to avert depression, isolation and suicide. Like Lew, many wounded veterans can continue to be very productive, but they can at the same time be afflicted by potentially fatal aftereffects. Unfortunately, no Memorial Day ceremony or war memorial that I have seen has explicitly honored the wounded. In fact, under House Concurrent Resolution 587 of Feb. 10, 1966, Memorial Day is simply for paying "tribute to those who gave their lives."

This oversight needs correction. We need to honor the wounded as well as those who died. Their numbers are growing, and society needs to both acknowledge their sacrifice and understand their situation. And it needs, through this tribute, to give support and encouragement to the families of the wounded -- families that bear great anguish, time devoted to care and economic loss.

Some wounds are not as visible as others. The Purple Heart excludes post-traumatic stress disorder as well as infections and disease that often become evident after a veteran has left the war zone. The Department of Veterans Affairs has reported, concerning Afghanistan and Iraq, that these new wars "will produce a new generation of veterans at risk for the chronic mental health problems that result, in part, from exposure to the stress, adversity, and trauma of war-zone experiences ... [I]t is important to ... raise the awareness of civilians back home, to prepare loved ones for soldiers' return."

The nation and its government need to give some thought to ways to honor the wounded and to recognize the full range of impairments suffered by those who have served and sacrificed for their country. Topics for discussion could include officially expanding the purpose of Memorial Day, establishing medals for cases excluded from the Purple Heart (severe illness in the war zone or later, and death in battlefield accidents), and mentioning the wounded, veterans who suffer illnesses and their families in war memorials.

AMEN.