- The Washington Times - Thursday, March 30, 2006

Third in a series of occasional editorials on wounded servicemen returning from Iraq.

Since an improvised-explosive device detonated beneath Army Sgt. Edward Wade’s Humvee outside Fallujah on Valentine’s Day 2004, Edward and his wife, Sarah, have experienced first-hand the extent to which the United States was unprepared for the severe injuries coming out of Iraq. The story of Edward’s medical care is in some ways one of incredible and unprecedented logistical feats which save lives and bring the severely wounded closer to normalcy than ever previously possible. On the other hand, it is also the story of an incomplete and frustrating system which is only beginning to adapt to cases like the Wades’.

In the 2004 blast, Edward was flung 20 to 30 yards, lost an arm, suffered a traumatic brain injury and would spend the next two months in a coma. He was shuttled from the scene by Medevac; sent to a temporary military hospital, then to Baghdad, Germany and Walter Reed Medical Center in Washington. The blast made Edward one of the first of hundreds of “polytrauma” wounded in Iraq.

Edward had severe difficulty speaking when he first emerged from the coma; he had temporary short-term memory loss; he was forced to re-learn many basic life skills; and while he has made an encouraging recovery — his wife reports that he is active and is the same Edward she married — he still suffers ongoing neurological effects, including severe anxiety and episodes which doctors have yet to be able to fully diagnose. His injuries are complicated and require multiple types of treatment.

No single hospital or clinic has been able to handle all of Edward’s needs adequately; he has spent the two years since leaving Walter Reed bouncing from facility to facility, making dozens of outpatient trips in various states and the District of Columbia. Care has varied from excellent to decent to poor, but no single facility has been able to treat Edward’s amputation-related needs and help him recover from his brain injury at the same time. Initially, this meant one problem was treated while the other languished. At Walter Reed in March 2004, therapists made great strides to help Edward out of his coma, but it was too early to take much advantage of Walter Reed’s extensive amputee resources. By the time Edward was able to do so, he was transferred to the Polytrauma Rehabilitation Center in Richmond. There, the Wades were able to take advantage of Richmond’s relatively advanced brain-injury resources, but the amputation treatment lagged.

Leaving the Army and transferring to the care of the Veterans Administration caused the most difficult transition. In September 2004, Edward was sent to a VA nursing home in Durham, N.C., where he ended up sharing a suite with two World War II veterans and a Korean War veteran. Sarah says that he was there “for lack of a better place to send him.” This wasn’t so much the fault of the VA as a reflection of the population the VA caters to: mostly people in their 70s and 80s suffering from afflictions common to their age group. A severely wounded Iraq veteran in his 20s and 30s was bound to be out of place in such a facility.

At that point, the Wades did the only thing the system allows them to: Become “road warriors,” as Sarah half-jokingly calls it. Since Durham, Edward and Sarah have made no fewer than 20 five-hour drives from their home near Chapel Hill, N.C., to Washington’s Walter Reed in the last year. Through a referral from a brain-injury specialist at Walter Reed, the Wades have found a clinic in North Carolina to their satisfaction, but the best treatment for his amputation is still found at Walter Reed. The Wades consider themselves lucky: They have no children or other reasons to weigh against the frequent medical travel. Sarah rightly remarks that people with greater family responsibilities wouldn’t be able to travel so far so often.

The immediate context for all this is the Veterans Administration’s plans to roll out several more “polytrauma” centers along the lines of the Richmond facility. More centers are clearly to the good. The Wades’ experience suggests another pressing need for the most severely wounded Iraq veterans, however: getting as much expertise as possible in one place. Congress and the Veterans Administration should heed voices at Walter Reed who call for expanded brain-injury treatment there. For the most immediate positive impact, we should try to ensure that at least one or two facilities offer all types of excellent care for veterans with multiple severe injuries.

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