On Aug. 7, 2003, his first day off in a month, Army Cpl. Robert “B.J.” Jackson headed into Baghdad’s commercial district with four other soldiers. The then-22-year-old had been in Iraq for four months with the Iowa National Guard. The Humvee he was in hit a land mine under Jackson’s driver’s seat. Almost immediately, a rocket propelled grenade (RPG) was thrown inside his door. The soldiers in Jackson’s group worked to free him from the truck as they fought off insurgents. “The tendons in my left leg were wrapped around the brake pedal. My right leg was burned to the bone. I must have grabbed for my legs because I had burns on my hands and arms,” recalls Jackson.

He was airlifted to an Iraqi field hospital, then to an Army combat hospital in Kuwait, and on to Landstuhl Regional Medical Center in Germany. He arrived at Brooke Army Medical Center (BAMC) in San Antonio Aug. 12 and remained there in a medically induced coma for one month. Jackson’s 20-year-old-wife, Abagail, left their two daughters with her grandmother and kept vigil by his side. “She broke it to me slowly that my legs were gone,” says Jackson.

By November, he was learning to walk on his new prosthetic legs, and by December he was skiing. “My right hand is deformed. Two fingers don’t straighten, and the others don’t bend. But I can still hold a pool stick,” laughs Jackson. He admits to some dark days but says he surprises even himself by his ability to stay upbeat.

Today, Jackson is employed by the Coalition to Support America’s Heroes, a nonprofit group that helps recently disabled veterans by building them accessible homes and sponsoring family support networks and programs to encourage companies to “hire a hero.” Jackson, whose occupation once was home improvement, says he is “not big on the office work, but I get a lot of satisfaction from helping others who have been injured.”

Team effort

Lt. Col. Tim Maxwell, USMC, has seen six combat deployments. “I always planned on getting killed,” he says. “But [I] never thought I’d be injured in a way that would leave me with diminished capacity.” Maxwell was severely injured by enemy mortar fire Oct. 7, 2004, during his second tour in Iraq. He awoke 34 days later at the National Naval Medical Center in Bethesda, Md., to find he had suffered traumatic brain injury.

More than a year after his injury, Maxwell has exceeded all expectations for his recovery. Still, he has severely impaired vision, cannot drive, has trouble reading, and often searches for the right word to finish a sentence.

Maxwell returned to his home base, Camp Lejeune, to further recover at the Naval hospital there. Lejeune’s Marines and the Navy corpsmen who serve with them have had particularly heavy casualties, with more than 1,200 injured in 2005. These young, injured servicemembers “were hurting. They felt isolated and alone. They missed their units. They felt guilty for leaving their team in the combat zone,” Maxwell says. “That’s hard to deal with when you’re 19 years old and the only team you’ve ever served with is still in Iraq.”

Maxwell, who admits to bouts of depression and anger during his recovery, was able to get them talking — so well that the Marine Corps encouraged him to stay on active duty to provide support to Lejeune’s injured servicemembers. Maxwell was especially worried about the Marines and sailors who were discharged from the hospital but still on convalescent leave, undergoing regular medical care and rehabilitation.

“I thought we could keep them together to form a new support team by housing them in one barracks,” says Maxwell. And so work began to refurbish a barracks into housing for the wounded with ramps and grab bars, wheelchair accessibility, and transportation to medical appointments and physical therapy. On Nov. 15, 2005, Maxwell Hall opened, and Maxwell and his family were on hand to cut the ribbon.

Devastating injuries

Jackson and Maxwell are just two of 16,742 servicemembers wounded in action in Operation Iraqi Freedom (OIF) and 688 wounded in action in Operation Enduring Freedom (OEF) as of Feb. 17, 2006. The survival rate for U.S. servicemembers injured in Iraq and Afghanistan is 90 percent — higher than in any previous war.

Advances in body armor and battlefield medicine are saving servicemembers who might otherwise have died in previous wars. Surgical field hospitals are closer to combat, and medics are better equipped and trained. Improved evacuation chains move the injured more quickly to combat hospitals, often within that critical “golden hour” after an injury.

But even as American servicemembers are better protected from fatal injuries, the enemy’s weapons of choice are devastating to exposed body parts. Land mines, RPGs, and improvised explosive devices (IEDs) are causing horrific injuries. The initial blast can rip off limbs and send shrapnel and other debris flying at such velocity that it shatters limbs, shreds bone, and destroys tissue. Dust, sand, and dirt also are blown into the wound, which can lead to severe infection. The bomb’s shock wave can rattle the brain and vital organs and cause internal bleeding.

After life-saving treatment is performed on the field and at combat hospitals, the injured are flown to Landstuhl Regional Medical Center in Germany, where further trauma care takes place. Once stabilized, usually within three to five days, the injured are flown back home to U.S. military hospitals, where they receive the best medical, physical rehabilitation, psychiatric, and prosthetic care available in the world.

Those with amputations most likely will go to one of two DoD amputation centers, located at Walter Reed Army Medical Center (WRAMC) and at BAMC; those with burns will go to DoD’s burn center at BAMC; and those with spinal cord injury and brain injury most likely will go to a VA hospital. Base hospitals across the country also are treating and rehabilitating thousands of war injured.

Capt. Justin Laferrier, USA, is a physical therapist and the officer in charge of the amputee section at BAMC. He works 12-hour days and says this is “the most rewarding job I’ve ever had.” Laferrier says he pushes his severely injured patients hard. “I tell them ‘impossible just means it hasn’t been done yet.’ These men and women are young, they had a high level of fitness prior to their injury, and they are motivated and competitive. They are constantly breaking the glass ceiling,” he says.

While military medical staff heal their wounds, the government is stepping up efforts to help them rebuild their lives. DoD and the VA are aligning like never before in an effort to provide seamless transitions for those servicemembers who will medically retire and move into the VA health care system. A year ago, DoD opened the Military Severely Injured Center to provide around-the-clock assistance to servicemembers severely injured in OIF and OEF and their families. Each of the military services has a similar program to assist on topics ranging from job reeducation to child care to accessing benefits to financial problems. The Department of Labor has established programs to help the war injured with job training and placement.

Nonprofit organizations across the United States are answering the call as well. The Fisher House Foundation, for example, provides free or reduced-price lodging and transportation for families visiting injured servicemembers. Its sister organization, the Intrepid Fallen Heroes Fund, is building a $40 million rehabilitation facility and lodging complex, the National Armed Forces Rehabilitation Center, adjacent to BAMC.

Another nonprofit group, the Wounded Warrior Project (WWP), sponsored the “Wounded Warrior” bill, which created a new traumatic injury protection insurance for servicemembers who have sustained severe, life-changing injuries since Oct. 7, 2001. (For a complete list of government, military, and nonprofit programs and organizations providing assistance to OIF and OEF wounded servicemembers, go to www.moaa.org/woundedresources.)

On the inside

WRAMC has treated 4,798 patients from OIF, 1,415 of whom have been battle casualties, as well as another 344 patients from OEF, 81 of whom have been battle casualties, as of Feb. 21, 2006.

A visit to the third floor of WRAMC helps tell the story of this generation’s war wounded. In the occupational therapy (OT) room, a young soldier sits at a table with a shirt in front of him. Using hooks that take the place of his amputated hands, he is working to push buttons through holes. In this room most of the upper extremity amputees work on routine tasks, otherwise known as activities of daily living (ADL). Within the OT department is Fort Independence, an ADL apartment, where soldiers concentrate on such everyday tasks as cooking meals and making beds using their prosthetic arms and hands.

Across the hall is the physical therapy room, where servicemembers who are missing legs work to regain their independence. It is a larger, louder room, bustling with activity as patients balance on exercise balls, weave in and out between cones, and navigate parallel bars.

On a cold morning in December, Jack Farley has just arrived. He shakes hands, shares an inside joke, and stops to observe one soldier’s gait. Patting him on the back, Farley congratulates him on his even stride. Farley is so comfortable on the third floor you might think he is a doctor or hospital administrator, but he is a volunteer. Farley spent 14 months at WRAMC 37 years ago after losing his right leg above the knee in a mortar explosion in Vietnam. He medically retired from the Army as a captain.

Now in his second retirement, Farley spends several days a week at WRAMC as a volunteer peer visitor. Farley is active with the Amputee Coalition of America, which trains and certifies military peer visitors. “We have about 50 of them,” he says. “They are one of the most important components of treatment here. There is nothing like talking to someone else who has been in your place.”

Nearby, a young soldier who is a double leg amputee is attempting to bear weight on one of his prosthetics for the first time. On his other leg, a metal contraption that looks like a NASA project is wrapped around his stump. Farley explains it is a “fixator,” which holds the bones together until they heal. The soldier grimaces and sweats with each slow, deliberate step. His balance is so unsteady, his muscles so weak that even though he is using crutches, he has a physical therapist on either side helping him with each step, while one walks behind him. After just a few steps, they help lower him to a treatment table.

“This place is special because he can look around the room and see where he’ll be in a few weeks,” says Farley, pointing to another young soldier who is walking slowly and just slightly off balance on one good leg and one prosthetic leg. His mother holds onto a belt around his waist with light support while a physical therapist stands nearby. “And a month or more down the road ...” Farley says, pointing to another young soldier, who is quickly weaving his way around orange cones.

Looking around the room, Farley says, “When you realize our entire military is volunteer, you understand the motivation in this room. They haven’t lost their desire to serve. The tightest bond imaginable is among comrades in wartime. As soon as these young men and women are injured, they are wrenched out of their units and thrown on a plane. And their ‘family’ is gone. For many, their first goal is to get back to their units in Iraq.”

Near Farley, Capt. David Rozelle, USA, sits with an injured young soldier and his wife answering questions about staying in the service. Rozelle wrote the book on returning to active duty — literally. In 2005, he published Back in Action (Regnery Publishing Inc.), an account of the injury that cost him his right foot in 2003 when his Humvee rolled over a land mine in Iraq. After his foot was amputated, Rozelle triumphed over excruciating phantom pains, depression, and addiction to morphine and was declared “fit for duty” less than a year after his injury. He returned to Iraq to take over 3rd Armored Cavalry Regiment’s headquarters troop.

Today, Rozelle works full-time at WRAMC providing support to patients in the amputee unit. He also helps develop amputee programs, including the new amputee training center being built at WRAMC. “The job is where my heart is right now,” he says, but admits, “Every single morning when I get up and have to put on a prosthetic leg I miss my foot. I know I have to put it on, but then I get over it, and every minute after that is a success.”

Rozelle says he still finds it hard to visit Ward 57 in the hospital, the first stop for most war injured when they come into WRAMC from Landstuhl. Depending on the severity of their medical condition, they may spend weeks or months there undergoing surgeries and fighting infection and other complications. “I only spent a few weeks there, but it is so emotional for me. I can only go one day a week, but once I’m there I spend the whole day. It drains me. In here I can see success,” he says.

No giving up

Staff Sgt. Heath Calhoun, USA, was squad leader with the 3rd Battalion, 327th Infantry, when an RPG hit his Humvee Nov. 7, 2003, in Mosul, Iraq. He lost both of his legs above the knee and spent eight months undergoing rehabilitation at WRAMC. He medically retired from the Army in January 2005. “There is nothing enjoyable about not having legs,” he says matter of factly. “This morning when my wheelchair started sliding down my icy driveway, there was nothing fun about that.”

But Calhoun’s third child was born in December, and he says “it is hard to give up when you have so much to live for.” Calhoun works full-time as WWP’s outreach coordinator, providing assistance to severely injured warriors who might feel like giving up. Last summer, Calhoun made national headlines when he joined the second annual Soldier Ride, riding a hand-powered bicycle 4,200 miles cross-country to raise money and awareness for injured servicemembers.

“When you’re in the hospital, they nurture you. You’re surrounded by others just like you. It’s normal not to have two legs,” says Calhoun. “But then you leave the military and go back to the community, and you’re not normal. We want to help the injured transition back into the community, help them find ways to continue to contribute, and make sure they are getting the benefits they have coming to them.”

Farley says, “Injured servicemembers recovering at … military hospitals are in a protected womb. … It’s when they leave [here] that we have to continue to watch out for them. That may be their toughest road yet, and our country’s greatest challenge.”

Reflecting on his war, Farley says, “If we’ve learned anything from Vietnam, it’s that we can’t take disagreement with policy out on those who are serving our country. We have to regard them as heroes. We owe it to them that they are not forgotten. Only time will tell how good a job we’ve done.”