Rebuilding Bodies, and Lives, Maimed by War

By NEELA BANERJEE
The New York Times

ASHINGTON, Nov. 10 — Every hour of every day for the last four months, Robert Acosta has thought of the moment when the grenade slipped from his fingers.

On the early evening of July 13, Specialist Acosta, of the Army's First Armored Division, was riding in the passenger seat of a Humvee toward the gates of the Baghdad airport. Something entered through his window, flew by his face trailing a ribbon of smoke, hit the windshield and landed next to the driver.

Specialist Acosta grabbed the grenade with his right hand, but as he turned to throw it out the window, he dropped it between his legs. He picked it up again. Somewhere between his ankles and knees, the grenade exploded in his hand.

"It was gone, it just disintegrated," he said of his hand. "It was just a mist of blood."

The driver of the Humvee was unhurt. Not only did the blast destroy Specialist Acosta's hand, it also shattered his legs, the left one now mended with a steel plate and skin grafts and the hole in his heel almost closed. In place of his right hand and part of his forearm, he wears a prosthesis that ends in a two-pronged claw.

"I think I should be dead right now," the 20-year-old Specialist Acosta said one recent afternoon, resting from doing pull-ups in physical therapy at the Walter Reed Army Medical Center here. "But I feel like I failed myself. If I hadn't dropped it, I would still have my hand."

Reminded that he had saved his friend's life, Specialist Acosta stared straight ahead and kept silent.

More than 6,800 have been evacuated from Iraq for medical reasons, including disease and "nonbattle injuries," the Army said.

[By Friday, the Defense Department said, 1,994 had been wounded in action, with 342 more injured. The dead totaled 399, the department said, with 272 from hostile action.]

Some of the most seriously wounded come through Walter Reed.

Thanks to advances in everything from flak jackets to battlefield medical attention, many soldiers survive attacks that would have killed them a generation ago. But as more survive, more inevitably return from Iraq with grievous injuries, including amputations. Already, 58 amputees have been treated at Walter Reed, 47 with major single-limb removals and 11 with multiple-limb amputations.

For all the numbing similarity of the ambushes with rocket-propelled grenades and roadside bombs that wounded the soldiers now at Walter Reed, each has begun to piece his life back together in a different way, into a shape he never expected.

There is Staff Sgt. Ryan Kelly, a reservist from Abilene, Tex., who is determined to become a firefighter as he had planned. There is Specialist Edward Platt of Harrisburg, Pa., who focuses his hope and unremitting anger on the use of a prosthetic leg he has just received. And there is Specialist Acosta of Santa Ana, Calif., who plays practical jokes on hospital staff members yet remains haunted by regret.

When soldiers are ambushed in Iraq, they are rapidly evacuated, their vehicles quickly towed and their plight boiled down into the day's tally of dead and wounded.

"When we get injured, all it says is `one soldier wounded,' " Specialist Acosta said, echoing others at Walter Reed. "Not that a soldier has lost an arm or a leg, or how hard that is."

The wounded stay at first in the main hospital building at Walter Reed, its Greek revival campus about eight miles north of downtown Washington. Once the threat of infection and the need for serious surgeries have passed, they go home for several weeks before returning to a hotel on the Walter Reed campus called Mologne House, while continuing rehabilitative therapy at the hospital.

The wounded from Iraq tend to gravitate toward each other and to memorize each other's stories. They are comforted to find others who knew towns like Hilla, Ramadi and Tikrit and who lost a part of themselves on some identical, stunningly hot Iraqi day.

"I hate this place so much, but all these guys, we form a bond," Specialist Acosta said. "Talking to Vietnam vets, that's cool. But it's not like talking to someone who's been through Iraq."

The wounded from Iraq have changed the population at Walter Reed, hospital staff members said, from retirees with chronic ailments to young men and a few women — many under 25 — often with limbs missing.

"We have a greater demand, so we have had to hustle a bit, ramp up staff," said Joseph Miller, the chief prosthetist at Walter Reed. "And the nature of the patients, too, is different. They're younger and they want to get moving more quickly."

Specialist Platt's Ordeal

A soldier with the Army's 101st Airborne Division, 21-year-old Specialist Platt enlisted right after finishing high school in Harrisburg in June 2001. His parents had been in the Air Force, and he had loved living in Germany as a child.

"I liked the military, and it was a guaranteed paycheck twice a month," he said. "There's not that kind of guarantee anywhere else these days."

By January 2002, Specialist Platt's unit was in Afghanistan, and talk began almost immediately that it would be deployed to Iraq next. "We were in Operation Anaconda, and we landed in Chinooks and we got attacked," he said of a mission in Afghanistan. "But no one got hurt, and I think everyone took it for granted that it would be the same in Iraq."

After his unit entered Iraq in the spring, it went north to Mosul. On Sept. 23, a rocket-propelled grenade near the Syrian border tore away Specialist Platt's right knee and the top of his shin, but a flap of skin and muscle along the back of his leg still attached his thigh to the lower leg and foot.

"I could still wiggle my toes," he said.

Specialist Platt arrived at Walter Reed with his lower leg, but after realizing that surgical reconstruction would very likely fail, he decided in early October to have the leg removed a few inches above the knee.

"Like my mom said, the leg isn't what made me a man," Specialist Platt said.

To prove his point, he fiercely pursues rehabilitation, and his recovery so far has been impressive, hospital therapists said. He knows he is lucky that his wound is not worse: unlike him, many amputees have secondary injuries like burns, blindness, deafness, splintered bones in an intact limb, smashed internal organs. At an occupational therapy session early in the week, between criticizing the 70's rock on the radio and talking about the latest additions to his 30 pairs of shoes, Specialist Platt hopped on his left leg along a Foosball table and handily defeated nearly all comers.

One Thursday afternoon, though, Specialist Platt growled quietly through his occupational therapy. The day before, he had taken his first halting steps on his new prosthetic leg: a sleek silver bone of titanium and carbon fiber with a microprocessor in the knee that recalibrates the gait 50 times a second. The devices cost $60,000 to $100,000. Immediately, Specialist Platt wanted to use his all the time.

Yet therapists at Walter Reed insist that soldiers begin using their prostheses gradually, so their bodies can adjust to the change, a notion Specialist Platt understood but could not reconcile himself with. He had been waiting so long for this: the chance to run and snowboard again; to argue with someone who might criticize him for parking in a handicapped spot because he would not look handicapped; to stroll through the mall without getting stares.

Maybe a leg did not make him a man, but the prosthesis seemed to give him hope that he could take back a life that had been stripped away.

The next day, about six soldiers, including Specialist Platt, went on an outing organized by the physical and occupational therapists to a bowling alley at the Bethesda Naval Base in nearby Maryland. The soldiers divided into two teams: arm amputations versus legs.

The bowling did not vex them as much as the temperamental electronic scoreboard, except for Specialist Platt, who wore his prosthesis but still leaned on his crutches. "I'm a very good bowler," he said. "I want to throw my curve, but I have to get into moving and grooving."

The first time, the curve was a gutter ball. The second time, a strike. But the ball would not be controlled and Specialist Platt was still wobbly on his new leg. After a few rolls, he left the game.

"He's coming to terms with the loss of his leg," said Isatta Kanu, 29, a physical therapist's assistant who had helped Specialist Platt bowl. "He used to be a soldier, a killer, an athlete, and now he's reduced to this."

"I think Ed is determined," Ms. Kanu continued, "but in a stubborn way, in that he wants to do it on his own. I think those who are more successful get help from others. It's hard for a young guy. He may not be conscious of his anger. They weren't bargaining for this: to be 19 or 20 years old and disabled."

A television behind Ms. Kanu was showing the news. The soldiers fell silent as they saw videotape of the Blackhawk helicopter that had been shot down in Tikrit that day, killing all six servicemen aboard. "How can they say the war is over?" Ms. Kanu said. "It's not over."

Feeling Guilt Despite Wounds

When Specialist Acosta and his friend Specialist Cory McCarthy from Gilroy, Calif., went to their homes for a few weeks recently, people regularly asked them, is the war over?

"No," Specialist McCarthy said.

"No," Specialist Acosta said.

The two men were flopped on beds in Specialist Acosta's room at Mologne House, one night, smoking cigarettes. Specialist Acosta lay on pillows that hid his amputated arm. On television, the superheroes of the World Wrestling Federation feigned rage and pain.

"We went over there for a good cause: to push Saddam out," Specialist Acosta said.

"But it backfired," he continued. "We're still there, and all these soldiers are still getting killed. We hadn't prepared for it. I really feel bad for the soldiers that are still over there and their families."

Specialist McCarthy, with the 173rd Airborne, said: "That's a big reason we all want to go back to Iraq. We're sitting over here with hot food and A.C., and there, you were lucky if you had power, and you just want to be back there sucking with the rest of them."

Specialist Acosta said, "That was a big thing at the beginning: guilt."

After the last Marlboro burned away, Specialist McCarthy went downstairs for more cigarettes. His right hand was mangled by a roadside bomb in Ouja. Part of the cast around his fingers had just been taken off. "I can finally scratch my head again," he said, smiling and doing so and then putting on his sneakers. Specialist Acosta watched every turn of his friend's hand, the twitch of his fingers.

A hierarchy of injury subtly governs relationships at Walter Reed, defining the respect and empathy the wounded show one another. Specialist Acosta said he never knew what pain truly was until his legs were broken. His hand, he said, felt only like it had gone to sleep.

In nearly every room of Walter Reed, a pain rating scale is taped to the wall, giving people a vocabulary for the ineffable. Ten is the worst. The scale also offers more subtle shadings, from pain that is cutting to one that is raw, burning, stabbing.

"I talked to this guy the other day and I asked him why he was here, and he said, `Stress.' " Specialist Acosta said. "Stress? I told him he was a coward and just walked away."

In his friend's absence, Specialist Acosta changed the dressing for his left foot, tearing open packages of gauze with his teeth. "I bet I still can't move my toes."

But then he flexed them ever so slightly against his left palm. "Cool," he said.

When he was first wounded, Specialist Acosta could still feel his right hand and its phantom fingers move. Now he feels as if his hand is balled into a fist.

A Wife Who Understands

One evening, Sergeant Kelly and his wife, Sgt. Lindsay Kelly, were packing to leave Mologne House for two months, and procrastinating. The real world, as they call it, is welcoming but scary. They need a new car, because the one they have is a stick shift, which is hard for Sergeant Kelly to drive with his prosthetic right foot. The stairs to their second-floor apartment in Abilene will be tough to negotiate, at first.

They say they have already heard the dumb questions that nearly all soldiers get: whether they killed anyone, and, what did it feel like?

But Sergeant Kelly, 23, may be better off than other soldiers. He is much more accustomed to his new right lower leg, a Cadillac of a prosthetic that will let him run again and perhaps be a fireman someday. His wife served in Iraq, too, and so, understands what her man has been through.

Sergeant Kelly does not obsess about the attack. He refuses to go it alone, relying on his wife and an amputee support group that meets twice a week at Walter Reed. He seems to understand that his recovery extends far beyond the mechanics of his leg.

Only in the quiet before sleep, when the ringing in his ears from the blast trembles loudest, does the old fear rise in him again.

Sergeant Kelly and his wife, 21, were both in Iraq as civil affairs officers with the 490th Civil Affairs Battalion, she in Baghdad and he in Ramadi. On July 14, a group of seven from Sergeant Kelly's unit left the base just after dawn in two Humvees for a health and education conference. The convoy came under attack as it neared Baghdad.

"I don't remember a blast," Sergeant Kelly said of the roadside bomb. "It was a gorgeous morning, that time when it's still cool. Then everything went black for a second, like when your TV goes out, and then the film comes back.

"I couldn't hear anything but a loud tone," he said. "The Humvee filled with dust and this smell, this smell that I can't describe. And the blood. The windshield was shattered, and we went from 70 to 40.

"I was knocked backward and I tried to use my foot to get back up and it felt like there was nothing under my foot, like there was a hole in the floor of the Humvee, and I pulled back my foot and I couldn't see it, the way it was hanging.

"I looked at Zayas, the driver, and there was blood all over his face and I said, my leg is gone," Sergeant Kelly said. "My leg is out on the road back there. I switched my weapon to fire and emptied it. I was scared out of my mind and furious at the same time."

Sergeant Kelly said he joked with the soldiers who evacuated him, though he knew he would probably lose his leg, which dangled by a strip of skin. Finally, at the military hospital, he wept, he said. First, when the nurse pulled back the covers to show him his bandaged wound. And then, when his wife arrived.

"I knew it would be hard for Lindsay," he said, smiling at her while she sat on the bed looking back at him. "If I was a wreck, it would be hard for everyone."

Once her husband was on his way to Walter Reed, Mrs. Kelly went back to work in Baghdad, angry at first at the Iraqis. "There was a female interpreter I had worked with for five months and we had become pretty good friends," she said. "When I got back, she had bought us a gift. Before she could give it to me, she started crying. They hadn't even met him — " Her voice caught suddenly on the memory.

Sergeant Kelly said, "Out of the blue about a month ago, I got an e-mail from an Iraqi man I knew in Ramadi who was kind of an unofficial interpreter, saying he was real sorry for what happened and hoped I was doing O.K."

The smile stayed on Sergeant Kelly's face, but his color rose. Still in the shadow of that morning four months ago, he chose now to look at the small kindness that had washed toward him. He bowed his head and swiped the back of his hand across his eyes. "It's not losing the leg that gets me," he said, "but what people then do for you after."