Wounds of War: Scars come home

Surgeons at Bethesda Naval Hospital prepared to drill a hole in Lance Cpl. Bret McCauley’s badly swollen head to relieve pressure on his brain when he unexpectedly awoke from a two-week coma

“Hold up one finger for me,” McCauley recalls someone saying.

He held up his middle finger – “and from that instant they knew I would be OK.”

OK in the sense that he would survive severe wounds suffered when a suicide car bomber rammed his military convoy outside Fallujah, Iraq, on Sept. 6, 2004, setting off 500 pounds of explosives and killing seven fellow Marines.

But not all right when the trauma of that tragedy and other war scenes kept flashing back through McCauley’s mind like a horror movie on rewind during his recovery.

Nightmares, hallucinations, helplessness, paranoia, depression and guilt about surviving when others didn’t. McCauley said he experienced all of these mental demons and more during his struggle to get back to normal.

It is a condition known as Post Traumatic Stress Disorder, first recognized during the Vietnam War era and now diagnosed frequently among troops returning from Iraq. Head injuries, doctors say, can make the condition worse.

McCauley’s life was saved by modern military medicine and a fast-responding team of medics, nurses, doctors and pilots. They removed his spleen and a kidney in Iraq before airlifting him to a regional hospital in Germany to stabilize his wounds, then to Bethesda for additional treatment and recovery.

But the bomb blast had sent McCauley flying from the open back of a truck, striking his head hard against the ground and causing it to gradually inflate to the size of a basketball.

A tumor-like blood clot - known technically as a subdural hematoma - formed inside his head, putting intense pressure on his brain and causing him to lose consciousness.

Surgery removed the blood clot. It did not fix the mental anguish the 23-year-old McCauley, of Kokomo, Ind., said accompanied his condition. Mental anguish that eventually moved him to wonder if the military even cared about his recurrent thoughts of trauma.

Maj. Gen. George W. Weightman, medical director and commander of the U.S. Army Medical Center and School at Fort Sam Houston, Texas, said McCauley’s state of mind was predictable. He said more than one in three soldiers who come back from Iraq face post-combat mental health issues.

A primary reason, he said, is that Iraq veterans are more likely to have witnessed someone getting wounded or killed from improvised explosive devices, the weapon of choice for rebel insurgents and terrorists.

“Think about what war is,” said Weightman. “It is sending a normal person into a very abnormal situation. Death and serious injury are very traumatic things to have to deal with.”

Military procedure calls for treating Post Traumatic Stress Disorder as soon as it is recognized. And often, said Weightman, that means in the war zone. Especially when there are significant casualties such as those from a roadside explosive or car bomb.