For injured, battle has just begun

By John Aloysius Farrell
Denver Post Washington Bureau Chief
Sunday, March 14, 2004 -

The C-141 transport planes that bear the wounded from Iraq are cold and noisy. There is little insulation. Blankets and earplugs are standard issue for those who come aboard.

With scaffolding, Air Force crews build tiers of bunks for the gravely injured in the center of the cargo bays. Doctors and nurses stand at their side.

The walking wounded sit or stretch out on fabric benches hung along the fuselage bulkheads.

It's an austere environment, and for warmth some crews decorate their planes with large American flags. On the flight I took, they baked chocolate chip cookies in a tiny oven and passed them out, hot and gooey.

"It is quite emotional," said Capt. Dominic Frederico, who coordinates such flights. "Sometimes the wounded won't let go of your hand, even as you tell them they are going to be OK. They get attached. Basically, they've been in hell."

The trip home is not without risk. Iraq had several thousand shoulder-fired missiles before the war, and many have been fired by the insurgents at U.S. helicopters and aircraft since last spring, claiming lives and closing the Baghdad airport to civilian aviation.

Frederico works at the main U.S. military airport, at Balad in the Sunni Triangle. As the big jets come and go, Army helicopters soar over the countryside, looking for potential attackers, and patrols sweep the neighboring fields. The pilots of the C-141 StarLifters and their counterparts on the C-5s and C-130s

put their aircraft through steep dives and other maneuvers to make them tougher targets. If sensors detect a heat-seeking missile, flares are deployed as decoys.

"The greatest danger is on takeoff and landing. Watch how our aircraft jump to the sky," said Frederico, 48, a Coloradan who volunteered for his tour. ("You have to step beyond yourself sometimes," he said when asked why.) Another dauntless volunteer, Maj. Carolyn Wood, helped the injured on board and made sure they had food and juice. At takeoff, we climbed steeply from the runway, ducked into a cloud bank and headed toward Europe.

We landed in Germany, at Ramstein Air Base, in a snowstorm. The wounded were taken by bus or ambulance to the nearby Landstuhl military hospital. They spanned the range of illness and injury: An engineer who had stepped on an explosive device and lost much of his foot. An officer with a bad heart. A hernia patient.

And several who kept to themselves on the flight, not caring to discuss their pain.

All told, some 12,000 sick, injured or wounded Americans have taken this route home: almost a full Army division. Hundreds, maybe thousands of them and their comrades will suffer the traumatic psychological effects of waging modern war.

"Going into war, the psychology was much different than coming out," said Dr. Gene Bolles, a Coloradan who served as chief of neurosurgery at Landstuhl and has just returned home himself. In addition to the brain injuries, amputations and horrific burns, he saw many of "these young kids breaking down and sobbing."

Post-traumatic stress disorder is insidious: It can spur pain and depression, emotional withdrawal or addiction, or explode - sometimes months or years later - in violent or self-destructive behavior.

The psychological toll of war is kind of a taboo topic in America, where we like to see our warriors as invincible. Its victims are often ignored, or scorned or resist seeking help because they might be stigmatized.

"Many, many, many of these young people are coming back to us" emotionally scarred, Bolles told a group of veterans and counselors at the University of Colorado last week. "I don't think we recognize that they exist. ... Our society has resistance to that."

As the kids return from Iraq, we need to appreciate that not all their wounds are visible.

I left Ramstein for a fine hotel. I ate venison with a claret and juniper gravy, took a hot shower and slept in a bed for the first time in two weeks. My war was over. But for many of those who served in Iraq, it's now beginning.

John Aloysius Farrell is the Washington bureau chief for The Denver Post. His column appears each Sunday. Contact him at 202-662- 8990.

http://denverpost.com/cda/article/print/0,1674,36%257E28203%257E2014668,00.html