Fog of war

One soldier's struggle with the Iraq war's trademark injury


Brett Miller was just 6 feet from the roadside bomb when it exploded amid a flash of light, a hail of dirt and splintering glass. A 31-year-old U.S. Army sergeant, he’d been speeding in his Humvee down a debris-strewn road in Iraq, a stretch between Mosul and Kirkuk that is notorious for its roadside bombs. Miller had been hit there several times before but never with the kind of head-splitting force that roared through on Aug. 11, 2005.

Jeffrey Decoster

This time he wouldn’t walk away. Instead he would become captive to a brain injury that would go unrecognized for more than a year. Today, after many months of therapy, he can express what that initial feeling was like — of literally losing his mind.

“You can’t communicate. You have no physical reactions. You have no feelings. It’s as if you’re duct-taped, blindfolded and tied,” says Miller, now in a brain injury rehabilitation unit at the Veterans Affairs Palo Alto Health Care System.

These hidden, often debilitating, traumatic brain injuries have become the trademark of the Iraq war. Kevlar-armored soldiers who would have previously died in combat are surviving blasts, vehicle collisions and other assaults, only to walk away with injuries to the brain that might not be immediately apparent.

Nearly 1,900 of the more than 24,000 soldiers wounded in Iraq and Afghanistan have been treated for traumatic brain injuries at the eight Defense and Veterans Brain Injury Centers, of which the Palo Alto-VA is one. Eighty-eight percent suffered “closed head” injuries — those that are buried in the brain and are often missed, especially when there are other obvious problems, such as an amputation, that need urgent attention, according to VA figures.

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In addition, there are believed to be many others — at least 8,000 to 10,000 based on U.S. Army estimates — who have been discharged home or are still in combat situations who might have head injuries and don’t know it, says Harriet Zeiner, PhD, a neuropsychologist with the Palo Alto-VA program.

“When people are very injured, that’s obvious, but what about the person who’s not bleeding, not unconscious on the scene?” asks Zeiner, who counsels brain injury patients and their families. “After the pressure wave [from a blast] has gone through, they may be dazed, but by the time all the hysteria drops down and the chaos ends, they pick up the gun and they’re moving again. But something’s changed. From that moment, they may have the effects of a brain injury. And the problem is, they don’t know it.”

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