July 07, 2004

Back to the table of Contents Page

Classifieds

Palo Alto Online

The fog of war

by Dwana Simone Bain

It was like waking from the dead.

Rigoberto Oceguera knew not where he was or how he got there. Days earlier he was in a Chinook helicopter shot down by a missile near Fallujah, Iraq. Suffering from a ruptured spleen, burns and a fractured pelvis, Oceguera lay broken and dazed in a Washington D.C. military hospital.

But his condition was far worse than broken bones and damaged organs. The 23-year-old also suffered a traumatic brain injury that clouded his mind. The wound brought him to the Palo Alto VA hospital, one of four military care sites in the nation helping soldiers suffering from brain injuries recover their memories and relearn everyday tasks.

For the growing number of soldiers suffering from brain injuries in this war the road to regaining their former lives is difficult, said Dr. Henry Lew of the Palo Alto VA Hospital.

The computer reboots but, "when it reboots, it's not the same programs that were there before," he said.

The person looks much the same as before, but is in many ways different.

Sometimes an injury exacerbates pre-existing personality traits - such as a quick temper. Other times, it creates about-face changes in behavior -- for instance a rowdy person suddenly becomes calm.

Many brain injury patients also experience changes in speech patterns. At times Oceguera struggles for words to express himself. Other times, he speaks with unfiltered frankness.

"A lot of these guys look normal," said Paul Johnson, a clinical coordinator for the VA's Brain Injury Rehabilitation Unit. "Everyone expects them to act normal and be able to be quick about making decisions and speaking.

"Even though they look normal, they've changed and they're unable to function in the ways that they used to function," he added.

Rehabilitating veterans with brain injuries is a relatively new concept, said Lew, the rehabilitation center's medical director.

With an increasing number of soldiers in Iraq surviving explosions and auto crashes -- in large part due to body armor - the need for such treatment is growing.

Recently, the VA central office asked Palo Alto to expand its bed capacity to accommodate anticipated future demand.

The hospital, which began caring for brain-injured soldiers in 1984, has 24 inpatient beds and an outpatient program. The facility treats between 50 and 100 brain injury patients each year from throughout the West Coast, including New Mexico, part of Texas, and the islands of Hawaii and Guam.

Every patient at the hospital is treated by an interdisciplinary team of doctors, nurses, social workers and therapists who help them do everything from recollect their past to remember their daily schedule. The staff will even pray for patients.

"We try to help them as much as we can," said Case Manager Myrlyn Alvarado.

In the rehabilitation program, patients are involved in speech therapy and language groups, reviewing reading, writing and spelling. They participate in computer-assisted training to address deficits in memory, motor skills and reasoning.

Patients also take lessons in math and money management. They improve their social skills and learn community re-entry by rehearsing everyday tasks such as taking the bus, shopping for groceries.

In addition to helping the patients regain or compensate for cognitive deficits, the program offers emotional support. During weekly rap sessions, the patients have a chance to talk about their emotions and frustrations in dealing with a brain injury.

Brain injury patients are tested each week on memory, problem-solving and social interaction. Most stay in the rehabilitation program for about six months.

As patients prepare to leave rehabilitation, a case coordinator helps them with decisions about the future, including planning for housing or transportation and exploring job prospects.

For First Class Platoon Sgt. Alec Giess many of his recollections are uncertain - he can't distinguish the memories from the dreams.

Sitting inside his room at the Palo Alto VA, he flips through several albums of photos he shot in Iraq. Some photos of places and people he remembers well. Others seem familiar but he can't quite place them.

The man who once had a razor-sharp memory uses the photos to help recall what happened only months ago. In December, he was riding shotgun in a five-ton transport truck in Iraq, when the vehicle skidded on the oil-slicked sand. The tipping vehicle ejected Giess and landed upside-down on top of him.

Body armor he'd received just three days earlier spared Giess' life, though he suffered fractured vertebrae and lingering damage to both shoulders.

It wasn't until the 44-year-old father of two returned home to Seaside, Ore. on a 30-day convalescent leave that deeper injuries surfaced.

In the weeks after his accident, Giess operated on a short fuse. He seemed to have trouble remembering things and found himself frequently arguing with this wife, Shana.

"She knew something was wrong," Giess said.

These days, Giess uses a memory book to keep a weekly calendar. It helps him avoid simple problems such as showering three times in one day. And it helps him maintain appointments -- important to a man accustomed to promptness and order.

Brain trauma patients also struggle with slow processing, said Jill Gandolfi, a clinical coordinator in the rehabilitation unit.

A person with slow processing has the ability to complete a task, but it takes longer than usual.

"The world isn't very patient with that," Gandolfi said. "The world is very fast moving out there and not used to waiting three minutes to get a 'yes' answer."

In Iraq, Giess oversaw teams of 75 Iraqis working on building projects. Now, he has trouble doing two things at once, such as flipping through a photo album while carrying on a conversation. And when Giess recently returned home for his daughter Simone's eighth-grade graduation, he found the whirlwind of activity surrounding him overwhelming.

Such difficulties can cause growing frustration within patients, who are sometimes unable to articulate once-simple concepts and find the world treating them differently.

While those who work with brain-injury patients preach the need for compassion and understanding, they also emphasize that each patient be treated in a respectful manner. Often patients complain that people talk "down" to them or address them like children.

"We try to just talk to them like we talk to everyone else," Johnson said.

While acknowledging that rehabilitation has limits, those working with patients said remarkable improvement is possible.

Program Manager Rose Salerno remembers a Navy Seal with a particularly severe brain injury.

"He has since graduated from college, graduate school and he's thinking about going into the CIA," she said.

Oceguera and Giess have both made dramatic improvements in the months since their injuries.

Oceguera, who expected to spend his career in the Army, said he would go back if he could. A proud soldier, he wears a U.S. Army cap pinned with an American flag. He smiles when he talks about his Purple Heart, a decoration given to armed forces wounded in action. He isn't afraid of getting hurt again. His head injury, however, makes him "un-deployable," he explained. Oceguera wants to go to school, to study "something" his brain "can do."

He is also working out everyday, hoping to regain his strength and skill at Tae Kwon Do. An advanced-degree black belt, Oceguera thinks he might coach the sport one day.

Giess -- who spent 24 years in the National Guard -- is also contemplating his future. He owns a small boat and thinks he might start a salmon fishing business. Right now though, he isn't sure how well he can operate the boat.

Potential for future recovery generally depends often on the severity of the brain injury. But there are other factors. Physical fitness makes a difference, the experts say. So does willpower, or as Oceguera calls it "heart."

Lew credits the program with much of the men's progress.

"If you guys had just been lost in the shuffle," he tells them, "You would not be here at this level."

The men seem to agree. The armor may have saved his life - Giess has said - but the program is making him well.

E-mail a friend a link to this story.