Margaret Benoit sits quietly watching her son learn to walk for a second time. The improvised bomb that blew through the bottom of Sgt. James Benoit's Humvee over a year ago left him missing much of the muscle on his lower
Margaret Benoit sits quietly watching her son learn to walk for a second time. The improvised bomb that blew through the bottom of Sgt. James Benoit's Humvee over a year ago left him missing much of the muscle on his lower left side and with unseen injuries to his brain that, for a time, made him seem like a stranger to those who knew him best. “Each day he becomes more and more his old self,” says his mother. “But it's taken a year to get there.”
Benoit had always been an easygoing guy back home in Wharton, N.J. But after the blast in Iraq, he became very particular. Little things jangled his nerves. And it wasn't just the 24-year-old soldier's personality that had changed. His thinking had slowed and his memory dulled. He now had trouble keeping track of the simplest details of daily life.
The changes were all signs that Benoit had sustained a brain injury in the blast-even though he had no external wound to his head. Although doctors don't fully understand what happens to the brain in an explosion, they suspect much of the damage occurs when soft, delicate tissue slams up against the solid inside wall of the skull.
This kind of brain damage is so common among soldiers coming home from Iraq that many experts are calling traumatic brain injury (TBI) the signature wound of the war. While TBI was not unheard-of in previous conflicts, a far greater proportion of the soldiers returning from Iraq and Afghanistan have suffered significant injuries to their brains.
The rise in the incidence of traumatic brain injuries results partly from the widespread use of improvised explosive devices, or IEDs, by insurgents. And ironically it results partly from innovations in protective gear and emergency medicine. Soldiers who might have died in earlier conflicts are surviving because high-tech helmets and body armor protect the head and torso from penetrating wounds. Advances in first aid and quicker trips to sophisticated medical centers are saving soldiers who might have died on the battlefield. But many are surviving with badly wounded brains.
And those survivors with the worst brain injuries must learn to live with lifelong disabilities. “TBI looms large in terms of chronic consequences,” says neurologist Warren Lux, M.D., acting director of the Defense and Veterans Brain Injury Center. “Brain injuries, like amputations, are for life.”
More than 20,000 U.S. military personnel have been wounded in the war through mid- September, according to the Defense Department. But nobody knows exactly how many of them have suffered traumatic brain injuries. That's because it's possible to have a TBI without any external wounds. And no one checks each and every soldier for signs of a brain injury after a blast.
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The impact of a missing leg or arm is clear to anyone meeting an amputee. But changes in the brain that result from a soldier being thrown around in a bomb blast aren't always immediately obvious, even to the soldier. When the wound is invisible, it can be easy to dismiss. “And a lot of guys don't want to leave their buddies after they've been injured,” Dr. Lux says. “They try to tough it out.”
At Walter Reed Army Medical Center in Washington, D.C., where many of the most severely injured soldiers are treated upon returning to the U.S., everyone gets checked for TBI. Doctors there found that about 60 percent of the soldiers screened have suffered TBI, with more than half of those injuries diagnosed as moderate or severe.
“Soldiers aren't being routinely screened for brain injury, and they should be,” says Wayne A. Gordon, Ph.D., associate director of the department of rehabilitation medicine at the Mount Sinai School of Medicine in New York City. “Without routine screening, soldiers with traumatic brain injury may be slipping through the cracks.”
James Benoit may have trouble recalling aspects of day-to-day life, but he remembers every detail of the day he drove down a road in Baghdad and a bomb ripped through the bottom of his heavily armored vehicle.
“I was the driver,” Benoit says impassively as he takes a break from his physical therapy, propping himself up against the rail of the parallel bars he's been using to practice walking. “I just heard this sound and looked around at the guys to ask what had happened and, suddenly, I had this numb feeling in my backside. And then my vision went black.”
Though temporarily blinded, Benoit was conscious as his comrades pulled him from the damaged Humvee. He remembers the long, slow ride back to the base and being loaded up onto a helicopter. After that, there is nothing until the moment he woke up at Walter Reed with a multitude of doctors milling around and his mother standing by his side.
She'd flown down to Washington while he was still being stabilized in Germany. The doctors initially weren't optimistic. “They thought I'd be fl ying to Germany next,” she recalls. “At that point, they put his chances of living at 5 percent.”
The injuries to