Grunt (8 page)

“You know what the hardest thing for us is?”
¶
Jack glances around the table. “This right here.”

“Yeah.” I get it. Strangers with their questions and assumptions.

It turns out Jack wasn’t referring to any of that. By “us” he didn’t mean snipers or Special Operators. He meant the hard of hearing. And “this right here” meant a loud dinner table. Jack says some of his peers cope by asking a lot of questions and pretending to hear the answers. “You see them sitting there nodding, going, ‘Uh huh, uh huh.’” Others just withdraw from the interaction.

A version of this withdrawal happens in combat. I tell Jack and Fallon about the work of a team of researchers with Walter Reed’s National Military Audiology and Speech Center. Doug Brungart and Ben Sheffield have been documenting the effects of hearing loss on lethality and survivability. (Because the data-gathering requires Sheffield, with his clipboard, to run around in the midst of the action, military exercises stand in for actual combat.) Members of the 101st Airborne Division agreed to wear special helmets rigged with hearing loss simulators. Among the top-performing teams, even mild hearing loss caused a 50 percent decrease in “kill ratio” (the number of enemies eliminated divided by the number of surviving teammates). Not so much because their difficulty hearing was causing them to shoot or run in the wrong direction, but because they were unsure of what was going on. With their ability to communicate compromised, their actions were more tentative.

Withdrawal carries over to the home front. Brungart told me about a Marine he’d worked with who had lost an arm and a leg and ruptured both eardrums in a blast. “He told me far and away the worst of the injuries was the hearing loss, because he couldn’t communicate with his wife and kids.” Despite or possibly because of their low profile, the less visible injuries of war can be the hardest kind to have.

___________

*
And, though you didn’t ask for it, here’s one more similarity between bullets and earplugs: Both have been used by physicians to protect their ears from screams. The
Army Medical Department Journal
states that the real reason soldiers in the pre-anesthesia era were given a bullet to bite was not to help them endure the pain but to quiet their screams. And from a paper called “The History and Development of the E-A-R Foam Earplug” we learn that emergency room docs use foamies “to block the screams of children during difficult procedures.” This was part of a section on “unusual applications,” none of which were especially unusual. I may have had unreasonable expectations for the history of the foam earplug.

†
“It’s almost like he knows you,” said the researcher.

‡
In Afghanistan, this means twelve and up, a designation we in the West innocently reserve for toys and board games.

§
According to the Department of Defense Hearing Center of Excellence, 12 to 16 percent of American children ages six to nineteen have noise-induced hearing loss. And not from vacuuming and mowing the lawn. Full volume on an MP3 player is 112 decibels, enough to cause hearing loss after one minute. Have you seen Die Antwoord live? (120–130 decibels.) I’m sorry for your loss.

¶
Apparently nothing. In 2008, a team of psychologists asked nineteen snipers who had served in Afghanistan what they’d found most troubling. Ninety to 95 percent reported having little or no trouble with killing an enemy, handling or uncovering human remains, engaging in hand-to-hand combat, being wounded, having a buddy shot nearby, or “seeing dead Canadians.” (It was a Canadian study.)

Below the Belt

The cruelest shot of all

T
HE AMPUTEES WEAR SHORTS.
I see them crossing the Walter Reed lobby, chatting with the security guy, standing in line at this or that café. It’s not shorts weather. It’s December 4, in Maryland. Christmas music ever in the background—jingle bells, holly jolly, Frank Sinatra agitating for snow. While it is true that a prosthetic leg is immune to the cold, this baring of limbs is about something else, I think. It’s an avowal of normalcy, of moving through the world with your hardware on show, no self-consciousness, no big deal. The era of the sad, stiff flesh-tone appendage is over.

Between a man’s carbon-fiber, vertical shock-absorbing, microprocessor-controlled prosthetics, it’s another matter. You don’t hear much about the injuries collectively known as urotrauma, or the techniques used to deal with them. Partly it’s the numbers: 300 genito-urological patients for 18,000 limb amputees. It’s not that insurgents don’t make big enough bombs. It’s that bombs that big create corpses, not patients. Advances in combat casualty care, swifter medevacs, and field hospitals closer to the action have meant that more men are surviving who need genital reconstruction. The work remains relatively low-profile, though, because genitals themselves are low-profile.

The clocks on the lobby wall say it’s 9:00 a.m. here in Bethesda (and 6:00 a.m. in Los Angeles, and midnight in Guam). I’ve been passing time in a café before heading up to Urology. A Navy officer practices his Spanish on a woman refilling the condiments caddy. “Thank God it’s
viernes
!” A stooped veteran looks at CNN—an Emirates airliner blown sideways during takeoff. “I’ve done that before,” he says to no one specific. Walter Reed is officially categorized as a national military medical center, but it has more the feel of a small indoor town. The larger corridors have been given names: Liberty Lane, Heroes Way, a Main Street with a post office and some fast food outlets. A poster board propped on an easel outside Dunkin’ Donuts announces that Colin Powell is doing a book signing at 11:00 a.m.

While General Powell is putting a Sharpie to the pages of
It Worked for Me
, while Guam sleeps, Gavin Kent White will be having his urethra rebuilt. Captain White, a 2011 graduate of West Point, stepped on an IED in Afghanistan.
It Didn’t Work as Well for Him.

T
HEY ARE
buried in twos and threes: one IED to kill the people in the vehicle, the others to kill the people who come to help. White saw the first blast from his lookout in the command and control vehicle on a route clearance mission on a heavily booby-trapped stretch of road in Kandahar Province. He was leading a platoon of combat engineers—specialists in construction and demolition: roads, walls, bunkers, bridges. A Humvee carrying Afghan National Army soldiers, partners of the US and NATO in the conflict, had ignored White’s warning not to drive on ahead. Three were killed, three wounded. The vehicle landed on its side, blocking the road, and it fell to the engineers to move it. White’s footstep on a buried pressure plate set off the second explosion—a twenty-pound “victim-operated” IED. I asked him what he remembers.

White lies in a hospital bed, propped against pillows but on top of the bedclothes, on the fourth floor of Walter Reed. The view is impressive, but after four months, you imagine he’s fairly well through with it. It began, he says, with intense red-orange in his field of vision and a feeling of lifting into the air. “I sat up, took out my tourniquet, and put it on my right leg, which I saw was missing.” The full length of White’s other leg remains, but the calf was blown off. He was unaware of this at the time. Because his boot and the front of his pant leg were intact, he assumed the leg was, too.

You sometimes hear that the first words of a man in White’s situation go essentially like this:
Is my junk okay?
White’s first concern was his soldiers: Was anyone bleeding to death? “I started calling out, ‘Who’s hit? Who’s hit?’” White was their commander, but any soldier’s first thoughts, post-explosion, are likely to be of fellow soldiers. Walter Reed surgeon Rob Dean, a colonel who served in Iraq, confirmed this. “The first thing they ask is, ‘Where’s my buddy? Is he okay?’ ” Which could, I supposed aloud, be a reference to one’s penis. “No,” Dean said. “Because the second thing they say is, ‘Is my penis there?’”

Despite the assurances of the medic (“Everyone’s fine, sir; it’s just you”), despite the fact that one leg was maimed and the other was elsewhere, White kept trying to get up to check on his soldiers. Appraise the situation. Be the commander. The medic had to strap him down. For better or worse, this kept him from taking more detailed stock of his injuries. In the immediate aftermath, he had seen that the tip of his penis was “flowered out” but was unsure how deep the damage went. (The verb
to flower
has found an incongruous home in descriptions of IED injuries. In the typical underfoot blast, leg muscle is blown out away from bone, and into that open bloom shoots a dense, fast-moving cloud of bacteria-laden dirt. The blossom then closes over the soil, making the wound hard to clean and prone to stubborn infection.)

White would have thirty-nine minutes to think about it. That’s how long the medevac helicopter took to arrive. “At one point I was like, ‘If my dick is gone, just leave me here.’ I was half-serious. I don’t have any kids yet. I didn’t want to have to go back without anything to do that with.” His men tried to reassure him. “They were like, ‘Your dick is fine, sir.’” I’m guessing that that’s White and his soldiers right there, in those five words: The formality and respect of “sir” with the easy slang of “your dick.”

“I was like, ‘Bullshit, I saw it. I just want to know, Is it fixable?’”

It’s fixable. Some urethral scarring and tightening has slowed urination and created some erectile torque, but surgery this week should remedy both, as well as some minor cosmetic damage.

Though the pain was heavy enough that White asked a medic for a second dose of fentanyl (“I can’t, sir; you’ll die”), he has little to say about it. “Honestly, I was more focused on my soldiers.” Though they were physically unharmed, a kind of psychic unraveling occurs when a leader falls. White could see how shaken they were, and tried to joke around with them: “Guess my running career is over, heh. Never really was any good at it.”

It’s hard for me to imagine: worrying about the emotional state of other people when you yourself have just lost part of both legs and possibly some of your genitalia and on top of that your pelvis is broken. White told me his platoon sergeant said to him recently, “Maybe it happened to you because you’re the kind of person who’s tough enough to handle it.” I think White is plenty tough, but I don’t think we’re talking about toughness here. This is some kind of blinding selflessness, the sort of instinct that sends parents running into burning buildings. The bonding of combat, the uncalculating instinct of duty to one’s charges and fellow fighters, these are things that I, as an outsider, can never really understand.

I emailed White the night after we met. It began as a thank-you, but came around to a sort of grasping fan letter. My world is full of people, and that includes me, who never have to put their lives and bodies on the line for other human beings or for things they believe in.
Hero
has always been a movie word, a swelling orchestral soundtrack word. A Walter Reed hallway word. Now it has something under it.

S
URGERY PATIENTS
are announced like guests at a ball. An orderly wheels them in and recites from the paperwork: name, age, procedure, body part. To be sure the surgeons are in the right room, with the right patient and the right piece. In White’s case, you might otherwise wonder. A nurse is swabbing the surgical site, applying the standard antiseptic man-tan, but she’s at his face, not his groin. Major Molly Williams, the almost comically pregnant assisting-surgeon, explains that a replacement stretch of urethra will be built from a strip of tissue harvested from the inside of White’s cheek. Mouth tissue makes an excellent urethral stand-in. For one thing, it’s hairless. Urine contains minerals that, were there hair growing in your urethra, would build up on the strands. The stony deposits are troublemakers, obstructing flow or breaking free and getting peed out in a blaze of pain.

The surgeon, James Jezior, has been over at the scrub sink going at his nails. He joins us now, hands front, drying. He has blue eyes and fine sandy hair and a mischievous wit. I would use the adjective
boyish
, but on paper he is very much not a boy. He’s a chief (of the Walter Reed urology department), a director (of reconstructive urology), and a colonel.