Stryker Brigade News

The first question was to clear up some confusion about the ocularist. Scott does not need his services. He is a buddy of the 3D lab guys. He comes over and chats with them when he's on break, they eat lunch together, etc. He's a nice guy and knows the story, so we invited him to the Purple Heart ceremony. Not to do so would have been awkward for him and stingy of us. The people I invited to attend work too hard not to get the chance to be present when the men and women they work for are honored. Everybody who attended got a huge morale boost. This is one of the reasons why I invited them. They are great people who worked hard for Scott or were supportive of our efforts to keep him on active duty (at least for now) and they all richly deserved to have their day brightened by such an event. We were honored to have them there.

The second question related to how exactly Scott was injured. Today, I got the chance to look in detail at the full-scale model of Scott's skull complete with bullet held in place by a small post. I talked about it with Tiffany and noted that the bullet was pointing toward the back of his skull. We always thought he has hit in the back of his head and were sort of confused when we didn't see any entrance wound back there, only sutures around his ear, when we first got here. Looking at the model suddenly cleared everything up for us. It's not the Warren Commission report (although I do have eyewitness accounts that there was one shooter, one driver and one other POS in the car--with any luck they blew themselves up in Mosul the other day when their car bomb went off prematurely), but here goes:

It now appears to me that the bullet entered his skull just above (or nearly so) his left ear and travelled toward the back of his head, missing all the major blood vessels. The trajectory appears to have been pretty flat which gave the bullet more bone to travel through than if it had been on a trajectory that was perpendicular to the side of his skull. This also helped to slow the bullet down, deform it and do less damage internally. This also accounts for the fact that the skull was too badly fractured there to save for later replacement.

The third question asked about how his brain was affected. The problem with Scott's brain is the bullet disrupted areas of the brain that control speech and the motor control of his right side. He also has peripheral vision problems with the right side of the field of vision in his right eye. This flickers in and out. Some of these symptoms are the result of the shock wave, so to speak, of the bullet's impact and other parts are due to disrupting neuronal connections up there as the bullet when through his brain. These pathways may resume eventually and they may not. The brain will encapsulate the bullet, but those pathways may have to go a long way around. Think of it as if an 18 wheeler rolled over on a road. If it's on a major highway through a big city and it blows out a bridge, you've got a catastrophic interruption of communication that would take months of re-construction to overcome. If it's on a farm road, maybe you have to lose some corn, but you can get to the rest of the crop pretty easily. Big difference. This is also why each TBI (Traumatic Brain Injury) is so different. The chance of two people having a bullet (or whatever) going through the same places with the same shock effect with the same neuronal pathways being disrupted is microscopic. Same thing with strokes. There are some general similarities, such as the vasospasms, but the specifics are unique. This is why Scott is recovering so well and is amazing people who only focus on the general factors.

The fourth question had to do with the various therapies Scott needs. The purpose of the Physical Therapy (PT) is to make Scott work the muscle groups that his brain "forgot" about and to strengthen and re-condition him so he can resume his life. The injury caused Scott to forget about his right side, so to speak. Looking at his hand on the arm cycle was so he would visually note he still has a hand there. It's called neglect and it's a bit scary when you first see it. At least it spooked me because I'm happy he still has those parts, but he was acting like they didn't exist for a bit. The PT strengthens Scott's muscles which atrophied as a result of the inability to eat for so long and because of disuse. He didn't have much fat on him anyway (too hot to eat and he worked too hard) and they can't give dextrose, etc. to TBI guys because it screws up the brain (I can't remember the exact reason/process right now). The muscle provided the food to keep him going from 9/14 to whenever it was he started to eat again. He will need to slowly build all that back up in order to be able to move around like he did before, regardless of what his brain does with the signals. Speech therapy does the same thing. It stimulates re-connection of neuronal pathways used to speak. Currently, Scott knows the words he wants to use, but can't make his mouth make them for him sometimes. Occupational Therapy is PT for the fine motor control stuff. For example, pick up that pen on your desk and write your name. Easy, unless your brain is screwed up and the signals to do those fine motor things don't get to the lower arm or aren't strong enough or aren't coordinated well enough. I suspect it's the latter for Scott. He can't pick up a nickel off a table unless he slides it to the edge and slowly pinches it. PT he likes because it's like physical exercise, working out. OT he hates because it's what he can't do well now and never had a reason to work at it before (No one talks about how "ripped" the muscles on your fingers are). Re-learning to write is hard to do and harder to watch someone re-learn to do.

Scott suffered a penetrating gunshot wound to the left side of his head. They had to remove a chunk of skull on that side so when the brain swelled, it would not press against the inside of his skull and kill brain tissue. The swelling went down eventually and now only a flap of skin (it's sewn back on, of course) protects his brain in that area. Thus, the need for the helmet when he goes anywhere. The helmet is made of foam with a cloth cover and presses against this flap of skin (occasionally causing some discomfort) and it "looks gay" in his opinion. Also, Scott uses his left hand to put it on and can't open it up with both hands very well to make it go on more easily.

Question time being over, let's get with today. Scott went to PT and worked the arm cycle, the red & Lakers-colored balls (a modified abdominal crunch) and the stepping exercise. The new exercise for today was stepping up all the way with the weak leg. I asked where we were with respect to assistive devices since this has been a recent topic of discussion. He's beyond walker and crutches don't seem right. We hit on a cane as the right thing to use. After some practice walking with it, we set out for the return to his room. Instead of going straight there, he turned down the hallway to Ward 57 and went out into a garden area off the hallway. He sat down and enjoyed the fresh air for a few moments. We went down to the OT room on the Third Floor to get a sponge cushion for the cane's handle before returning to his room.

Scott had speech therapy in his room and earlier than usual. I went to the Air Evacuation Office to check on the status of Scott's paperwork. They wanted more information on me (it figures) as if not knowing my date of birth meant I was going to impair the lift capacity of the aircraft. I went again later in the day and discussed Scott's progress with the man doing the work. He job was to put the information in the computer, but then had to hit "search" every so often to see if Scott's status changed from "submitted" to "accepted" on the feed from Scott Air Force Base. This seemed like a silly system to both of us so he followed my suggestion to just call over there and check on it personally. Still later, I learned he had more questions from the flight surgeon about the last CT scan Scott had and about the possibility the VA would not take Scott because admitting him on the weekend would cause weekend workload problems. It appears now that we're probably not going to go now until Monday. All this drama means I'll probably get a call in ten minutes telling me I just missed the flight! Or maybe they're waiting to read tonight's update or are concerned about the possibility of their flight crew fainting. In any event, if you don't hear from me it's because we're in transit without Internet access.

After lunch, Julie and I borrowed one of the full-scale models of Scott's skull at the 3-D lab after a discussion with Dr. Oakes of Dentistry who makes the actual replacement pieces at Bethesda and now, Walter Reed. The actual model to be used to make the replacement part was in our hands briefly and the pieces fit perfectly. We arranged to have Dr. Oakes look at Scott with the copy I had borrowed to check out muscle connections and other details. The copy I borrowed will eventually be given to Major General Farmer, commander of the North Atlantic Regional Medical Command, for him to use in his discussions with his superiors on budgeting the services of the 3-D lab (which is currently running on air as the budget ended with the start of the current fiscal year 28 days ago).

After I left the lab, I went up to show Scott the skull, but he was down at Occupational Therapy (OT). I noticed PFC Majors was awake and I thought he might like to see the skull model. I told him what the model was (not a Halloween decoration, like someone said in the elevator on the way up--"No, it's a full-scale model of my younger son's skull.") and now he had the opportunity to be the first soldier to look inside his squad leader's skull to see what was in there--it's empty like you thought! He enjoyed the joke, but said he was sorry Scott was hurt so bad. I told him Scott was sorry he was hurt, too, but happy to see him doing better. Travis reported his trach tubes were out and he was going to have a skin graft soon to cover the wound in his foot. He has the ability to move his right arm up almost to the point where the hand can touch his shoulder. However, he needed me to straighten his arm back out after he did so. I told him maybe one day he could move that hand up to salute again. He said he was afraid they wouldn't let him stay a soldier. I told him we didn't know how much improvement he might have one day and not to give up hope just yet.

While I was talking to Majors, Scott was at OT working on his right arm. When I arrived Scott and Latonya Henriques (the OT) were playing Rummy to get him to use his right hand more in a normal activity. Scott was winning, but she was just learning the game. Julie and Tiffany were giving her hints and tips on play and Scott pretended that this bothered him. Dr. Oakes and Dr. Rouse arrived during the game. Dr. Oakes took the skull and compared it to Scott's head and examined them both thoroughly. He told Scott the operation should be routine because of the good job done by the surgeon who did the craniotomy. There was little need to worry about muscle attachment and similar complications. There may be a need to expand the skin on the head in order not to overstretch the part of the scalp covering the patch. Dr. Rouse took some pictures of Scott holding his skull (which had to have been a little weird). Dr. Rouse said he didn't see the patients before, but now he is seeing the people who need his work because it's more rewarding to see them benefit from his work. (This is the result I was hoping for.) He would have done the same outstanding job as before (so it's not like I got anything out of it--other than another friend, which I can always use), but now he has the joy of seeing how helpful his work is to a family. I warned Drs. Oakes and Rouse when they left with the skull that if I found the model being used as a paperweight on General Farmer's desk (something I know he would never do--he took a genuine interest in Scott's case when he met him during his recent tour), I'd "liberate" it from him.

Scott went downstairs to the 3-D lab later in the afternoon (I was at the Air Evac Office) to sign releases for the training film about the skull replacement process. I'm sure my title suggestion Skull Replacement and You! will not be used. I guess Army training films have improved, at least in the titles, since I last viewed them.

When I returned upstairs, Scott was on his way to get a new ID card. It seems the Army went to some trouble and expense to make ID cards with chips on them so the soldier's medical records could be easily accessed. Scott's ID card is somewhere between an alley in western Mosul and Walter Reed and of no use whatsoever out of his hands. Now, as you can imagine (and if you've seen the pictures of Scott's head, you don't need an imagination), Scott's picture on an ID card might be a bit alarming to a guard at a gate. Scott decided to have some fun with this and the man taking the photos "went with it." Scott's eyes are wide open, creating a classic horror picture image.

The rest of the afternoon was quiet. Scott watched Audie Murphy in To Hell and Back, the first such movie he's shown any interest in. He has avoided looking at pictures of himself in uniform up to now and shown little interest in "war" pictures. We'll see how this changes over time. Scott, Aly and Julie fell asleep as the movie ended so Tiffany and I went to get some dinner. When we returned, Julie and Scott were awake. I needed to prepare for a possible move early in the morning, so Julie and I left the family for the evening.

ST