Reporting
from San Diego —
A Navy
corpsman, part of the same patrol, kept Dominguez from bleeding to death and
wisely refused his pleas for morphine, lest he go into shock. Then there was
the Navy doctor at nearby Forward Operating Camp Dwyer who "wouldn't let
me die" and the intensive care he received at Landstuhl Regional Medical
Center in Germany.
After that,
Dominguez spent five months at the National Naval Medical Center in Bethesda,
Md., and at Walter Reed Army Medical Center in Washington, D.C., where he
underwent 23 surgeries. Today, the 26-year-old from Deming, N.M., is an
outpatient at Naval Medical Center San Diego.
"This
is home now," he said of the hospital on a hill beside Balboa Park.
Dominguez is
among a growing number of Marines and soldiers who have suffered catastrophic
wounds that will require years of care in military hospitals. The Pentagon and
the Department of Veterans Affairs are scrambling to put together a continuum
of long-term care for Dominguez and other severely wounded personnel.
Based on
what trauma doctors call the Injury Severity Scale index, the average score for
battlefield casualties brought to the Landstuhl intensive care unit is at its
highest level in the nearly 10 years that the U.S. has been at war, Landstuhl's
top trauma surgeon, Air Force Lt. Col. Raymond Fang, said last week.
"These
patients are young, they are fit, and they have the best protection available
right now, but their injuries are very severe," Fang said.
The number and
rate of double- and triple-amputees have risen dramatically in the last 18
months. So has the number of military personnel suffering wounds to the
genitals and urinary tract.
The most
grievous wounds are traceable to the Taliban's continued use of improvised
explosive devices. U.S. counter-insurgency strategy calls for soldiers and
Marines, whenever possible, to go on walking patrols rather than ride in
armored vehicles — increasing their vulnerability to buried roadside bombs.
The Army
surgeon general, Lt. Gen. Eric Schoomaker, has formed a Dismounted Complex
Blast Injury Task Force headed by Brig. Gen. Joseph Caravalho Jr., a
cardiologist and commanding general of Brooke Army Medical Center in San
Antonio. Its report is due in weeks.
The task
force, including 27 medical experts, is charged with going beyond trauma
medicine and examining "all the optimal acute management and
rehabilitation of these more severely wounded warriors, including pain control,
psychological and spiritual support, and family support."
At Naval
Medical Center San Diego, patients are seen by doctors and therapists from a
wide range of specialties. Outpatients like Dominguez live in two-person rooms
on the hospital grounds.
Dominguez
arrived a month ago. Days later, the corpsman who had saved his life, Stuart
Fuke, 22, of Honolulu, arrived directly from Landstuhl; he had been shot in the
thigh while on foot patrol.
Programs
never dreamed of when the U.S. invaded Afghanistan in 2001 and Iraq in 2003 are
now part of the San Diego regimen for wounded personnel, including a full range
of sports activities, counseling for family members and group discussions with
Vietnam veterans.
Dominguez is
looking forward to a surfing trip to San Onofre. He'd like to run in the Marine
Corps Marathon once he is fitted and capable with his permanent prosthetic
legs. Part of his therapy will be relearning to play the guitar.
"My
plate is pretty much busy from morning until dark," he said.
Dominguez
sees a dermatologist, ophthalmologist, neurologist, vascular specialist and
primary care physician, among others. He receives occupational and physical
therapy and sees mental health specialists for post-traumatic stress disorder
and traumatic brain injury. He's had surgery to regain the hearing in his left
ear.
He underwent
what doctors call a fractional carbon dioxide laser surgery to shape his scar
tissue, promote healing and soften the tissue in order to improve the tolerance
for a prosthetic limb. More than 500 such treatments have been done on amputee
patients at Naval Medical Center San Diego in the last two years.
Dominguez's
mother, Martha, lives in an adjoining room in the battalion housing and
accompanies her son to his appointments. Several other mothers live in rooms
beside their wounded sons.
Navy and
Marine Corps brass have agreed that wounded Navy corpsmen should live on the
same floor as the wounded Marines. Both groups recover more quickly when they
are near personnel who share their battlefield experiences, officials said.
Fuke and
Dominguez, for example, are part of the Camp Pendleton-based 3rd Battalion, 5th
Regiment, which was assigned to the Taliban stronghold in Sangin. "He's
one of my boys," said Dominguez, adding that he has finally forgiven Fuke
for not giving him morphine as he lay in the dirt writhing in pain.
From the
beginning of the assault on Baghdad in 2003, the San Diego hospital has treated
patients with traumatic amputations. But last year, particularly as the
battalion fought the Taliban in late fall, the numbers surged to unprecedented
levels.
In 2010, the
San Diego hospital received 31 patients who had undergone amputations, a
three-fold increase over 2009. In the first four months of 2011, 18 more
patients with amputations were transferred to San Diego.
In 2009,
only one of the 10 amputees had lost more than one limb. In 2010, the figure
was 10 of 31. So far in 2011, the figure is 11 of 18.
In all, the
hospital has had 99 patients with amputations from Iraq and Afghanistan. From
those cases, doctors and therapists have devised improved methods for building
and fitting prosthetic limbs.
Along with
an increase in amputations, there has been an increase in severe wounds to the
genitals and urinary tract. In that regard, Dominguez counts himself lucky.
A shard of
metal came within a fraction of slicing his testicles. He survived unscathed.
"God must have had his hand on me," he said.
Other
Marines and soldiers have not been as fortunate. Their wounds are different
from those suffered by patients in traffic accidents or other civilian mishaps,
doctors say.
"It's
unusual for us to see these kinds of genital mutilation," said Navy Cmdr.
James O. L'Esperance, a urologist at the San Diego hospital. "We've all
done some reconstructions."
Caravalho
said he is confident that from their recent experiences, military doctors will
soon publish articles in medical journals on "how best to salvage
testicular function."
Meanwhile,
the Marine Corps plans to send blast-resistant underwear to Marines in
Afghanistan to protect their genitals and femoral arteries.
Although the
new "blast boxers" will not make Marines immune to improvised
explosive devices, they are meant to prevent dirt and shards of metal from
being embedded in a wound and causing an infection.
In November,
Dominguez told The Times that he occasionally wished he had died in Sangin.
Those kinds of thoughts now seem largely gone, replaced by a pride in what his
battalion accomplished there
"The
Taliban failed," he said. "Their purpose was to kill me. I
survived."
To walk the
grounds of Naval Medical Center San Diego is to see numerous Marines, soldiers
and sailors like Dominguez, in wheelchairs or with prosthetic limbs, many
accompanied by spouses or parents and sometimes young children. More seem to
arrive daily as the fighting in Afghanistan intensifies after a winter lull.
"It's
part of our life; it's all around us," said L'Esperance. "You can get
used to it.
"I hope
we don't."
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