Traumatic brain injury in the war zone.

Sergeant David Emme, a supply officer with a U.S. Army Stryker Brigade, was stationed at a submachine gun on a truck rolling through northern Iraq last November, in a convoy transporting Iraqi volunteers to Mosul for military training. As they entered the town of Talafar, Emme noticed that the streets were unusually quiet: no children were outdoors running toward the vehicles demanding sweets. Emme got on the radio and warned others in the convoy: “Something might happen. They might have some plan for us.” Moments later, as they slowed at a traffic circle, an improvised explosive device (IED) went off right next to Emme’s truck, knocking him out. Emme’s version of what happened next is patched together, from his own memories and what others told him later. “I remember waking up and wondering who the hell I was, where the hell I was, and why can’t I see or hear? My soldier was screaming for me to get out of the truck and I told him no, because it hurt too much. So he literally threw me out of the truck and guided me to a Stryker,” a lightweight armored vehicle. The blast wave and fragments from the explosion had blown out Emme’s left eardrum, fractured his skull, injured his left eye, and caused a severe contusion in the left frontotemporal area of his brain. His fellow soldiers rushed him to the nearby military base, where he partially regained his vision and tried to walk before again losing consciousness. He was medically evacuated, first to a combat support hospital in Balad and then to one in Baghdad. There, neurosurgeons performed a craniectomy, removing a large piece of skull from the left temporal region to give Emme’s brain room to swell (see diagram). They implanted the bone under the subcutaneous tissue of his abdomen, hoping that it could be replaced later — if Emme survived. He remained unconscious and remembers nothing about his stops in these hospitals. “The next time I come to, I’m at Walter Reed — like, 10 days later,” he recalled. Emme spent about six days in the intensive care unit, sometimes mistaking nurses for CIA agents or believing he was back in Baghdad. Then he was transferred to a room in ward 58, the neuroscience unit at Walter Reed Army Medical Center in Washington, D.C. At some point, he became alert enough to realize that he was having difficulty speaking. “I called for the nurse. . . . I kept on just trying to say something, but I couldn’t really say anything,” Emme recalled. The nurse asked him questions and waited patiently for him to answer. Finally, she left to check on other patients. About a half hour later, she returned, and Emme managed to articulate his message: “My head hurts.” In the five months since then, Emme, 32, has made a remarkable recovery from his severe brain injury. He is a clean-cut young man with expressive brown eyes, a scarred left cheek, and a depression on the left side of his head where the missing piece of skull has yet to be replaced. (That will be done after surgeons finish reconstructing his tympanic membrane.) His vision has returned almost to normal. With time and intensive therapy, his speech and cognitive function have dramatically improved. “Basically, I had to learn what things were again,” Emme explained. Then he corrected himself: Dr. Okie is a contributing editor of the Journal . Sergeant David Emme. Jo na th an E rn st Traumatic Brain Injury in the War Zone