Reconstructing lives--a tale of two soldiers.

n engl j med 355;25 www.nejm.org december 21, 2006 2609 knowing they’re out there — and even more, he savors the silence. Pepper, who was blinded by a bomb in Iraq in 2004, completed a rehabilitation program for blind veterans last year at the Edward Hines, Jr., Veterans Affairs Hospital in Illinois, learning to find his way using a cane and a personal global positioning system (GPS) device. With this device he was able to travel alone by public transportation into downtown Chicago. By moving to the country, Pepper has given up that independence: his wife or her brother must drive him to his college classes and other appointments. But to Pepper, a former Army combat engineer still struggling with disabling headaches, episodic anxiety, and other sequelae of the blast that blinded him, damaged his brain, wounded both arms, and destroyed his sense of smell, it seemed more important to escape from the sounds he associates with danger and combat. “I want the quietness, the serenity of knowing that I’m in the country,” said Pepper, a powerfully built man in his late 20s. “You don’t have the hustle and bustle of all the traffic. You don’t have the honking of horns, the sirens. You hear gunshots, but it’s target practice or hunting.” He grinned. “The crickets get kind of annoying.” Pepper and another soldier, David Emme, were profiled in the Journal last year while they were undergoing treatment and rehabilitation at Walter Reed Army Medical Center in Washington, D.C. As sergeants in the U.S. Army serving in Iraq, both had been wounded by improvised explosive devices and had traumatic brain injury (TBI), which has been called the signature wound of this war. Both also had symptoms of post-traumatic stress disorder (PTSD). Among more than 22,600 U.S. soldiers wounded in the conflicts in Iraq, Afghanistan, and other locations as of November 4, 2006,1,2 blasts have been by far the most common cause of injury, and 59% of blast-exposed patients at Walter Reed have been found to have a TBI.3 As thousands of brain-injured veterans come home to recover and rebuild their lives, medical experts have expressed concern about the challenges of providing them with continuing medical care and vocational and emotional support, especially beReconstructing Lives — A Tale of Two Soldiers