Remember the Wounded

By John Wheeler The Washington Post Monday 30 May 2005

We should recognize and honor all sacrifices for America.

Eleven years ago Lewis B. Puller Jr., winner of a Pulitzer Prize for the book "Fortunate Son" on his experiences as a Marine platoon commander who was severely wounded in Vietnam, took his own life. Puller had lost both legs and the use of his hands in the war. On May 11, 1994, he finally succumbed to stump pain, to frustration at his inability to grasp objects and to depression, which he had fought for 25 years.

We were close friends, and I can attest that Lew fought his troubles to the end. Despite his disability, he had just completed a trip to Hanoi to pick school sites for the Vietnam Children's Fund. The first school was named for him.

Wounds like Lew's -- from what is now called an improvised explosive device -- are more frequent in Iraq than they were in Vietnam. With protection around vital organs, the rate of wounded Americans having amputations is 6 percent -- three times the rate it was in Vietnam. Also, because of the angle from which such explosive devices strike, about one in five of those evacuated to Landstuhl Regional Medical Center in Germany has head or neck injuries; many have brain damage, breathing and eating impairments, blindness, or severe disfiguration.

Thanks to forward surgical teams, in mini-hospitals close to battle, the ratio of wounded to killed is 8 to 1 in Iraq, up from 5 to 1 in Vietnam. Surgeon Atul Gawande wrote in the New England Journal of Medicine about one Iraq case, "Injuries like his were unsurvivable in previous wars. The cost, however, can be high. The airman lost one leg above the knee, the other in a hip disarticulation, his right hand, and part of his face. How he and others like him will be able to live and function remains an open question."

Lew's case shows the need for recognition, support and encouragement for these wounded, especially to avert depression, isolation and suicide. Like Lew, many wounded veterans can continue to be very productive, but they can at the same time be afflicted by potentially fatal aftereffects.

Unfortunately, no Memorial Day ceremony or war memorial that I have seen has explicitly honored the wounded. In fact, under House Concurrent Resolution 587 of Feb. 10, 1966, Memorial Day is simply for paying "tribute to those who gave their lives."

This oversight needs correction. We need to honor the wounded as well as those who died. Their numbers are growing, and society needs to both acknowledge their sacrifice and understand their situation. And it needs, through this tribute, to give support and encouragement to the families of the wounded -- families that bear great anguish, time devoted to care and economic loss.

Some wounds are not as visible as others. The Purple Heart excludes post-traumatic stress disorder as well as infections and disease that often become evident after a veteran has left the war zone. The Department of Veterans Affairs has reported, concerning Afghanistan and Iraq, that these new wars "will produce a new generation of veterans at risk for the chronic mental health problems that result, in part, from exposure to the stress, adversity, and trauma of war-zone experiences. . . . [I]t is important to . . . raise the awareness of civilians back home, to prepare loved ones for soldiers' return."

The nation and its government need to give some thought to ways to honor the wounded and to recognize the full range of impairments suffered by those who have served and sacrificed for their country. Topics for discussion could include officially expanding the purpose of Memorial Day, establishing medals for cases excluded from the Purple Heart (severe illness in the war zone or later, and death in battlefield accidents), and mentioning the wounded, veterans who suffer illnesses and their families in war memorials. This is a good day to start.