Traumatic brain injury (TBI) is an important source of morbidity in the Iraq and Afghanistan wars. Although penetrating brain injuries are more readily identified, closed brain injuries occur more commonly. Explosion or blast injury is the most common cause of war injuries. The contribution of the primary blast wave (primary blast injury) in brain injury is an area of active research. Individuals with TBI and posttraumatic stress disorder require treatment of both conditions. Families and communities need to be cognizant of the needs of these returning veterans.
Journal of Head Trauma Rehabilitation.
Highlights From the 2nd Federal TBI Interagency Conference.
21(5):398-402, September/October 2006. Warden, Deborah MD
Highlights From the 2nd Federal TBI Interagency Conference.
21(5):398-402, September/October 2006. Warden, Deborah MD
Within the Limits of My Post
"No tienes hambre, Mi'jo?"
Irma Vigil looks at her son, Ernesto, with battered hope and a lot of fear. Ernesto doesn't even pick at his breakfast. She's prepared his favorite food, cocido and hand made tortillas de harina, hot off Mama's comal. Now he isn't answering, gives no indication he's heard. Six months now out of the Army, Ernesto’s affections remain out of reach. The silence is new.
Bloodshot eyes stare absently into the bowl of cocido. Ernesto sleeps only a few hours a night. He spends the silent predawn hours smoking mota, drinking tequilazos. Some nights, Irma wakes to listen to her son's side of long phone calls to his asshole buddy Ro. It is the only time her son grows animated again. Then he sounds like the laughing high school boy who'd volunteered the week after graduation. Now he stares at his breakfast and struggles to find the word in English for helote. And what's cabbage in Spanish? Does he butter, or salt, the tortilla?
Irma has learned not to move suddenly nor speak loudly, that emotions upset him. She gently probes, "Mi'jo?" She struggles for neutrality, to keep her mother's concern out of her speech, but she gets the kind of answer she feared would come from the empty shell of her son.
"It's too fucking hot, puta!"
Ernesto stands, screaming "Aaaaa" at the top of his lungs. He sweeps his right arm across the table, lofting the bowl of cocido into the air. Hot soup backsplashes onto Ernesto's furious arm, the rest of the soup and all of the steaming vegetables arc onto his mother's apron in a glistening cascade. The bowl shatters against the porcelain stove.
The tears in Mrs. Vigil's face come from puro fear at what has become of her little boy. Since his first day back—here, not home she thinks--Irma spends hours alternating between wondering where her sweet little boy has disappeared and wishing he was still in Iraq. He’d signed up straight out of high school. He came home on leave after AIT, when he’d hung around town with his buddies until he left for Iraq. He was still the same old Mr. Happy-go-lucky high school debater full of opinions and fancy talk talk talk. What the Army sent back to her is an impostor. There isn’t enough of the real Ernesto left to make this house a home.
The president did this to her son. She curses herself not for the first time, for being such a taruga, believing his lies both times. He said he cared about the soldiers but ran from his own duties. And the "other priorities" vice president handing out medals. Irma didn't say anything about that when she took her concerns to the recruiting office after Ernesto's first week back. The gigantic Marine referred her coldly to the Veterans Administration. “Three concussions,” the recruiter told her, meant she’d been lucky to “get him back in one piece.” Then the clerks at the VA told her at first that PTSD was for cowards and schemers, that what Irma read in the paper was yellow journalism. But they sent him for an interview and group counseling meetings. Last week Ernesto’s file was closed. The VA concluded Ernesto’s moodiness and problems were from drug and alcohol abuse.
Irma bends at the waist and pulls her apron away from her body. Steaming cabbage leaves slough off her garment and flop onto the bare wood floor. She grabs the broom and starts sweeping the mess toward the back door. Outdoors, the chickens recognize the sound of food coming their way and set off a cackle in their rush to the screen door. Ernesto’s head swivels from his mother's sweeping to the noise coming from the back door then back to the sweeper.
His mother's tears spark a flash of guilt. He starts to apologize but he bites off the words, the emotion turns back on itself. Anger wells but this time he recognizes it. He draws in his lips tightly, pushes his tongue against his teeth. He starts to chant in a low mumble, "Control, troop, control." The sound of Piolín, doing an irritating silly voice on the radio melds into the racket the gallinas make clamoring for their sweepings, melds into the "clack clack" of the broom hitting the stove, the rush of a passing car. Everything comes at Ernesto as one undifferentiated roar. His vision blurs, he sees his mother as a silhouette, a moving target. "Control, troop, control," he chants, "Control, troop, control." It had been his calming mantra during his 22 months in country.
BOOM! Ernesto sees the cloud of smoke and dust first, then a few seconds delay follow until the sound of the explosion reaches him. The timing, flames, dense black smoke, locate who took the hit. The third deuce and a half in convoy, the new girl’s truck. Now the point of highest danger, when the locals open up on anyone rushing to the rescue. "Bring 'em on," Ernesto thinks, "I'll nail them before they can duck for cover." He takes a breath, holds it, and exhales slowly. Concentrating on the feeling of his breath passing across his lips centers his focus. "Control, troop, control," Ernesto chants. From his position in the machine gun turret, Ernesto has a clear view of the landscape, sweeping his sights steadily from left to right, right to left, his eyes fixed forward to catch the slightest movement in off-axis vision. Anyone running--in any direction--anyone moving too fast, anyone poking their head out a window or the top of a building, squinty-eyed Ernesto knows he will spot them and squeeze the trigger on them. Sometimes he’s right, sometimes he’s wrong. But he never misses. "Control, troop, control." Then clouds of dust obscure his target. Sometimes Ernesto hears them scream.
"Control, troop, control." The first time Irma hears the phrase, Ernesto has called in the early morning, the end of his first month in Iraq. Ernesto is telling her not to worry about him. He explains how the most experienced soldiers are scared when they see action, and how most of the rookies fire wildly and hit nothing. "Ma, it's magic," he laughs. "Hincho mis ojos then
I just tell myself, 'control, troop, control' and just like that I'm all steady and sure.”
“Oh, Mi’jo, I’m so glad,” Irma interrupts.
“Then someone dies." He says this with dramatic effect in this teevee announcer voice. It’s a game they’ve played for years. In synch they sing their version of television teaser music, “tan tan tan tan.” Irma smiles knowing Ernesto is smiling with her, that miles and miles away, where it’s already tomorrow, she shares a smile with her son.
“It's them or me, Ma, and it ain't gonna be me. Relax, Ma, calma calma." Sure, she can relax now, knowing her baby boy has a sure-fire killing prayer. Irma crosses herself and kisses her hand five times.
Now Ernesto keeps his mother in his sights, ojos hinchados staring straight ahead, alert for movement at the periphery. Irma sweeps slowly, moving gingerly toward the door and the safety of her back yard. Ernesto's arm stings from the hot cocido so he wants to cry but men don’t cry. His fingers find the butter knife. He runs his thumb along the dull edge. "If she moves toward me, it'll have to do," he thinks. He watches the broom sweep and waits for the enemy to make a sudden move. "Control, troop, control," Irma hears him chanting and breathing, knowing what it means to him, knowing he means it for her.
The phone surprises him--an intrusive ring instead of a soft click. Ernesto presses the handset hard against his ear, listening for the alert. A call means some forward outpost has spotted movement "out there," heading his way so be on guard.
"Bravo niner niner, Specialist Vigil, Sir" he answers sotto voce.
"Bueno, Ernie, no 'sta tu 'ama?"
Ernesto's eye grow wide with alarm, then he slams the phone into the cradle. "Raghead trick," he says, "something's up." Training kicks in. He squinches his eyes into slits. It's supposed to cut the glare, takes the details out of a landscape and you look for movement alone. Anything that moves needs to be dead. Ernesto's eyes sweep the field of fire in a 180 degree pattern. The target moves out of vision, that's OK. Ro has his back.
"Ro?" he whispers, "Ro, you got it? Ro?"
Last Thanksgiving Robledo stormed through the transit barracks, screaming. "Goddamned headquarters bullshit! Goddamned headquarters bullshit!"
"What's up, bro?" There was so much Hq B.S. Ernesto wanted clarification on Ro's most recent revelation. Ro would magnify it into something hilarious that would be another highlight of Ro’s novel. The unit had been assigned for R&R in the green zone, and they'd taken up residence in the EM transit barracks, AKA Paradise: Lights, electricity, air conditioning. Hot running water. 24 hours a day. Vending machines with refrigerated water, unmelted candy bars, microwave popcorn. Hot chow. And now a great big Thanksgiving Day dinner that couldn't be beat. They would rotate home from here.
"Put on your fuckin' dress uniform. No uniform, no turkey!" Robledo declared.
"Says who?" demanded Ernesto.
"Sergeant Major. BeeCee's order."
"What total bullshit!" Ernesto was on his feet now. There was nothing hilarious in this total Lifer bullshit. "We're out there every day in the dirt and sun, no chow, no baths, no PX, and the fuckin BeeCee 24/7 basks in all this cushy luxury. Now he wants us to dress up for Thanksgiving or we don't get to eat? Fuck that shit, just fuck him all to hell and back, and the pinche white horse he rode in on!"
Ernesto thought about digging through his duffel for the dress uniform he'd rolled tight and stuffed into the bottom of the heavy canvas bag. He had to do it anyhow, to process out. Torn between thoughts of turkey cranberry sauce mashed papas gravy pie, the works, and the total bullshit of being forced to put on the dress uniform, Thanksgiving lost and bullshit won.
"Let's get some kabobs from Falafel Freddy, Ro. We’ll eat turkey when we get back to the world, man!" And that's what they would have done. Everything would have been hunky dory, as Sergeant Major liked to say, except some asshole drew a bead on Robledo and shot Robledo in the head. Ro hadn't even tasted Falafel Freddy's chicken, "Famous from Boston to Baghdad" the sign read. Three days later, Ernesto walked into his mother’s front door.
"Ma," Ernesto cries, "Ro was a good guy. The best. Ma, how come Ro had to die? How come they wouldn't let us have any cocono, Ma?" Ernesto buries his face into both hands, then drags his fingernails deep across his forehead and cheeks. He slaps his face to rub off the tears and the palm comes back bloody. He holds them out to his mother. "Ma, Ro didn't have a face, he didn't have any face left, Ma."
Mrs. Vigil slips out the door and listens to the misery overwhelm the son she'd lost in Iraq, and decides what has to be done. The medical review board has declared Ernesto's problems "unrelated to military service," so there is no money, no help. The counselor told her not to appeal, still, he said it was urgent to get the veteran into private medical treatment. "Arnie is in a world of hurt, Ma'am, and there’s no way the VA can help."
"His name is Ernesto," Irma declared, "Ernesto, after his grandfather." The man stared through her. He didn't understand her point and waited quietly for the woman to vacate his space.
Irma climbs to the garage rafters to bring down her father's memento box. Ernesto Grande, she thinks proudly, the neighborhood called her father Ernesto Grande. Not because Dad was tall-- he was a short indio-- but because he merited so much respect. Her son was Ernesto Chiquito, a name he wore proudly.
The boy worked hard to earn money, mowing lawns in the Anglo part of town, delivering free newspapers for whatever he could collect, picking aluminum and bottles out of trashcans, walking across town to the scrap yard because they paid more per pound. The boy wanted money not for himself but to help his mom pay the bills. Ernesto Chiquito was a good son, everyone said so.
But now the neighbors call her son "Ernesto loco," and cross the street when they spot mother or son walking to the bus. The memento box holds Ernesto Grande's World War II stuff. Three pieces of shrapnel that he'd carried in his body from Normandy to Paris. "I'm saving them for Private Ryan," Ernesto Grande had laughed. She didn't like touching the Nazi paraphernalia, buttons, medals, leather cases Big Ernie had taken from the bodies of men he'd killed on the road to Leipzig. Irma finds what she is looking for, wrapped in one of Ernesto Chiquito's tie-dyed diapers. Mother holds baby’s diaper to her nose. She breathes in desperately to catch the lost scent of that precious infant. The smell of gun oil drags her back to the moment. She cries as she unwraps the pistol, a Walther PPK. "James Bond's gun", her Dad always laughed. She chambers a round, flicks off the safety, and waits at the top of the ladder for night.
It is dark in the kitchen where Ernesto still sits at the table, talking to himself. "Sir, my first general order is, 'I will guard everything within the limits of my post and quit my post only when properly relieved.'" Irma stands outside the back door, listening to Ernesto repeat the words over and over. "Sir, my first general order is, 'I will guard everything within the limits of my post and quit my post only when properly relieved.’ Sir, 'I will guard everything within the limits of my post and quit my post only when properly relieved.’ Sir..."
Irma coughs to alert her son she is near. Silence blares from the kitchen. He resumes the chant. Irma pulls the screen door slowly, hoping to stifle the noisy hinges and slip quickly into the shadows. Ernesto stops with the sound, then resumes his chant where he'd left off.
"... will guard everything within the limits of my post and quit my post only when properly relieved.’ Sir..."
Tiptoeing slowly forward, she approaches the kitchen table where her lost little boy sits. Her fingers guide her slow progress around the unseen table where step by step brings her pistol hand within touching distance of the hollowed source of the empty voice that repeats its first general order with meaningless precision.
"...I will guard everything within the limits of my post and quit my post only when properly relieved.’ Sir..."
The shadows are darker where Ernesto fills the chair. He stops chanting, slumps forward in the chair, his face hits the table, he is silent. His mother inches her way forward until she feels the heat her suffering child’s body gives off. The pistol feels like an angel's feather in her hand. Her thumb finds the safety. It sets with a click.
“Ma?” Ernesto asks out of the dark, “What are we gonna do, Ma?”
Mother’s arms find child’s shoulders, child’s arms find Mama’s waist. They tremble together like that until the dark turns to daylight.