Battle Field Angels (36 page)

The increasing presence of women on the battlefield notwithstanding, the belief persists among some in the military that war is best fought by men. Some objectors maintain that women are unable to perform some duties required of soldiers and the medical corps in combat. For example, some argue that a wounded, nonambulatory soldier lugging up to one hundred pounds of gear should not have to rely on a female corpsman or medic who may not be strong enough to carry him off the battlefield. In 1994, the Department of Defense issued a policy prohibiting women from being permanently assigned to or alongside ground combat troops. Women were limited to support roles such as analyzing intelligence, driving trucks, flying helicopters, and being corpsmen and medics confined to military base hospitals and clinics.

Despite the experience of guerilla warfare in Vietnam, the 1994 policy was issued at a time when the Pentagon still considered the battlefield to have identifiable forward combat zones and relatively safer rear areas. But the conflicts in Afghanistan and Iraq didn’t conform to what had been the bulk of the American experience in war. There were no clearly defined battle lines. Nearly every patrol was a “bubble mission” in which U.S. troops potentially could become surrounded and ambushed by the enemy. Regardless of their official assignment, female corpsmen and medics in Afghanistan and Iraq were effectively an integral part of America’s combat ground forces.

Although they have accounted for only 2 percent of combat deaths in Afghanistan and Iraq, women have been present on the battlefield. Nearly every outpost, hospital, and military base was within range of enemy fire. Clashes with insurgents took place in mountains, deserts, cities, towns, and villages. By 2007, more than 10,000 mothers had served in Iraq. Women in Afghanistan and Iraq have completed more than 170,000 tours of duty. By the end of 2008, nearly five times as many women had been killed in Afghanistan and Iraq than had been killed in World War II, Vietnam, and the Persian Gulf War combined. Many were mothers and more than half were under the age of twenty-five.

On March 21, 2008, Vice President Dick Cheney awarded Monica Brown the Silver Star. She was only the second woman in more than sixty years to receive it. Four nurses had received the award in World War II, and an Army policewoman in Iraq had been awarded the Silver Star in 2005. But by the time she received the award, Brown was no longer treating wounded soldiers in the field.

Within a week of the firefight, Brown was transferred back to the Army base at Khost. Her presence in the riverbed had violated the rule that banned women from the battlefield. Smith, one of the soldiers Brown treated under fire that day, agreed with the policy. Others, however, including several soldiers on patrol with Brown that day, said she performed as capably as any male medic.

Not everyone, though, believed Brown’s actions merited the Silver Star. There were those, including men who belonged to Brown’s unit, who believed she received the award in part because she was a young woman, only eighteen years of age. Some cited the actions of other medics who courageously saved the lives of wounded soldiers under intense enemy fire yet did not receive any recognition.

The ban on permanently assigning women to combat units remained, although in Afghanistan, Army officers continued to temporarily attach female medics to combat units as a way to circumvent the regulation. For some, it added to the combat stress that always has been a hallmark of war.

With each war, the military medical corps’ perception and treatment of combat stress has evolved. During the Civil War, it was called soldier’s heart. In World War I, it was referred to as shell shock. During World War II, it was identified as battle fatigue or hysteria. One Marine Corps report revealed that approximately 10 percent of troops were diagnosed and treated for battle fatigue in the war zone during World War II. In Vietnam, about 1.2 percent of the troops received care in the field for what generally was considered to be a weakness or personality disorder.

War traditionally has been viewed as a test of manhood. A soldier proved his worth to himself and to others on the battlefield. For more than thirty-five years following the elimination of the military draft, Americans have volunteered for military service. To become a psychiatric casualty after volunteering for combat has been seen by some as particularly damning. Psychological wounds that otherwise may be invisible have made acknowledgment shameful for many soldiers. In 1980, post-traumatic stress disorder became a diagnosable mental disorder recognized by the American Psychiatric Association. For many in the military, however, “some water and a good run” remained the best way to restore a soldier’s mental health. Although PTSD is now more widely accepted, the stigma remains, effectively rendering these wounds somehow less honorable in some eyes than gunshot or shrapnel wounds.

Combat stress has always been used as a weapon of war. A stressed enemy is a less dangerous foe. For decades the United States has conducted psychological operations against enemies designed to weaken their will to fight. In Afghanistan and Iraq, heightened combat stress among American troops was one of the goals of insurgents who planted and detonated IEDs and conducted ambush missions in order to create uncertainty, shock, and devastation.

Today, the military medical corps acknowledges that nearly everyone deployed to a war zone is affected by combat and operational stress reaction. Medics and corpsmen constantly watch for emerging signs of COSR, which generally is considered to be an expected emotional reaction to combat stress, while PTSD is a more protracted psychological condition. A soldier who no longer makes eye contact, whose body language indicates a detachment from his surroundings, who appears numb, or has difficulty remembering details of a battle may have COSR. It typically surfaces shortly after an incident or series of events. With time and counseling, the symptoms usually abate without significant treatment or removal from the war zone.

Many stress factors can lead to COSR. In Iraq, corpsmen and medics endured desert heat that could exceed 120 degrees, made worse by modern combat and medical equipment. Their Kevlar helmets and body armor intensified body heat, making dehydration a constant threat. The fine, powdery grit of the desert sometimes created massive “brown out” clouds that resulted in respiratory issues, helicopter crashes, and more dangerous missions.

Noise, too, could wear down soldiers and medical personnel. Newcomers to the Middle East war zone often were unprepared for the sounds of battle. Enemy fire split the air, bullets ripped into the sand, and exploding mortar rounds produced a continuous roar and frequent sensory overload on the battlefield.

Yet most deployments of medical personnel were marked by long stretches of monotony and boredom punctuated by what many called the terror of patrols, missions, and firefights with the enemy. A veteran corpsman or medic learned to appreciate the relative routine of base camp “barracks medicine” that meant distributing various medicines, conducting inspections, and monitoring troop hygiene and mental health.

In some cases, COSR developed into more severe PTSD. The soldier, corpsman, or medic frequently relived the traumatic events and became lost in memories vivid with the sights and sounds of the battlefield. Recurring memories left him in a continuously anxious state. He found it difficult to concentrate, suffered memory lapses, was unable to sleep, or became irritable. Hallucinations and paranoia sometimes followed, requiring significant treatment. Not only did corpsmen and medics watch for signs of combat stress among their troops, they maintained a level of self-awareness for the same symptoms.

Military operations that included medical personnel in Afghanistan and Iraq were based on training, teamwork, and trust. Corpsmen and medics were trained in hand-to-hand combat and weapons. They were expected to support mission objectives as well as treat fallen soldiers. In turn, most soldiers found it unimaginable to lose a corpsman or medic. Medical personnel provided a sense of security, a reassurance that somehow the soldier would return home even if he was wounded. Soldiers were more effective warriors when a trusted corpsman or medic was nearby. They would do anything for their corpsmen and medics on the battlefield, but often considered it almost impossible to forgive one who failed them. Corpsmen and medics knew they could not quit or offer excuses in battle.

Most corpsmen and medics were very young: many were under twenty-one years of age. Youth often led them to believe they were invincible, but they soon discovered that fallacy on the battlefield. They also bore a dual responsibility, apart from their fellow soldiers. Marines were deployed on the battlefield in tight, cohesive units. There was a clear chain of command, as well as support and complementary roles. Unit operational integrity was paramount. Corpsmen performed as Marines under the same structure. But an injured Marine instantly transformed a corpsman into an emergency medical professional. A man’s life sometimes depended on how quickly and effectively a single corpsman could make that shift. The corpsman usually found himself alone, solely responsible for emergency care, often issuing commands to others.

These were responsibilities unique to combat corpsmen and medics. They demonstrated toughness on a par with their soldiers, learned to contain personal fears, and never revealed weakness. One way of coping was to find a friend in the field or back at base in whom they could confide. They trusted in the unwritten code that such conversations were never shared with anyone else.

It was during the relative quiet between missions that corpsmen and medics confronted their greatest fear: failing their troops under fire. They had to accept their inability to save the lives of fatally wounded soldiers and to acknowledge the fragility of life in combat. Unlike civilian paramedics, trauma doctors, and surgeons, most corpsmen and medics found it impossible to “depersonalize” in the war zone. The shared mission and kindred spirits forged on the battlefield prevented them from simply treating a chest wound. Every injured soldier was a brother fighting for a common cause who needed potentially lifesaving care. Failure to save their men could haunt corpsmen and medics long after they returned home. Guilt was the defining characteristic of corpsmen and medics who suffered from PTSD. The emotional toll on combat medical personnel could be severe.

On October 6, 2005, Joseph Dwyer’s nightmares became too real to ignore. In his mind, Texas became Iraq. That night, the former Army medic repeatedly shot at an imagined enemy he thought had broken into his second-floor apartment in El Paso. Frightened neighbors called the police. A three-hour standoff ensued before Dwyer surrendered his pistol and was taken into custody.

Dwyer spent ninety-one days in Iraq two years earlier. He became famous on March 23, 2003, when a photograph of him carrying an Iraqi boy who had been hit by shrapnel to safety appeared in newspapers around the world. But when Dwyer returned home three months later, the medic was scarcely recognizable to his friends.

He had lost nearly thirty pounds and was tormented by nightmares. He began abusing alcohol, sniffed inhalants, and was sure that the enemy had followed him to Texas. He sat with his back to the wall in restaurants. He fortified his apartment against enemy attack, turned a closet into a bunker for protection against infiltrators, and answered the door with a pistol in his hand. One day Dwyer veered off an El Paso street to avoid what he thought was an IED and crashed into a street sign.

Dwyer entered several drug treatment and psychiatric programs following his return from Iraq. He admitted to therapists that he had denied suffering from PTSD when he returned to the United States because he wanted to become a policeman. The hallucinations continued. Dwyer was admitted to another treatment program several weeks after his confrontation with police.

In July 2007, Joseph Dwyer’s wife obtained a restraining order to keep the former Army medic away from their two-year-old daughter. The breaking point came when he grew enraged after she took an AR-15 assault rifle away from him.

Dwyer was living on disability payments. His life had turned inside out. He slept during the day and at night patrolled the neighborhood against imagined enemies. He hid knives throughout the house in case he was attacked. Dwyer spent hours on the computer, looking at Iraq war photographs that were set to patriotic music. He was embarrassed by the photo taken of him carrying the injured boy to safety four years earlier. On July 27, 2007, Dwyer checked into another psychiatric inpatient program. He was discharged in March 2008, and returned home with twelve drug prescriptions. Within a week, the nightmares returned.

On June 28, 2008, Joseph Dwyer called a local taxi service in Pinehurst, North Carolina, where he had moved from Texas. When the driver arrived, Dwyer’s front door was locked. Dwyer yelled that he could not get up to open the door, so a police officer who also had responded kicked it in. They found Dwyer lying in his urine and feces. He had been sniffing a refrigerant-based aerosol used to clean electrical equipment.

“Help me, please! I’m dying. Help me. I can’t breathe,” he told police.
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Thirty minutes later, Dwyer died from a drug overdose. He was thirty-one years old. In many ways, Dwyer was a combat casualty.

Combat injury in the early years of the twenty-first century has been studied more than at any time in our history. Research has shown that soldiers and military medical personnel suffer psychological injuries more than any other type of combat injury. These can come from experiencing a traumatic event, grief, fatigue, or inner conflict (incongruity between personal values or religious beliefs and the realities and demands of war).

Studies have revealed that there is little difference in combat stress, PTSD, and related disorders between men and women. Even though women technically were not assigned to combat units in Afghanistan and Iraq, they were as likely as men to know someone who was killed on the battlefield and to be exposed to enemy fire. One study linked the incidence of PTSD to the number of firefights in which a soldier, corpsman, or medic engaged. About 40 percent of PTSD cases were comprised of those who had participated in six or more firefights. Combat exposure, not gender, was the most direct predictor of modern war’s most common and potentially long-lasting battlefield injury.