VA trauma center treats most grievously wounded troops

By Tony Perry | LA Times | LATimes. com | June 5, 2011

The Palo Alto facility is among four nationwide in which physicians and therapists take a team approach to care for those who have suffered amputations and other catastrophic injuries, many from bomb blasts.

Marine Lance Cpl. Jorge Ortiz is in pain.


A combat photographer, Ortiz was taking pictures of a captured weapons cache in Sangin, Afghanistan, on Jan. 15 when he stepped on a buried explosive device.

LCpl Ortiz photo LA Times

Marine Lance Cpl. Jorge Ortiz, 19, of Fresno, who stepped on a buried explosive in Afghanistan, rests in the hospital. The blast ripped off his legs, snapped off four fingers on his left hand and his right thumb. (Photo by Mark Boster, Los Angeles Times / June 5, 2011)


The blast ripped off his legs above the knees and snapped off four fingers on his left hand and the thumb on his right hand.

Classified as a triple amputee, Ortiz is now an inpatient at the Polytrauma Rehabilitation Center at the Department of Veterans Affairs hospital in Palo Alto – one of four VA centers nationwide staffed and equipped specifically to treat the most grievously wounded U.S. military personnel in Afghanistan and Iraq.


The centers have become a key element in caring for the wounded as the war in Afghanistan enters its second decade and the injured from Iraq continue to need care. They are the result of important medical insights gleaned from the long wars in the Middle East – that modern battlefield injuries, particularly those from bomb blasts, require a team approach from physicians and therapists.


The number of troops suffering amputations and other catastrophic injuries is increasing as the U.S. counter-insurgency strategy requires them to leave the protection of heavily armored vehicles and do more foot patrols to help win support from Afghan civilians.


Also increasing are the numbers of personnel suffering a kind of wound, traumatic brain injury, that may leave no outward marks but can inflict lasting damage.


Once saved, many face years in need of medical care, rehabilitation and support, first for their bleeding wounds and later for the depression and suicidal thoughts than can exact a deadly toll.


Into this breach have come both military-run hospitals and the VA medical system. Palo Alto has the only VA polytrauma unit on the West Coast. Others are at VA hospitals in Tampa, Fla.; Minneapolis; and Richmond, Va., all care for both active-duty and medically retired personnel.


The Palo Alto unit has a staff of medical specialists and an agreement with nearby Stanford University School of Medicine. There are specialists in amputation, auditory impairments, blindness, spinal cord injuries, and post-traumatic stress disorder and other mental health conditions.


Here, mending bodies is only one piece of the puzzle.


Recently, the 19-year-old Ortiz suffered a complication common to new amputees: leg bone growth protruding through one of his stumps.


Ortiz, who grew up in Los Angeles before his family moved to Fresno, underwent surgery to remove the growth so he could resume the long, difficult ordeal of being fitted with prosthetic legs and learning to walk.

But the surgery has left Ortiz in enormous pain.


His doctors have given him a variety of medications that leave him foggy and could slow down his recovery from another of his wounds: traumatic brain injury.


Although he lacks a visible head wound, Ortiz has the slowed responses and memory difficulties common to troops damaged by the blast of roadside bombs that are the Taliban’s weapon of choice.


“Can my pain medications go up?” Ortiz asked one of his doctors during a bedside visit.


“No,” Dr. Ted Scott, the attending physician at the polytrauma unit, answered softly. “We want to start getting you off that.”

“But what if the pain gets worse?” Ortiz said.


“You’re basically on everything known to medicine,” Scott replied. “It’s one of the things that make me sad to be a doctor: We can’t fix everything.”


It’s a dilemma for doctors and patients: medication can dull, although not eliminate, pain but it also can delay recovery from traumatic brain injury and other wounds.


Still, Ortiz has some advantages. He is known among the medical personnel for his determination.


When other patients are taken to outings such as the movies in Palo Alto or Fisherman’s Wharf in San Francisco, Ortiz prefers to stay at the hospital and work on his memory and coordination therapy and his stretching exercises.


His mother and 7-year-old sister have moved into Fisher House across the street from the hospital to provide moral support. The facility provides free housing for military families whose loved ones are receiving care.


The VA found a translator for Ortiz’s mother so she can talk to his doctors and has enrolled his sister in school.


Staff Sgt. Jeffery Jimerson, an Iraq veteran, is assigned to the hospital. He monitors the progress of Marines and visits those who are recuperating at homes and other facilities throughout California, Oregon and Washington. The Marine Corps wants to avoid a repeat of the Vietnam War era, when some wounded personnel felt abandoned.


“Depression can kill,” Jimerson said.


When Marine patients begin to slack off on their therapy sessions, Jimerson closes the door and provides a motivational speech. “Despite your injuries,” he tells them, “you’re still a Marine and the commandant has ordered you to cooperate with the doctors and therapists and get back in the fight.”


Ortiz was attached to the Camp Pendleton-based 3rd Battalion, 5th Marine Regiment as it battled to oust Taliban fighters from control of Sangin, a farming community in southern Helmand province, on the Pakistani border.


Cpl. Farrell Gilliam, 22, of Ridgecrest, Calif., was a machine-gunner with the 3/5. Now he’s also a patient at the Palo Alto polytrauma unit.


A week before Ortiz was injured, Gilliam stepped on a buried bomb. The blast took off both legs and severely damaged his right arm. He also suffered a severe abdominal injury.


Two weeks of testing have indicated that Gilliam does not show what the doctors call “residual effects” of traumatic brain injury.

One of the mysteries that military medicine is trying to unravel is why some troops suffer traumatic brain injury after stepping on a roadside bomb and others do not. The answer could help in the development of treatment strategies.


“No two brains are wired the same,” said Pawan Galhotra, director of the polytrauma unit.


Gilliam’s brother, Daniel Lorente, 27, is living in Fisher House. He put his plans to go to law school on hold to help his brother.

Gilliam is set to be transferred to the Center for the Intrepid, a rehabilitation facility specializing in amputees and burn victims adjacent to Brooke Army Medical Center in San Antonio.


Several days after his conversation with his doctor about his medication, Ortiz reached a milestone, despite his pain.

For the first time, he took a step on preliminary prosthetics, so-called stubbies. Later, he will be fitted for full-size artificial legs.

Doctors are encouraged and believe that if he continues to work hard, he could be transferred to outpatient status in two to three months.


On his Facebook page, Ortiz wrote of his joy at his first “stubbies” exercise:


“Damn, today was the first day I walked since January 15th this year. I could still remember that day as if it was yesterday.

“The future is bright for those who try, I guarantee you that because I’m witnessing it myself.”

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