Now he wears a different helmet: A veteran’s access to care

A bomb buried in the asphalt road hit Army Sgt. Michael Boothby’s Stryker military vehicle on Sept. 17, leaving three pieces of shrapnel in the back of his brain. Doctors removed nearly half of his skull to prevent permanent damage to his brain from swelling.

By December, he was back home in Kerrville, Texas. But there were problems with the V.A.—a mix-up with his patient number that delayed his therapy. He entered a rehabilitation hospital in San Antonio, where he has received physical, occupational and speech therapy.

Now he wears a padded helmet for protection. It makes his head sweat—but it’s not as hot as Iraq.

Advice for family and friends of brain-injured patients: These patients need an advocate to represent them, until they’re fully mentally competent.

Read another of our veteran’s stories, or John Tedesco’s source story on April 22 in the San Antonio Express-News.

The bomb that got him was within his own body: A missed diagnosis story

The story of his widow, Melanie Bloom:
He had been on some really long-haul flights between New York and Kuwait in the weeks and months leading up to the war. He was sleeping with his knees up to his chin in a cramped tank night after night.

 The supply lines were dwindling and so he wasn't as hydrated....He did share with me on a phone call home two nights before he died that he was sleeping outside on top of the tank to stretch his legs because he said he had these cramps. 

Huge warning flag, but again, not having heard of DVT or knowing any of the risk factors, we didn't even think to do anything.


He had pain in his leg, and then the pain went away, he was feeling great.

 He called me the morning of the day he died. He ... sounded upbeat, he wasn't limping and everything was good.

 They were going to make the push across the Baghdad border and that night...he abruptly collapsed to the ground and died. The clot had broken free, so his leg didn't hurt anymore. But it had made its way to his lungs.


[David Bloom, NBC News correspondent, had been covering the war.]

Two million Americans will develop a DVT each year. Out of that, 600,000 will go on to develop the pulmonary embolism. Out of that number, 300,000 will be fatal.



Her Advice:
People can take a little test [on the Web] and test their own risk level, because that's the biggest piece of it - just knowing, "Do I fall into these risk categories?" and if you do, talk to your doctor.

(We're) encouraging people to take their risk assessment tool results to their physician and start that dialogue.


[If] you might have pain in the leg, you might have swelling or tenderness to the leg, and that's good if you have those warning signs because you should immediately get to your doctor and get that checked out.



Read another Iraq story, or read Dawn Sagario’s source story in the Des Moines Register.

Patient Safety Quiz: The Power of Telling our Stories

Q1.Which headline was on the front page of the New York Times this week:

A) Man Bites Dog
B) Israeli and Hamas Leaders Mark Broad Peace Pact with Joyful Group Hug
C) Large Hospital System Fires CEO over Patient Safety Problems


Yes, it was a toughie, but if you guessed C, you’re right. Bob Woodruff broadcast his story, and stories of other American men serving in Iraq, about brain injuries and the frequently inadequate treatment for them. Yesterday’s NY Times headline read, “Army Secretary Ousted in Furor on Hospital Care,” and the story noted it was “the second change of command in two days.”


Q2. Which national hospital system has both a unique and outstanding electronic medical record that integrates patients’ histories over inpatient and outpatient visits, AND a computerized physician order entry system with a dazzling set of alerts to protect patients against medication errors?

A: The Veterans Health Administration


Q3.In 1982, New York Yankees owner George Steinbrenner fired two managers, four pitching coaches, and two hitting instructors. Did it help?

A: No. They lost more games than they won.


Q4. Which hospital has made tremendous progress in patient safety since firing their CEO in the wake of the widely told story of a medication error that led a journalist’s death? Hint: The hospital’s exemplary patient advisory council is a focus of pending Massachusetts legislation.

A: Dana Farber Cancer Institute. Only time will tell whether these firings have effects more like those of Steinbrenner or the Dana Farber’s Board.


Woodruff's public airing of these men's powerful stories may make it possible to speed the return to good health of thousands of wounded veterans.

Advice: Your stories are powerful! Share them with us, and share our stories widely with your family, friends, and colleagues.

Read another story about a veteran’s care.

Not only to linebackers: Undiagnosed brain injuries

Last night, ABC broadcast the moving story of journalist Bob Woodruff’s miraculous recovery from a severe head injury from an improvised explosive device in Iraq. Woodruff’s program warned that many soldiers have invisible, undiagnosed head injuries due to the concussions they suffer in explosions.

This tragic war is disturbing enough, as are the heart-breaking images of our wounded soldiers. Adding insult to the injury is the frequent failure to diagnose their head injuries, and once diagnosed, the failure to provide adequate treatment.

Mr. Woodruff illustrates quite graphically that some veterans are sent home to recuperate in smaller cities that do not have veterans’ hospitals equipped to handle the growing number of those returning with severe traumatic injuries. He interviews a young soldier who is slowly but steadily recovering at a state-of-the-art veterans’ polytrauma rehabilitation center in Tampa, Fla., then checks in on him weeks later in his hometown in Texas, where he has noticeably regressed.

Others are not even diagnosed. One solider in the story mentioned the frequent memory lapses he attributes to undiagnosed head injuries in Iraq.
Researchers screening returning soldiers and Marines at four military bases found that about 20% of troops in front-line infantry units had suffered such injuries.

"This blast group is going to be potentially huge," says Angela Drake, a neuropsychologist with the Defense and Veterans Brain Injury Center, a research arm of the Department of Veterans Affairs and the Pentagon. "We're looking at thousands of potential patients." Military doctors describe brain injuries as a signature wound of these wars. That's because advances in body armor save soldiers who might have died in previous conflicts, but blast waves from roadside bombs can cause brain damage. U.S. troops in Iraq are exposed to hundreds of bombings each month. "We've seen patients who have had three deployments and have had some (head) injury on every single one," Drake says.

The damage from multiple concussions can be irreversible. "Repeated concussions can be quite serious and even lethal," says Air Force Maj. Gerald Grant, a neurosurgeon who treated troops in Iraq.

Eight months ago, Pentagon health official Michael Kilpatrick said “in a few months,” combat medics could start using a simple mental exam to show evidence of concussions. The time is now.

Recent news reports describe the many concussions suffered by Tedy Johnson, a former linebacker with the New England Patriots. Undiagnosed brain injuries occur to the rich and famous, and also to our young soldiers who get very little respect, pay and fame. Not just to linebackers.

Read another of our stories about veterans, or read the source articles by Alessandra Stanley in the New York Times yesterday and by Gregg Zoroya in USA Today.