WASHINGTON—When the Army doctor walked into the musty hospital room, the patient, strapped in a neck brace, eyed his uniform, looking for the patch on the right shoulder that would signify that the doctor, too, had been in combat.
But Dr. Brandon Goff doesn't have one. He's never been to war. War comes to him.
Goff, a major, has spent this war in Wards 57 and 58 of the Walter Reed Army Medical Center in Washington, where as director of patient rehabilitation he treats soldiers who've suffered amputations, traumatic brain injuries and spinal cord injuries. At 35, he's an unintended historian of the wars in Iraq and Afghanistan.
He knows that improvised explosives in Iraq are bigger now because he's seeing more patients with both legs blown off above the knee, not just one below the knee. He thinks that insurgents first acquired especially lethal explosively formed projectiles last spring, because that's when he saw his first patient who'd been wounded in such an attack. And he thinks that brain trauma from explosions could be the cause of the abnormal bone growths that soldiers wounded in this war have around their amputated limbs. The phenomenon didn't exist in previous wars.
While patients, resident doctors, families, politicians, reporters, celebrities, foreign delegations and medical researchers all have walked his halls since the war began, no one stays very long. Goff does.
Most in his wards live the horror of losing a limb once. Goff relives it with every patient who's come through his ward. More than 1,000 of them. And counting.
Pvt. Travis Webb lost both legs and had to return to the hospital two months after his discharge because of an infection. The wife of Sgt. John Kriesel of Cottage Grove, Minn., slept in the same hospital bed as her husband, much to the dismay of the staff.
Pfc. Michael Alsop, the man with the neck brace whose eyes searched for Goff's combat patch, was injured in Tal Afar when a bomb exploded under his Humvee on May 17. He was the rear passenger, and sustained a spinal fracture. It was his second overseas deployment, and he was in the 25th Infantry Division.
"Iraq's not as bad as Afghanistan. There is nothing but dirt in Afghanistan," he told Goff hours after arriving. Goff moved to the end of the bed so Alsop wouldn't have to turn his neck.
"What happened?" Goff asked.
"Honestly, I don't remember. It (the explosion) was on my side," Alsop managed through a haze of drugs. He wondered if the doctor understood him. Then his eyes moved to Goff's right shoulder.
Goff, 35, from Tyler, Texas, isn't from a military family. Like many of the doctors at Walter Reed, he joined the military to help pay for medical school.
He wears Army boots and a uniform, but not a white doctor's coat. He's unassuming but driven. He's quick to praise other members of his team: the social worker, the chaplain, the physician's assistants, the physical therapist, the group that makes new limbs.
Before Goff arrived at Walter Reed in 2003, he'd worked at the Pentagon. He treated the wounded there on Sept. 11. He's still amazed that he didn't feel the explosion when the plane hit just one building section away; that when he saw a man covered in ash walking toward him he still thought it was a drill; that an admiral turned to him, a lowly Army captain, and asked, "What should I do?"
"I told him your job is to stand on the road and commandeer vehicles," Goff said, laughing. "He just looked at me, smiled and said, `I can do that.'"
Goff's day starts anywhere from 4:30 to 7:30 a.m., and he spends the next several hours walking the halls, from the ward to the rehabilitation center to his office to where his resident doctors and physician's assistants work.
An amputee spends two months in Goff's ward on average and a year on the Walter Reed campus relearning motor functions. Families move in and work with the loved one through physical therapy. Though Goff can't remember every name, he remembers the details of their recoveries. That one has been here for 200 days, he said about one sleeping soldier. This one isn't recovering well from his brain injury; he can't remember things, he said about another in the physical therapy room.
As he came into work at 7 a.m. Wednesday, Goff was thinking about the distraught Army wife he'd counseled the day before. Her husband had been shot in the neck by a sniper and was paralyzed from the neck down. Goff told her that people with such injuries can live happy lives. He knows he'll have to tell her that again. And again.
He was thinking about the oral exams he'd taken the weekend before at the Mayo Clinic in Minnesota. They'd asked him to answer a question about amputees as though he were working in the civilian world, where such injuries happen to elderly diabetics, not young men.
"They all think it is interesting, but none of them would want to do it, I could tell. They all wanted to go back to their incredibly high-paying jobs," Goff said. "I do question it sometimes, my insanity."
His mind then turned to the day ahead. He had a 9 a.m. appointment with a doctor who was researching ways for amputees to gain a sense of touch in their artificial limbs. Dr. Joseph Schulman described how a 5 mm computer chip could allow an amputee to feel the tip of his finger on his artificial limb.
Schulman wanted to work with Goff's patients. Goff was enthusiastic. Schulman, a regular visitor, promised he'd be back.
During World War II, the U.S. Army had more than 100 hospitals to deal with war injuries; in Vietnam, there were around 15. Today, there are three.
Every Wednesday, a rehabilitation outpatient can come to Walter Reed and see a doctor. About a dozen were waiting on the Wednesday before Memorial Day; some had artificial limbs flung across their shoulders or sitting in their laps.
Goff let the resident doctors take the lead. He waited in an empty conference room, then went into the examination room afterward to chat with the patient.
Sgt. Kriesel, 25, and his wife, Katie, met with Dr. Laura Sterns, an internist. Kriesel, a member of the Minnesota Army National Guard, lost both legs above the knee when a bomb exploded under the left side of his vehicle just south of Fallujah on Dec. 2. Kriesel, who was seated on the right-hand side, doesn't know what happened next.
"I kept my eyes closed. I knew bad things were happening around me," he said.
The blast took a tremendous toll. His left leg was gone and his right leg was shredded. His pelvis was shattered. His left arm was broken in several places. The blast's force left him with brain injuries.
The driver, Sgt. Bryan McDonough, 22, of Maplewood, Minn., was killed. Kriesel wears a black bracelet remembering McDonough on his right wrist. Another soldier died in the blast; Katie Kriesel wears a bracelet remembering him.
Kriesel was having a good day. He wore a shirt that read "Hippies Smell," and he was carrying a copy of "The Complete Idiot's Guide to American Government." The axle of his wheelchair had a Minnesota Viking logo on it. He's out of Goff's ward, and he lives on the hospital grounds with his wife. He'd come to the center this day to go over his eight medications.
Kriesel was lucid as he described what had happened to him, unwilling to be the object of pity. He said he'd thought he'd die that day, so he was grateful to be alive. He said he'd go back to Iraq again—because the Army was making progress.
The room grew quiet. At moments such as these, even Goff feels that he's not doing enough.
Goff broke the silence with a story about Kriesel's 4-year-old son, who says he wants to lose a leg like his father. Everyone smiled and Kriesel promised to keep going to physical therapy twice a day so he could get back home to his sons.
Everywhere he goes in the hospital, Goff carries a batch of print-outs, often tattered by the end of the day, detailing what brought the young amputees to his ward.
Alsop, who was injured in Tal Afar, was among the last patients Goff saw that day. Goff asked Alsop to tell him everything he knew about the explosion. But Goff didn't ask about the others in the vehicle because they could be dead.
Alsop, who through the haze of drugs gave his hometown only as "just outside of Kansas City," told Goff he wanted to move to San Antonio, where one of the three Army hospitals is, so his family could be closer to home. Goff promised to get him out and headed for his office, converted from a hospital room, a few doors down.
It was now 2 p.m., time for his daily meeting with his doctors to find out what had changed since he'd first printed out his batch of papers. Goff told the resident doctors to force a patient who didn't want to learn to dress his wound. He sighed as he thought about the day the soldier would learn that all the surgeries couldn't save his right leg.
Two patients, including Kriesel, had told Goff that he has a tough job. After the doctors and physician's assistants left, Goff sat down and started planning for the next day.
(c) 2007, McClatchy-Tribune Information Services.