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Rebuilding Soldiers Transformed By War Injuries

Military members who lost their limbs overseas participate in a run in California. (AP)

Improvements in medical care and equipment mean fewer troops are dying on the battlefield. But more troops are returning home severely wounded, with injuries that require lifelong care and cost millions of dollars in medical bills.

On Thursday's Fresh Air, veteran combat reporter David Wood talks about some of the challenges that severely wounded soldiers face when they return from Afghanistan and Iraq. Wood is the author of a new 10-part series for The Huffington Post called "Beyond the Battlefield" that examines some of those challenges and setbacks.

Wood tells Fresh Air's Terry Gross that fewer U.S. troops die outright on the battlefield — because of protective equipment and better medical care. But more Americans are being wounded, and their injuries are more "severe and complex." The number of American soldiers who lost at least one limb doubled from 2009 to 2010, and the number of triple amputees has nearly doubled, he says. Almost all of the severely injured troops return to the U.S. with traumatic brain injuries (TBI).

"It's so tragic to see these young men and women struggling not only to master prosthetic legs, for example, but to try to fight their way through the fog that descends into your brain when you have a brain injury like that," says Wood. "It's often very hard for them to think clearly, to recall words, to do small problems, to remember to take their medication and make their appointments. Surprisingly, there's been so much advancement in physical medicine during this war — but it's only been in recent years that the military has recognized TBI as a combat wound, and it's pretty clear that no one knows what the best treatment is."

A Soldier's Story

One of the things that we as a country are learning is that people who are wounded in war are wounded forever.
David Wood

One of the soldiers Wood profiles is Lance Cpl. Tyler Southern. Southern was 19 when an improvised explosive device, or IED, blew up underneath him in Afghanistan. The blast tore up both of his legs and one arm, and mangled his remaining left arm. Southern was taken to an intermediate battlefield medical facility where he flat-lined.

"He was bleeding so heavily that they could not keep blood in him, and the blood was pouring out of him," says Wood. "As soon he came off the helicopter and they rushed him into an operating room, doctors slashed off the side of his chest and reached in and clamped off all of the veins leading to the lower part of his body in an effort to squeeze what little remaining fluid was left up to his brain to keep his brain alive."

After he had stabilized, Southern was transferred to Walter Reed Army Medical Center's amputee center, where wounded veterans learn how to adapt to their injuries. He faces years of rehab, after having endured dozens of surgeries to clean and repair his limbs. But he manages to make light of his situation — he has handed out T-shirts to other Marines on his floor that say "I had a blast!" and spends most of his days working out to try to build muscle in his remaining limb.

"He's an extremely active, very funny, very bright, very quick person ," says Wood. "It's hard to get him to stand still to talk to him. He's constantly moving."

'People Who Are Wounded In War Are Wounded Forever'

But not all of the soldiers Wood writes about have thrived as much as Southern. Jimmy Cleveland Kinsey II, a Marine, returned from Iraq after driving over an IED. The blast tore through his leg, leaving him with shrapnel wounds, burns, post-traumatic stress disorder and TBI. When he returned home, Kinsey was in chronic pain.

"He was a good Marine, a fun-loving guy. I never knew him, but he's the kind of guy you'd like to hang around with," says Wood. "He got drugs to control the pain. His leg got worse and worse, and they had to take it off. ... That set him into a depression. His addiction to pain medication and anxiety medication got worse. Jimmy was a strong guy, but in the end his wounds and the effects of them did him in. He died in a PTSD clinic of an overdose of [the pain killer] fentanyl."

It's not clear whether Kinsey's overdose was intentional or accidental, but what is clear, says Wood, is that Kinsey didn't get the help he needed. And he's not alone. Wood writes that 18 veterans kill themselves every day. (That figure includes veterans from Vietnam and other wars.)

"When you think about it, one of the things that we as a country are learning is that people who are wounded in war are wounded forever," he says. "Even though there are many cases like Tyler Southern, people who seem to almost thrive on the challenge of their new life, even with Tyler Southern, he'll be dealing with his wounds for the rest of his life. They don't go away."


Interview Highlights

On IEDs

"IEDs are designed to create mayhem on the human body. For dismounted troops especially, stepping on or near an IED when it explodes beneath you, it tends to traumatically amputate one or both limbs, very often it severs the genitals and on up through the body, slashing through flesh and bone, ripping off cartilage — and on top of that, there's a fireball that burns away the damaged flesh that's left. ... Trying to clean out the wounds, trying to prevent infections, is often the first order of business, and a lot of the wounded who arrive at Walter Reed [Army Medical Center] in suburban Maryland or the Brooke Army Medical Center in San Antonio, Texas, spend many, many days having their wounds gently cleaned and cleaned and cleaned over and over again."

On troops losing their genitals after stepping on IEDs

"The Army sent a team of doctors to Afghanistan earlier this year to talk to soldiers about IEDs [and the] kinds of injuries [that result]. One of the things they reported back is that soldiers and Marines are signing do-not-resuscitate pacts — in the event that they lose their genitals, they don't want to live. ... It does reflect a deep fear among many troops that they, in essence, lose their manhood."

On getting vets the care they need

"The [Department of Veterans Affairs] is an amazing place. They do a lot of great stuff and almost everyone I've met there has been smart and creative and dedicated, and I have a lot of admiration for the people who work there. At the same time, it's a gigantic bureaucracy and it's hard to transform that bureaucracy to take care of the unique problems that we're seeing among the wounded coming back from Iraq and Afghanistan. There's been a gigantic demand for mental health services, which the VA has scrambled to keep up on, not always successfully. A lot of veterans have difficulty getting services. The wait times are sometimes very, very long. Things got so bad that a federal appeals court in California ruled that the VA was denying veterans their constitutional rights by not providing good services on time."

On being a Quaker and a conscientious objector who has been embedded with troops on and off for the past 35 years

"I got interested in telling the stories of people who were caught up in conflict. People who were fighters, people who were refugees, people who were victims — the vast number of people who work constantly to resolve conflict and to get sides talking. I never felt that by reporting the stories of people in conflict that I was endorsing conflict in any way. ... Being a conscientious objector is a very personal thing. The way I thought about it: Do you want to spend the next several years killing people, or do you want to spend it doing something more productive? And that's really the way I came at that."

"I'm terrified when I'm out on a battlefield. Telling these stories, I think it's important that people understand what it's like out there, what people go through, who are the people who are doing this in Afghanistan on our behalf. Most of us have sat this war out. I want them to know what it's like and who is in the middle of it and what the consequences are. Beyond that, I don't really have an agenda. I think that's really important, especially in a democracy. We need to know who is doing it and what it's like for them."

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Transcript

TERRY GROSS, host: This is FRESH AIR. I'm Terry Gross. The wars in Afghanistan and Iraq have created a new kind of casualty: IEDs are ripping apart soldiers, tearing off limbs and genitals, burning faces and leaving them with traumatic brain injury. But with new medical breakthroughs, soldiers who would never have survived these catastrophic injuries in previous wars are alive and facing a future of difficulty and pain.

My guest, David Wood, has written a series of articles about what this means for survivors, their families and the veterans' medical system, which wasn't prepared for the severity of injuries or the number of surviving wounded from these two wars. Wood is senior military correspondent for the Huffington Post. His series "Beyond The Battlefield" began this week and runs through next week. It includes videos of some of the soldiers he profiles. Wood has been a correspondent for Time, the L.A. Times and the Baltimore Sun. He has spent the past 35 years covering armed conflicts and has accompanied troops in Iraq and Afghanistan, as well as many other war zones.

David Wood, welcome to FRESH AIR. Why did you want to do this series on the catastrophically wounded?

DAVID WOOD: Terry, I've been a combat reporter for a long time, many, many years, and I've covered a lot of wars. And most recently, of course, during the last 10 years, being embedded with combat troops in Iraq and Afghanistan.

I've seen people get wounded, and it's always a terrible situation, very high-stress, ending of course with the helicopter coming in and taking them away in a big cloud of dust, and that's it. And then there's silence. And I never knew what happened to these guys who were wounded. Where do they go? What's it like for them? What do they do? What happens to them?

And so when I got the opportunity to really spend a lot of time tracking down the severely wounded and telling their stories, I leaped at it.

GROSS: For people who survive IED blasts, they're living with catastrophic injuries the likes of which people never were able to survive before. Would you describe some of the injuries that people are living with?

WOOD: Well, they are horrific injuries. IEDs are intentionally designed to create mayhem on the human body. For dismounted troops especially, stepping on or over an IED when it explodes beneath you, it tends to traumatically amputate one or both limbs, legs, very often it severs the genitals and on up through the body, slashing through flesh and bone, ripping off cartilage.

And on top of that, very often there's a fireball that burns away the damaged flesh that's left.

GROSS: And you also say that as the blast erupts upward, it drives sand, dirt pebbles, bone fragments and barnyard filth deep into vulnerable soft tissue, leading I'm sure to not only tears and ruptures but also horrible infections deep inside the body.

WOOD: It's a terrific problem for the surgeons who receive these severely wounded. Trying to clean out the wounds, trying to prevent infections, is often the first order of business. And a lot of the wounded who arrive at Walter Reed hospital here in suburban Maryland or at the Brooke Army Medical Center in San Antonio, Texas, spend many, many days having their wounds gently cleaned and cleaned and cleaned over and over again to get that stuff out.

But you can imagine an IED is usually a plastic bucket full of explosives buried not very deep, a foot or two under the dirt. And in Afghanistan, it is an agricultural society, so there's a lot of goats and other animals around. It's pretty filthy. When that erupts underneath you, it does drive that stuff deep into your body, and it's hard to get out.

GROSS: And you say that because of the counterinsurgency strategy, more of our troops are on foot patrol in Afghanistan. So they're more likely to have this kind of stepping-on-an-IED injury.

WOOD: Yeah, under the strategy devised by David Petraeus, the retired general who used to be in charge in Afghanistan and Iraq before that, the strategy has been to put soldier and Marines out into the villages on a level with the villagers and in that way secure their cooperation with the U.S. and Afghan government war aims.

The problem is that that does expose our troops to these IEDs, which are deadly.

GROSS: You described before how if you're walking over an IED, the explosion can sever your legs and your genitals. And you say that's the most disturbing war injury: the loss of both legs and genitals. Why would you describe that as the most disturbing, at the risk of asking the obvious?

WOOD: I am reflecting what soldiers say, and Marines. If you are in a platoon, on patrol in Afghanistan, that's the thing that they worry about the most is losing their manhood.

The Army sent a team of doctors to Afghanistan earlier this year to talk to soldiers about these kinds of weapons, IEDs, and the kinds of injuries, and one of the things they reported back is that soldiers and Marines are signing do-not-resuscitate pacts in the thought that if they lose their genitals, they don't want to live.

Now, I don't know how legally binding such a pact would be, but it does reflect a deep, deep fear among many troops that they will, in essence, lose their manhood.

GROSS: And I have to say you add up all these injuries, and then you add on top of that the probability of traumatic brain injury.

WOOD: Almost all of the severely wounded come back with traumatic brain injury. And it's so tragic to see these young men and women struggling not only to master prosthetic legs, for example, but to try to fight their way through the fog that descends into your brain when you have a brain injury like that.

It's often very hard for them to think clearly, to recall words, to do small problems, to remember things like to take their medicine and to make their appointments, and it's a real struggle. Surprisingly, there's been so much advancement in physical medicine during this war, and we can talk about this later, it's only been in recent years that the military has even recognized traumatic brain injury as a combat wound, and it's pretty clear that no one really knows what the best treatment is.

GROSS: If you're joining us, my guest is David Wood. He's a veteran combat reporter, and he has this new series in The Huffington Post that continues through next week called "Beyond the Battlefield." And it's about people who have come home severely wounded from IEDs, what their lives are like, how it affects their families and the stresses it's putting on the veteran health care system.

You write that triple amputees are becoming more common, and you profile one triple amputee. His name is Tyler Southern. Describe what happened to him.

WOOD: Tyler Southern was a Marine Corps lance corporal who served in Afghanistan, and in May of 2010 was leading a squad around the side of the house and stepped into an IED ambush. And one of the IEDs blew up underneath him.

It immediately tore off both his legs and his right arm and mangled his left arm. The corpsman who saved him told me he heard the blast and rushed around the side of this adobe building, where the IED attack had occurred. And Tyler Southern, what was left of him was lying in a crater, in a smoking crater.

He was bleeding heavily. The corpsman got tourniquets quickly on all three of his stumps, started an IV solution into him to - with what's called blood volumizer to try to keep his blood in him and did some other things: cleared his airway and put in a breathing tube and so forth.

That was the first combat casualty that corpsman had ever treated. He was 20 years old, a brand new combat corpsman, and he did a terrific job. He saved Tyler's life.

GROSS: And he survived the IED. He was near it, and he was probably in shock when he was doing all of this.

WOOD: I said: What was it like to see your good buddy Tyler lying there dying? And he said: I have no idea. Muscle memory took over; I just acted. And it wasn't - surprisingly to me, after Tyler was evacuated by Medevac helicopter, the corpsman, James Stoddard, went around and picked up the bloody bandages and the pieces of Tyler's leg and boot that he could find, and then they continued the patrol.

GROSS: Wow. So Tyler Southern arrived at the first place he was treated essentially dead. I mean, he'd flat-lined. He'd just about bled out. What did they do to save him?

WOOD: Well, this sort of illustrates the huge burden that's put on surgeons and surgical staffs in Afghanistan. The fact that battlefield medics can now save a lot of people on the verge of death means that some of the patients arriving at these intermediate care facilities in Afghanistan are virtually dead.

And they have to do some extraordinary things to save these guys. In Tyler's case, he was bleeding so heavily, he was punctured all over his body, that they could not keep blood in him, and the blood was pouring out of him as fast as they could get it into him.

And in that case, the surgeons really focus on the brain: How do we keep the brain alive? And what they did in Tyler's case was as soon he came off the helicopter, and they rushed him into the operating room, which typically is in a tent, doctors slashed open the side of his chest and reached in and clamped off all of the veins leading to the lower part of his body in an effort to squeeze what little remaining fluid was left up to his brain to keep his brain alive.

That's an operation that is like the final Hail Mary, last-ditch, extremely dangerous, high-risk operation, and they're doing more of those kinds of things now because, as you said, many of these patients are coming in virtually dead.

GROSS: So Tyler Southern is brought back to life through this extraordinary treatment and all the blood transfusions, but he's still missing three limbs: both legs and one arm. So what shape is he in now?

(SOUNDBITE OF LAUGHTER)

WOOD: He's very active. It's hard to talk to him. In many cases, I went to Walter Reed to talk to him, and we met in the amputee center, which is basically a gym full of people trying out their new limbs, trying to run, practicing going up and down steps. And for lower-limb amputees like Tyler, building up their torso muscles because when you walk with two artificial limbs, you're basically using your torso muscles to power those legs.

Tyler would skip around, and it was hard to get him to stand still or to sit still to talk to him. He's an extremely active, very funny, very bright, very quick person and really goes to answer the question that I started my reporting with, and that was: Okay, if these guys are so badly wounded, wouldn't it be better if they died?

And many, many people answered that question in the affirmative. I never met somebody who said no, I really prefer to be dead. You know, there was a nurse at one of the hospitals, a trauma nurse, who said: If you can save them, you do.

And I said to her: Well, but, you know, what kind of quality of life would they have? And she said, in sort of a chiding tone: It's not up to us to define their quality of life. It's a very personal thing, and they decide.

All of the severely wounded that I talked to were upbeat and positive, and that's what gets them through this. It's such a life-changing experience. They get a lot of mental health counseling, therapy. It's a hard struggle. It's a struggle that will go on for the rest of their lives in most cases. But the ones that I've meet seem to be coming through it okay.

GROSS: One of the things I really love, you know, you have a series of videos on The Huffington Post website, where your reporting series is. And in a video of Tyler Southern, you see him working out at Walter Reed. And one of the exercises he's doing, he's taking the stump of one of his arms, and that goes into a sling that's attached to basically a weight machine, and so he's exercising his torso by exercising the stump of his arm.

And it's not a very big stump, and it just made me think of how remarkable the human body is that, you know, he's still able to work out.

WOOD: A lot of the credit goes to the folks that design and fit the prosthetics.

GROSS: Absolutely, absolutely.

WOOD: And I think it's pretty much acknowledged that the folks at Walter Reed are the world's experts in doing this, and they are so creative and ingenious. Their approach really to these amputees is tell us what you want to do, and we'll build you a prosthetic device that will enable you to do that.

If you want to ski, if you want to mountain-climb, if you're a runner, if you - you know, we can fit you out on a bicycle. They told me of one amputee who said, in sort of a wistful tone, well, I used to play ice hockey. I'd love to play ice hockey. He's now got a prosthetic leg with an ice skate attached.

GROSS: Wow. So if you're just joining us my guest is David Wood, and he's been a combat reporter for about 35 years. His new series, "Beyond the Battlefield," which is in The Huffington Post and continues through next week, is about people who have returned from the wars with catastrophic injuries: amputations, traumatic brain injury, combinations of both, and what's happened to them since coming home, how they survived and what's happened to them since.

Let's take a short break here, and then we'll talk some more. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: If you're just joining us, my guest is David Wood, he's been a combat reporter for about 35 years. But now he has a series about veterans who return home catastrophically wounded from the wars and what happens to them after they return. The series is called "Beyond the Battlefield." It runs through next week in The Huffington Post.

You just told us an inspiring story about Tyler Southern, who returned from Afghanistan missing two legs and one arm and having a lot of other injuries, as well.

And he has prosthetics, he's working out, he's able to walk, and he's really upbeat. I mean, he describes himself as happy. I mean, it's a really amazing story. Not all the stories you tell, not all the people who return home catastrophically wounded are as inspiring. And I want you talk about the story of Jimmy Cleveland Kinsey II, and this is a Marine who got blown up in Iraq. Describe his wounds.

WOOD: Jimmy Kinsey was riding in a vehicle in Anbar province in Iraq that ran over an IED. It was blown up. He was badly injured but did not suffer traumatic amputation. He was medevacked back to the United States.

His case illustrates a problem that many of the wounded have, and that is that their limbs are so badly beat up that astonishingly bad things happen to them. One of the things is called compression syndrome, and basically it means that your limb swells inside the skin, and it's very hard to control.

The other thing is called ossification, and it's basically your body is, as I understand it, your body is so medically traumatized that it kicks off uncontrolled bone growth. And some of the wounded have described to me the feeling of bone growing inside a knee joint, for example, that feels like coral, sharp branch coral, and that's the way it grows.

Pain is a big problem for these guys, chronic pain. The Army has acknowledged that it doesn't do a good job in pain management. So they struggle with that. All of these things affected Jimmy Cleveland Kinsey. He was a good Marine, a fun-loving guy.

I never knew him, but he's the kind of guy you'd like to hang around with. He got a lot of drugs to control the pain. His leg got worse and worse. After several years, they had to take it off, it got infected, and they just couldn't save it. That sort of set him into a depression. His drug addiction got worse. He got out of the Marines.

GROSS: This is his addiction to pain medication?

WOOD: Yes, pain medication and anxiety medication. It's such a difficult thing. People struggle and struggle with this. Jimmy was a strong guy, but in the end his wounds and the effects of them did him in. And he died in a PTSD clinic of an overdose of fentanyl, which is a very, very powerful painkiller.

GROSS: And if I understand correctly, nobody knows for sure whether that was an intentional overdose or an accidental one.

WOOD: It's not really clear. But what is clear is that like many of the wounded, he volunteered to serve his country, went to a distant place, got blown up, came back and for a variety of reasons did not get the care that he needed. And his family feels that the country really let them down and let him down, that he should've been taken better care of.

GROSS: David Wood will be back in the second half of the show. His Huffington Post series "Beyond the Battlefield" began this week and continues through next week. I'm Terry Gross, and this is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR. I'm Terry Gross. We're talking about troops who have returned home from Iraq and Afghanistan with catastrophic injuries caused by IEDs. Injuries like multiple amputations and ripped off faces.

My guest David Wood writes about what this means for survivors, their families, and the VA medical system in his series, "Beyond the Battlefield," published in the Huffington Post. He is a veteran war reporter who is now military correspondent for the Huffington Post. I want you to know that there's a couple of fairly graphic descriptions of war injuries coming up.

One of the horrible statistics you have in your series "Beyond the Battlefield," is that 18 vets kill themselves every day, that figure includes Vietnam veterans.

WOOD: Yes it does.

GROSS: It's an appalling statistic.

WOOD: It is appalling, but when you think about it, one of the things that we as a country are learning, is that people who are wounded in war are wounded forever. And even though there are many cases like Tyler Southern, people who seem to almost thrive on the challenge of their new life, even for Tyler Southern, he'll be dealing with his wounds for the rest of his life. They don't go away.

The other thing we're learning is that PTSD does not appear very often, does not appear immediately, but months, years or even decades later.

GROSS: I think it's fair to say that medicine often advances during wartime because each of war presents new kinds of injuries and combat medicine rises to the occasion to treat them, and then eventually those advances filter out to the civilian population. So I'd like to talk with you a little bit about some of the advances that medicine is making because of these horrific injuries. And as an example of that, let's talk about the story of Army Staff Sergeant Todd Nelson, who was the victim of a suicide bomber in a car in Kabul. Describe Sergeant Nelson's injuries.

WOOD: I guess the easiest way to describe it was his face was blown off. Shrapnel tore through his flesh, tore out an eye, tore off his nose and his ears. The blast pressure flattened everything and then a fireball - his head actually caught on fire under his helmet. He was just catastrophically wounded. I've seen the pictures of the vehicle on fire and you can't believe anybody got out of it. He can't believe anybody got out of it. But they got him out and within about 60 hours they got him to the Burn Center at Brooke Army Medical Center in San Antonio.

Where I met Todd, was outside the offices of the Armed Forces Institute of Regenerative Medicine. And we think about that, the U.S. military has invested a lot of money and has hired a whole bunch of very, very talented researchers and is working in conjunction with the National Institutes of Health and other federal agencies and a huge network of universities across the country, to try to figure out how do you save a guy like Todd Nelson and how do you give him some kind of life back?

If you see talk today, for a second he looks normal. He's such a nice guy. Very gracious, great sense of humor, a good storyteller. And it's only when you take a second look at him that you notice he wears a wig. One of his ears is a prosthetic. It's held onto his head by magnets. There's a plate inside his head that it attaches to, which is an annoyance to him because he's always afraid it's going to fall off and he won't notice or he'll lose it. His face is a network of scar tissue and that's the problem.

GROSS: Why is that a problem?

WOOD: That's a problem because it's painful and when flesh scars it contracts. When it contracts in Todd's case, it pulls - for example, it pulled his eyelid down. It pulled his nose over to the side. It distorts his mouth. And so the way they treat him is by skin grafts. So they take - they harvest patches of skin from elsewhere on his body and graft it on to his face. They also use cadaver skin and they use skin from pigs.

GROSS: And you mentioned synthetic skin also.

WOOD: Todd is an example of what needs to be not done, not what has been done. And his face doesn't work well and isn't aesthetically pleasing, because up until now, they haven't been able to do some of the new techniques that they are about to start testing and which they think can give people new faces.

One of the interesting things I learned in San Antonio was that the U.S. Army has funded all of the full-face transplants that had been done in the United States. I think there have been five in the past several years. But the problem with full facial transplants is you have to keep that person on drugs to suppress the immune system, otherwise if they stop taking their pills, basically their face falls off.

What they're looking at instead is several experimental treatments that will give people new, good skin. One of them is a procedure in which in the operating room they harvest a piece of skin from the patient, they separate out the adult stem cells, put it in a solution and spray it on and it dries as a layer of skin.

One of the problems with burn patients like Todd is that unless they get new skin or are covered in some way, they're extremely vulnerable to infection. And in Todd's case they were worried - really worried about brain infection because so much of his head was charred. And so they put skin grafts on there in an effort to quickly close it off. But with this spray on skin, they can do that right in the operating room and get a cover on there immediately and prevent those kinds of infections.

GROSS: So when will spray on skin actually be ready to be used?

WOOD: Well, it's ready now. It's used in Europe. The Army is doing FDA testing to get their approval to go ahead and use it. So it's a proven technology. It would help save a lot of lives. They're ready to go with it just, as I say, waiting for FDA approval.

GROSS: It's really remarkable. Now another soldier who had his face blown off is now doing some standup comedy. How did he get from, basically having no face, to going before an audience and doing standup?

WOOD: Well, you're referring to Bobby Henline, who was a sergeant in the 82nd Airborne, who was blown up in Iraq in a Humvee in which there were five paratroopers riding. He was the only one to survive. And when he started to recover, he told me look, I'm not a terrifically religious guy. I, you know, I don't believe in all this stuff, but you can't go through an experience like that, being the only one out of five people who survived without thinking why did I survive?

(SOUNDBITE OF LAUGHTER)

WOOD: What of my supposed to do, because those four guys, my buddies, are watching, saying you better do something with this opportunity. And he said it was so clear to me, God wanted me to do something but he didn't tell me what it was. And it was several years before Bobby was convinced to try to take his humor public.

I should say that Bobby Henline's face was just about completely burned off and he hasn't had a lot of cosmetic surgery. And he's pretty shocking to look at, which he freely admits. He didn't like being stared at, and he would often smile and make a joke in an attempt to get people to, sort of, approach his as a person. You know, he's like many of these veterans - proud of his wounds. These guys volunteered, sacrificed, survived and their wounds, their scars are visible sign of their sacrifice and they want to be acknowledged; they're proud of them.

And so Bobby was looking for a way to say, come talk to me, I'm a human being. And the way he found was comedy. And he started to do standup comedy, and it was a - I think it was kind of a painful beginning. He made a few jokes about his face. People didn't quite know how to react. Are we supposed to laugh? And how do we - what do we do here? But his comedy sort of won people over and now he does a lot of standup comedy.

We went to Fort Jackson, South Carolina where he was doing his standup act during a concert - a benefit concert - for wounded troops. And it was so interesting to watch him come out on the stage and there were probably 3,000 young soldiers there. Fort Jackson is a place where they do basic training, so these were young soldiers.

And he came out on the stage and it was kind of a hushed silence, and he started doing his routine. And in about 30 seconds those soldiers were just - they were weeping with laughter. They were just absolutely out of control and he's very, very good at this.

GROSS: So let's hear a short clip of Bobby Henline performing before troops.

ANNOUNCER: Ladies and gentlemen, please welcome Bobby Henline.

(SOUNDBITE OF APPLAUSE)

(SOUNDBITE OF CHEERING)

BOBBY HENLINE: I usually walk out and I'm quiet. I kind of look at the crowd. Let them take it in. And I tell 'em, you should see the other guy.

(SOUNDBITE OF LAUGHTER)

HENLINE: I did four tours in Iraq. You know, I love my job. I tell you, I would do it again. I had a great time. But for real, that last tour, was a real blast.

(SOUNDBITE OF LAUGHTER)

HENLINE: And if I continue to do this and I help people the rest of my life and I help better them, then that's the best revenge I can get on this guy that did this to me and my buddies because I will help more people than he will ever hurt.

(SOUNDBITE OF CHEERING)

GROSS: That's Bobby Henline, performing before troops, and his face was blown up in - was it Iraq or Afghanistan?

WOOD: It was Iraq.

GROSS: Now you mentioned he also has a fart machine he uses.

WOOD: You know, that was an idea that didn't work. His idea was when people stared at him, he would pull out his portable fart machine, as he said, and crank one off. And I said, when you did that, what happened? And he said people would just walk away.

(SOUNDBITE OF LAUGHTER)

WOOD: So it didn't really work.

GROSS: My guest is David Wood. His series about catastrophically wounded veterans is published on the Huffington Post. More after a break. This is FRESH AIR.

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GROSS: If you're just joining us, my guest is David Wood, and he's a veteran combat reporter. He has a new series in the Huffington Post called "Beyond the Battlefield." And this series is about men who have returned home with catastrophic wounds - home from the wars in Iraq and Afghanistan, and what it's like, what kind of treatments they've had and what it's like for them to have survived wounds that, in previous wars, you definitely would have died of.

So when a soldier comes home and needs long-term care that affects the family very directly. And, you know, wives, husbands - depending on who the soldier is - parents often become full-time caregivers. And there's been a movement from the family caregivers to have that recognized with payment. Because for a full-time caregiver, you can't go to work, means you've given up your income. So where does that movement stand now?

WOOD: The Veterans Administration finally agreed to recognize and compensate mostly spouses - sometimes mothers - who are suddenly thrust, with no preparation, into this role of being a full-time caregiver. You can imagine if you are married to a soldier who is a very active and, sort of, high adrenaline person who suddenly comes home as a triple amputee or a double amputee, or someone with severe PTSD and traumatic brain injury. It's a huge burden to take care of that person. Even those who, injured people who can walk and even drive a car, very often their traumatic brain injury means that they can't remember when take their medicine or they can't remember how to get to the doctor's office. And so it's a full time and draining kind of role.

GROSS: So what's the compensation going to be like?

WOOD: The Veterans Administration will now train full-time caregivers in whatever they need, basically - how to give injections, how to deal with a person's PTSD, how to deal with a person's anger and violent outbreaks and other mental health and physical problems. Very importantly, they will give them a stipend and two weeks of paid vacation a year - I think it's two weeks - so that that caregiver can get away and go sit by the ocean and do nothing, because it's such an intensive job taking care of a traumatically wanted person.

GROSS: Now, as part of your series "Beyond the Battlefield," you write about how the military and the VA medical system weren't prepared for the number of injuries, the duration of the wars in Iraq and Afghanistan, and the terrible wounds that people are returning home with. And it's also been very difficult for veterans returning home and for the medical advocates to get the kind of care that they need sometimes, not always but sometimes. What are some of the problems that wounded vets are up against now?

WOOD: The Veterans Administration is an amazing place. They do a lot of great stuff and almost everyone I've met there has been just so smart and creative and dedicated. I really have a lot of admiration for the people who work there. At the same time, it's a gigantic bureaucracy and it's hard to transform that bureaucracy to take care of the unique problems that we're seeing among the wounded coming back from Iraq and Afghanistan. There's been a gigantic demand for mental health services, which the VA has scrambled to catch up on, not always successfully. A lot of veterans have difficulty getting services. The wait times sometimes are very, very long. Things got so bad that earlier this year a federal appeals court in California ruled that the Veterans Administration was denying veterans their constitutional rights by not providing good services on time.

GROSS: Is there an effort to change that?

WOOD: Yeah. Because there's so many gaps in what both the Defense Department and the Veterans Administration can do for veterans, there are a huge number of nonprofit private organizations that help out, and we list them on our website at the Huffington Post. Veterans could not get along without these private organizations and they do great work. And one of the purposes of writing this series that I've done is to try to get people aware of the needs and really to encourage people to get involved.

GROSS: One of the issues we're facing now as a nation is how exactly are we going to fund the medical care, the long-term medical care, the multiple surgeries, the prosthetic devices that so many vets returning home need. And this has never - I mean has this - how do we address this as a nation? How much is it costing? Is it budgeted in anyplace?

WOOD: Terry, we haven't addressed this as a nation. It was astonishing to me amid all of the debate we've heard about the Social Security system that there is no similar system for veterans. All of the care that Tyler Southern receives, all of the surgeries that Todd Nelson and other burn victims will need over the next several years, all of that is paid for out of the annual appropriation from the Veterans Administration. And so what that means is that it's a political football every year in Congress - how much are we going to appropriate for the veterans. And you know, if I were veteran and knew that I was going to need new prosthetics a year after next, I'd be kind of nervous because there have already been proposals in Congress to slice back funding for veterans' health benefits.

There has been a move afoot to say, okay, look, we need to at least, when we go to war we need to start a fund and we need to be putting money into that fund so that we can fund the future healthcare costs of the veterans who are going to be wounded. That idea, it's a great idea and it's gone absolutely nowhere in Congress. It's just dead.

GROSS: My guest is David Wood and he is a 35-year veteran combat reporter, but he has a new series called "Beyond the Battlefield" that's about veterans from Iraq and Afghanistan who are returning home with catastrophic wounds that need long-term care and that are totally life-changing. "Beyond the Battlefield" is published in the Huffington Post. The series continues through next week.

Let's take a short break here, then we'll talk some more. This is FRESH AIR.

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GROSS: My guest is David Wood and we're talking about his series "Beyond the Battlefield," which is published in the Huffington Post and continues through next week. It's about catastrophically wounded soldiers from Afghanistan and Iraq who are coming home with their lives transformed and requiring long-term care, perhaps care for the rest of their lives.

Now, it's so interesting to me. You are Quaker by birth and by wish you are a conscientious objector. I mean that's your position. Yet you spent 35 years putting yourself in war zones to cover wars, to report on wars. Why if you're opposed to war have you voluntarily put yourself in the middle of war zones for so long?

WOOD: I got interested in telling the stories of people who were caught up in conflict. People who were fighters, people who were refugees, people who were victims - the vast number of people who work constantly to resolve conflict and to get sides talking. I never felt that by reporting the stories of people in conflict that I was endorsing conflict in any way.

GROSS: Have your experiences in combat zones made you anymore or less of a conscientious objector?

WOOD: Being a conscientious objector is a very personal thing. It's do you want to - the way I thought about it - do you want to spend the next several years killing people, or do you want to spend it doing something more productive? And that's really the way I came at that.

GROSS: Do you think that filing reports from war zones for over three decades has among other things helped you prove to the world and maybe to yourself that your CO status had nothing to do with cowardice? Because one stereotype of conscientious objector is like they're just afraid to fight.

WOOD: Oh, Terry, I'm terrified when I'm out on a battlefield.

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WOOD: No, I don't think that that's the case. I don't think...

GROSS: But you're there. But, you know, whether you're scared or not, you put yourself in jeopardy to report; that's why you're scared, because you know you're in jeopardy.

WOOD: Well, that's true. But, you know, telling these stories, I think it's important that people understand what it's like out there, what people go through, who are the people who are doing this in Afghanistan, for example, on our behalf. Most of us have sat this war out. I want them to know what it's like and who's in the middle of it and what the consequences are. Beyond that, I don't really have an agenda. That's - but I think that's really important, especially in a democracy. And we do conduct wars and most of us don't participate. But we need to know who is doing it and what it's like for them.

GROSS: So getting back to your series "Beyond the Battlefield," about veterans returning home with catastrophic injuries - what impact has writing that series, meeting a lot of catastrophically wounded vets, had on you?

WOOD: When you go into a dangerous situation, you carry or at least I carry a huge piece of denial. I'm not going to get injured. I can't get injured. It's not going to happen to me. It always happens to somebody else. And that's been my armor for a long time going into these dangerous situations. I thought a lot now about, well, I know what it's like, you know, I've been around people who thought this is not going to happen to me and it did, so it's been very, very hard and I've done a lot of thinking about, you know, what really is the value of life? What is the value of, what do I value in life and do I really want to put that at risk in order to get a story? Is it worth that risk? It's a difficult question and one that I'm wrestling with.

GROSS: So you're thinking of getting out of the combat zone business?

WOOD: Every time I come back from a war zone I say to myself that's the last time I'm doing this.

GROSS: Well, how old are you now?

WOOD: Sixty-six.

GROSS: Isn't it time to start doing that? I mean...

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GROSS: No, really. So many people like retire from their job no matter what it is at 65. People who are 66 don't usually go into combat zones, if they have a choice.

WOOD: Terry, these stories are so compelling. I love to tell stories like this. I love to tell stories of people involved in combat. I don't know how else to do it but to go out there and spend time with them. And so it's - I have never seriously considered retiring or saying, well, I'm too old to do this anymore. It does occur to me. It occurs to my wife and kids very often, but it's something that I've put my life into, I believe in strongly, I think it's important to tell these stories, and as long as I can keep doing it I will.

GROSS: Well, whatever you choose to do, I wish you well. Stay safe and healthy, and thank you so much for the series and for this interview. Thank you.

WOOD: Thank you, Terry.

GROSS: David Wood's Huffington Post series "Beyond the Battlefield" continues through next week. You'll find links to his articles and a video profile of veteran and triple amputee Tyler Southern on our website, freshair.npr.org. Transcript provided by NPR, Copyright NPR.

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