A proud soldier's battle back: "So this is what it's like to get blown up"
  Spc. John West cringes in pain as a nurse helps him back into bed at Madigan Army Medical Center near Tacoma, where he arrived in September. The Army National Guard soldier was injured when his Humvee triggered a roadside bomb in Iraq. He's now home in Federal Way and able to walk on his own but continues extensive physical therapy.
By Warren King Seattle Times medical reporter; December 06, 2004

  In a cramped little office near Madigan Army Medical Center's physical-therapy room, Spc. John West stares hard at a computer screen filled with an X-ray of his spine and pelvis.

An X-ray shows the rods and bolts that stabilize his spine and pelvis.

  It's the first time he's seen the image, dominated by the metal rods and 6-inch screws that shore up his fractured bones like girders and rebar. He is seeing his future.
  "Jesus. Oh, my god," he says, his voice breaking. "So I'm stuck."
  West, a 38-year-old former Marine turned software developer, joined the Army National Guard two months after the Sept. 11 terrorist attacks, out of a strong sense of duty.
  In August, he was on patrol in Iraq when a roadside bomb blew his Humvee 20 feet in the air. His gunner was killed. The blast broke West's back, pelvis, heel bone and leg. His platoon leader also was seriously injured.
  While the nation mourns the 1,200 Americans who have died fighting in Iraq, more than seven times that number have been injured since the war began. That includes nearly 300 wounded servicemen and women from Washington state.
  Many have recovered and returned to their units. Some remain at Walter Reed Army Medical Center in Washington, D.C., the military's main stateside hospital for war wounded. Others, such as West, are back home, undergoing outpatient treatment and facing an uncertain future of adjustment and disability.
  "At first, I was really angry. This seemed kind of unfair," West said. "But really it's not. It's part of my duty — like going on patrol. When this happens, it's your job to get better."
  West, who lives in Federal Way, is a tough-minded, matter-of-fact soldier. He tends to see his challenges clearly and deal with them head-on. He has forged his way through life with grit and an intellectual curiosity that has served him well — from a difficult childhood through military service, college, a variety of jobs and finally to the world of computers and software at Microsoft.
  His story provides a window into how the military handles the thousands of wounded in Iraq, the improvements in battlefield medical care and the challenges these injured servicemen and women face.
  Though the force of the bomb's explosion was tremendous, West's heart and other internal organs were protected by Kevlar-and-ceramic body armor all combat soldiers now wear. His bones suffered most in the blast.
  The sophisticated military medical system brought to bear just moments after the blast has dramatically improved survival rates of the war-injured over the years. About one in three of those wounded died in Vietnam and World War II. In Iraq, about one in 10 of those injured has died.
  Now back home, West works to heal his broken body and quiet the fears that trouble his combat-weary mind.

West strains to lift his leg during physical therapy at Madigan Army Medical Center. The hospital has treated 1,400 military personnel who have fought in Iraq. About 60 have been hospitalized.

  At Madigan, south of Tacoma, he takes in the image of his patched-up back and pelvis. He turns to therapist Steve Travers and asks what his chances are of enjoying his two favorite pastimes again: bicycling and backpacking with his wife, Rebecca, and their four children.
  Travers speaks frankly.
  "I think you have a fair fight on your hands. Yes, it could be rough," he says. "But I think those goals are realistic."

Getting blown up
  It was blazing hot last Aug. 4 when West drove the lead Humvee in a four-vehicle caravan patrolling outside the Anaconda supply base, about 50 miles northwest of Baghdad. A gunner poked from a turret atop each vehicle.
  Months of the grueling duty had given the scouts — all from the 81st Brigade's 1st Battalion, 303rd Armor, out of Kent — a special edge.
  "The longer you're on patrol, the more you get nervous. Where's it gonna come from?" West said. "Out there, you never know."
  This time it came from a bomb buried under the road.
  West remembers only waking up, hanging nearly upside down by his seat belt and screaming for help. His gunner, Spc. Donald McCune, later died of his injuries. Two others were in the Humvee. Sgt. Robert Johnson, who escaped injury, swept the area for other bombs and with others dug frantically to free West. Lt. Timothy Ozmer, the platoon leader, escaped but was seriously injured.
  "I was having a hard time breathing," West recalled. "A lot of them were telling me to stay calm, don't move, and I kept thinking, 'So this is what it's like to get blown up.' "
  The bomb's impact was devastating.
  As West's body lurched forward, three vertebrae and five other spinal bones were fractured. On the left side of his pelvis, a horseshoe-shaped structure called the ischium cracked in two places.
  His left heel bone fractured. His right fibula, in the lower leg, was broken. His right lung ruptured. The blast ripped the skin and fat from his lower back, and tore his scrotum. Later, his pancreas and gallbladder became infected.
  "I think he was very lucky," said Dr. Timothy Kuklo, the orthopedic surgeon who operated on West at Walter Reed.
  The spinal injury nearly paralyzed him.

Rapid response
  In the ruined Humvee, West remembers, his rescuers told him he was going home. He felt guilty for being happy about that.
  About 30 minutes after the explosion, he and Ozmer were aboard a helicopter flying to a nearby field hospital. West eased in and out of consciousness, his pain on hold from a morphine injection.
  Doctors at the Combat Support Hospital, known as the "Cash," temporarily stabilized his shattered bones, drained blood from his back, installed a drainage tube in his lung and gave him blood. Two days later, he was flown to Landstuhl Regional Medical Center, a sprawling American military hospital near Ramstein, Germany, so he could be further prepared for the trip to Walter Reed.
  Such rapid medical care is typical in Iraq. Every soldier knows first aid; most units have a "combat lifesaver" who can provide advanced first aid, such as starting an IV, and some have a combat medic, trained at the level of an emergency medical technician. Field hospitals have high-tech equipment, and long-range evacuation aircraft are staffed with doctors, nurses and respiratory technicians.
  At Landstuhl, West was agitated — when he was conscious. He pulled at the tube in his lungs, at his neck brace and at the tube that helped him breathe. He thinks he remembers someone tightening screws in his pelvis, but it was really nurses turning him in bed. He remembers, for sure, being fed ice chips by his wife, Rebecca, who had flown to Germany to be with him.
  "I think you probably knew at some level I was there," Rebecca, 30, told him recently as he struggled to remember those first days after the blast.
  After three days at Landstuhl, West flew to Washington, D.C., on a half-full Air Force evacuation plane, beds stacked four high and two wide. Nurses and Rebecca checked on him throughout the 10-hour flight. Doctors at Walter Reed moved quickly to repair his wobbly spine to prevent nerve damage and paralysis.
  Dr. Kuklo fused the vertebrae from the middle of West's back to the base of his spine. The surgeon then attached an 8-inch titanium rod down each side of his lower spine, held in place by 2-inch screws.
  The metal will stabilize West's spine and help his bones heal. It won't be removed unless an infection develops. The same is true for the two 6-inch bolts in his pelvis, installed in a separate operation several days later.
  West wore a shin-high cast for a month to allow his heel bone to mend. His leg fracture healed without a cast. The skin on his lower back healed with medical dressings, and his scrotum was sutured and healed.
  Antibiotics cured his inflamed pancreas, but his gallbladder had to be removed at Madigan, where he arrived Sept. 3 — six months after leaving his home, his family and his job to fight in Iraq.

Spc. John West shows progress in the healing of a surgical wound from the removal of his gallbladder. In the background are wife Rebecca and daughter Iris.

It's still a tough climb up the stairs of West's home in Federal Way. But he walks on his own now, after spending months with a walker and wheelchair.

A home at Microsoft
  West's parents divorced when he was 10, and he left California to live with his father in Oklahoma. His two sisters stayed with his mother. His father, an electronics technician who struggled with alcoholism, moved from job to job — first in Oklahoma, then back in California.
  In high school, West was "geekly," as he describes it, and interested in science. But he didn't do well in school.
  "I consistently sounded off at people because I was easily offended," he said. "I didn't have any social skills whatever."
  In 1984, West quit school in his senior year and joined the Marine Corps. He worked as an electrician on the EA-6B Prowler airplane, stationed in North Carolina, Japan, the Philippines and aboard an aircraft carrier.
  After four years in the Marines, he earned a two-year degree in science, then worked a series of jobs: for an aircraft company in San Diego, on a fishing boat and processing plant in Alaska, for a computer company in Tacoma. He married, fathered a son and divorced after five years.
  In 1995, West landed a temporary job at Microsoft, repairing printers and monitors. He thrived there, often staying late to teach himself about programming and various products. He was laid off after two years but returned to Microsoft in a permanent job a year later.
  His job was a bright spot. So was his relationship with Rebecca, whom he had met through an on-line dating service in February 2001.
  The Sept. 11 attacks left West deeply moved. He tried to re-enlist in the Marines but was rejected, at age 35, as being too old. He joined the Army National Guard in December 2001.
  "Our country was calling and still is calling," said West, who didn't think enough volunteers were stepping up after 9/11. "If you can do military service, it is a duty, not really a choice."
  On Nov. 15, 2003, West was called to active duty, eight months after he married Rebecca and settled in with her and her three children. He left for Iraq in March.
  Rebecca sent him off with a lock of her hair and a foot-long knife he kept strapped to his chest.
  He called it "Becca's Fist."

 Price of recovery: pain
  Two times a week, West's new battle is in full swing in Madigan's gymnasium-size physical-therapy room. He also swims once a week and works out privately. His fellow patients include other soldiers who served in Iraq, active-duty military personnel, retirees and dependents. But very few have the multiple injuries he suffered.
  He was bedridden for two months and now focuses on rebuilding his cardiovascular and muscle strength and tuning up his coordination.
  On a recent morning, his workout started with 10 minutes of pedaling on a stationary bicycle, then moved to a mat for leg lifts. His lips were set thin, his face red as he puffed with each lift. He rolled to his right, and pain from nerve damage exploded through his arm. "I'm pinned," he said, before rolling back and struggling to sit up.
  West then practiced rotating his hips while sitting on a big, orange ball, and later played catch with a small, heavy medicine ball. Finally, Travers, his physical therapist, asked West to walk in place while sitting on the big ball, arms swinging opposite to his foot steps.
  The exercises retune his body's sense of movement and spatial orientation — an ability called proprioception.
  The hardware in his back limits his body rotation, hip extension and arm swing. It hurts when he bends over. Putting on his socks takes at least five minutes.
  The physical therapy makes him stronger, but the price is pain. He's frustrated that his strength is not returning faster.
  "I used to be a really strong man," he said, "Now I'm one of the weakest."
  Still, his progress has been steady: from agonizing, nurse-assisted walks, to using a walker, to unassisted walks up the 19 steps from his driveway to the living room of his yellow, split-level home.

Terri Metzler, a physical-therapist technician at Madigan, encourages West after he has trouble lifting his arm during a therapy session.

  "He is very much a glass-is-half-full person," Travers said. "He has been very positive every step of the way. It's very impressive that his enthusiasm is always there."
  Much of that attitude, West said, stems from Rebecca's rock-steady support. She sympathizes, prods and teases him. She brings him his favorite peppermint soap. She doesn't let him feel too sorry for himself.
  "You're just old," she told him when he complained of fatigue. And when he complained about his trouble bending over, she said, as West laughed, "You'll have to go around saying to people, 'Will you tie my shoes, please?' "
  "I have every advantage to get better quickly," he said. "She is definitely my soul mate."

Wounded on the inside, too
  In September, about a week after his discharge from Madigan, West was roaming the Puyallup Fair in his wheelchair with Rebecca and his family when an amusement ride backfired.
  Suddenly he was at war again.
  "Get down! Get the kids down," West yelled, shaking and crying.
  Such symptoms of acute stress affect about one in six returning combat veterans, according to a recent Walter Reed Institute of Research study. Experts say the symptoms disappear within a year in about three-fourths of these veterans. But some may need medications and long-term counseling.
  The wounds to West's psyche emerged early.
  Dr. Suzette Peng, the internal-medicine specialist who treated him at Walter Reed, well remembers West's battles and his fixation on returning home.
  "He thought he was in the field, even while he was awake," Peng said. "He would ask the nurses to turn off the lights so the snipers wouldn't see him."
  One of his delusions was especially disturbing:
  A Special Forces unit had "gone rogue" and was trying to free Saddam Hussein. A surgeon in the unit, a lieutenant colonel, was searching the hospital to kill West. So was a sergeant. The sergeant killed Rebecca and laid her head on West's lap. He saw his father shot and killed on closed-circuit television.
  Apart from the delusions, West was certain he would die from his injuries. He wanted desperately to go home with Rebecca and "die in Washington air."
  Some of the horrific images have eased since he's been home.
  Still, he sees roadside objects — a box, vegetation — and sometimes worries they hide a bomb. Rebecca has him lie down on the van's seat so he can't see out the window. At a bookstore recently, he saw a customer in bulky clothing and feared the man carried hidden bombs or a rifle.
  The memory of two soldiers killed on foot patrol in June particularly haunts him.

West wipes away tears while describing the death of a fellow soldier he was serving with in the Army National Guard in Iraq. The deaths of two soldiers on foot patrol particularly haunt him.

  One was shot in the face. The other was shot in his trunk as he turned sideways, the bullet entering through a gap in his armor. His body crumpled in a heap. But what West remembers most is the gleaming wedding band on the dead soldier's left hand.
  West's unit, assigned to protect the men, heard the gunfire, ahead and out of the line of sight. But they couldn't move their Humvee because it was surrounded by children begging for food.
  He still sees the faces of the dead soldiers. "They have a right to be in my conscious. I was part of the overwatch team, and part of me feels responsible."
  West takes an antidepressant and occasionally sees a counselor. But mostly he relies on Rebecca and his pastor to help steer him through the emotional storms.
  "Becca lets me talk about it for a while, and then she changes the subject and won't let me talk about it anymore," he said. "And if I'm scared and I think somebody is attacking, she says it's safe, it's safe ... and then it's OK."

'No risks, no chances'
  West loosely follows the war with some dismay. He thinks the fighting was necessary to remove Saddam Hussein, but now wishes it could end through diplomacy.
  He's proud that he learned Arabic in Iraq through books his wife sent to him. It was invaluable in gathering information from Iraqi civilians and helped him bond with the people.
  He does not know when he will be discharged from the Guard or what kind of disability payments he will receive. He takes one day at a time, anticipating his return to his job at Microsoft.
  On a recent crisp fall morning, West sat in his wheelchair on an outdoor basketball court at Fort Lewis. A shaft of sunlight bathed his head, Rebecca rubbed his shoulder, and two ranks of soldiers from the 81st Brigade stood at parade rest.
  Soon the soldiers snapped to attention and Maj. Gen. Timothy Lowenberg, commander of the Washington National Guard, presented West with the world's oldest military decoration in current use — a Purple Heart. He cited West's "uncommon patriotism and service," thanked him and pinned the heart-shaped medal on his left shirt pocket.

Spc. John West receives the Purple Heart from Maj. Gen. Timothy Lowenberg, commander of the Washington National Guard. West's wife, Rebecca, and the 81st Brigade Combat Team, Rear Holding Company, attended the ceremony at Fort Lewis in Pierce County.

Spc. David Sorrentino greets his buddy West, in wheelchair, at award ceremonies at Fort Lewis.

Two of West's fellow scouts, home on leave, attended the ceremony. They later talked about his selflessness and dedication: how his Arabic helped in scouting, how his good cheer and irreverent humor buoyed them all, how he volunteered for extra missions, how he was like a big brother to many.
  "It was awesome having John out there," said Sgt. Rick Larsen, of Sequim.
  West and the soldiers talked and laughed for nearly an hour after the ceremony.
  Larsen gave West his unit's cloth uniform patch and a souvenir bolt from the destroyed Humvee. They posed for a group photo. They planned a barbecue with beer, tequila and roast pig at West's house for when the scouts return. They told each other not to worry.
  West, the old man of the unit, worried anyway. Twice he interrupted the conversation and looked hard at his friends who soon would return to battle. Twice his fellow soldiers stopped their banter and listened respectfully.
  "No risks, no chances," he told the young soldiers. "I want to see you all back here so I can give you a hard time. We're gonna drink some beer."
Warren King: 206-464-2247
or wking@seattletimes.com
Steve Ringman: 206-464-8143
or sringman@seattletimes.com