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PRESENT-TRAUMATIC STRESS

'For some reason, I’m alive and he’s not'

U.S. troops with the 1st Battalion, 504th Parachute Infantry Regiment search for improvised explosive devices while on patrol near Highway 1 in eastern Afghanistan's Ghazni province.

ESPANDI, Afghanistan — The Polish sergeant took one step off the dirt path that the U.S. soldiers ahead of him had scanned for buried bombs. Those few inches marked the line between Jan Kiepura’s life and death. His foot triggered an improvised explosive device that forever separated him from his wife and two sons.

First Lt. Joshua Fosher was 15 feet in front of him; Capt. Dusty Turner was about as far behind. The distance saved the two Americans from his fate. Yet they were casualties in a less obvious sense. The blast inflicted hidden wounds, physical and psychological, that lingered long after Kiepura returned to Poland in a metal box.

Fosher and Turner suffered brain injuries that were slow to heal, injuries that magnified the mental trauma of their close exposure to death. Their ordeal resembles that of thousands of U.S. troops affected by brain injuries during the war in Afghanistan, now 12 years old, and the eight-year war in Iraq that ended in 2011.

In the weeks after the blast, as the two soldiers continued to endure the rigors of a nine-month deployment, they searched for order amid war’s uncertainty.

“He was there, then he wasn’t,” said Fosher, 26, of Exeter, N.H., referring to Kiepura. “When you realize how fast that can happen, it makes you aware in a very real way how everything can end.”

It is an awareness that, for each man, remains bereft of answers.

“For some reason, I’m alive and he’s not,” said Turner, 28, of Center Point, Texas. “For some reason, God allowed me to be here. I have no idea why.”

Less than a second

Fosher and Turner belong to the 40th Mobility Augmentation Company, 2nd Engineer Battalion. On the morning of June 10, Fosher’s platoon and Turner, the 40th MAC commander, climbed into armored trucks at Forward Operating Base Ghazni to drive to the nearby village of Espandi.

American troops share the base in eastern Afghanistan with a company of Polish soldiers. A platoon led by the 35-year-old Kiepura joined the patrol.

Espandi hugs Highway 1, the primary route between Kabul, Afghanistan’s capital, and the country’s second-largest city, Kandahar, about 300 miles to the south. The road is heavily guarded by foreign and Afghan troops. Their presence fails to deter insurgents from targeting military and commercial vehicles with IEDs and rocket-propelled grenades.

The U.S. and Polish platoons rolled out under a luminous blue sky to comb the highway for IEDs en route to Espandi. The town of fewer than 200 residents presents a brown-on-brown tableau of mud-brick homes and farmland, and on dozens of patrols, Fosher and his men had walked through its fields without facing any greater threat than feral dogs.

Entering the village on foot, he and a handful of soldiers, including Kiepura, approached a five-foot-high mud wall bordering a pasture. U.S. intelligence analysts had received reports that, contrary to Espandi’s serene facade, enemy fighters were planning to launch an attack in or near the field.

Trailing two members of his platoon, Fosher strode through a gap in the wall and began moving up a small hill. Kiepura followed him.

Fosher stared at the path, perhaps three feet wide, looking for evidence of bombs: the tip of a copper wire, a patch of disturbed earth. He crested the slope as Turner, some 30 feet behind him, passed through the wall opening. Kiepura was roughly halfway between them.

At that moment, the Polish soldier stepped from the path. His boot landed on a pressure plate hidden in the topsoil. The small plank of wood tripped a set of wires connected to 25 pounds of homemade explosives.

The firing sequence lasted less than a second. A geyser of dirt shot skyward.

‘It has to be done’

Fosher rose from his knees in a daze. The throbbing in his ears made him wonder whether his skull had collapsed. Faintly, as though he were underwater, he heard soldiers yelling, “Man down!”

The lieutenant saw Kiepura and staggered toward him. He was on the ground, legs torn off at the pelvis, torso “unzipped.” Blood drained from his shattered body, shading the dirt beneath him from brown to black.

“You’re rattled, but you just snap into your training,” Fosher said. “You think, ‘OK, someone’s hit. Let’s get his head up, let’s get his helmet off, let’s start doing first aid.’”

At the bottom of the slope, Turner unclenched his eyes. The bomb, buried at a slight angle, had created a stronger blast wave downhill. The captain was blown off his feet through the space in the wall. He patted his arms and legs, relieved to find them attached. A ruptured eardrum filled his head with a high-pitched whine. He struggled to stand.

“I knew there were four or five guys on the other side of the wall,” he said. “My fear was that everybody was dead because of the size of the explosion.”

A medic with the U.S. platoon ran to Kiepura. As he stuffed roll after roll of combat gauze into the dying man’s wounds, Fosher collected body parts from across the hillside.

“Those are his pieces,” Fosher said. “They’re not Afghanistan’s, they’re not the terrorists’. They’re his. They’re for his family. So you pick them up. It has to be done.”

Soldiers loaded Kiepura into one of the trucks; the convoy returned to the base within minutes. Their urgency was futile. Surgeons were unable to revive him.

Lean and muscular, his dark hair and goatee trimmed short, Kiepura had carried himself with a soldier’s purpose. Fosher and Turner had not known him well in life. In death, he is a familiar presence.

“You don’t forget something like that,” Turner said. “I don’t want to forget.”

Internal echoes

Both men endured nausea, vertigo and a lashing headache after the blast, symptoms that suggested brain trauma. They flew later that day to Bagram Air Field, one of the largest U.S. bases in Afghanistan, where the military runs a traumatic brain injury clinic. The helicopter’s vibrations and the thin air at altitude left them choking back vomit.

The Army opened seven TBI clinics across the country in 2010 in response to a gathering health crisis. Thousands of troops who suffered brain injuries during the Afghanistan and Iraq wars, most from IEDs, spiraled as their condition went undiagnosed, burdening them with physical, mental and emotional problems that shadowed them back to America.

Doctors and occupational therapists at the clinics work with soldiers to reduce symptoms and monitor their brain function. Treatment typically lasts three to seven days and combines medication, cognitive testing and light physical rehabilitation. The prevailing intent is to return troops to their units rather than send them home.

Brain trauma tends to increase sensitivity to light and sound. At the Bagram clinic, comprised of a cluster of wooden huts, the barracks for patients is kept dark, and an external layer of spray-foam insulation cloaks the space in quiet. A handmade quilt donated by a troop support group covers the bed in each soldier’s private room.

After Fosher and Turner arrived, doctors gave them sleeping pills to calm their minds. They seldom strayed from the barracks in the first three days, sleeping under the quilts for up to 16 hours at a stretch. When they watched TV in another building, they shut off the lights and wore sunglasses, an effort to dull the screen glare that knifed their eyes.

The two officers are compact and athletic, and as teenagers, each had rebounded from a sports-related concussion — rugby for Fosher, football for Turner. With rest, they expected a quick recuperation.

Instead, as doctors tested their motor skills and short-term memory, the pair felt betrayed by body and mind alike.

They sometimes tipped over when sitting and banged into walls when walking, their balance erratic like a toddler’s. Asked to touch his right heel to his left shin, Fosher paused and thought for several seconds, then did the opposite. Neither showed signs of long-term memory loss. But trying to recall names and numbers a minute or two after hearing them, Turner found the answers had vanished.

“You get a little frustrated,” he said. “You’re focusing all your attention on some simple task when before you didn’t have to think about it. You’re having to retrain your brain.”

The soldiers slogged through their physical recovery while, in dozens of discussions with one another, they sought to cope with the internal echoes of the blast. Reliving the mission, they broke down minutes to moments, scoured their memories for details, compared what they had seen and heard and feared.

“Man, when I saw you on the ground,” Fosher told Turner, “I didn’t know if you were going to make it.”

“I knew you were up on the hill,” Turner told Fosher. “I was thinking you and the other guys were gone.”

Talking about the patrol provided catharsis by degrees. Closure was more elusive. Both of them are married, and Turner is the father of an 8-month-old son. As they imagined the anguish of Kiepura’s wife and two children, an explanation for his actions proved as inscrutable as the meaning of his death.

“You go over what happened so many times that you start to realize we couldn’t have done anything else,” Fosher said. “Maybe he was rushing, maybe he didn’t realize his foot was going off the path. All we really know is that he took a wrong step. There’s really no way of understanding why he was killed.”

He and Turner each met once with a military psychologist as part of the clinic’s program of care. The sessions felt stilted, useless. They preferred their own conversations, rooted in the shared experience of an explosion that at once destroyed a life and gave shape to their mortality.

“It’s a sudden shift of reality when you see that the worst thing can happen at any time,” Turner said. “You think life’s one way, now it’s another — forever.”

Stark wisdom

The soldiers were cleared to rejoin their unit in Ghazni one week after the blast. Their headaches had dissipated, their short-term memory was improving. They exited the cocoon of the patients’ barracks and boarded a flight that returned them to the war.

Their symptoms flared before the helicopter touched down.

Fosher and Turner fought the impulse to retch as dizziness gripped them during the trip. Afterward, legs unsteady and stomachs roiling, they stumbled across the rock-strewn landing zone. Their condition worsened in the ensuing days.

Acute headaches, recurring nausea and episodes of impaired vision provoked questions for both men about the possibility of lasting brain damage. In turn, the physical ailments deepened a sense of existential unease.

“Being on base definitely took a little adjusting,” Turner said. “There was some anxiety. We weren’t feeling great as it was, and being here sort of brought everything that had happened to the surface.”

Their superiors sent the duo back to Bagram less than a week after they left the clinic. Doctors reassured them that their uneven recovery fit the trajectory of patients with mild to moderate brain trauma.

Over the next week, aided by more rest, Fosher and Turner saw their cognitive skills sharpen and symptoms abate. They again returned to their base, and as days passed, they began to regain the mental equilibrium lost in the blast.

“I think it was a matter of just needing extra time to recover from what we’d gone through,” Fosher said. “The first time back, it was too soon.”

The two soldiers reacclimated to the combat zone at a measured pace. Neither went on patrols for several weeks to limit the risk of suffering another brain injury. They added hours to their work schedule as their health allowed, decelerating when the occasional headache or bout of nausea arrived.

The explosion still lurks in their thoughts. The sight of a Polish soldier’s uniform or the guttural blare of the mortar siren can transport Fosher to that hill in Espandi. A loud noise in a dream might splinter Turner’s sleep and summon the panic of those airless moments after the earth erupted. “I’m all right,” he tells himself when he awakens, heart bucking, thoughts swirling. “I’m alive.”

Fosher and Turner rarely talk about the blast anymore. There is little need; their mutual empathy is implicit. Each man recognizes that the other carries the stark wisdom imposed by the violent end to Jan Kiepura’s life. They understand survival is as random as death.

“I’ll never know why it was him and not me,” Turner said. “But I know that because I’m alive, I have to make it count. I can’t live as if I’m dead.”

news@stripes.com

martinkuz [at] yahoo.com
Twitter: @MartinKuz

Editor's Note: This series examines the mental health of U.S. soldiers in Afghanistan and how they cope with war’s internal burden while deployed. Stories explore the work of psychologists, psychiatrists, social workers and chaplains to reduce the combat-related stress of troops; the efforts of senior officers to balance the needs of soldiers with the demands of the U.S. mission; and the fear of asking for help that still exists within the Army. This series is produced with the support of a Rosalynn Carter Fellowship for Mental Health Journalism.

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