Doctor applies traumatic brain injury experience to mission
June 11, 2009
WASHINGTON (June 10, 2009) -- When Army Col. (Dr.) Kenneth Lee began evaluating more than 3,000 Wisconsin Army National Guardsmen called to duty last fall in the state's largest operational deployment since World War II to ensure their medical readiness, he approached the task with unique and personal insights.
Lee, who holds the Wisconsin Guard's top medical post as the state surgeon, had to determine the deployability of about 600 members of the 32nd Infantry Brigade Combat Team who had been classified on their medical records as "ambers."
Between their initial alert last year and early this year, when they moved to their mobilization station at Fort Bliss, Texas, Lee had to put these Soldiers into one of two categories: "green" if they were deployable or "red" for they weren't.
It was a tough call, he admits, because many of the Soldiers didn't want to confess to issues that might keep them from deploying with their units. Some hid musculoskeletal or other injuries for fear they'd be forced out of the military if deemed nondeployable. Others acknowledged they had medical issues, but hadn't addressed them because they had no health insurance or couldn't spare time away from their civilian jobs to get treated.
But the bigger challenge, Lee said, was identifying troops with mental-health issues, including post-traumatic stress and traumatic brain injuries. Lee calls these "the invisible wounds" of war - issues that don't mean a Soldier can't deploy, but that have to be weighed when making that determination.
Lee is no stranger to these signs. In his civilian capacity, he's the chief of the spinal cord injury division at the Zablocki Veterans Administration Medical Center in Milwaukee. About 30 percent of the veterans he works with, regardless of what conflict they served in, exhibit symptoms of PTSD or TBI or both, he said.
As he evaluated the Guardsmen's medical records and met with them to discuss their individual cases, Lee said he understood all too well their reluctance to acknowledge these symptoms - in many instances, even to themselves.
Many, like him, had served previous deployments in Iraq or Afghanistan. And many, like Lee, had experienced battlefield trauma.
Lee and two of his Soldiers were severely wounded when a suicide bomber attacked their three-vehicle convoy on the airport road outside Baghdad International Airport. The incident occurred on April 12, 2004 - a day Lee now refers to as his "Alive Day."
"That's the day I was supposed to have been dead, but somehow survived," he said. "It's my Alive Day, and I celebrate it every year now, just like my birthday."
Lee was medically evacuated to Landstuhl Regional Medical Center in Germany, then spent four months at Walter Reed Army Medical Center here undergoing five surgeries and extensive rehabilitation therapy. As he recuperated from shrapnel wounds that took a big chunk out of his knee and ripped open his skull, Lee told his medical providers he wanted nothing more than to return to Iraq.
"I wanted so badly to go back to Iraq to be with my Soldiers," he said.
But Lee's physicians, family and friends noticed what he wouldn't admit. He suffered from head-splitting headaches. He laughed less. And his once-razor-sharp mind now struggled to remember the simplest of things.
But Lee admits now he wasn't willing to acknowledge that something was amiss. His rehabilitative counselors convinced him to take a neuro-psychology test. Unfortunately, "I didn't test fine," Lee said. The test confirmed a mild case of TBI.
"Severe TBI is easy to see. You have deformed skulls, facial defects, severe speech impediments," Lee said. "It's pretty easy to pick these cases up, so you can bring people in and start treating them."
Moderate TBI is a more difficult to identify. "People with moderate TBI might not have physical defects," Lee said. "But once you start interacting with them, you see that there's a disconnect between their speech and thought processes. It's something you pick up on."
Mild TBI is the most challenging to recognize, he said, expressing concern that many Soldiers don't realize they are experiencing it. And once it's diagnosed, he added, there's no specific therapy to treat it.
Lee initially struggled with depression after his diagnosis, then decided to take matters into his own hands. He got counseling. He resisted prescription medications, fearing the side effects and risk of addiction, and using only over-the-counter drugs when his headaches pounded.
He began reading one novel after another to keep his brain exercised. And he turned to a notebook and his BlackBerry to make up for his short-term memory loss.
"I write everything down," he said. "I e-mail myself constantly so I don't forget anything."
Lee admits he initially wondered if he'd be capable of returning to his civilian job at the VA hospital. But now that he's back and keeping up with his heavy patient load, he said, he's brought a new sense of connection to the patients he works with every day. "I have so much more understanding as I deal with them," he said, "because of what I went through."
As a final step toward recovery, Lee set out to repair the family relationships he admits he had come dangerously close to destroying as he struggled with denial, anger and self-pity.
Looking back now, Lee said, he never realized how much his family had endured during his deployment as they worried about his safety and well-being. But exacerbating it, he said, was his attitude when he came home.
"It was all about me," he said. "It took a long time for me to realize the collateral damage I was causing at home by telling them they didn't understand without realizing what they had gone through themselves."
Lee finally faced that fact when he found his wife alone in the garage, crying. He said turning the focus away from himself and toward those he loves actually strengthened his family as it helped him turn the corner. "That has had a huge impact on my recovery," he said.
Another big impact has been sharing his story. Lee lectures regularly about his personal experience with TBI and the challenges of reintegrating back into his family and professional life. He's also a regular at the National Disabled Veterans Winter Sports Clinic and the National Veterans Wheelchair Games, where he talks freely about his own experiences.
"It's therapy for me to talk about it," he said. "Every time I give a talk, I feel a little sense of calm."
Lee said he drew on his newfound understanding as he reviewed the cases of National Guard members late last year and earlier this year to determine if they were medically fit to deploy. He encouraged those with symptoms of TBI to get screened, and to seek treatment if they tested positive. Unlike the active Army, where a commander can order his Soldiers to take these steps, the reserve components only can recommend it, Lee explained, because the Guardsmen and reservists have to cover the cost if they're not on active duty.
"It hurts for me to tell them they have to do that," Lee said. "There's a huge discrepancy." Yet Lee said he's amazed how many of the Guard members followed up on his recommendation so they could be cleared to deploy.
Mild TBI and PTSD don't have to be deployment show-stoppers if they're addressed, Lee attested. He himself is a "deployable asset," and could be eligible to be mobilized as soon as this year. If called up, he said, he feels he's up to the challenge and ready to go, and that in many respects it will bring a sense of closure to his last deployment, which ended so abruptly.
"This is a problem with many of our combat wounded, who never really felt they came home to reconnect the dots in their life," he said. "Going back would be a way to reconnect the dots and move on."