By James Dao for the New York Times
It was Lt. Col. Richard Brunk’s second Sunday in Baghdad, and so, of course, there was church. Only 16 soldiers showed up, but that was good for that busy day, election day across Iraq. The presiding chaplain asked everyone to take seats up front. It was a providential move.
A 122-millimeter rocket exploded outside, virtually collapsing the rear of the chapel. Colonel Brunk was pitched forward, an outstretched arm failing to stop his head from hitting the marble floor. Gathering himself amid the chaos, he noticed some foil-wrapped chocolates scattered like pebbles before him and offered one to the chaplain, sprawled on the ground nearby.
“If I’m going to die, it’s going to be with chocolate on my breath,” the colonel said jokingly. The chaplain moved his lips in reply. “And I realized: ‘Uh oh, I’ve got a problem,’ ” Colonel Brunk recalled. “Because I couldn’t hear him.”
The explosion broke Colonel Brunk’s wrist, shattered both his eardrums and rattled his skull, medical records show. It would be the first of two major blasts in 2005 that traumatically injured his brain.
Seven years later, the symptoms have not gone away. Colonel Brunk, who retired from the Army this summer, regained his hearing, but he still has daily headaches, ringing in his ears, double vision and dizziness, all typical of traumatic brain injury, or T.B.I. Occasionally he struggles to remember once-familiar words, faces and names.
The military says it has diagnosed more than 260,000 cases of T.B.I. since 2000, about 42,000 of them involving deployed troops. That is less than 2 percent of the service members sent to Iraq and Afghanistan, and many experts believe that the actual number is higher. Though three in four of those cases were labeled “mild,” many veterans like Colonel Brunk have struggled with powerful aftereffects for years.
In his case, age has been a factor. A chaplain himself, Colonel Brunk was 54 when he was injured, a rarity in these wars, where 99 percent of the 2.3 million troops who deployed to Iraq or Afghanistan were under 50. Now 62, he faces a much steeper path to recovery than a younger person, doctors say.
But emerging research shows that traumatic brain injuries may have long-term effects on troops of all ages. A study by the University of Oklahoma this year, for instance, found that a majority of veterans treated at a traumatic brain injury clinic continued having headaches, dizziness and poor coordination eight years after their injuries.
Data from the Center for the Study of Traumatic Encephalopathy at Boston University suggests that multiple traumatic brain injuries during one’s youth may be linked to degenerative brain disease later in life.
Colonel Brunk’s story underscores another important issue: how poorly the military understood brain injuries early in the wars.
Since 2009, the Pentagon has required troops suspected of having head injuries to rest immediately after blast exposure, a crucial period when brains can often heal themselves, doctors say.
But in 2005, Colonel Brunk was allowed to return to work within hours of his first exposure. When doctors eventually recognized that he had neurological damage, he was sent home for about three months but was treated mainly for hearing problems. He was then permitted to return to Iraq, at his own request, where he had a second, potentially devastating head injury.
He had gone to war not expecting to experience warfare quite so intimately. But once he was hurt, he was determined to rejoin his battalion and finish the tour with his flock. And like many of those soldiers, he did his level best to ignore injury, pain and, eventually, a collapsing marriage.
“I went to Iraq a chaplain,” Colonel Brunk says. “But I came home a soldier.”
But to those close to him, his dogged good cheer was a mask that did not always serve him well. “People look at him and say, ‘That’s Chaplain Brunk, he can’t be having problems,’ ” said Kathy Curry, a close friend. “But he’s got problems at home. He’s got T.B.I. He’s got pain.”
And so, not long after meeting him, Ms. Curry felt compelled to ask: Who counsels you? Who counsels the counselor?
The answer, for a time at least, was nobody.
He had wanted to be a doctor, but college microbiology killed that notion. So he followed his father, an Army chaplain, into the ministry, leading Texas parishes of the Evangelical Lutheran Church while volunteering as chaplain for fire departments and hospitals. But the military, a family tradition, called.
In the fall of 1989, Colonel Brunk found himself chatting with an Army chaplain recruiter at a church convention in New Orleans. By the end of their stroll down Bourbon Street, the minister had signed on for the Texas National Guard. He was 39.
When he was mobilized for Iraq, he was thrilled. He would be the chaplain for an engineer battalion, but he would also oversee religious support for a 6,000-person base, Camp Slayer near Baghdad. He arrived in January 2005, as the insurgency was gaining steam.
The day he was injured, he was observing the chaplain whose job he was about to assume, known in the military as riding in the “right seat.” After the explosion, medics splinted his wrist. By nightfall, he was back assisting at a chapel service.
But he was plagued by headaches. Several weeks later, he collapsed during a meeting, and doctors sent him back to Fort Hood, Tex., where a case manager recommended a medical discharge. But he lobbied hard to go back to Iraq, and once his hearing improved, the doctors agreed. In May 2005, he returned to war.
He spent the early part of that Baghdad summer visiting troops at fire bases, conducting services and counseling units after casualties. In August, as he was walking from a memorial service, a mortar exploded nearby, flipping him onto the back of his head. There was no blood or open wound — there usually are not in less severe traumatic brain injuries. He shook it off and returned to work.
But over the coming weeks, a senior noncommissioned officer noticed lapses: the colonel was forgetting things, becoming easily confused and having uncharacteristic outbursts of anger. The sergeant notified a battalion doctor, who showed up unannounced at Colonel Brunk’s office and asked offhandedly about a photograph on the wall.
It was a picture of the colonel’s children, but he could not name them. The doctor sent him for neurological tests, and he failed them all. In October 2005, he was sent home for good.
Today, when Colonel Brunk thinks back on his deployment, there are extended patches about which he cannot recall a thing. He struggles to explain why, for those many weeks in Iraq, he stubbornly believed he was just fine.
“You don’t realize your brain’s not working,” he said. “If you’ve ever had a dream that makes perfectly good sense while you’re in the dream, it was like that. And then you try to recall it later, you’re like, ‘That was insane.’ ”
Back at Fort Hood, Army doctors treated his wounds as best they could, giving him powerful medications that made his headaches dissipate but also put him in bed, weak and disoriented. There was therapy and more medication for dizziness, depression and post-traumatic stress disorder.
In April 2006, they sent him home to his wife and three children in Pearland, a Houston suburb. But in early 2007, the Army mobilized him again, this time to provide predeployment training to chaplains at Fort Hood. For the next five years, the sprawling base became his home.
The war in Iraq was at full throttle, and Fort Hood was its gas tank. Colonel Brunk was extraordinarily busy, overseeing chaplain training and ministering to thousands of soldiers leaving or returning each week. In one four-month stretch, he did not take a day off, returning only occasionally to Pearland, 200 miles away.
Through it all, headaches came in crushing episodes that could stagger him like a blow from a nine iron. His long-distance vision remained 20-20, but because of nerve damage, objects within arm’s length came in pairs. Polished floors looked like ice, and sometimes they proved just as slippery.
Work was perhaps his best therapy, but it was no cure. In 2009, the Army sent him to a traumatic brain injury clinic at Fort Hood, followed months later by a stint at the National Intrepid Center of Excellence in Bethesda, Md. He received special glasses and sophisticated interactive therapy for overcoming dizziness. Doctors discovered damage to his inner ear and introduced him to new kinds of therapy, including acupuncture, which eased his headaches more effectively than drugs.
But there was only so much they could do. In Bethesda, a doctor said: “You’ve made optimal recovery. For a man your age, you’ve done pretty well.” It was time, the Army told him, to retire.
At the same time, his wife asked him for a divorce, unhappy with his military life and the long separations. In the summer of 2011, she moved out.
He had hit bottom. Once garrulous and relentlessly cheerful, he had become depressed and increasingly isolated, searching for quiet enclaves in libraries or bookstores to escape the crowds, bright lights and blaring noises that might induce headaches or anxiety. He began to think idly about suicide.
He needed a savior, and he found one in Ms. Curry.
At 45, she, too, was going through a painful divorce. She, too, was struggling with dizziness and migraines, the lingering effects of a benign brain tumor that was removed in 2010. She, too, had experienced what she called “burnt tongue,” the odd sensation, caused by nerve damage, that her tongue was on fire.
And so not long ago, when Colonel Brunk had a migraine so powerful and disorienting that he began speaking in French, a language he learned fluently as a youth, she instantly understood.
“I’ve seen the fireworks in my head, too,” she said.
Horses have been her drug of choice, and she introduced her two animals to Colonel Brunk. Together, they feed them daily, and Colonel Brunk has found the activity so soothing that he has overcome concerns about dizziness and tried riding.
In August, he officially left the Army, which denied him a medical retirement that would have entitled him to special tax breaks. Now he must wait for the Department of Veterans Affairs to evaluate his claim for disability compensation. Already the agency has raised questions about whether his hearing and vision problems are results of age rather than traumatic brain injury.
Frustrating, yes. But for the first time in years, he feels as though he is on the mend. The crushing migraines are less frequent and some days he can read an entire book, though other days he still struggles to comprehend every sentence.
Steps forward, steps back. No turning points, just incremental adjustments.
“I know factually that as an older guy who got hurt in combat, that I’m probably not going to bounce back,” he said. “But I also know as a stubborn old guy, that I’m not going let these kids outshine me.”
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Posted on December 15 2012 in News