DALLAS -- For nearly four days, the squad of Marines stood guard on Bridge 286, an overpass that crossed a highway thick with traffic between Baghdad and Fallujah. Just a few hours before the end of their shift, a dump truck approached the bridge and rolled to a stop under the overpass. It was loaded with 3,000 pounds of explosives.
An explosion blasted the bridge, spraying chunks of concrete and debris and shooting plumes of black, choking smoke skyward. The eight troops on the bridge, tossed into the air like plastic toys, plunged into the rubble. None were killed, but six suffered serious injuries -- from punctured lungs and broken bones to mangled limbs requiring amputation.
Navy Corpsman Anthony Thompson, the squad's medic, was in the worst shape. Pinned under pieces of shattered concrete and twisted rebar, he was unconscious when rescuers found him.
Halfway around the world, his wife, Ivonne, was at a high school in Twentynine Palms, Calif., where she taught Spanish. As she sat in an empty classroom preparing for her next class, her cellphone rang. She recognized the area code from her husband's base.
"Mrs. Thompson?" The casualty notification officer identified himself.
Ivonne's heart jumped into her throat.
The officer began reading from a prepared statement.
Hearing the word unresponsive, she felt woozy as if standing on a wobbly chair.
Their baby was due in the fall. Anthony had planned to be home for the birth. They would become a family. Now her whole world was collapsing.
All gone in the split-second it took a suicide bomber to trigger an explosion.
On that day, April 20, 2007, Ivonne and Anthony crossed into the perilous new world of those who survive serious injuries in Iraq and Afghanistan, injuries that in previous wars would likely have killed the soldiers.
Improvements in body armor and equipment and advances in battlefield medicine are keeping more wounded troops alive. But many are left with incapacitating injuries, including traumatic brain injuries and other disabilities requiring years of physical and cognitive therapy.
Since 2001, nearly 6,000 U.S. troops have been killed and more than 42,000 wounded in the two wars. The major cause of combat injuries in Iraq and Afghanistan are explosions. Since 2001, more than 200,000 troops have experienced traumatic brain injuries, the signature wound of the two wars, according to a Department of Defense database. Although most such brain injuries are classified as mild concussions, about 5,500 troops have sustained severe brain trauma, including penetrating head wounds.
Seriously injured veterans often require lifelong support. Spouses and other family members provide much of their daily care. Thrust into the role of caregiver, many family members sacrifice their own careers and personal goals for this new responsibility.
Studies show that spouses of wounded veterans are likely to have young children and shoulder the bulk of household responsibilities. They also are plagued by feelings of isolation and experience higher levels of depression, anxiety and other stress-related conditions.
The Department of Veterans Affairs said Tuesday that it will pay thousands of family members who care for severely wounded soldiers at home under a new and expanded program approved by Congress last year.
Family caregivers of veterans with severe brain injuries face a special set of challenges. The last two decades have seen tremendous advances in knowledge about how the brain works, but there is still much unknown about brain injury and how patients can recover from it.
The phone call from Anthony's casualty officer left Ivonne with unanswered questions: How serious were the wounds to his head and back? How long would he be comatose? What were his chances of a full recovery?
Anthony and four Marines from Bridge 286 were flown to Landstuhl Regional Medical Center near Ramstein, Germany, which handles seriously wounded troops.
Ivonne flew to Germany to be with the man she had fallen in love with at first sight.
That was in her hometown of Humble, just north of Houston. Anthony walked into Mulligan's, a sports bar, and went straight to the table where she sat with a mutual friend. She talked to him nonstop. Didn't matter -- he was too dazzled to talk.
When he left for Navy boot camp a month later, they were in love. When he returned from his first deployment to Iraq in January 2006, she flew to his base at Twentynine Palms to welcome him home.
A formal church wedding followed on June 17, 2006. In the wedding photo, the 24-year-old, 6-3 sailor with the square jaw and sea-blue eyes smiled broadly. Ivonne, then 28, rested her head on his chest, her auburn curls framing her glowing face.
At Landstuhl, Ivonne nearly fainted when she entered the ICU.
Her husband lay in a mesh of tubes, cords and IV lines. His face was unmarked, but he looked fragile, his skin like an unlit light bulb. The eyes that usually shone with a mischievous sparkle were closed. She wanted to hold him and cover his face in kisses. But doctors, fearing infection, wouldn't let her touch him. She stood nearby, repeating that she loved him and hoping he would recognize her voice.
A CT scan showed multiple, severe bruises on Anthony's brain, a condition akin to shaken-baby syndrome. The highly pressurized blast waves from the explosion had caused his brain injury, the doctors said.
Cpl. Eric Morante, the squad leader, was recuperating from surgical amputation of his right leg. When Ivonne went to see him, he stood up on his one good leg. He apologized for Anthony's injuries, saying he had promised the families of his Marines that he'd bring them home safe, and cried as he tried to recall details from the blast.
She also met the other Bridge 286 Marines. They told her how much they loved and admired Anthony, how he was a great medic -- a professional even with the unpleasant task of checking daily for foot blisters. Back in the barracks, he could be as fun as anyone. They laughed about the time several of them jumped on his back, trying to wrestle the grizzly-size man to the ground, and he shrugged them off like bear cubs.
And now he needed their help.
"It was my first step to healing," Ivonne wrote that night to friends and family in an online journal on the CaringBridge website. "Hearing the story of what happened, from their perspective. ... I needed that. That was Step One for me."
Near the end of April 2007, doctors moved Anthony to Bethesda National Naval Medical Center, just northwest of Washington, D.C. The goal was to stabilize him, after which he'd begin intensive physical and cognitive rehabilitation.
Day after day, Ivonne kept vigil, chronicling her husband's progress in the online journal. After a week, she wrote: "All they keep saying is 'It's a marathon, not a sprint,' so I'm trying to be patient."
As weeks turned into months, Ivonne remained by Anthony's side. Mornings, when his eyes opened, she often would prop herself in front of his face, look into his eyes and tell him what a great job he was doing and how pretty his blue-green eyes looked. Evenings, she often bathed him, slathering his skin in lotion, checking his wounds. Sometimes, she slipped into bed and cuddled, murmuring in his ear how she loved him, what he meant to her, why he had to keep living.
She became a persistent brain researcher, cornering medical staff and asking questions nonstop. Anthony had a severe traumatic brain injury that rendered him minimally conscious, a step above a persistent vegetative state.
The line between a persistent vegetative state and being minimally conscious is a matter of degree. According to experts, patients like Anthony have occasional awareness of themselves and their environment and show signs of attention and memory. In some cases, these patients emerge from a minimally conscious state and become consistently aware of the world around them and can communicate to some extent. But nobody can predict if, or when, that will happen because every patient is different.
Ivonne found herself torn between gratitude that Anthony was alive and anguish over his limitations.
"I miss him," she wrote a month after his injury. "I miss his eyes when they stare into mine, I miss the smile he gives me when he knows I'm being goofy, I miss his raspy, yet wonderful voice. ... What makes it hardest is the fact that he's right here in front of me."
One day, she circled his face in kisses ending with his lips. If she could only pour enough love into him, maybe she could bring him back. "Kind of like Prince Charming and Sleeping Beauty, only in reverse," she wrote in her journal. "But apparently that only happens in fairy tales."
By midsummer 2007, Anthony was stable enough to move to James A. Haley Veterans Hospital in Tampa, Fla. One of four polytrauma rehab centers in the U.S., the facility specializes in spinal cord and brain injuries.
Anthony showed progress. He began moving his arms and legs. His eyes opened intermittently. He became more attuned to Ivonne, squeezing her hand when she held his. Yet he was unable to speak and was mostly confined to bed after therapy sessions.
Ivonne worried that Anthony might not be fully conscious for his baby's birth in mid-September. Around his bed, she tacked up photos with captions such as IVONNE WIFE and WEDDING. She showed him gifts from her baby shower and stroked his face with one of them, a teddy bear. Many days, she would hold his hand and talk to him, hoping her voice would cause something to click inside his brain. She tried everything, even reading him the sports section from USA Today, to get a spark of recognition. One day, she gave him a sponge bath and a pep talk: She told him why he needed to wake up soon, that he would want to help out when the baby arrived.
On Sept. 12, 2007, exactly one month before Anthony's 26th birthday, Ivonne gave birth to Anthony Cavett Thompson Jr. and began calling him A.J. Three days later, she carried her newborn to the hospital to meet his dad. Both were sleeping, so she gently placed A.J. in the nook of Anthony's arm.
They seemed comfortable with each other, Ivonne wrote. "A.J. didn't even flinch. Anthony turned his head very slowly in his direction and didn't even turn it away the entire time."
Despite Anthony's progress, Ivonne sensed an uncertain future. She wondered how she would balance being a mother and a full-time caregiver. "It's an emotional tug-of-war," she wrote the next day. "The whole 'motherhood' part of my life has been so very bittersweet, and it just makes me more and more angry that this happened to Anthony. I have a million questions reeling through my head and a million 'what-ifs,' but no answer to any of them," she wrote in her journal.
In addition to keeping friends and family up to date on Anthony's progress, the journal also became her confidante, a place to pour her worries, weigh decisions, clarify her thinking, pray and express hope and even despair. She could trust it with her deepest feelings.
A month after A.J.'s birth, she wrote that she needed answers. She went to see Anthony's doctor to ask the questions that weighed most heavily on her mind:
What did Anthony's future look like?
What could she expect in the long term?
The doctor methodically reported the results of clinical tests and brain scans. When she asked what it all meant, he told her every brain is different. Each heals at its own pace. She needed patience.
That night in her journal, she recorded the doctor's bleak prognosis: "Do I think (Anthony will) be able to hold a job? No. Do I think he'll be able to communicate? Possibly."
Ivonne wasn't sure whether to feel better or worse. "I had heard some things I didn't want to, but I heard things that were a teeny bit promising," she wrote. "What I really heard was 'Don't give up!' "
RyAnne Noss had a good idea of what Ivonne was going through.
In February 2007, about two months before Anthony's injury, her husband was seriously injured in Afghanistan. Sgt. 1st Class Scot Noss, an Army Ranger, was on his eighth special operations deployment when the helicopter carrying him crashed. Like Anthony, Scot had a severe traumatic brain injury and remained in a minimally conscious state.
Like Ivonne, RyAnne met her husband through a mutual friend and fell in love almost immediately. RyAnne earned a doctorate in chemical engineering but put her career on hold to care for Scot.
In Tampa, Ivonne and RyAnne grew as close as sisters. Their husbands were roommates in the 5 North polytrauma unit. The two women moved into a new residential complex run by Fisher House, a nonprofit foundation that operates housing for families of service members being treated at military hospitals.
Ivonne and RyAnne followed the same daily routine, spending most of the day by their husbands' sides, then returning home to cook dinner and watch a TV show or a movie. RyAnne, who had no children of her own, became like an aunt to A.J., who spent most of his time in the hospital, too. The friendship grew and sustained the women through medical setbacks, doubt and discouragement.
They worried about what would happen when their husbands were discharged from the military. As active-duty inpatients at the VA hospital in Tampa, they had ready access to doctors and all the medical services they needed. They had peace of mind that if anything happened to their husbands, they'd be taken care of immediately.
But how might that change when their husbands went home? In a bureaucracy as large as the VA's health care system, how long would it take to see a doctor? What would happen if there was an emergency?
Ivonne and RyAnne had grown accustomed to being part of a close-knit military community. They loved the support they received in Tampa, including almost daily visits from someone in a uniform. Would they become isolated after their husbands were discharged and went home?
For service members like Scot and Anthony who require around-the-clock care, nursing homes are another option. But neither Ivonne nor RyAnne could bring herself to go that route. They insisted to family and friends that their husbands were too young for nursing homes. They felt their husbands deserved permanent homes of their own -- especially after spending so long in military hospitals.
In early 2009, a volunteer with Homes for Our Troops got in touch with Ivonne and RyAnne. They were encouraged to apply to the Massachusetts-based nonprofit group, which builds homes adapted for seriously wounded veterans. Months later, they were both approved for the program, which has built nearly 100 homes across the country. The Thompsons' home would be in Humble; the Nosses' home would be built in Alabama.
Months later, just after Thanksgiving 2009, Scot and Anthony were admitted for a six-month program at the Kessler Institute for Rehabilitation in New Jersey, nationally recognized for its treatment of spinal cord and traumatic brain injuries.
Meanwhile, Anthony's old buddies from Bridge 286 had been following their own paths to recovery.
The squad leader, Eric Morante, had finished physical therapy and acquired a prosthetic leg. Then he spent a year struggling with depression and post-traumatic stress disorder. He was on the mend and planned to surprise the Thompsons with a visit from several members of Anthony's squad.
One evening, just before Christmas, Ivonne kissed Anthony good night and sat down in the dining room to eat a slice of pizza and watch TV. Suddenly, from around the corner, she spotted Eric, trailed by Brandon Mendez and Steven May, who both were medevacked to Germany with Anthony. Ivonne hadn't seen Eric in more than two years, and she was so shocked, she could hardly speak.
The group talked and laughed until 2 a.m. The next day, joined by two more of the Bridge 286 Marines, they gathered in Anthony's room. Each took turns sitting with Anthony and talking to him, holding his hand or putting theirs on his arm or shoulder. To Ivonne, Anthony seemed engaged, turning his head toward each one who spoke to him.
By evening, snow was falling in heavy flakes. But inside, the room was bathed in a warm glow. For this one night at least, Ivonne's spirit was buoyed by laughter and joy.
She knew there would be more difficult days ahead. Almost three years after the blast that nearly killed Anthony, her little family remained up in the air, suspended on the bridge between the battlefield and home.
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