ROCKVILLE, Md. -- Sometimes the remains of American war dead arrive at the military morgue intact, sealed inside a "human remains pouch" -- a body bag.
Sometimes they arrive as "dissociated remains" -- a leg, an arm or other body parts ripped loose by the force of a roadside bomb or suicide bomber or air crash.
And sometimes there are "co-mingled remains" of several victims of a blast or crash, including service members, civilian bystanders and, in some cases, a suicide bomber.
Air Force Lt. Col. Laura Regan literally lays hands on remains of the dead. For U.S. troops killed in action, she is among the last service members to touch them as she tries to provide families of the fallen with the full truth about their deaths.
As the military's only active duty forensic anthropologist, Regan unravels mysteries borne of wars in Afghanistan and Iraq, where the most common cause of death is not a bullet but a homemade bomb. She uses DNA, fingerprints, tissue analysis and painstaking observation to make positive identifications. Part of her "noble mission," she says, is making sure the remains survivors receive belong to their loved ones -- and no one else.
These are the first wars in which every American battlefield death is autopsied -- and, since 2004, the first in which every set of American military remains undergoes a CT scan. In previous wars, autopsies on American combat casualties were rare and CT scans were never done.
Like a casualty notification officer, Regan encounters family members on the worst days of their lives -- and delivers painful truths.
In Regan's hands, each case is much more than anonymous remains. It's a fellow service member whose grieving family is desperate for answers.
"I'm a service member, and these people have made the ultimate sacrifice," she said inside a chilly basement morgue of the Armed Forces Medical Examiner in Rockville, Md. "Everything we do is to honor them and make sure we have uncovered the truth."
Regan is director of operations at the Rockville facility. She assists in autopsies at the Port Mortuary at Dover Air Force base in Delaware and with autopsies following plane crashes and natural disasters.
One of her first autopsies involved a soldier who had been kidnapped and beheaded in Iraq. Although the body was recovered long after death, Regan was able to help positively identify the remains and return them to the family after years of anguish and uncertainty.
In another case, she was able to help identify the remains of an American civilian kidnapped and murdered in Iraq a few years earlier. Her investigation answered a question that had been gnawing at the family for years: Was he tortured? He was, Regan concluded, and she delivered the terrible news.
"These families go through an incredible ordeal," she said. "They deserve to know the truth, no matter how painful."
Ami Nieberger-Miller, whose brother, Spec. Christopher Nieberger, was killed by a roadside bomb in Iraq in 2007, said she wanted to know every detail of his death -- especially whether he suffered.
"Families can take a lot of painful information if they're told in an honest and compassionate manner," said Nieberger-Miller, spokeswoman for the Tragedy Assistance Program for Survivors (TAPS), which counsels families of fallen service members.
On Memorial Day weekend, 1,300 family members attended a TAPS seminar where the most popular workshop was titled "Did My Loved One Suffer?"
"The questions tend to be: What happened to my loved one? What type of trauma was there? Did they die instantly? Did they suffer?" Regan said. "We tell the families up front: We will tell you the truth."
Regan, 38, speaks in a precise, direct manner -- a reflection of her dual role as a military officer and scientist. She was recruited to the U.S. Air Force Academy as a cross country runner, and studied biology before earning a Ph.D. in forensic anthropology. She is the only female forensic anthropologist in the military's medical examiner system, which includes about 30 civilian forensic anthropologists who work on missing service member cases from previous U.S. wars.
Because even scientists can be overwhelmed by unrelenting death and tragedy -- Regan gets 80 to 100 cases a month -- the same chaplains, counselors and psychologists who serve families at Dover also counsel medical examiner staffers. To relieve stress, Regan runs marathons.
Each body or fragment that arrives at Dover in a sealed body bag is tagged with a bar code. A team of specialists, including a medical examiner, conducts an autopsy. If the case involves fragmented remains, Regan attempts to identify each body fragment by performing a "mini-autopsy" on each specimen.
"If I've identified a body fragment -- say, a leg -- I need to make sure there is nothing attached to that leg, no piece of tissue that does not belong to that person," she said.
In some cases, the remains of a suicide bomber or an Afghan or Iraqi civilian are included when service members' remains are gathered at a blast site overseas.
"We have to make sure those remains are not included in the remains we are returning to the families," Regan said. The remains of Iraqis, Afghans or citizens of other countries killed in blasts are returned to their home countries.
Regan retrieves ball bearings, nails, screws or other projectiles built into bombs. She provides them to U.S. military investigators seeking to learn more about explosive devices that kill Americans.
Work by the morgue has helped the military improve force protection and combat medical procedures. Patterns of blast injuries developed through autopsies, for instance, have led to improvements in body armor.
In 2005, a military radiologist noticed on CT scans that needles and tubes used to treat collapsed lungs in emergency battlefield treatment were too short to penetrate the chest cavity in some cases. It turned out that some soldiers were so muscular that their chest walls were thicker than those of the average civilian patient.
As a result, needles and tubing were lengthened to make sure that the chest walls of all service members could be penetrated to re-inflate collapsed lungs.
One of the most difficult parts of Regan's job is answering questions from family members about what they can do with body fragments.
Most families choose to bury or cremate body parts, though some decline body fragments that are identified weeks or months later -- long after the funeral. In those cases, the remains are cremated and buried at sea.
Regan said many families request autopsy reports and photos but few actually look at them. "I try to warn them that the photographs can be quite graphic, and I suggest they have someone with them for emotional support," she said.
Regan is on call around the clock, whenever the war dead arrive at Dover.
"Those services members did not get to choose a day to die," she said. "I need to be there for them."
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