Neurology Now:
Special Report: Brain Injury

SAVING SERGEANT RADKE

NAUGHTON, JIM

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Jim Naughton is an author who has been a staff reporter and writer for The New York Times and The Washington Post.

Before beginning the day's therapy for his wounded hands, Sgt. Brian Radke decided to take off his wristwatch. Five times he rose from his seat in the bustling physical therapy room at Walter Reed Army Medical Center. Five times he walked to the wheelchair where he kept his belongings. And five times he arrived at the wheelchair having forgotten why he was there.

Figure. WINDOW TO HI...
Figure. WINDOW TO HI...
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His biggest problem, he says, is short-term memory. Except when it is long-term memory. Radke doesn't remember his favorite color, favorite food, favorite football team. He remembers his wife, Nova, but not all of what she has confided in him. He remembers his parents, Dave and Lynn, but not their address, although they still live in the house he grew up in. And sometimes this native of Vancouver, Wash., speaks, inexplicably, in a southern drawl.

“In some ways,” he says, “it is like starting all over. In a way, sometimes, I look at it as being born again.” His new life began on Oct. 5, 2005, on a stretch of highway in western Baghdad as his Humvee rolled through the 110-degree heat toward a pedestrian overpass. Near the same spot just one week earlier, another Humvee had triggered an improvised explosive device, or IED, killing a member of Radke's unit, the Arizona National Guard's 860th Military Police Company.

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On this day, Radke's best friend, Army Spc. Jeremiah Robinson, 20, was at the wheel of the Humvee. Radke, 30, manned the gun turret, clutching the grip of a .50-caliber machine gun. There were two other soldiers in the truck, one of them a medic. The highway was deserted, yet Radke, who normally would have been standing upright, had a sense of foreboding, and so he crouched inside the turret as the truck approached the underpass.

He remembers hearing a click, then white light filled his eyes and the sound of the explosion filled his ears. Waves of pain swept through his body as a hail of molten metal ripped through the door of the truck, piercing whatever fl esh his armor did not cover. Had he been standing upright in the turret, he might have lost both arms, and perhaps his head. As it was, hundreds of shards of copper lodged in his arms, legs, neck, face, and brain. Blood flowed into his eyes, and his vision came and went, returning long enough for him to see that Robinson had been decapitated, but that his body was still behind the wheel.

The truck lumbered on until it struck a post, perhaps a mile from the blast site. The medic, only slightly wounded, pulled Radke and his surviving comrade from the truck, and then, seemingly in an instant, there was help and helicopters everywhere, people cutting his clothes off and carrying him to a chopper. In the air he pleaded with them to roll him on his side to keep the blood out of his eyes. The last thing he remembers was a female voice asking him a question he cannot recall.

Figure. HELPING HAND...
Figure. HELPING HAND...
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On the ground in Baghdad, Radke had a stroke and lapsed into a coma. While he was unconscious, his heart stopped twice. He had a fractured jaw and a punctured lung. He had lost his right index finger, his left wrist was shattered, and the arm was broken in four places. His carotid artery had been severed, and there were five pieces of shrapnel in his brain.

Eight doctors worked on him for 12 hours until he was stable enough to be airlifted to Landstuhl Regional Medical Center in Germany. There, his heart stopped a third time. He arrived at Walter Reed six days after the explosion in a druginduced haze with his wife and parents at his bedside.

Not long afterward, he watched the University of Southern California defeat Notre Dame University in a college football game. Radke remembers the decisive play of that game with perfect clarity. But he also remembers watching it in a vast British cathedral, and he knows that can't be right.

It was among his first indications that he would not be able to rely on his brain the way he once had. With his brain serving up memories he knew should not be trusted, Radke began the long process of rehabilitation. Walter Reed is home to scores of soldiers recovering from traumatic brain injuries and other wounds from explosions in Iraq. On a recent morning, he sat in the physical therapy room behind a machine machine that looked like a high-tech meat grinder while a gaunt teenager in a wheelchair raised and lowered an exercise ball behind his head and another man leafed through an issue of Amputee Golfer magazine. These soldiers devote hours each day to learning how to live with a wound that not only undermines their ability to negotiate daily life, but alters their understanding of who they are.

“Sometimes I feel like I'm just a body,” Radke says. “I don't really have a lot of thoughts. I'm still taking everything in, and trying to process it, but sometimes I can't process it. Probably over 50 percent of the time I won't process it.”

Since the blast, his body has been in almost constant turmoil. He has had surgery to replace a damaged nerve in his arm, to fix his broken jaw, and to repair one of his knees. He takes morphine and Percocet to calm raging headaches, and while the painkillers do their job, his neurologist, Navy Lt. Robert Beck, thinks they may have precipitated three instances in which Radke suffered stroke-like symptoms but sustained no additional brain damage.

His shrapnel-riddled body has extruded dozens of small copper shards. On his 31st birthday, he was eating a grilledcheese sandwich when one worked its way through his throat and into his mouth. Keeping his strength up is a constant struggle. Since his injuries, the former high school quarterback and college infielder has lost 50 pounds, most of it muscle.

But the calamity that has befallen his body is nowhere near as mysterious as the one that has befallen his brain.

There is moodiness: “One day I'll get really emotional. This past Sunday I cried for seven hours and I don't even know why.”

There is irritability: “For the most part I've always been really passive and quiet-mannered, and now I'll go from happy to ‘I wanna kick your butt’ in 60 seconds.”

There are problems in concentration: “I have a hard time flowing in the conversation, or trying to think what my next word is. In a way I feel like I'm babbling. I'm not really getting out what I'm thinking. If you wanted me to explain something to you, I'd have the hardest time.”

There is an inability to self-censor: “Sometimes something pops into your head and you shouldn't say anything. Somehow I don't have that mechanism anymore.”

And there is insomnia: “When irelax, that's when my brain really seems to take off. Thinking about my day's events, thinking about what happened, thinking about my friend who was killed. And it keeps me awake. I have the hardest time trying to relax so I can go to sleep.”

Since his injury, Radke has had several highprofile visitors such as Iraq-war critic Rep. Jack Murtha (D-Pa.) and Secretary of Defense Donald Rumsfeld; and Sen. John McCain (R-Ariz.) presented him with his Purple Heart in a ceremony at the Capitol. Yet Radke has struggled to sustain his most important relationships.

“My number of friends has dropped,” he says. “A lot of times I'll forget who they are, and I'll forget to call them for the longest time. I barely talk to my parents and my sister, really anyone in my family. I just forget to call.”

“And it has put a strain on my relationship with my wife. A lot of her past I don't remember, and that's really frustrating for both of us. We have really had to start over. I can't imagine what she's going through. I don't really understand what I'm going through.”

Radke says Nova shared his premonition that he would be injured in Iraq, and that they talked about it one night in his parents' garage during his home leave, two weeks before he was wounded. He remembers telling her he thought he would not escape the war intact, and her saying, “You're going to get injured. You're not going to die or anything like that. You're going to get injured, but it's going to be OK.”

“I guess it was a way of my old soul saying goodbye,” he says. “Everything about me has changed this last year.”

Even an activity as mundane as eating dinner presents new challenges beyond the difficulty of grasping a knife and fork. How else to explain why Radke, whose favorite food is steak, recently ordered shrimp at a steakhouse? “Little things like that,” he says. “I have to kind of rediscover myself.”

A lifetime of memories will not return quickly, but Radke's search goes on. “I have high hopes for him,” Dr. Beck says. “Since he began therapy, the speed of his mental processing has quickened, and his visual memory and attention span have improved.” Dr. Beck says Radke's memory problems have less to do with the memories being erased than his not being able to find them just yet. “The filing cabinet is there,” Dr. Beck says. “His ability to go to it is what is impaired.”

Figure. LONG ROAD AH...
Figure. LONG ROAD AH...
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Radke and his therapists work hard on exercises that may one day help him locate that filing cabinet. He memorizes random sequences of letters and numbers for memory. He repeats sentences uttered by his therapist. He names all of the animals he can think of, grouping them into categories like household pets and farm animals to make the job easier.

“My life is almost like a game right now,” he says. “You have to do certain things to get to the next level.” But if this is a game, what does winning look like? “Some days, it's like, ‘God, I just wish I could run, or walk a long distance without having to be in a wheelchair,’” he says, pondering his changed goals.

Radke enlisted in a military police unit in the hopes that it would lead to a job in law enforcement. He'd still like to do police work, but he realizes he'll never have the strength or mobility to be a beat cop. A former volunteer coach, he's also thought about going into education.

“I guess those are what I am hoping to do,” he says. “But I don't know what I am going to be able to do.”

Some days, he says, he is eager to leave Walter Reed and go back with his wife to Arizona, where they met and were married. But in other ways, he says, it is comforting to be in an environment in which people are caring for him and where they can appreciate the significance of each small step forward.

One recent night, Radke dreamed that he and Nova were mixed up in an intricate Asian drug deal. One of his doctors traced the origins of the dream to painkillers and the Jackie Chan movie that Radke had watched before falling asleep. But Radke cared less about the meaning of his dream than that it stayed with him.

For the first time in almost a year, he had remembered a dream.

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A year after his severe brain injury in Iraq, a solider walks the long road through rehabilitation and rediscovery

©2006 American Academy of Neurology

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