(This is part one of a two-part series about three Soldiers who were blinded in combat and their journeys back to active duty.)
The story is similar for many Soldiers: Contact with the enemy, a searing explosion and then darkness.
There is usually more to it than that, of course: a high-stakes mission, other Soldiers who may have been wounded or killed, medics and surgeons who feverishly worked to save lives on the battlefield, a long trip back to Landstuhl Regional Medical Center in Germany and then to the United States, multiple surgeries.
And then came the crushing realization that the darkness wasn’t temporary. It was permanent.
Vision loss by the numbers
According to the Blinded Veterans Association, 138,636 service members suffered eye injuries between 9/11 and March 2013. The majority were minor, but about 4,000 were severe, usually as the result of a blast. About 2,000 service members were left with low vision and about 200 were blinded. Of those, the Department of Veterans Affairs provided inpatient treatment to 180 severely disabled blind Iraq and Afghanistan service members and veterans as of July 2013. (According to BVA, some 43,000 have also lost vision as a result of traumatic brain injuries, although these injuries are tracked separately.) It usually means that any future in the military is gone forever.
With great determination and perseverance, however, a handful of service members, including Maj. Scott Smiley, Capt. Ivan Castro and Capt. Joe Bogart, have fought to return to active duty service. While Smiley and Castro were totally blinded, Bogart lost his right eye and was left with partial vision in his left eye. He even deployed to Iraq a second time. By some reports, he is actually the first Soldier since the Civil War to return to a combat zone after catastrophic vision loss.
Maj. Scott Smiley
Smiley came first. He was injured in April 2005 in Iraq. Barely two years out of West Point and then Ranger school, he was in his first assignment as a platoon leader with the 25th Infantry Division. His new bride, Tiffany – his high school sweetheart – waited at home and a promising life stretched before him.
Then he was given an assignment to find a car bomb in Baghdad. He split off from the main company with three Strykers, and then, on a side street, he found a car whose rear was sitting lower than its front. Smiley cordoned off the street before ordering the driver to get out of the car twice. The driver shook his head twice, then started to pull forward. Smiley raised his M-4 and managed to get off two rounds before the driver “disintegrated the car and my world went black.”
Smiley’s rear gunner and one of his squad leaders received relatively minor injuries and quickly returned to duty, but within an hour, Smiley was on a helicopter to Balad, which had the most advanced medical facilities in country. They removed his left eye and then performed a craniotomy because some of the shrapnel had made it past Smiley’s helmet and through his skull, and his brain was swelling. There was shrapnel in his right eye as well, but at the time, surgeons thought they might be able to save it.
After a stopover at Landstuhl and another surgery, Smiley woke up in Walter Reed Army Medical Center in Washington a week and a half later. Even through the haze of painkillers and sedatives, he knew something was wrong with his eyes.
“I knew my left eye was gone, and at the same time, I couldn’t see anything,” he said. “I went through an eight-hour surgery to take the metal out of my right eye. The doctor came up to me and he said, ‘Sorry, Scotty. It’s sad that I have to do this, but I have to inform you that you’re never going to be able to see again.’ That’s kind of when reality hit me.”
Capt. Ivan Castro
After a long career in the infantry and special operations that included deployments to Iraq for Desert Storm, another two to Bosnia, plus Kosovo and Albania, as well as multiple operations in Central and South America, Castro decided to go to Officer Candidate School at the age of 37.
He deployed to Iraq with the 82nd Airborne Division in June 2006 as the leader of a scout platoon. During a mission in Yusifiyah, Sept. 1, his unit engaged the enemy, losing one Soldier and sustaining several casualties. The next night, Castro’s snipers and reconnaissance Soldiers were told to take up positions on a rooftop.
“I knew it was a very bad position,” he said, and as daybreak came, he ordered his Soldiers to find an area with more cover. As he knelt down to radio
his commander, the first round hit, landing next to the building. Castro looked over his left shoulder to order everyone inside the building for cover and the next round landed five feet to his left.
He was knocked unconscious, and two of his men immediately jumped back on the rooftop and lowered him down. Fortunately, the battalion surgeon was already on scene and he immediately started working on Castro and two other wounded Soldiers, who would both die of their wounds.
Doctors at Balad and then at Landstuhl weren’t sure if Castro would join them on the casualty list, but he fought for life. At Walter Reed, they noticed that in addition to his facial injuries, his missing finger and the shrapnel that peppered his lower body so heavily that he looked like he’d been through a meat grinder, a piece of shrapnel had caused a bilobed aneurism of his left vertebral artery, so they transferred him once again, this time to Bethesda Naval Medical Center in Maryland. When he finally came to, after six weeks on life support, Castro still had some limited light perception, but the risk of infection was high and the fragment had to come out.
“That was the hardest thing,” he recalled, “when I came out and they took off the dressing, I knew I wasn’t going to have vision. … Removing the fragment really scarred the retina and possibly damaged the optic nerve.”
Capt. Joe Bogart
Like Castro, Capt. Joe Bogart started out as an enlisted Soldier. He loved his specialty – combat engineer – so much that after OCS he branched engineer. As a second lieutenant, he deployed in the summer of 2006 to join a unit that was already in Iraq, taking over a platoon leader role. Then, Oct. 6, 2006, on his very last mission, a route clearance patrol, Bogart’s armored Humvee pulled around another patrol that had cordoned off an improvised-explosive device only to hit a second.
He doesn’t remember much — the whole incident is still fuzzy. When he awoke in a combat field hospital in Iraq, Bogart learned that some shrapnel had penetrated the vehicle’s armor and ripped off his eye protection, cutting across his right eye and nose. The impact threw Bogart into the Humvee’s blue force tracker, fracturing his forehead, nose and cheeks, and inflicting blunt trauma damage to his left eye.
“No one else was injured in my vehicle,” he said. “We joked that my fat head protected everybody.” He was at the hospital within 22 minutes. “That’s when I first woke up to a world of darkness.” Doctors in Iraq didn’t want to risk removing his right eye yet, and it was so damaged, they had no idea whether his left eye was still intact or not.
Five days later, at Walter Reed, they knew: He had a corneal rupture, his lens was folded over and had to be removed, his iris was ripped and misshapen and needed to be reattached and he had some retina damage. He also developed injury-induced glaucoma and the pressure in his eye skyrocketed.
After several surgeries, “my wife led me to my appointment,” he recalled, “the doctor took the bandages off and the world was still dark. That was very, very hard. You see in the movies, they take the bandages off and they blink a couple times and they can see. That’s kind of what I had hopes set on. After sitting there for a while, trying to regain my composure and breathe so I didn’t pass out, I noticed that I saw something moving on the floor and it was my foot. I could barely see it.”
It was like seeing at night, he explained, adding that although his vision continued to improve, he is still legally blind. Even corrected, his vision is blurry at about 2040 if he concentrates or 2060, his eye is light sensitive and permanently dilated, he has no peripheral vision and he has blind spots in his field of vision. And he is still missing a lens.
The news that they were blind was, the men agreed, shocking and overwhelming, extremely difficult to accept. “I think everyone receives that sort of news differently,” Castro explained. “We go through these phases of depression, survivor’s guilt, anger, sadness. Some people may even experience suicidal thoughts. I was a man of faith and I kind of pushed them away, but I was really down. … Every night you go to bed praying that the next morning you’ll wake up and you can see. You wake up and you’re just looking around to see if you can see light. You strain so hard trying to see it. So just coming to terms that you’re not going to see it, it’s really hard.”
Phantom vision, formally known as Charles Bonnet Syndrome, made it worse. For example, his then-wife would walk in the room, and he would be convinced that he could actually see her: “I was like, ‘Baby, I can see you. You have those (capri) pants you like to wear. …’ You can really see and you get so happy, and for a minute, they think that also. But then they realize, ‘I’m not wearing my capri pants. I’m wearing jeans.’ Just imagine what it’s like for your family when you say, ‘Hey, I can see!’ And then all of a sudden, you realize it’s not true. It’s like someone just ripped your heart out of your chest.”
He managed to hide how depressed he was from everyone but his wife, but after about three weeks, she finally told him that he was fortunate compared to many of the other service members at the hospital. Castro thought about what she said and he thought about the two Soldiers who had died. His men were still in Iraq. “I came to realize that I’m still a man. I’m a father. I’m a husband. Bills still had to be paid. The grass was still growing in my yard. Life was going to go on and I still had guys deployed. I was still an officer. I was still a leader. I was still alive. And two guys died. I couldn’t quit.”
It was that image, the thought of the men he had left behind, that bothered Smiley as well. Only 25 when he was injured, he worried about what the rest of his life would be like, how he would work, how he would support his wife, but he was also concerned about his men. He wanted to go back. He had a responsibility to them. “I felt like if I could fully recover, I could deploy again and be with my men,” he admitted. “There was still a part of that denial that I just want(ed) to recover, get better, go to blind center and boom, maybe I could go back to Fort Lewis, Wash., and they’d deploy me again. So there was still a disconnect between reality of what had truly happened and what my life was going to be.”
While Bogart is extremely grateful he regained the amount of vision he did, and will never forget the first moment he saw his wife’s face again, calling it “fantastic,” his life is still different. Unfamiliar terrain is difficult for him to negotiate, although his dog and his cane help. He misses driving the most. “I had an awesome pickup truck before I deployed that first time. One of the worst days of my life was when I had to give it up. It feels like you’ve lost a huge part of your independence.”
That loss of independence grates on Castro and Smiley as well, just having to rely on someone else to get them to and from work. On the one hand, Castro said, he still has all of his limbs and he’s grateful for that. But on the other hand, if he had prosthetic legs, he could still drive. He could still see the restrooms he’s already standing next to when he has to use them. He could still see his son and his two-year-old daughter. Smiley also has three children who have been born since his injury. Not seeing their faces, the two men agreed, has been one of the most difficult parts of losing their sight.
Gale Watson, the national director for blind rehabilitation services for the Veterans Health Administration, said that for many people who are blinded, the hardest part “is not just the lost of vision, it’s the concomitant losses of other aspects of the person’s life. This person may be saying to himself or herself, ‘How can I be a parent if I’m blind? How can I get a job if I’m blind?” That’s where therapy comes in.
After Bogart, Castro and Smiley arrived at military hospitals and their immediate, acute needs were taken care of, occupational therapists came in to ensure they at least had a sense of mobility and independence in their rooms. For example, OTs will work with nurses and family members to ensure that a patient’s call bell and pain pump are always in the same location, said Meghan Crow, an outpatient occupational therapist in the Traumatic Brain Injury Center at Walter Reed National Military Medical Center in Bethesda, Md. They’ll remove any barriers in the room that a blind person could trip over or walk into, and will work on a clock system for meals. For example they’ll identify the location of utensils, cups and even food at 12:00, 1:00, 2:00, etc.
“I think for most of it, the set-up is key, learning to say, ‘OK. This is what soap feels like. This is what sponges feel like,’” she said, “then placing everything in the same location. And it’s repetition, repetition, repetition. … It’s learning a task and learning to do the basics all over again for the first time. … So from the very first instance when they are blinded, we work from very basic, primitive tasks, and then the VA will come in and work on use of developing technique, if it’s the use of a white cane for the mobility aspect.”
The VA sends blind rehabilitation specialists to Walter Reed to help service members with more advanced tasks, such as how to negotiate the halls of the hospital. That’s because the military stopped providing comprehensive, long-term blind rehabilitation services shortly after World War II, turning that responsibility over to the then-Veterans Administration. Today, the VA provides this care via outpatient specialists who visit military hospitals like Walter Reed, and at 13 inpatient and nine outpatient facilities, as well as 44 low-vision clinics.
Blind rehab has drastically changed over the past 60 to 70 years, Watson explained. After World War II, Korea and Vietnam, service members would spend about four months in an intense rehab program that focused on vocational skills. Now, she said, they’re more likely to go to inpatient programs for about two months, but return for more specific therapy as they look for jobs or go back to school. This is in part because today’s veterans are more likely to face multiple traumas and disabling conditions – Smiley, for example, had to strengthen and learn to reuse one of his hands after his brain injury and Castro has had multiple reconstructive surgeries on his nose – for which they still need acute care while in rehab. (Once his vision partially returned, Bogart was able to get around on his own enough that he never got around to checking into one of the inpatient VA programs. It’s still on his list, he said.)
Rehab starts with evaluation and counseling for both veterans and family members. That’s because it can be so devastating, and veterans may also need help for other conditions like depression and post-traumatic stress disorder, Watson said. People often “have a set of beliefs about blindness,” she added, “that you inhabit a world of darkness and you can never recover from this and it would be so depressing, so many things that you don’t believe you would be able to do again. … Multiple studies have indicated that people fear blindness more than any other disabling condition.
“I used to always say to my adult patients … ‘Look, there’s only two things that someone who’s blind can’t do yet, and that is drive a car or fly a plane. Everything else you can get back. You have to learn a different way to do it.’” Families also often need to know how to talk to their newly wounded service member, and have to be reminded not to do everything for him or her.
Blind therapy, she continued, encompasses everything from learning to read braille to using tricks like cans of food marked with rubber bands and measuring cups with raised lines to cook. After blinded service members and veterans can safely navigate the hospital, first by holding their hands in front of their faces and trailing them along a wall, and then by tapping a white cane, it’s time to learn how to read a map, how take a bus and navigate city sidewalks or country roads, lessons Smiley wishes he had paid closer attention to, although some tasks like left facing and right facing were already second nature to the West Point graduate. (He also wishes braille had been easier to learn. Instead, he found it almost incomprehensible, like learning another language.)
There are even special classes in hobbies and skills like woodworking and engine repair. In addition, the VA provides training in all of the new technology that helps blind people go about daily living, such as special computer and smart phone software that’s voice-activated and will read emails, documents and Web pages.
The technology isn’t perfect, Smiley and Castro caution. The software can’t differentiate between advertisements and the text of a website, and Castro still finds the touch screen of his smart phone difficult to use. In fact, he carries a second, push-button cell phone as well.
Overall, though, “It’s not hard,” said Smiley. “I was a fully capable person to begin with. … It’s basically you doing what you’re doing by just closing your eyes. It’s not hard. You’re just now focusing on memory. You’re focusing on other aspects of living life, just unsighted.”
(Check back tomorrow to learn how Smiley, Castro and Bogart were able to stay in the Army and either redeploy or conquer mountains and continents.)