Those like Bartlett who survive suffer severe, multiple wounds that together are beyond the scope of ordinary medicine.
To meet the avalanche of IED survivors, the Department of Veterans Affairs has expanded a small "polytrauma" program originally designed for car wreck victims into a national network of four major polytrauma hospitals and 21 regional centers that specialize in the challenges of the grievously wounded
In one typical case, described by Dr. Shane McNamee, medical director at the Richmond, Va., polytrauma center, a soldier arrived having barely survived an IED attack.
The blast had torn off both legs, severely injured one arm and shattered his pelvis into 60 or 80 fragments.
He had bled so badly his blood had been replaced five times. His possible brain damage due to lack of oxygen and a spinal cord injury had destroyed his lower-limb muscular control, meaning he could not wear prosthetics.
He was severely disoriented, often waking up screaming. His wounds had become infected.
He was 22 years old.
"One of the most gruesome things I've seen in medicine," McNamee said in an interview. "How do you fix a guy like that?"
It takes a large staff and intensive care. For 12 inpatient cases, McNamee directs a staff of 36 nurses, three physicians, three mental health specialists, a psychologist, four physical and occupational therapists, pain management experts, a dietitian, a wound specialist and others - some 60 people in all.
Treatment is specialized, and innovative. When the patient's wife gave birth, they moved mother and baby into his room.
After two years he was moved home, attended by full-time caregivers and therapists. He can dress himself and feed himself. His family declined to be interviewed.
"But it's not good, just getting around at home, getting a pat on the back," said Dr. David Cifu, chief of physical medicine and rehabilitation service at the Richmond polytrauma center. "America just isn't set up to get handicapped people back to work."
Even for veterans without visible wounds, the searing experience of combat, the constant threat of IEDs and the often jarring return to "normal" life produce readjustment problems that often can be solved with family support and what some mental health experts refer to as "beer-sex-sleep-pizza" therapy.
IED blast survivors have a wider range of mental health challenges. Most, like Bartlett, suffer from post-traumatic stress disorder.
