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thedrifter
11-04-07, 06:25 AM
Scripps Encinitas partners with Camp Pendleton to help treat Marines with brain injuries

By: ADAM KAYE - Staff Writer

ENCINITAS -- Capt. Waylon White can conjure up a very clear picture of himself leading battalions, briefing Congress and performing other duties of top-level Marines.

But he can't remember what he ate for breakfast.

A 33-year-old resident of Temecula, White suffered a traumatic brain injury on May 3, 2006, when his unit was attacked in Ramadi, Iraq.

Today, after months of recovery from burn and shrapnel wounds, White's silent injury has sent him to Scripps Memorial Hospital Encinitas.

At the hospital's rehabilitation center, White and other Marines are rebuilding the bomb-blasted paths of their memory.

Sometimes, therapy brings them to the beach, parks, and maybe a resort.

In boxing therapy, the Marines don't strike each other but they must remember combinations of hooks and jabs. Grappling awakens their spatial awareness, challenges their memory and provides good exercise.

As the battle-hardened patients acquire tools to compensate for their condition, for White, one of them came from the electronics store.

"I bought a $2,000 navigation system to put in my 4Runner because I can't remember how to get to my damn house," he said.

Body and mind
Scripps Encinitas launched its brain-injury program 20 years ago, when White was a boy on a cotton farm in Louisiana.

Today, military physicians send Marines to Scripps for outpatient treatment three to five days a week for periods ranging from two to four months.

The nonprofit Scripps Health chain treats troops and their families by contract with the military's insurance system.

Camp Pendleton has sent Marines with brain injuries to Scripps Encinitas for nearly two years in a relationship both of convenience -- the base is 15 miles from the hospital -- and need.

Better body armor, evacuation techniques and care in the field mean more troops are surviving physical injuries, but are left with jostled, damaged brains.

"The number was more than the military's care infrastructure could handle," said Dr. Michael Lobatz, chief of staff and medical director of the rehabilitation center at Scripps Encinitas and medical director of the brain injury program. "Because of our proximity and experience, we're happy to provide that care. We're a community hospital. We think it's sort of a sacred duty to do so."

He noted that the brain injury program at Scripps Encinitas is the only one in San Diego, Riverside and Imperial counties that is certified by the Commission on Accreditation of Rehabilitation Facilities, an independent, nonprofit accreditor of human service providers.

"It's a great partnership," Lobatz said of the hospital's relationship with Camp Pendleton. "We're here as long as they need us."

Many Marines from Camp Pendleton come from the base's Wounded Warriors' Center. White drives to the hospital from Temecula.

Although 80 percent of the Marines who complete the program return to their units, Lobatz said, White said he worries that the brain injury he suffered when a truck barreled into his camp and exploded could force him to retire.

His splitting headaches, memory loss and trouble concentrating could place other Marines in danger, he said.

"My scary thought is, I'm a senior captain, fixing to be a junior major in the Marine Corps," White said. "If it was just me putting my life on the line, that'd be one thing, but I don't want to put others in harm's way."

Deadly fireworks
White confronted danger head-on in May of 2006 when enemy forces attacked his camp with small arms, mortar shells, rocket-propelled grenades and other explosives.

At that point, White had completed one, five-year commitment with the Marine Corps, which included a seven-month deployment to Iraq. In Louisiana, however, White couldn't quit thinking about the war. He re-enlisted as an artillery officer in January 2006.

After four months of training, White was assigned to a "transition team" of four Americans, who would train Iraqi forces based in Ramadi.

He had been in Iraq for about a month and with his unit for 10 days when at 2 p.m. -- a time of day when most Iraqis rest -- the enemy attacked.

Gunfire riddled White's encampment. Then a dump truck crashed through a Humvee that served as a makeshift gate.

The truck exploded and the blast destroyed a nearby building and killed an Army sergeant.

White had hunkered down behind a concrete barrier, where blast waves reached him and blew out his ears, causing both of them to bleed.

Then a mortar round landed near White and 10 gallons of fuel. Its blast hurled White through the air, engulfed in a ball of fire.

He thought he was dead. Realizing he wasn't, he grabbed hold of his best friend, Capt. Brian S. Letendre, and dragged him to safety. But White's efforts came too late. Letendre died in White's arms.

White's recovery took him to American bases in Iraq and Germany and then, for two months, to the burn unit at Brooke Army Medical Center in Texas. He received cosmetic surgeries and doctors told him they were struck by how well he had healed.

But not entirely.

In August of 2006, about four months after the raid, he was assigned to limited duty as an assistant operations officer for the 11th Marine Regiment based at Camp Pendleton.

Easy wasn't easy
That meant desk work and processing operations orders, which state who does and who doesn't deploy, he said.

White soon realized the simplest of tasks seemed taxing.

"My short-term memory -- someone would tell me something and I just couldn't remember," White said. "Before, I could multitask and do four projects at once."

He compensated by taking copious notes and keeping a detailed, color-coded calendar. He took assignments home and worked after midnight to complete them.

When a migraine would kick in -- he was getting up to four of them a week -- he would tell his commanding officer he had to leave to get a haircut.

For six months, the unmarried White hid his memory and concentration problems from his commanders.

Despite his brain injury, White himself became a commanding officer in December 2006 and assumed responsibility for 280 troops assigned to the 2nd Battalion, 11th Marines.

That job was easier, he said, because he had a staff to support him.

But the headaches persisted, decisions took 10 times longer to make than they should have, and White struggled with the reality that 280 Marines depended upon him for their safety.

At last, White consulted his battalion's medical officer, who ordered him to complete a battery of neuro-psychological testing.

"The doctor didn't believe the results, that I was so bad," White said. "That's how I ended up here. Five months later, I'm at Scripps."

'They look perfectly normal'
One look at White shows no evidence of injury. He carries no body fat on his lean frame.

During boxing therapy, his footsteps are deft and fists are quick. His precision haircut and confident eye contact seem to embody the spit-and-polish image of the United States Marine Corps.

"The problem is they look perfectly normal," Lobatz said. "They're healthy young men. They can converse, but ask them to assemble or disassemble an M-16, or to do two things at once, and they can't do more than one thing at a time."

"On a superficial level, you have people looking OK, but when you scratch the surface, there's a depth of problems," he said.

In treating brain injuries, one problem physicians face is that two of their most powerful diagnostic tools, the CT scan and the MRI machines, show normal readings when a patient has suffered mild to modest brain injury.

Bomb blasts are the most common cause of such injuries.

An improvised-explosive device can blow a 10-foot crater in the ground and issue 600 mph blast waves. The waves compress and expand all air cavities in the body. Lungs, guts, ears and sinuses all can explode, Lobatz said, and a helmet won't prevent brain injury.

The brain is a gelatinous organ that is bathed and floats in spinal fluid. With a brain injury, the finest, microscopic connections between brain cells get disrupted.

Lobatz likened the end result to a mis-routed telephone call.

"If I were making a call from here to my office in Encinitas, instead of going direct, it will get routed to New York, and by the time the information gets there, it may no longer be valid," he said.

Working together
An injured brain might also fail to tell the heart to speed up during exercise. During a workout, the blood pressure soars and so does the headache.

"We're training the heart and brain to work together again," said Jessica Martinez, lead therapist of the brain injury program.

That kind of training happens in the hospital, on outings to the grocery store and to other locations, some of them exotic.

Some field trips take the Marines and their healers to Torrey Pines State Reserve, where the troops must hike a steep hill wearing heavy backpacks.

Tennis practice brings the Marines to Four Seasons Resort Aviara in Carlsbad, a glitzy hotel where a tennis professional for years has donated his time to work with patients from the Scripps rehab center.

Closer to the hospital, the Marines hike to Swami's Beach for workouts on the sand, where therapists integrate cerebral drills. Marines must stop to take their pulse rate, and Martinez said that for some them, the act of counting their pulses for 15 seconds, multiplying that number by four -- then remembering it -- can be difficult.

"It can take weeks," she said of mastering the seemingly simple steps.

In more than nine of 10 cases, Marines with brain injuries also suffer post-traumatic stress disorder and its symptoms: nightmares, insomnia, lack of attention and an irascible temper, she said.

"All of these patients are recommended for psychological support, and they get it on base, but they forget their appointments," Martinez said.

That's why the brain injury program focuses on what Martinez calls "functional" activities, such as following schedules, making appointments and bringing gym clothes and shoes on exercise days.

Social workers aid in the readjustment and visit the Marines' homes and workplaces, where meetings with supervisors determine whether a patient is fit to return to work.

That's the goal of every Marine in the program, Martinez said.

"These guys are motivated," she said. "It's a huge loss for them, that they're not in their unit."

A long way from Iraq
During a recent round of exercise at Swami's, therapist Rebecca Askew ordered the Marines to form a circle.

Each Marine took a turn leading an exercise, and in true Marine fashion, the men counted each push-up out loud.

"I can't hear you!" one of them barked.

A young Marine named Tony couldn't resist the chance to crack wise. When his turn came to lead an exercise, he crossed his arms and stared at the ocean.

"Let's do wave-watchers!" he said.

The session ended with Marines and their trainers hiking through downtown Encinitas to return to the hospital.

Sweaty and sandy, clad in khaki, hair buzzed and towels around their necks, the Marines marched quietly past storefronts and through sidewalks filled with busy breakfast tables.

They climbed a hill by City Hall and marched past bungalows that command a sweeping ocean view.

It's a long way from Iraq, but one Marine said that's where he wanted to be.

"I'd go like this, right now, but I know with my injuries, I'd be putting a lot of other Marines at risk," he said.

White said he feels the same way.

That's why he's committed to completing therapy in the brain injury program, even when it hurts his head. Waves of concentration seemed to radiate from White as he performed what's called a "divided attention task."

Therapist Kristina Contreras placed a grid on the table, and on the squares she set items such as scissors, a matchbox, a paintbrush and a toy car. She then removed the items and ordered White to place them back on the squares where they belonged. He was mostly successful.

In another drill, Contreras gave White a deck of playing cards and told him to place red cards down and black cards up in separate stacks, as quickly as possible. Then Contreras changed the drill: black down and red up, she said.

White paused, briefly, then regained momentum as the deck in his hand grew thinner.

"I don't make mistakes," he said. "I will sacrifice speed for accuracy."

Contact staff writer Adam Kaye at (760) 901-4074 or akaye@nctimes.com.

Ellie