The shadows have grown slightly longer on a hazy, warm, late afternoon. Summer is giving way on the grounds of the West Los Angeles Veterans Administration. On the north portion of the sprawling campus, a mature grove of elms provide a generous canopy of shade over the Veteran’s Garden intersected by enticing gravel paths and potted horticultural specimens. This serene spot - located only yards away from the traffic on Wilshire Boulevard and the 405 freeway – is a quiet refuge.

Right on time, a smiling Tatiana Reyes joins me at a group of shaded picnic tables. The tables are used on Thursdays for people to eat lunches, fruits and drinks purchased at the farmers market. Reyes arrives from her volunteer work with the Occupational Therapy Clinic at the VA, elsewhere on the campus, and we begin to talk. 
 
Reyes grew up in Southern California and graduated from Gardena High School. After graduating in 2003, she enrolled and began a course load at El Camino College. Immediately after high school graduation she also signed up to join the Army Reserve.

“I don’t really know exactly what made me decide to join the Army,” Reyes muses. “I guess I did it to get away from home.”

“Tati,” as she prefers to be called, served her basic training in Fort Jackson (South Carolina). Her advanced training in November of 2005 was at Fort Lee (Virginia). According to the plan, her primary MOS (Military Occupation Specialty) would be 92Alpha - Supply and Logistics. Following the completion of advanced training, she was assigned to the 693rd Quartermaster. However, in October of 2005, Reyes was informed that she would be shipped over to Iraq and that her MOS would be reclassified to “88Mike” (Truck Driver). So much for the plan.

She was sent to Fort Knox (Kentucky). At 4 foot 11 inches in height and a petite build, this new job seemed, at the very least, incongruous.  Was Reyes surprised by the job change?     

“Well, yes, I was surprised. I even asked my commander, am I going to be reclassified? He told me it was unlikely as they needed people with my primary MOS.   That made me mad, as driving a truck was not what I’d been trained to do.” 

Getting to the 250th  Transportation Company 
Before going to Iraq, Tati was sent to Fort Bliss (Texas) where she trained on driving both the M915a and the M800 series 5-ton trucks. She also went through additional truck driver training on the 18-wheelers at Camp McGregor, located near Fort Bliss.

“We practiced on the vehicles we were supposed to drive.  But when we arrived in Iraq, that all changed and I ended up being assigned and driving a Humvee Performer.”

For Tati to get to Iraq proved to be considerably more complex than simply booking a flight to the nearest military base. At stops along the way, soldiers with printed orders would join the initial contingent and the numbers of Iraq bound troops continued to grow.  Making new friends was a somewhat pleasant experience, as Reyes explains.

“From Fort Bliss (Texas), we went to Fort Knox (Kentucky) to await the main group of troops destined to go to Iraq. When all had arrived, a charter flight took us to Kuwait.

“From there we took a C-130 (The Army’s venerable military cargo plane) to Iraq. Along the way, it was easy to get acquainted.”

But when the group reached Iraq, they were split up and individuals were sent to different platoons…it was hard on Reyes to lose contact with those with whom she had found much in common.

“In fact,” Reyes says, “it sucked.” 

The newly arrived soldiers were offered very little in the way of hospitality or courtesy; no helping hands or smiles. Reyes expected this and explains that it was because she and the others coming in fresh were not a part of the original unit; they had not shared the same experience (combat exposure) the original people had in common.

“This was true throughout my entire time in Iraq. We were considered ‘outsiders.’”

Despite the cool reception in a very hot climate, Tati began to assume her vehicle maintenance and driving duties. The job included some very long hours.

 “It was tough. First we had to get our truck up and ready to go. We had to perform ‘Level-Ten’ (routine vehicle maintenance) and be sure the vehicle was prepared and  fueled for the mission the following day. We worked from lunch time (Noon) to get ready, then all the way through the night on our convoy until the next morning or until noon.”

The Night Riders
Reyes was stationed in Tallil, Iraq which was two-hours away from Kuwait. The mission was to convoy overnight (Hence the name of the unit) to Camp Anaconda and deliver food, water, fuel and replacement troops to approximately five military organizations along the route and then return. Other convoys had very frequent encounters with small arms fire and improvised explosive devices (IEDs) planted along the route.  Tati’s good fortune was holding.

“When I first began driving in the convoys, it was scary because I didn’t know what I was getting into. I kept hearing stories about other convoys that got hit nearly every time they went out. But we just did our runs every night and I sort of got used to it.”

While driving the convoy over and over without incident helped make Reyes and the others in her squad feel somewhat more at ease with a routine, it was none-the-less a physically uncomfortable experience. Everyone had to tolerate being cooped up in intense heat while wearing several layers of body armor. They would drive three-hours to a forward location to pick up the load and wait for nightfall.

“We weren’t in the ‘green zone’ but it was safe enough to drive during the day. That was where we would pick up our load and wait for our SP (time to depart).

“It was hot and the air conditioning in the vehicles usually wouldn’t work. To have an AC but not be able to use it made it worse. We also were required to keep our windows rolled up at all times which made it at least ten-degrees hotter inside the cab. We were required to wear a Kevlar PASGT Flak Jacket.  It was torture. I don’t think you ever get used to the heat in Iraq, you just drink a lot of water. We would come out and be drenched in sweat.”

Instant Hell
On March 9, 2007, Tati’s good fortune as a driver ran out. The vehicle she was driving was suddenly rocked by the intense explosive force of an IED. At first she was dazed and confused.

“I don’t remember much about it. I didn’t even see the flash. One moment I was driving and in seconds I was still behind the wheel, confused, wondering what had happened?

“My vision was weird. Everything seemed to be illuminated in a green light. I was about to turn to my TC (Co-driver and navigator) and ask him what happened. But, for some reason, I didn’t turn.  Instead I looked down and saw that my legs were on fire. I just looked. I didn’t realize, at first,  what was going on.  Then it hit me what had happened. I went into ‘panic mode’ for a couple of seconds and I started screaming that I was on fire. My first instinct was to get out.

“I vaguely remember opening the door and jumping out. I don’t think the vehicle was moving very fast. I must have rolled to the curb. The flames were gone and I felt no pain at that point.”

Her fellow soldiers were ignoring the imminent possibility of an enemy ambush so that they could move Tati – who was seriously injured and unable to walk - out of harm’s way.

“I recall people picking me up and then, oh my God, I did feel intense pain when they lifted me off the street. It was chaotic.”

Her vehicle had taken a direct hit, was still smoking and was no longer operable. Army Specialist Salas, ran over to assess her injuries. Reyes’ uniform was covered in fresh blood. Staunching the blood loss was of primary importance. Salas located the source of the profuse bleeding and fixed a tourniquet on her leg just above where most of the blood was flowing.

Distracted by the noise of the situation, Salas turned away for a moment and when he looked back, she had gone into shock. All color was draining from her face. He later confided, “I was scared that we would lose her right there.”

She was carried by her teammates to another Humvee in the halted convoy. Reyes used all her strength to pull herself into the Humvee. 

“I remember people looking in and asking me, ‘Are you OK?’ And I would answer them, ‘Yeah,’ I’d say, ‘I’m fine. But I feel like taking a nap.’”

Feeling sleepy was a sign of shock and those around her loudly implored, “Don’t fall asleep! Stay awake!”

“I was laying down in the middle of the Humvee and I looked up to see who the gunner was. It was Sergeant Pintu, the convoy commander. He looked down and gave me a smile to say everything would be alright.”

“The TC from my vehicle, who received shrapnel wounds to his legs and I were both ‘casevaced’ (Driving from the point of injury to the nearest military medical facility) to a TMC.”

From the TMC, Reyes was transported to a CASH unit in Baghdad. She was placed in an artificial coma and transferred to Landstuhl, Germany.  Her condition: Extremely critical.

Including a probable traumatic brain injury (TBI) Reyes sustained a splenectomy, cut sciatic nerve, transverse colon tear, torn kidneys, a collapsed lung, as well as 2nd and 3rd degree burns to her left flank and lower legs, and multiple infections. She was in very bad shape.

According to Stacey Curtis, M.S., CCC-SLP and Speech Pathologist at the West Los Angeles VA, “Most of our vets with TBI’s sustained in the current conflicts fall within the mild TBI range or what is also known as ’post concussive syndrome’ (PCS).  It is considered one of the “signature injuries” of this conflict and a ‘silent epidemic.’ TBI’s can be closed head injuries or penetrating injuries. The part that can be frustrating is that the term “mild” TBI is a bit of a misnomer because it does not mean that the effects a mild TBI have on one’s life are ‘mild.’”

“From my sciatic nerve injury, today I still have no movement or feeling in my left foot and ankle,” Reyes explains.

Once her condition was medically stable, she was transferred to Walter Reed Hospital in Washington, D.C. for three and a half months. Later, she would be transferred to the Palo Alto VA facility for another month to receive further rehabilitation of her injuries and an evaluation of a traumatic Brain Injury (TBI).

The medical teams that initially treated Reyes along the way, were pessimistic about her ultimate prognosis. They tried to prepare her family for a troubling time ahead. Even if she was to survive her injuries (which was very much in doubt during her hospital stay), it was likely that she would be facing many years of therapy. A large unknown was the extent of her TBI.   Reyes was on anti-pain medication which caused her to slip in and out of consciousness.

“When I would wake up, I had no idea where I was. Walter Reed Hospital was a pretty big surprise to me. This mental fog continued for about a month. My family arrived the same day I did and so they had to look at a stranger who didn’t even recognize them.”

Feeding tubes were inserted, then removed and then reinserted. The injuries, operations and drugs often conspired against each other. Her stomach was shutting down. Her normal weight of 110 lbs went down precipitously to 88 lbs.

“I was covered by all sorts of tubes, IVs and monitors. The surguries and medications affected my ability keep food down. As a result, I had lost a lot of weight and my hair fell out. I must have looked very strange to my family.”  

After a difficult three and a half months, Reyes had reached a turning point in her recovery. While she was not out of the woods medically speaking, there were signs of recovery and stability.  Her skin grafts (to cover the burned tissues on her legs) were taking and she was finally able to leave Walter Reed.  

However, before being discharged, she would be transferred to the VA hospital in Palo Alto (CA) to assess the severity of her brain injury. The Palo Alto VA assessment of TBI would take another month. It would, however, be the last stop before she would be allowed to come home.

Coming Home
“Being at home was the best feeling ever. I can’t describe it. I loved every moment with my family. Most important, I was finally able to keep food down,” Reyes explains.

After a month at home and home cooking, Reyes spirits were buoyed, she regained lost weight and her physical recovery continued. She had turned another important corner.

In July 2007, Reyes began her course of therapies at the West Los Angeles VA. Today, she continues therapies, under the aegis of Polytrauma (Please refer to Footnotes below) She continues to volunteer in the Occupational Therapy Clinic and commutes to the VA from home.

“I feel much better. My spirits are up…Being at home made such a drastic improvement. My walking has improved. I still have more surgeries scheduled for my burns. I continue to work on my TBI.”

In July 2008, Tatiana Reyes was awarded the Purple Heart for the injuries she sustained in combat operations in Iraq.

“I did not lose a limb and TBI is not a visible injury. Today I look OK and it is possible for me to hide my injuries. But I’m not about to live my life avoiding signs of what happened to me in Iraq. Sometimes, if choose to wear shorts, there will be some people who will notice my scars and ask, ‘What happened to you?’

“It is rude to ask and I resent that type of question because the people who ask it are not in touch with who I am or care about me as a person. They don’t deserve a straight answer from me.”    

“My family provides me with my most important base of support. They know first-hand what I have gone through and continue to be with me as I recover and take on new challenges.”

“In my recovery, I have learned to get past the fear of doing things. And while I have a disability, it is not the focal point of who I am. I have no limits and take pride in proving to myself that I can accomplish the goals I set out.”

Reyes is focusing on a return to school and earning an eventual degree in Recreational Therapy.

                                                                                   * * *

Footnotes

Definition of Polytrauma:
Current combat operations produce new patterns of multi-system injuries—blast injuries
• Two or more injuries to physical regions or organ systems
• One or more may be life threatening
• Result in physical, cognitive, psychological, or psychosocial impairments and functional disability

A Polytrauma veteran’s care and rehabilitation is overseen and managed by the Polytrauma Rehabilitation Team, which may include: physiatrists, physical therapy, occupational therapy, speech therapy, vocational rehabilitation services (Supported Employment is one example service within Vocational Rehab Services which can also include vocational assessment, vocational/career exploration, trade training, college and university training, on the job training as well as a number of other services.), neuropsychology, psychiatry, nursing, blind rehabilitation outpatient specialists (BROS), social work, recreational therapy and anaplastology/restorative therapy. 

The Polytrauma Rehabilitation and Education Program (PREP) at the West Los Angeles VA was developed by the Polytrauma Rehabilitation Team specifically for Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans who have been diagnosed with cognitive deficits due to brain injury and/or PTSD.  This program is designed to allow veterans to further their rehabilitation and independence in a group setting in addition to their individual therapies.
 
What is a Traumatic Brain Injury (TBI)?
Individuals with Disabilities Education Act (IDEA, 34 CFR 300.7) defines TBI as “an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child’s (person’s) educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition, language, perceptual, and motor abilities; psycho-social behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.”