The Lucky Ones

By NANCY GIBBS

You have to stand a ways back, but from a certain angle these look like the lucky ones. In any other war, they would be dead, having bled to death on the battlefield or died in a hospital from wounds so grievous that their armor could not protect them and the doctors could not save them. In World War II, 1 in 3 wounded soldiers died; in Vietnam, 1 in 4. In the Iraq war, the rate is 1 in 8. As of last week, just over 1,500 U.S. military personnel had died in Iraq and 11,285 had been wounded. The Pentagon does not keep counts of dead or wounded Iraqis. Human-rights groups and academics have tried to estimate the number of Iraqi deaths, speculating it could range from 15,000 to 100,000. No one has even tried to guess the number of Iraqis who have been wounded.

It is so much easier, of course, to call the U.S. wounded unlucky, the double and triple amputees maimed in a war that has not always gone as planned. If Kevlar and ceramic plates are the great lifesavers of modern warfare along with quick-clotting powders and ultrasound units that fit in backpacks, how many more lives and limbs might have been saved if the humvees that were meant for transport in noncombat zones had been equipped with the armor necessary for a guerrilla war that has no front lines, no safe havens?

Many of these men and women owe their lives to the Critical Care Air Transport Teams (CCATs), the flying intensive-care units that treat the troops as they are lifted by helicopter within minutes from the kill zone to the combat hospital. From there they are flown 6 1/2 hours to the military's Landstuhl Regional Medical Center in Germany, which has evolved from a small backwater military hospital into a top-line trauma center.

Every war mutilates in its own way, leaves its distinctive marks. In this war, unlike battles past, only 16% of injuries were caused by gunshots, according to a study; 69% were from explosions--the roadside booby traps, the car bombs, the rocket-propelled grenades. The vast majority of injuries are to arms and legs left vulnerable even as body armor is protecting vital organs. The amputation rate of 6% of wounded soldiers is twice that of earlier wars. But in addition, doctors are seeing new injuries, some of them inconspicuous compared with the shredded flesh of bombing victims. Traumatic brain injury occurs when the shock from an explosion damages neurological fibers. Soldiers may survive a blast with scarcely a cut, only to find over time that they suffer coordination and memory loss, dizziness, insomnia. Some have to learn to walk again--or to recognize their wives and children.

From Landstuhl the next stop is often Walter Reed Army Medical Center outside Washington or Brooke Army Medical Center in San Antonio, Texas, which was originally set up to handle the military's worst burn cases but is now taking the overflow amputees from Walter Reed. TIME correspondents Amanda Bower and Cathy Booth Thomas and photographer James Nachtwey spent time with the doctors and patients who together are writing the next chapter of their lives--and of combat medicine.

We name and honor the dead, but the wounded return home more quietly, privately. They are beginning to walk and wheel among us, visible reminders of the cost of war and the courage it takes to fight it. More than half of those injured cannot return to duty. Yet there are also soldiers so committed to their comrades and their calling that they have petitioned to go back to Iraq the moment they learn how to work a new hand, a new leg. And many who say, even knowing what they have to lose, that they would sign on to the fight if they had it to do all over again. --With reporting by Douglas Waller/Washington and Vivienne Walt/Landstuhl

With reporting by Douglas Waller/Washington, Vivienne Walt/Landstuhl