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Intrepid Center Provides New Level of Warfighter Care

By Donna Miles
American Forces Press Service

BETHESDA, Md., Dec. 17, 2010 – When it officially opened its doors in June, the National Intrepid Center of Excellence at the National Naval Medical Center here set out to provide a new level of care for warfighters suffering traumatic brain injuries and psychological disorders.

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Marine Corps Sgt. Tim Brooks chats with Dr. James Kelly, right, director of the National Intrepid Center of Excellence, and Dr. Thomas J. DeGraba, the center’s deputy director, about the comprehensive, holistic treatment that’s preparing him to return to his unit. Brooks suffered a traumatic brain injury after being exposed to a rocket attack and three improvised-explosive-device attacks in Iraq. DOD photo by Donna Miles

(Click photo for screen-resolution image);high-resolution image available.

Six months later, as it continues to build staff to reach full operational capability, the center is making a difference in the lives of servicemembers struggling to deal with the unseen, signature wounds of war with hopes they can continue their military service.

“Our vision is to be an instrument of hope, healing, discovery and learning,” said Navy Capt. Thomas Beeman, a reservist recalled to active duty to lend his civilian health care administration expertise to help stand up the facility. “We are living out that vision and trying to meet those needs.”

The $65 million center, a gift from the Intrepid Fallen Heroes Fund, features the most advanced equipment and facilities available to diagnose and treat TBI and other psychological disorders. Among its offerings is $10 million in imaging equipment that enables health care providers and researchers the rare ability to see inside the brain to formulate diagnoses and treatment plans.

State-of-the-art medicine is just one aspect of the center’s holistic, multidisciplinary approach to treating TBI, post-traumatic stress, depression, anxiety and other combat-related psychological stressors.

“We try to take care of the spiritual, the physical and the emotional, psychological health of the people we serve,” said Beeman, the center’s deputy commander. “Our mission is to return as many warriors back to active duty as possible, or at least to get them in the right place and at the right spot so they can enjoy healthy and holistic lives.”

A playground just behind the facility hints at the center’s family-centered focus, which Dr. James Kelly, a neurologist serving as the center’s director, called critical to patients’ long-term recovery.

“This isn’t just for individual servicemembers in uniform. It’s for their whole family,” he said. “That’s been the concept of operations from the very beginning.”

The new, 72,000-square-foot center is one of six created under the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. Located on the grounds of the National Naval Medical Center, and directly across the street from the National Institutes of Health, it provides unprecedented opportunity for collaboration and information-sharing. That supports all of the center’s missions: not just providing clinical care to servicemembers and their families, but also expanding the body of research about TBI and psychological disorders and sharing it with the broader medical community.

“This is not just one place that a handful of people come through and get excellent care,” Kelly said. “This is actually an opportunity for all of us to learn together and to learn from one another and to share that information nationwide. … So everybody will benefit.”

Marine Corps Sgt. Tim Brooks, assigned to the Chemical and Biological Incident Response Force at Indianhead, Md., was among the first servicemembers to receive treatment at the new facility. Serving in Iraq from September 2004 to May 2006 with just a seven-month break between deployments, Brooks experienced what he refers to as four “incidents” –- a rocket attack and three improvised-explosive-device attacks.

During his third deployment in Iraq, in 2007, Brooks started noticing signs that something wasn’t right. Pounding headaches wouldn’t go away. His short-term memory had slipped. Sometimes he simply would forget where he’d put a pen. But during other, more troubling times, he’d forget where he was.

“I thought it was stress,” Brooks said. He tried to hide his problems from his fellow Marines, and sometimes even from himself. His family noticed changes and pressed him to get help, he said, but he worried about the impact on his Marine Corps career –- or on his civilian job prospects if the Marine Corps discharged him.

Brooks finally relented and consulted a psychologist and psychiatrist and started getting treatment for mild TBI, post-traumatic stress and depression.

But his care took a major step forward with the opening of the National Intrepid Center of Excellence, he said. No longer did he have to wait for months for an appointment for an MRI and travel to Andrews Air Force Base, Md., to get it. “Here, they give you an MRI in the morning, and you have the results in the afternoon,” he said. “They work hard to get answers here, and explain to you what they’re doing, and why.”

Brooks developed a comfort level with the staff that enabled him to open up and discuss his issues and problems. He talked about his dissolving marriage and his new role as a single father to a 19-month-old son. Now, Brooks remains attached to his unit and looks forward to the opportunity to pass lessons learned during three combat deployments to younger Marines.

Leaving the Corps was never in his plans –- TBI or no TBI, he said. “There’s a lot of tradition and the brotherhood of the Marine Corps,” he said. “You just don’t see that in the civilian world.”

Like Brooks, Air Force Maj. Nathan Green tried to deny the changes after a rocket attack just outside the U.S. Embassy in Baghdad in April 2008. It was exactly two weeks before his tour in Iraq was to be over, and he had gone to the embassy post office to mail some personal items home. Just as he was leaving the building, the incoming fire threw him to the ground, unconscious.

Green quickly regained consciousness, not knowing what had happened. He wiggled his fingers and toes and, thinking everything was fine, walked away in a daze. He later realized that both of his ears were bleeding, a condition that would require four surgeries over the next year.

What Green didn’t initially realize, but that his comrades at the embassy’s personal security coordination cell did, was that his speech was slurred and his responses had slowed. “My unit said I was out of it,” he said.

“That was the hardest thing for me to come to grips with: all the impacts this had on me. I was in denial for about a year and simply couldn’t accept myself,” he said. “I tried everything to compensate for it.”

He spent 12 hours doing a project that normally would have taken four. It exhausted him and wreaked havoc with his home life. “You feel you are drowning,” he said.

Green was the third patient to be admitted to the National Intrepid Center of Excellence, earning him the nickname, “003.”

Unlike previous hospitals where he’d received treatment for his mild TBI, the center provided a comprehensive program. No longer did he have to bounce among different doctors in different facilities, “all starting from square one every time I’d see them” and treating just one aspect of his condition but not the others, he said.

“The biggest improvement at this facility is the integration,” he said. “Here, you walk in the door and they review your case. They identify what tests you need and do them, and the doctors all talk with each other about the test results. This is a huge change. I feel like they are real advocates for me.”

Green has seen slight improvement since coming under the center’s care, but still suffers from moderate vertigo. He’s hopeful his condition will continue to improve, but said he’s come to the difficult decision not to return to the Air Force.

“I knew that I was never going to be able to meet the standards, and I just wasn’t going to let myself off the hook,” he said. “Knowing I couldn’t be the leader I need to be wasn’t fair to me and wasn’t fair to my troops.”

While coming to terms with his decision, Green said, he’s thankful for the new lease on life he’s received through the National Intrepid Center of Excellence.

“It’s shown me that there is hope out there and allowed me to accept who I am and move on,” he said. “This is not the end. For me, this is a new beginning.”


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Click photo for screen-resolution imageAir Force Maj. Nathan Green said the comprehensive patient approach used at the National Intrepid Center of Excellence at the National Naval Medical Center in Bethesda, Md., has been a huge benefit in treating the traumatic brain injury he suffered during a rocket attack in Baghdad. DOD photo by Donna Miles  
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