Exit Wounds: A Survival Guide to Pain Management for Returning Veterans and Their Families

To Hell and Back: Derek's Story

American flags mean a lot to me. I fly one from my house in the small town of Waterford, California. On one wall of my home office are three glass-faced triangular frames, each holding a folded American flag used in the military funerals of my two grandfathers and a step-grandfather. On another wall of the office is a flag covered with handwritten notes from 19 of my fellow Marines. The American flag represents the values of freedom and service that I believe in, that I went to war for, and that I sacrificed for.

But three years ago, I was losing my battle with chronic pain. The scene I’m about to share testifies to the power of pain to grind down a human soul.

Picture this: It’s a chilly March evening in Bethesda, Maryland. I’m in a wheelchair, rolling myself along a path on the sprawling grounds of the National Naval Medical Center, where I was being treated for my injuries. It was dusk, and a Navy sailor was lowering the flag from a pole — a ceremony called “evening colors.” Ordinarily, like any service member, I would stop, face the flag, remain silent, and salute until the “carry on” signal was given. That was the tradition I learned and, until that evening, rigorously upheld. But at that point, I didn’t care. I was coming back from a meeting with my medical team — and nobody was listening to me. I was in such pain, and nothing they were doing was working. I was totally pissed off, muttering to myself, “Fuck it, fuck this place, I’m outta here.” I rolled right through “colors” and went inside. It was something I would never do normally, because you think of all those people who have gone before you, and how they fought for that flag. That’s what “colors” is all about, thinking about the people who have gone before you. That evening though, I was too consumed with my own battle to stop.

This chapter is the story of how chronic pain drove me to the point where I no longer cared about one of the most sacred things in my life. It’s also the story of how, with the help of dozens of professionals and the deep love of my wife and family, I finally beat the pain, rebuilt my life, and began helping others who are struggling with the same issues.

I grew up in Fremont, California, a suburb of Oakland on the eastern side of San Francisco Bay. As a kid I was athletic. I loved surfing, skimboarding, and skateboarding. In school I played defensive end and tight end on the football team, and defense on the soccer team. Track was my favorite sport, because it was individual — you’re competing with yourself, trying to beat yourself.

Whenever I got interested in something, I locked on to it and worked hard. I liked biology, for example, and got A’s. But, honestly, aside from sports, my friends, and my high school sweetheart, I didn’t focus on much in school. By my junior year, I was itchy. I didn’t know what I wanted to do with my life. I knew I wasn’t ready for college, but I wanted to leave the house, be independent, do my own thing.

With veterans on both sides of my family, I figured the military was a good bet. I wanted to be a Marine, but my mom, Barbara, was pushing hard for me to learn a skill that I could build on when I came out. I had always been interested in emergency medicine. Problem was, the Marines have never had their own medical corps, like the other branches of the military. As an advance attack force that had evolved out of the Navy, the Marines have historically relied on Navy Corpsmen who train and fight with them. (In the famous photograph of Marines raising the U.S. flag on Iwo Jima in World War II, one of the six men, John Bradley, was the Navy Corpsman assigned to that platoon.)

So I chose the Navy, because Corpsman training was more extensive than the training given to medics in other branches of the military. Also, there were the beaches. I mean, c’mon—I love the sea! I didn’t want to end up in the middle of nowhere a thousand miles from the ocean. All the Navy bases were on the water, on a beach somewhere, which was cool.

So I locked on to a career in the military. It was 1996, five years after Operation Desert Storm drove Saddam Hussein’s Iraqi troops out of Kuwait. Saddam had been defeated, but he was still in power. It was peacetime. The Twin Towers were still part of the New York City skyline.

In the early hours of July 2, 1996, it was still dark when a Navy recruiter picked me up at my home and drove me to the airport for the flight to boot camp. I already looked the partmy good friend Tim had shaved my head several days before. I flew to the Navy’s Recruit Training Command on the shore of Lake Michigan, about 30 miles north of Chicago, and began an eight-week transformation from civilian to sailor. As anyone who’s been through boot camp knows, first they break you down, take away your individuality. Then they bring you back up, as a team. The whole mental game is to get the team working together. Your culture changes, your vocabulary changes, everything changes. (To this day I say “hatch” for “door” and “head” for “bathroom.”)

I was okay with boot camp, but I quickly realized that not having a college degree was a major limitation. I was on the very bottom rung, looking up the ranks, at the officers, and thinking, “Man, all that guy did was go to school for four years and he gets to be an officer? I can do that.” I wanted to be the officer. I wanted to be in charge. But there I was scrubbing toilets.

So I locked on to a new goal: earning a college degree. But before I could start taking courses, I had to become a Corpsman. After boot camp, I flew to the Naval School of Health Science in San Diego to begin my training. It was tough. I wasn’t exactly the academic type in school, and suddenly I was taking classes in anatomy, physiology, and pharmacology. I had a lot of catching up to do. The pressure was on, too, because if you flunk three tests, you’re outta there, back into the fleet, a Seaman. I was really nervous.

Of course, it wasn’t all books and tests. When I wasn’t studying, I was on the beach with my buddies or enjoying liberty in San Diego and Tijuana, just over the border. I was back in California, with some close buddies from boot camp. And we did everything together — PT (physical training), chow, getting into trouble, getting out of trouble. Your buddies and your group become your family.

I pulled through with decent grades and graduated as a Navy Corpsman in January 1997. Then I moved on to Camp Pendleton, north of San Diego, for three months of additional training before joining the Marines as a Fleet Marine Force Corpsman.

Some guys didn’t want to go with the Marines, but I was good to go — locked on. It was awesome training. I was doing major PT, humping 12-mile patrols with gear, doing weapons training, field emergency care, land navigation, night ops — everything I needed to give me the stamina, mentality, and knowledge to support the Marines. If you’re not up to that peak level, you could fail the mission.

After my training with the Marines, and for the next four years, “mission” for me was really just code for “personal goal.” I plugged away toward my bachelor’s degree, taking courses whenever and wherever, I could. I worked in military medical clinics in California, Guam, Spain, and Hawaii. When my five years of service were up, I reenlisted for another five.

Then, in early 2001, I fell in love with a pretty Navy servicewoman named Andrea O’Malley. She knew the military and, at that point, was more decorated for service than I was. We received orders to deploy to a Navy base in Spain. We had a terrific time exploring Spain and southern France on our time off—it was an adventurous setting for our courtship! I finally popped the question on a beach in Hawaii where we were both stationed. We got married in a luau ceremony on my favorite surfing beach in the spring of 2004. Two months later, Andrea was pregnant. We found out it was a boy, and we named him Sean Patrick.

Then the word “mission” got very real, very fast. It was late summer, 2004. Operation Iraqi Freedom had stalled. A year after “shock and awe” and the toppling of Saddam’s statue in Baghdad, Iraqi insurgents had reorganized and begun a series of deadly attacks using improvised explosive devices (IEDs) — bombs strapped to a body or a car and detonated to inflict maximum carnage.

The 1st Marine Division was in Iraq, and they needed corpsmen. On our base, word went out: corpsmen could volunteer for a seven-month deployment or they could wait to be ordered to deploy. I sat down with Andrea and we talked. We knew I’d have to go at some point because the Marines were hurting for corpsmen. I figured that if I volunteered, I could be home for Sean’s birth. It was a hard call. I wanted to be there for Andrea, of course — being pregnant is no picnic, after all. But I also wanted to do my job, do my duty, get the job done, and get home. And I wanted to be with the Marines, on the offensive. I felt it was my time to do what I’d been trained to do.

Andrea, who had already served a stint in Iraq and Kuwait, coordinating purchasing and logistics, was equally torn. She knew what it meant to serve, and she understood my desire to help out. But she was dealing with bouts of morning sickness, and afraid of what I might face in Iraq.

She also had a horrible feeling about my deployment from day one. She knew I’d be with a grunt unit on the front lines. In the end, though, she agreed that I should go sooner rather than later.

My folks were worried, too. When they learned that I would need a month of combat-readiness training at the 29 Palms Marine base in the southern California desert, they decided to fly down to see me before I shipped out to Iraq. On the visit, I showed them the 14,500-pound light armored vehicles (LAVs) that were the mainstay of the Marines 3rd Light Armored Reconnaissance Battalion (3rd LAR), in which I would be embedded. I also showed them my gear and the Kevlar body armor that would protect my chest, abdomen, and groin.

My mom put on my helmet and the flak jacket. I remember her joking that there was no protection for the arms and legs. She said she wanted the knight suit — you know, a full suit of armor.

In early September, I climbed on a bus before sunrise to begin the trip to Iraq. Everybody was in full battle gear, ready to go. Most of the guys had just said goodbye to their wives or girlfriends, and children. We all carried weapons — a 9-millimeter pistol for me. It was dark outside, and dead-silent, everybody just riding with their thoughts.

After a series of flights to Kuwait, a bus convoy into Iraq, a flight on a C130 cargo jet, and finally a helicopter flight, I landed in a tiny village in the desolate Anbar Province, hundreds of miles west of Baghdad. The Marines had established a forward operating base just outside of town. The base was little more than a handful of huts and improvised shelters surrounded by high dirt berms and guarded by short watch towers.

For the next several months I worked in the battalion aid station (BAS) where wounded Marines were brought directly from the field. Marines with minor wounds would be patched up and sent back. Those with serious injuries would be stabilized, if possible, and air-lifted to the nearest military hospital. If they needed more advanced medical attention, they would be flown to Landstuhl Regional Medical Center in Germany, the largest military hospital outside of the continental United States.

When I arrived, the BAS was quiet. There were no battles going on. The Marines stationed there were mostly engaged in “hearts and minds” missions — helping rebuild infrastructure, provide security, and restore trust levels with local Iraqis.

Within the base, I was relatively safe. The danger lay beyond the berms whenever I went with the Marines on supply runs or patrols — which was often. This was at the time when the insurgents were starting to ramp up their use of IEDs. On patrols we’d vary how fast we drove to make it harder for them to time when to trigger a bomb. Everyone was constantly scanning for the trigger man.

I went along on many small-scale missions to clear specific buildings of suspected insurgents, but it wasn’t until I made a supply run to a sister BAS that I encountered real casualties. I saw some Marines standing around three pairs of boots, each with an M-16 and a helmet. I knew they’d lost three buddies, but I was thinking, “That’s not gonna happen to me; I’m not gonna get hurt.” You start thinking about other things — training, talking to your buddies and telling stories, and you try to forget about it right away. You don’t want to dwell on that stuff. You focus. You’re good to go.

The next few weeks were a blur of patrols, tending to minor injuries from accidents around the base, and building bonds with the Marines under my care. I also took time to talk and sing into a portable tape recorder, sending messages to Andrea and Sean. Back in Hawaii, Andrea would listen to them and then put the speaker of the tape player on her belly, so that Sean could hear the sound of my voice.

Then rumors of a new mission began to circulate. Fallujah was heating up again. After being secured by U.S. forces and turned over to the new Iraqi army, Fallujah had disintegrated into chaos. It was now ground zero for insurgent activity. Rumor was that the United States would attack it again — soon. That would mean urban warfare, house-to-house, close-quarters fighting against an enemy impossible to distinguish from ordinary Iraqi civilians. U.S. airpower and advanced technology would help in a battle like this, but in the end the job would fall to individual Marines picking their way through a dense warren of buildings. It was the most deadly kind of warfare a Marine — or Corpsman — could face.

In the first week of November, our unit joined the most massive deployment of U.S. forces since the war had begun. Four Marine regiments and two Army regiments prepared to attack Fallujah from the north. My unit, the 3rd LAR, would attack early, from the west, both to distract the insurgents and to secure a key position: a hospital and three nearby bridges spanning the Euphrates. As I moved from western Anbar to a position just outside of Fallujah, I learned that my specific mission would be to support the Marines attempting to seize the hospital. During the fight, I would drive an unarmored ambulance — basically, a Humvee rigged with four stretchers in the back — into a live battle to pick up wounded Marines, stabilize them, and bring them back to a forward aid station. It would be dangerous as hell, but that’s what corpsmen do. It was what I wanted to do.

On the night of November 7th, I was at the station, waiting. It was nearly pitch-black because we had cut electricity to Fallujah. Suddenly, the sky blazed as the initial air bombardment of the city began. By the light of the rocket fire and explosions I could see that Fallujah was getting hammered.

In the predawn of November 9th, the invasion of Fallujah began in earnest with all regiments attacking from north and west. At around 10:00 A.M. the radio in the aid station crackled with an urgent request for a Corpsman and ambulance. Near the hospital several Marines from 3rd LAR had been hit with shrapnel from an exploding 82mm mortar round. This was it.

“Okay, let’s go guys; we got casualties,” I said.

I grabbed an M16 and hopped into the passenger seat of the Humvee ambulance across from the driver. As we roared down the road, I had my M16 in my right hand, sticking out the window, and the radio in my left hand. A new order came through the static: an LAV had been hit with an IED, injuring several more Marines. We were driving north, toward the Euphrates, and a line of Iraqi civilian cars had pulled to the side of the road to let us pass. Concentrating on the radio, I had no time to wonder whether the civilians were innocents or insurgents. I could see activity up ahead, and my ear was pressed against the radio. I had just turned to tell the driver to speed up when — BOOM! — we got blown up.