Tending to Bodies Near the Breaking Point

One recent morning, 13 soldiers came to visit her in the small wooden medical hut of a 100-man camp near the village of Rahman Khel, cradled by the snow-tipped mountains of Paktia Province near the Pakistani border. One after another, the soldiers told her of their twisted knees, back pains or shoulder strains — the increasingly familiar-sounding toll of a long war.

After multiple deployments in Iraq and Afghanistan, some of these soldiers’ bodies are nearing the breaking point. It is up to Captain Odom, 28, from Moselle, Miss. — the only physical therapist attached to the 3,500 men and women of the Fourth Brigade Combat Team of the 25th Infantry Division — to keep them together.

“These bodies get a beating,” she said as she spent the next 12 hours stretching out legs, lifting arms or standing on a box to lean over and pummel pulled back muscles, accompanied by sighs, groans, thanks and the occasional curse.

“They walk up and down mountains carrying a lot of gear, just a lot of weight, and that can result in daily aches and pains, and also injuries,” she said. “I am keeping them doing their job, living their lives with as little pain as possible.”

These soldiers are likely to be some of the last Americans to serve in Afghanistan, and as troops are beginning to withdraw ahead of the 2014 deadline, the war here can take on an end-of-the-race feel at times: the finish line is distant but finally in sight, and Captain Odom is working just to keep her charges running till they can reach it.

The action these days is rarely about face-to-face combat. Instead, it is an effort to keep up with an elusive enemy that slips from the looming mountains this time of year and moves invisibly from village to village through the woods and fields, heading west for the fighting season.

For the Army company based at this outpost, among the 19 on Captain Odom’s rounds, it involves long, bone-rattling journeys in armored vehicles protected against roadside bombs or suicide attacks. Or it is a five-hour slog encased in ever more elaborate body armor — designed to protect against a distant sniper shot or rocket. But it can add at least 35 pounds to a soldier’s load, even without his helmet, pistol, ammunition, water, medical kit and rifle.

“When you carry all this stuff and then go climb one of those mountains, it definitely takes a toll on your body,” said Sgt. James Daoust, a company medic.

Today’s protection is the I.O.T.V., or improvised outer tactical vest, a bulky affair that involves heavy ceramic block plates, side plates, deltoid protectors and groin guards. Some soldiers even have Kevlar underwear. (At higher altitudes, soldiers are allowed to wear a slimmed down I.O.T.V., called a platecarrier, but it is still heavy.) Around the bases in this region, sweating soldiers in shorts and sneakers run laps around the outer perimeter wearing the vests just to get used to them.

Captain Odom, who has broad rosy cheeks and a practical, considerate manner, represents a new kind of emphasis in the military on getting to these kind of injuries quickly, even mundane ones like twisted ankles or tweaked backs, before repeated strain can force soldiers out of the war altogether.

She was encouraged to go into the military by her uncle, a retired colonel, after she graduated from the University of Southern Mississippi. Now, she is five months from the end of her first tour of duty. She seems comfortable sprinting from a standing start in the darkness to board a waiting Black Hawk, or flying over the Afghan mountains in the moonlight, bound for yet another camp in her 19,000-square-mile territory, carrying her medical bag and an M4 carbine.

Among her patients this day, one said he felt as if the pain was crushing his back, which had hurt since Iraq. Another, First Lt. Jeffrey Russell, from Copperas Cove, Tex., said that when he jumped loaded with gear from the wall of an abandoned house during a patrol, his knee buckled.

“I don’t like being the platoon leader and having to sit back in the truck,” Lieutenant Russell said, “so I have come for a professional opinion.”

Captain Odom says Army Ranger units were the first to include physical therapists, rather than have them stay back at the hospital or in separate medical units. But now with their success, therapists have spread into mainstream combat units; Captain Odom is the first her brigade has had. “They are becoming more common,” she said.

One of the biggest challenges for the therapists is dealing with an injury that has become all too common in a war defined by the Taliban’s roadside bombs: blast concussions. Back at Captain Odom’s brigade base, Forward Operating Base Salerno, over the mountains amid the sweet-smelling eucalyptus trees of Khost Province, there is a special center to treat them.

The center is run by one of Captain Odom’s friends and colleagues, Capt. Jamie Bell, 32, from Lancaster, Calif., and has been open only for the past couple of years.

“A lot of the soldiers here have been deployed three, four, five times, so they are already coming with some PTSD, and then they get concussion,” said Captain Bell, referring to post-traumatic stress disorder. “They might get blown up three or four times in a month, and that’s when you might have a high risk of permanent damage. But if they have proper treatment and rest, they can be returned to duty without long-term effects.”

Inside the small concussion center, she gives soldiers who have been caught in blasts computer tests and games like Lego, Scrabble and Blokus to improve their memory, visual perception and sequencing skills. Three recovering soldiers were sitting on a black sofa and chair, silently watching “The Big Bang Theory” on television and looking tired and worse for wear.

One of them, Sgt. Junior Daniel, a tousle-haired 24-year-old from Mims, Fla., was on his third deployment. Two weeks earlier, while he was running from his armored truck toward a building occupied by insurgents in Gardez, his group came under gun and rocket fire. He said something “blew up close to my head.” He lost his hearing for a while, and still looked groggy.

One of the men with him in Gardez, Staff Sgt. Joseph Marcinko, 29, from Ohio, was also at the concussion center, with black bags under his eyes. He had stayed behind in the armored truck, but a rocket hit the door and knocked him unconscious for 10 seconds, he said.

The third soldier, Specialist Edward Herrera, 22, from Miami, on his first deployment, was a gunner in a truck when a truck in front was hit by a roadside bomb.

“I hit the turret with my head,” he said. “The driver slammed his brakes, and I hit my head on the turret again, and then I was being shaken awake.”

Sergeants Marcinko and Daniel insisted that they would be returning to work soon, and they did: about seven hours later, they were at the camp airport with rifles and packs, looking only a little more awake, trying to catch a night flight back to Gardez.