This started out as letters home to my friends and family while I was at Hurricane Katrina, and continued through my deployment to Afghanistan. I have recently added my friend Clara Hart as a contributor. Now it very roughly chronicles life as a civilian, and citizen of the USA. If you need some assistance with Workplace Safety Programs, please let me know, I am happy to help.
Friday, December 25, 2009
Merry Christmas!
Clara
P.S. My last two stories have been posted on Doonesbury's The Sandbox as I have been too lazy to put them up here! ;-) Merry Christmas!!
Saturday, November 21, 2009
The Gretchen Mitchell Band truly makes it a pleasure to live in Portland.
Let me say that if you live in Portland, and you like live music, you should make sure and catch the Gretchen Mitchell Band... They are fantastic! Gretchen Mitchell is the primary singer for the group, and Haley Horsfall backs her up on vocals and percussion. I have to say they both have voices that are truly a joy to listen to, and when they bring their group of musicians with them, it is some of the best entertainment you will find in the city. Tonight was something special, her new and first CD was presented for the first time at Jimmy Mak’s it is called “Love For Real” and it is a treat.
The group that opened at Jimmy Mak’s was Carib a trio put together by Mike Horsfall, who pays the piano and vibraphone, Mike is a very talented musician who has a gift for putting together groups of people who play their instruments very well. I also think that Mike is truly blessed being able to play with his very talented daughter as well as with the GMB.
Of course the people in the audience who got to enjoy a moment in time that will never be completely replicated were also blessed with a fantastic evening, in great company, by some of Portland’s greatly talented people.
Tuesday, October 27, 2009
From 9/11 forward to today
Since that time, I have been on some form of Active Duty for almost 5 of the 8 years. I am not a full time National Guard soldier, or "AGR" but I have been on orders to prepare units for deployments, deployed to Afghanistan, and been on orders in support of deployed units. When I returned from Afghanistan I started my own business, with the assistance of my pre deployment employer, because while I was gone, my position was filled in part, and in part was eliminated as a risk management solution. I can’t blame them at all, because really, who can expect a civilian company to keep a job open for you when you really can't commit to being their at least 11 months out of each year?
I was running my own consulting business when our lovely economy tanked, which coincided with another deployment for the Oregon Guard, so I have been on Active Duty again since January 2009. I have a great situation, in that I am working in the State back filling positions for soldiers who are now in Iraq. When they get home, I am off of orders again.
The down side of course is that while trying to serve two masters, I serve neither of them very well. I am not progressing in my chosen professional field, although I am making enough to justify continuing along.
It has been a very uncertain group of years, and I am much more thoughtful and distrustful of relying on anyone other than myself as a result. Now I am almost 45, I have raised my two kids through OIF and OEF, and OIF is winding down. Funding for the National Guard is becoming much tighter, and with no pending deployments, the National Guard effect on my life and pocket book may well drop down to pre 9/11 levels. It is the natural course of events, and isn’t a bad thing at all from a global point of view, however, I find myself again looking at my income producing activities as a civilian, realizing that the economy is still trashed, and that I have got to figure out what I will do going forward. Right now that means doing a little of everything I have done, and venturing into some new ventures as well.
Wish me luck.
Sunday, October 11, 2009
Friday, October 02, 2009
Gretchen Mitchell Band
Cheers.. hope you enjoy.
http://www.gretchenmitchellmusic.com/
Sunday, September 20, 2009
Ponderings
After 3 weeks of no word from s.o. the anxiety level was slowly creeping up into slow panic level. Deployed to OEF for the next 9 months it's been a struggle. IM and webcams help a great deal and the 2 hours we talked flew by, I'm sure we would have spoken longer had it not been for the insurgents that started to mortar his FOB. Talk about a rude awakening and a sad reminder I care too much for someone in a war zone. He still hasn't recieved the package I sent back in August so I'm thinking the next one I send will have his Thanksgiving and Christmas cards in it.
I got an email from a RN friend also deployed to OEF. She's been there since February and is badly burnt out. She writes of being tired and alone. Of missing her family and her children. She tells me she's sad all the time and doesn't want to go to work.
To that I can relate. I have been in that place, where the wounded continue to arrive and you do the same thing over and over. The same thing being trying your damnest to save a young life. Some days it works, some days it doesn't.
My problem these days is I have too many friends deployed. Too many people I care about in a very dangerous place, a place where the CIC will not send the help they so badly need.
Thursday, September 10, 2009
Eight Years Later by Clara Hart
The day dawned bright and beautiful; sunny, cloudless blue sky, temperatures in the 80s. A day a lot like Sept 11th, 2001, and there was an eerie sense of calm as I stepped out of my car and took it all in. Sucking in deep breaths I reached back for the flowers I had brought and straightening with them in my shaking hands I gazed at the memorial. It was the first time I had seen it except in a picture or architectural plans.
As my friends walked by my side, my steps slowed with trepidation the closer we got to the entrance. Two black granite walls were inscribed with “Pentagon Memorial” and words which reduced me to tears.
The first wall said, “We claim this ground in remembrance of the events of September 11th, 2001. To honor the 184 people whose lives were lost, their families and all who sacrifice that we may live in freedom. We will never forget”.
The second wall bore these words: “On September 11th, 2001 acts of terrorism took the lives of thousands at the World Trade Center in New York City, in a grassy field in Shanksville, Pennsylvania and here at the Pentagon. We will forever remember our loved ones, friends and colleagues.”
As my vision began to blur I scanned the names for one in particular. Unable to find it I clutched the flowers to my chest and began to cry in earnest. I remembered hearing the words “We can’t find him” that day and in the days that followed. I smelled the jet fuel and saw the flames and black clouds of smoke rising from the destroyed building. I heard the “evacuate” orders and in my mind I watched people running. Pain blindsided me and sobs buried deep within clawed their way out. I wanted to fall to my knees, wrap my arms around my body and scream with the absolute agony of the hurt inside me. The sorrow overflowed and I was helpless. My friends, on either side of me, wrapped their arms around me and protected me from the onlookers witnessing this very private hell.
Slowly I was able to regain control and move forward into the memorial. As I walked the perimeter I looked at the years on the markers. The memorial is set up from youngest to oldest, each name engraved on the open end of a bench, with the bench opening to the Pentagon if the person was on the plane or opening away from the Pentagon if the person was in the building.
Reaching the correct year I began to walk amongst the granite and silver benches; once again unable to find that particular name I began to feel panic whelm up inside me. My friend called my name and as I turned around he pointed and said, “It’s here”. Making my way over I sat and laid my flowers in the water flowing below. Thoughts and images raced around in my head, silent screams once again threatening to become audible. How is it possible after almost eight years it can still hurt this badly?
Later I faced my friend and looked at him and said, “You often tell me I am passionate about my work, protective as hell of my wounded and their families." I waved my hand in the direction of the other benches and the Pentagon. “This is why." With tears streaming down my face and in a voice choked with emotion I spoke of that day and I told him things I have never shared with anyone. I talked about the very basic fact that, to me, every single one of the men and women I care for is helping to prevent another September 11th.
When I finished speaking he walked over to me and wrapped his arms around me, my sobs again taking over as we stood there. A combat veteran and a nurse, both with memories too painful to put into words but sharing the common ground, the agony, that such images and experiences bring.
Needing to be alone I wandered off, and when I was ready I circled back around to meet my friends. As they approached I saw another woman accompanying them. As we drew even she gazed at me and said, “I’m sorry to intrude, but I felt led to come over and tell you how sorry I am for your loss." Her face filled with sadness. She said she was from Texas, and I recognized her as the woman who had arrived at the same time we did, and had witnessed my collapse. Embarrassed, I wanted to move on, but she opened her arms and said, “I’m so sorry for your pain. Please, I’d like to give you a hug if I may.” In that moment the kindness and empathy of strangers was shown to me. She understood, even eight years later. I briefly hugged her, thanked her for her words and had to move on, afraid if I stayed any longer the pain would resurface and I would once again be reduced to wrenching sobs.
Friday, September 04, 2009
It Kills Our Warriors Too
Thursday, August 20, 2009
Thoughts
Before I began my shift today I sat in my car in the parking lot and prayed. I asked for strength and compassion because, believe me, when I'm tired and sad, compassion is hard to find. I asked the Lord in some way to encourage me in my day. An hour later my boss handed me a card. It was from the wife of a former patient, he had been transferred to a facility closer to their home and I had said my goodbyes many weeks ago. This card made me cry. His wife had taken time to write a beautiful letter, telling me how much my care of both her husband and her meant. She told me I was one of the family's favorites. I placed that card near my computer terminal so every time I charted I could see it and be reminded why I do what I do. It was affirmation when I needed it most that I do make a difference.
Saturday, August 08, 2009
We Cried
Today we took him to the OR, he wanted to be an organ donor. The family was there in the OR with him when he took his last breath, they held his hands and cupped his face. Amongst all the medical professionals and transplant coordinators there was not a dry eye in that room.
My friend and fellow nurse was his primary caregiver, I was there to help her. We talked today about the patient we had exactly a year ago, same situation, different patient.
I cried on the phone to a friend tonight. He let me ramble and sob and when I slowed, he tried to divert my attention by changing the subject. I wasn't ready, I signed off the telephone by simply saying "I think I need to go cry some more."
And cry I did. Deep wracking sobs that had the puppy curled up at my side. I cried for the family and the friends, his buddies still deployed who's emails were full of encouragement to get better. I cried for the friend who tried so hard to come and see him but distance and finances prohibited him from being at the bedside. I cried for the patient, a young man I only knew through photos.
I cried for my nurse coworker and I cried for myself. For tomorrow aerovacs arrive bringing more gravely wounded.
MS - May you have been carried by the Angels to God's welcoming and loving arms. You will be missed, of this I am positive.
Monday, August 03, 2009
Dread
We've dealt with death and comatose patients for the past 3 weeks. I've held wives and mothers in my arms while they've cried. I've touched the shoulders of fathers, brothers and commanding officers who stared with tear filled eyes at my patients.
Landstuhl has been holding patients. There was an outbreak of the swine flu in Germany so they put the aeorvacs on hold. Only the most gravely injured have reached us these past 2 weeks. Friday we only received two and they arrived late into the night, long after I had gone. Sunday I have no idea how many came in and I am clueless about those that will arrive tomorrow. Three times a week they come and I dread what I will find when I get there.
Thursday, July 30, 2009
Worth Your Time
http://www.libnot.com/2009/07/20/ssgt-john-c-beale-killed-in-action-a-beautiful-tribute-to-a-fine-american/
Thursday, July 16, 2009
Careful What You Pray For
Like the title says careful what you pray for. Our young patient did die, I prayed he would, he needed to, so badly decimated was his body. However even knowing it's the best thing and praying it would happen do not make it any less sad. It was agonizing on the family and damn painful for those of us staff who took part in his last days. Now in the same room he occupied lies another war wounded. Shot in the head by a sniper his brain is destroyed. Destroyed beyond repair. The family is unwilling to accept it and so as before we wait. We partake in the death watch. We wait and watch for the day when the family begins to grieve a loss that started in war ravaged countries.
More are coming. The medevacs bring them in now three times a week. It's becoming routine and it sucks.
Monday, July 06, 2009
I put a post up on the Sandbox, sorry I was not inclined to write anything over the 4th of July. There was simply too much emotion associated with the holiday weekend. Today when I arrived at work I was dismayed to see our severely wounded young man still with us. I watched his parents stand by his bedside and grieve. The pain and fear were only too evident on their faces. Oh, it was so incredibly sad. The patient himself lies in a drug induced slumber. On a regular basis we decrease the meds to wake him, once awake enough he looks around and begins to cry. Every single time we do this he awakens and cries. How much pain does one endure?
I talk with one of the trauma surgeons and we both agree we do good work. We can put the physical body back together but the psychological? For this patient? I already feel we failed him. We willed him to live when he was already dead. We used all our skills and great technology to bring him back to life. We put his remaining body back together but at what cost?
I try so hard not to judge. It is not for me to say who lives and who dies. I only know it hurts and I struggle with that knowledge.
Monday, June 29, 2009
Worse Than I Thought
Saturday, June 27, 2009
Another Month Gone By
As I read through the reports of tomorrow's incoming one WIA in particular caught my eye. He's so badly injured it's easier to say what's RIGHT with him than what is wrong. Those are the ones that wound my heart, so grievously broken it would be better if he simply slipped away. However it is not for me to judge, but instead to mend what I can. To nurture and encourage and to hold a hand.
Saturday, May 23, 2009
Awful Denial
No one survives that kind of wound. Perhaps the biggest tragedy is his brainstem is still fully intact. The tiny part of the brain high up on the neck that controls the body's most primitive functions, breathing and heart beat, were not damaged and so he lives. He lives in a coma, never to wake up, limbs slowly contracting and posturing. His family won't let him go.
No matter how many times the physicians, social workers and nursing staff talk with them they hold on. Each time I speak with them my words become a little more brutal in what I say, "you do understand he had his brains in pieces coming out of his head? His brain is no longer whole, it is in shreds?" and each time they assure me the do understand.
Lat week before I left the hospital for a week's vacation I tried one more time hoping something I say may click and they will understand nothing can be done. It did not, they are too firmly entrenched in denial.
Me, on the other hand, am wrecked. I find the Soldiers and Marines we've withdrawn care on and according to their wishes allowed to die now plague my sleep. I wake up heart pounding after conversations in my dreams with ones who never talked. I've cared for these patients and their families to the best of my ability only now my slumbering mind tells me a different story.
It's Memorial Day Weekend and I don't want to remember.
Tuesday, May 12, 2009
Tweet to Remind
Dear Friends,
We all have people in our lives we consider heroes.
All of us at the Bob Woodruff Foundation would appreciate your support and participation helping raise $1.65M for our heroes returning home from Iraq and Afghanistan by participating in our TweettoRemind campaign. Through the power of the social web, Tweet to Remind campaign aims to raise $1.65 million by Memorial Day, May 25, 2009 to ensure our service members get the help they need as they integrate back into society.
This is a call to action, requesting you write a short blog post or tweet telling us who your hero is on Tuesday, May 12.
After I was severely injured while reporting on location in Iraq, my family and I realized we had a unique opportunity to reach out and help many of our nation's injured heroes. In January 2008, my wife Lee and I started ReMIND.org, an organization dedicated to raising money and awareness for service members injured in Iraq and Afghanistan as well as their families. Our current project is the TweetToRemind campaign, which asks individuals and corporations to donate $5.25 or more in an effort to raise $1.65 million by the end of the Memorial Day weekend.
I have so many heroes in my life who have affected me in so many ways. But after what my family and I went through more than three years ago, my greatest heroes are the doctors, nurses, medics, soldiers, pilots and others who risk their lives on a daily basis to save injured soldiers and bring them back to their communities. They did it for me, and my family and I can never thank them enough.
This is what I ask of you: on Tuesday, May 12 post a simple blog or tweet answering, "Who is your hero?" and asking them to do the same. Please link to your blog post from your Twitter account, a link back to www.tweettoremind.org, and the ChipIn widget which you can copy onto your blog.
I hope you find it in your heart to support this effort on May 12 and throughout the campaign which ends on Memorial Day, May 25th.
Thank you in advance for your support.
Sincerely,
Bob Woodruff
"SUPPORT OUR TROOPS" IS NO LONGER A SLOGAN. IT'S AN ACTION.
info@tweettoremind.org
www.tweettoremind.org
www.remind.org
www.twitter.com/Remind_Org
www.twitter.com/BobWoodruff
www.twitter.com/LeeMWoodruff
Friday, May 08, 2009
Nurses Week
This is Nurses Week and two families have given us cards thanking us for what we do. It's so nice to be remembered!
One of the families belonged to a patient who arrived little over a week ago. This was someone so critically wounded he went directly to the OR within an hour of his arrival to us. He was so gravely injured I doubted, even with surgery, that he would survive. I was certain I would return to work the following day to find him brain dead. That we would simply wait until his family arrived, tell them the grim story, let them say their good byes and begin "end of life" care.
Instead, much to my huge surprise this soldier, while still critically injured was able to follow commands appropriately. In the week that has followed I've seen him improve tremendously. He still has a long way to go but watching him get better has sure been an awesome way to celebrate Nurses Week!
Monday, April 27, 2009
Kudos Dr Carskaddan
Dr Carskaddan does this on his days off, volunteering his time and skills. He flies under the radar never asking for anything and only speaks of this heartening mission when specifically asked. He is a man who knows the therapeutic benefits that only an animal can bring and he is trying, one dog at a time, to make a difference in the lives of our troops.
If you'd like to help him or simply wish him well in his efforts please go to their website at www.clocktowervets.com
Bravo Zulu Dr Carskaddan! Keep up the awesome work!
Clara
Wednesday, April 15, 2009
Death
Such was the case yesterday, my patient from Sunday died, a personable woman who was only in her 40's. Although I wasn't her nurse, her husband wouldn't allow it, I was able to visit her in room after he left. I held her hand, brushed her hair back from her face and wished her well in her new life with God.
Goodbyes said I headed down the hallway and passed one of my doc buddies who stopped me. As a remaining tear rolled down my cheek he asked what was wrong. Upon hearing my explanation he looked at me and with a sad smile stated "what we do is hard". Yes, my dear doc friend, it is.
Sunday, April 12, 2009
Idiots Are Everywhere
Four hours later she looked even worse, the numbers on the heart monitor slid downhill, her heartbeat erratic and I began to pester the docs even more than I already had. I demanded orders for this med or that treatment, I dragged the airway cart over and then the crash cart closer still. I hoped by simply having the carts nearby and at the ready I could ward off evil spirits. Again and again I bugged doctors, "what's the plan?" I asked. Finally, in frustration and fear for the patient I simply told them what they needed to do. In then end, she did crash and they listened.
We were able to stabilize her and make her more comfortable, her vital signs and appearance improved and we settled back into a routine. Until the husband showed up, that is. He took one look at me and told the doc he didn't want me taking care of his wife, wanted another nurse to take my place in her care. When questioned as to why he simply said "I don't like her". When the nurse in charge told him she did not have the staffing to accommodate his request and attempted to explain all I had done to help his wife he walked away from her mid sentence. He then threatened to call the hospital administrator, his senator and then his governor if I was not removed as his wife's nurse. He even went so far as to demand they send me to another unit.
With my coworkers, the charge nurse and the nursing supervisor all supporting me and voicing their displeasure I turned over my patient's care to another nurse. It simply was not worth the hassle to me. My nurse buddies were pissed, they kept asking if I was ok and to be honest, I think they were more upset and angry about the whole situation than I was. I really don't have much feeling other than disappointment. Disappointment in that my patient was no longer able to receive the care I could give her.
Friday, April 10, 2009
And So It Begins
I look into their faces and am filled with sorrow but I will hold their hands, wipe their tears and hug battered misshapen bodies. It was only a matter of time, I know this. And so another influx of wounded warriors begins.
Please pray and let me draw on your strength as I will need every bit to make it through.
Sunday, March 29, 2009
Unlike Clara
Wednesday, March 18, 2009
A Mixed Bag
Second: I really really wish that the so called forth estate would actually do critical reporting, rather than regurgitate more idiotic, inflammatory rhetoric disguised as information.
Senator Chuck Grassley from Iowa has been in the Senate since 1980, and he wants people to commit suicide. Think about that for a second. He has been around since before this mess even got started. He was a relatively senior guy when our SEC truly got in bed with corporations and did nothing. During his oversight the fecal matter hit the oscillating blades, during his oversight Martha Stewart was thrown in jail for a $50,000 stock sale. He has the nerve to suggest suicide for people rather than actually calmly lay out the facts of the situation. Maybe it shouldn't have happened that AIG delivered bonuses. However, I bet they knew before they did it, that it would result in negative press, and I bet they care. So maybe it needed to be done. There are pretty good arguments for that case.
I am embarrassed for his constituents. I am disappointed in our fourth estate, and actually I think Jon Stewart may have said it best in his discussion with Jim Cramer. Please, Please do your flipping job.
Tuesday, March 17, 2009
A New Post
I have many new experiences to write about. Several posts are floating around in my head, clamoring to be written, however, once again life calls and I find myself challenged to find time to put them into words. Some time soon I will have a new story up, but for the meantime, I simply wanted to say "hello" and let you know I was thinking of you!
Clara
Wednesday, February 18, 2009
WOW, Okay Portland, Listen Up At Arrivederci's
Let me say that Mike Horsfall, Tasha Miller and Dennis Caiazza delivered the WOW for those of us lucky enough to be in attendance at Arrivederci Wine Bar in Milwaukie tonight. This is a place where you can sit away from the band or right up next to them, and tonight I did both.
When the music is clear and pure you can almost see it or feel it move through you and listening and watching as the music is being played is just awesome.
Tasha Miller sings in a way that makes you wish you could listen forever, The three of them delivered fantastic songs, there were 5 that took over the room, one that Dennis Caiazza sang, and sang very well, and the other four sang by the Tasha Miller, they were The Beatle's Imagine, Cindy Lauper's, True Colors, and My Funny Valentine by Frank Sinatra, and Memories by Barbara Streisand. Now I am sure that the glass of wine, the room full of friendly people and just how intensely into the music these three people get makes a difference, unfortunately you just can't capture it on a CD, but that will be a memory that I will enjoy for a long long time.
If you find yourself some where that any of these three are playing, get yourself a cup or glass of your favorite beverage, and sit back and enjoy the moment.
If you don't know where to find them, start in Milwaukie and ask Katie or Steve or Derek, I am sure they will know when they will be back in the restaurant.
Cheers to you all.
Appreciate what you have, because life is uncertain, and it is short.
Keith
Tuesday, February 17, 2009
One Sad Comment
Does that comment hit you in the gut the same way it did me?
Tuesday, February 10, 2009
No Name
Up until this evening this work week hadn't been too bad. This evening I learned a young soldier I cared for last week, flown in from Afghanistan, has cancer. The bad kind, not that all cancer isn't bad but this one is exceptionally bad, it's liver cancer, which is almost always fatal. He's 19 years old.
Monday, February 02, 2009
New National Holiday
This has given rise to a new holiday that I believe anyone in America who has taken the path of financial irresponsibility will appreciate. I think it should be called National I Am Not Responsible For Past Transgressions Day, It is long I know, but it is descriptive, and besides I am open to another name if someone has a better one.
The key to this is that after you run up your credit cards bills on pizza, bowling, movies, cars parts and hotel bills, you can then call someone up who out of the goodness of their hearts will help you pay only half of the honest debt you incurred. It is like a get out of jail free card, except you don't get the cool cartoons.
Tuesday, January 20, 2009
Inaugural Oaths and Military Oaths
I am an officer in the United States Army National Guard, and one of the things that I have always found to resonate with people from different countries is our methodical, predictable, and most importantly peaceful transition of power every four years in our country. This allows people to hold our leadership accountable for their actions, to reward those leaders who best represent our ideals with votes, and those votes determine who the new leader will be.
People in the military take the following oath, notice it has no bearing on the party of the President, but it supports his oath directly.Officer Oath: I, ___., do solemnly swear (or affirm) that I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely, without any mental reservation or purpose of evasion; and that I will well and faithfully discharge the duties of the office on which I am about to enter. So help me God.Most of my family voted for President Obama, Just FYI to the news media, I appreciate the historic perspective that goes along with electing a black man to the office of president. I will point out that every single voter who voted for either candidate was an American Citizen.
When I look to my left or right in a formation or on a mission in a HMMWV, I do not see a German American, or a Hispanic American, or an African or Irish American. I see an American who will save my ass if I get in trouble, regardless of what part of our nation he was born in.
Along with it being time to embrace our new President, I believe it is also time to embrace each other as Americans, and please hold the prefixes.
V/R
Keith
Sunday, January 18, 2009
Under Siege
Security, we're used to it here in the Nation's Capital. Make sure you have nothing other than your wallet and your winter woolies and get ready to stand in line. And wait. Photo ID is a must have, don't leave home without it. Metal detectors, magnetic wands, military and law enforcement by the thousands. Yep, we've seen it here. This is, after all, life in DC post September 11th.
Road closures, uh huh, used to that too. Phantom traffic jams that occur for no reason are a daily event. However the road closures expected over these next few days are exceptional. I'll be heading in to work on Tuesday 4 hours early just to make sure I get there.
Although to be honest, making it into work is the least of my anxieties. Once I do arrive at work I will wait with my coworkers. As we go about taking care of our patients we will be waiting and watching and praying for a quiet, calm day. On a this unprecedented day few will recognize or understand what those of us in law enforcement and health care know. There is a monster lurking in our country. A monster that seeks to destroy us for no other reason other than we were born in the United States of America.
I spoke with my family on the very real possibility "an event" could occur. I set in place the communication plan I would use if something were to happen. I didn't incite fear or attempt to be melodramatic. I'm simply realistic in this post September 11th world. Realistic in a way only one who has cared for terrorism victims and war wounded can be.