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In The Irritable Heart Jeff Wheelwright profiles five ailing veterans, unraveling the health mystery through their intimate and fascinating case histories. He describes the veterans' experiences, beginning with their deployment to the Gulf and tracking them through their return, their mysterious suffering, and their struggles to find the reasons for their illnesses.
Drawing on his experiences as a reporter in the Gulf in 1991, he reviews the toxic substances in the environment, such as oil smoke and nerve gas, that many believe to be the cause of the conditions. Wheelwright demonstrates why such scenarios are unlikely. Rather, he shows that the gulf war illnesses belong in the company of chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity -- symptom complexes that are increasing in America and evading a biomedical explanation. Although these contemporary illnesses are unrelated to war, Wheelwright points out that the gulf war ills have their own precedents in military history as far back as a Civil War malady known as "irritable heart."
Doubters have dismissed the veterans' conditions as a psychological fabrication -- "It's all in their heads." Wheelwright maintains that gulf war syndrome is a real illness, involving both the body and the mind.
It consists of physical symptoms greatly magnified and aggravated by psychological distress. But because modern medicine deals with the body and mind separately, the health investigation of the veterans' illnesses was bound to fail, leading to a bitter political polarization over the cause. Wheelwright puts us in the thick of the controversy -- one that both obscured the medical inquiry and slighted the suffering of the veterans.
The only way to understand these elusive sicknesses is to consider the mind and body as one suffering system. With profound insight, The Irritable Heart takes the subject of chronic illness far beyond the medical aftermath of a desert war.
The centerpiece of the complex is a six-story hospital. Built in the 1970s, it replaced a seismically shaky structure known as Wadsworth Hospital, which had been erected in the twenties on the site of an old soldiers' home, which in turn had been established for disabled veterans of the Civil War. Thus a thread of pain connected John Cabrillo, the disabled veteran occupying room 4011, to men whose lives were ruptured more than a century before.
John was sent to Wadsworth-still its informal name-from a VA facility in a southwestern state. If you telephoned his home hospital and were put on hold, a recorded voice would come on and announce: "If you are one of those veterans who either served us well during the Persian Gulf War, or who claims exposure to Agent Orange or atomic radiation, did you know that a free, comprehensive medical exam is available to you?" John had responded to the offer and to everything it implied. He was a victim of environmental history. He came to Los Angeles to pursue both a diagnosis and a disability pension for an illness he blamed on toxic exposures during the 1991 Persian Gulf War.
John's disability cut more ways than he knew. When the first Wadsworth was founded, in 1888, medical care and pensions for veterans of the Civil War absorbed nearly 20 percent of the federal budget. The editor of the Nation wrote that "the ex-Union soldier is coming to stand inthe public mind for a helpless and greedy sort of person, who says he is not able to support himself, and whines that other people ought to do it for him."
Among the amputees, morphine addicts, and war-torn "insane" were pensioners who had been weakened by "irritable heart."
Veterans with this diagnosis had a rapid pulse and complained of palpitations, shortness of breath, chest pains upon exertion, fatigue, headache, dizziness, and disturbed sleep. First seen during the combat period and often leading to medical discharge, irritable heart was a vague sort of disease, even by the standards of the time. The structure of the heart did not appear to have anything wrong, nor was disease evident in other parts of the patient's body. To military doctors, irritable heart was a mysterious condition of diversely physical origin, since diarrhea, fever, or a hard march could bring it on. The same debilitating symptoms, the same melange of causes, and the same mystery accrued to "gulf war syndrome" in the 1990s.
Wadsworth was a medical backwater until after World War II. Then, thanks to an infusion of newly wounded patients and the money to take care of them, the hospital was able to attract high-caliber staff. UCLA Medical School, founded in 1947, placed some of its faculty at Wadsworth. Conversely, the VA had some of its physicians appointed to the medical school. It was a good quid pro quo. The stature of the university boosted the status of the agency in medical circles, and in return UCLA got stipends for its doctors, laboratory space, and patients.
There was a third party to the arrangement, rather a silent partner, the Atomic Energy Commission. As the postwar guardian of U.S. nuclear materials, the AEC urgently needed to understand the biological effects of ionizing radiation. Starting in the late forties, the agency extended a series of research contracts to the medical school, some of which were channeled through the Veterans Administration. The AEC provided radioisotopes, the newborn elements of the atomic age, for experimental use, and select VA hospitals, including Wadsworth, provided the medical subjects.
The picture looks ominous, I know. The history to which John subscribed begins here. Abuses in the government's human radiation experiments were revealed years later; most of the problems centered on the failure to obtain the subjects' consent. In several instances radioactive substances were injected into unknowing patients just to see how their bodies would respond.
Upon review by a presidential panel, the VA escaped censure, as did the procedures performed at Wadsworth Hospital. The doctors used the radioisotopes as tracers-that is, testing their potential to illuminate and diagnose disease-and as therapeutic agents for otherwise untreatable conditions. Indeed what is known today as nuclear medicine began with the VA research. John, evaluated in 1997, had a PET scan of his brain, a test derived from the early tracers. He didn't mind the PET scan, but he did protest that other tests amounted to experiments upon him.
The VA solicited publicity in the late forties for its magical radioisotopes. Kept under wraps was the need for biomedical information about nuclear radiation in case of veterans' disability claims. With atomic testing under way and atomic warfare a possibility in the future, the agency wished to be prepared for the special illnesses that might result and the compensation that might be due. In the 1950s the military deliberately placed troops near detonations in Nevada, testing its men while it tested the bombs. As the "atomic veterans" got older, some contracted cancer. Eventually the government offered them compensation, acting on the assumption that exposures to radiation had harmed their health. There is some scientific basis for this assumption, for a few more leukemias have occurred among the atomic veterans than would be expected in men of their age.
The Agent Orange episode was similar. Soldiers were exposed to a chemical herbicide during the Vietnam War. Many years passed before the government awarded compensation for diseases and deformities occurring among the veterans and their offspring. Again there is some scientific evidence that Agent Orange was responsible, but it is slim. John, however, was convinced of the precedent. Of the cause of his own illness, he said, "It's important that it not take twenty years [to establish] like it did for the Agent Orange vets."
You see that before properly introducing him, I have put this man John in a context in which sickness and disability have long-standing political ramifications. Politicizing John's illness may make you angry on his behalf and spur you to seek redress for him and others like him, but the risk is that you will lose sight of John the patient, John who is suffering.
John too was removed from the sight of his suffering. The figure implanted in his mind was the soldier betrayed by his governmentbetrayed not as some exceptional necessity of service but insidiously and repeatedly, by means of slow-acting poisons. Even when the government poisoned its soldiers accidentally, as with Agent Orange, it didn't admit the truth behind the calamity. That's what John believed anyway, John clinging to his bed in room 4011, and many other Americans believed likewise.
The West Los Angeles VAMC had a special role in the care of Persian Gulf veterans. It was a referral center for special patients like John, who were just a trickle statistically, yet they were driving the political controversy. Their unresolved cases, like a hydraulic force being applied through the mass of concerned veterans, kept the pressure on Washington when the issue should have exhausted itself for lack of answers.
They were not walk-in patients. Any veteran of the gulf war who was no longer on active military duty could go to his or her local VA facility and register as an outpatient for special care. The VA called this step of the process Phase 1. Bill Williams, the first gulf war vet I met, came to West L.A. for his Phase I evaluation. Most vets provided this single statistical snapshot of their health and then dropped from view. John by contrast, had been transferred to Wadsworth in order to undergo the more elaborate testing known as Phase lI. His was a chronic case, well documented, and much thornier than Bill's.
The VA had set up referral centers at three facilities in addition to the one at West Los Angeles: Houston, Texas; Washington, D.C.; and Birmingham, Alabama. According to the promotional literature distributed to gulf war vets, "These centers provide assessment by specialists in such areas as pulmonary and infectious disease, immunology, neuropsychology, and additional expertise as indicated in such areas as toxicology and multiple chemical sensitivity."
This was considerably overblown. Separate investigations-by the American Legion, the Presidential Advisory Committee on Gulf War Veterans' Illnesses, the General Accounting Office of Congress (GAO), and even the VA's own inspector general (IG)-all were critical of the program.
"Misleading hyperbole," said the IG's report of the program's description. "Knowledgeable VA clinicians repeatedly told us that the referral centers do not have any more sophistication or expertise in treating Persian Gulf War veterans than many other major VA facilities."
"Delays of three months or more are not uncommon," said the Presidential Advisory Committee about the backlog of patients waiting to be referred. By the end of 1997 fewer than five hundred veterans had been evaluated of the fifteen thousand-plus who might qualify for the program because they had undiagnosed illnesses...
|1.||John during Lent||17|
|2.||On the Coast of Arabia||55|
|4.||Ron Loses One||189|
|5.||Pete at Sea||199|
|6.||Darren Is Dying||245|
|8.||The Mind-Body Shop||331|
|Notes and Sources||361|