Fred Dickey's Island of Human Drama
FACE• TO• FACE
FACE• TO• FACE
Survivor of IED blast in Afghanistan finds reason to smile thanks to surgeon, a fellow Army vet
By Fred Dickey Nov. 10, 2013
This is a story about two men. One, a young soldier home from Afghanistan with a disfigured face and damaged spirit. The other, a surgeon at the top of his profession and at the edge of retirement.
Two men who never before walked the same streets. But then war happened, and they were suddenly face to face.
It starts with the young soldier from Vista who defied the flames.
The frantic afternoon call comes for a QRF, quick reaction force. A scout patrol has been ambushed and is taking heavy small-arms fire. A dozen soldiers from a military police unit attached to the 3rd Infantry Division pile into four Humvees and rush into the danger of southern Afghanistan, near the Pakistan border.
In the lead vehicle, Spc. Joey Paulk, the driver, and Sgt. Thomas McGee are in the front seat. Standing in the turret, manning the .50-caliber machine gun, is Pvt. Josh Cook.
It is a hot day in July 2007, and it will not be a good day.
The Humvee was recently outfitted with upgraded armor intended to give added protection against insurgents’ primary weapon: the improvised explosive device, the dreaded IED. Two other times, Paulk’s caravan has hit one of the mines, but he was not in the lead. Today, his vehicle is out front.
The dirt roads are winding, rocky and dotted with litter. The men in the lead vehicle, especially, are looking for suspicious activity and warning signs of IEDs that enemy fighters try to leave for villagers.
The tip-off might be the wreck of an old auto with the door painted green, or a roadside rock painted red, or it might be nothing.
The soldiers know the mines are there, somewhere. They try to find them and hope the mines don’t find them first.
Paulk is a 21-year-old on his first deployment. He’s in the military police because he’s thinking about law enforcement when his enlistment ends. Or, increasingly, he’s thinking of re-upping and trying for the Rangers. When he’s not corralling wayward soldiers, he and other MPs give support to the infantry, as they are doing on this mission.
Paulk grew up in Vista and graduated from Rancho Buena Vista High School. He wasn’t interested in college. He wanted action, and today he could get his wish, just down the road. He’s a physical, hands-on guy. He stays buff, and when he’s at work, he’s all eyes and ready for action.
Paulk is not a navel gazer. He’s straight-ahead. He’s friendly and respectful, but has a “don’t tread on me” attitude. You’d never have to puzzle over his opinions.
He loves his comrades and doesn’t mourn the Taliban who died trying to kill them. He invites them to try again. Rudyard Kipling could write about Joey Paulk — no, he already has.
Paulk has sympathy for innocent Afghans, but not a whole lot. They’re part of the landscape, and the landscape is alien. “You almost never see them,” he says. “They disappear whenever we’re around.”
The heat, the cold, the dust and the grit? Ha! Bring it on. Those are just the cost of doing business — impediments to be cussed at and shrugged off. Paulk will take his shirt off in the winter snow and invite the cold to bite.
He is armed with an M-4 assault rifle. But what insurgents fear most is that bad boy in the turret, the .50-caliber gun. The convoy’s destination is about 45 minutes away, traveling at 15 to 20 miles per hour. No one speeds when IEDs are in the neighborhood.
Then comes the moment that will change Paulk’s life and almost destroy it. Six eyes squint down the dirt road, looking for some sign, and see nothing. But as the Humvee crawls forward, a buried pressure plate is directly in its path. And then —
Paulk doesn’t feel anything, just a boom and a flash of red and black. Then: nothing. Nothing.
His Humvee has exploded the IED, probably an anti-tank mine. It has flipped over and turned into a torch. Paulk and Cook are thrown clear. McGee is trapped in the wreck.
The other soldiers race to their top priority, which is to establish a perimeter defense line. Then they look around and see Paulk unconscious and on fire. They later tell him he lay there for about five minutes — count to 300 slowly — before they could rush over and spray him with extinguishers.
“I wake up hearing my name. I stand up and my buddy is, like, ‘Hey, you’re still on fire!’ I look and see flames, so I rip off my vest, drop to the ground again and start rolling. Then I pass out again.
“I’m out for one minute and three seconds, according to a buddy, then I wake up to the sound of my name. I hear gunfire and search for my weapon, but they tell me the firing is show-of-force in case any insurgents get ideas. The pain hasn’t hit me yet.
“I ask them where is Sgt. McGee and where is Cook, my gunner, and they are, like, ‘Don’t worry about them.’ And I say no and push them off and try to go back to the (Humvee), but it’s really hot and then I start feeling the pain.
“It’s beyond description. Imagine the worst pain of your life, and multiply it a hundred times, a thousand times.
“My friends are cutting my shirts off to check the injuries and see how bad my arms are burned. They try to pull my gloves off, but they’re melted onto my hands, so I tell them no, just leave the gloves on. Weirdly, I feel terrific pain in my back, but my back is not hurt.
“I look around and see the shock on my buddies’ faces. I don’t realize at that moment what they’re seeing: me standing there screaming in agony, skin hanging off my arms, skin hanging off my face.
“My gunner, Cook, comes over to show me his little finger that was half severed in the blast. He wiggles it in front of my face and laughs, trying to distract me.
“I am at the scene for about 45 minutes to an hour. I just stand and walk around, screaming and yelling. I have the interpreter and a couple of my friends pour water on me to kind of ease the pain, and kind of clean the dirt off my burns.
“I just keep telling them, I say pour it on my back. They say, ‘Dude, your back is fine.’ And I was, like, I don’t care, that’s where it feels good. And then they’re keeping me conscious as long as possible so that I don’t fall into shock or a coma or anything like that on the scene. I’m drifting. I’m getting really weak and I’m freezing. I go into shock, into the cold phase where I’m just shivering. So they put a sleeping bag around me and I’m still shivering, for maybe 10 to 15 minutes. So I kind of lay down and I just want to go to sleep.
“The pain is excruciating. I’m screaming and yelling at my lieutenant because he is hooking up the radio and getting medics on the way, and I’m yelling at him, telling him that he needs to hurry, and they need to hurry.
“We don’t have a medic with us, and we don’t have any morphine. We don’t have anything. I just sit there for 45 minutes, but it feels like forever.
“I tell my buddy, Stevens, I say, ‘I know what you’re supposed to tell me. You’re supposed to reassure me, to tell me I’m going to be OK, that I look good and all that. I know that, but I want you to be honest, like, how bad is it?’ And he goes, ‘It’s pretty bad, dude.’
“I can see out of my right eye, but not my left. I ask Stevens, ‘Am I, like, going to lose my eye?’ And he is, like, ‘No, it’s just swollen shut. I say I’m going to try to open it, and he is, like, ‘No, no, dude, just hang on.’
“I need more than reassurance. I tell him, ‘I’m going to open my eye and I’m going to try and look.’ And he is, ‘No, no don’t.’ And I’m, like, ‘I have to.’ I pry it open as hard as I can with my gloves melted on my hands. I get it open, and I see him, so I let it go and it closes again. I’m, like, ‘OK, how bad is my face?’ And he again tells me, ‘It’s pretty bad, dude.’
“The pain never goes away. Have you ever brushed yourself on the stove or on the barbecue? It’s that, times a million. It’s like pins and needles just stabbing you all over, that burning sensation, just all over. Super hell. I’ve had buddies come up an hour after I get a tattoo and smack it, and that’s what it feels like. I mean, it feels like that but it never goes away.
“The pain is driving me crazy. I’m screaming and yelling at the Taliban: ‘You guys failed. I’m still alive. You guys want to kill me, come try now, because you guys just missed your opportunity.’ I’m screaming and yelling all sorts of stuff like that: ‘You can’t kill me. I’m a super soldier. I’m unstoppable.’
“The lieutenant is on the radio, and I’m yelling at him to tell them to hurry up. I hear him say: ‘One minor injury, one critical condition, one KIA.’ And that’s right when I got confirmation. I know Sgt. McGee is dead. I want to believe he died in the blast. I don’t pray. I haven’t seen that work.
“Finally, the helicopters come, circle and pop purple smoke on the best landing site. I walk over to the medic, I’m still screaming, and he takes one look, and says, ‘Holy ----.’
“I’m getting on the helicopter, and I turn to Stevens. I say, ‘Tell everybody I love them, and I’ll see you guys soon.’ He says, ‘Take care. Love you, too,’ or something like that. The door was shutting.
“They get me in the chopper and hit me with two morphines, but it doesn’t touch the pain.
“Finally, we land and pop open the doors, and I see, like, 20 white coats and army medics. I mean, there’s a bunch of people there waiting for us. So they take me off the bird and they take my gunner off the bird. My gunner goes one way and I go another, and I damn near jump off the stretcher because he is my responsibility. I’m, like, ‘No, no, he’s with me.’ They tell me, ‘You’re going somewhere else, you’re in worse condition.’ I comprehend that. I just want to make sure he’s OK.
“All this time, the pain hasn’t stopped. Then I hear this female voice, and I hear her say, ‘I can’t find a vein.’ That’s when I start thinking, ‘Wow! I’m that bad you can’t find a vein on me?’ And I hear this other female voice, like an elderly woman, say, ‘Check his feet. His feet are OK.’ They must have found a vein because I’m unconscious from then on. That’s the last thing I remember.”
A difficult road back
Paulk was injured July 5, 2007, and flown to Brook Army Medical Center in San Antonio on July 8. He stayed in a medically induced coma for three weeks while they amputated all 10 fingers and started treatment for the burns that covered 40 percent of his body. During that time, his weight went from 185 to 126 pounds.
When he opened his eyes, at his bedside were his girlfriend, mother, sister and stepfather. He also saw two huge balls of bandages covering his hands.
Through her tears, his mother, Judy Soper of Vista, told him he had lost his fingers.
“All of them?”
“All of them.”
During the next 17 months, Paulk underwent 30 operations, mainly skin grafts. The treatment at the Army hospital was successful as far as it went, and where it went successfully was as high as his neck.
The face? Well, that didn’t work out so well.
In his hospital room, Paulk studied his face and was devastated. One lower eyelid was inside out and his upper lip was pushed upward. The eyes and mouth were misshapen and looked like open wounds. He didn’t want to go out in public. He didn’t want to shock people, scare children, and — worst of all — be pitied.
He asked if these things could be fixed. He’s told maybe, but no promises. His faith is shaken, and he’s tired of the surgery prison. He just wants to go home.
“I was thinking that, maybe when I got home, all my darkness and my down moments would go away because I was back home, I would be with my friends. But it wasn’t like that. I was deeply embarrassed when people would stare at me.”
He couldn’t open his mouth to eat properly and spoke with a lisp.
“As far as the Army was concerned, that was just how I was going to look. That was how I was going to be, and I was thinking that was the way I was going to look the rest of my life.”
He couldn’t smile. Not that he saw the need.
On Dec. 8, 2008, grateful for all that was done to restore him but sick at heart over his face, he decided to leave the Army and return to Vista.
He rejoined his old buddies, but buried himself and his face in hoisting beers and doing the things young single guys do with time on their hands. When his buddies were at work, there was always TV, but daytime reruns can get boring. He had plenty of money, but no place to go. Whenever he felt ambition stirring, he got rid of it by looking in the mirror.
While Paulk was at Brook Army Medical Center, he was introduced to the program manager for a new charity at Ronald Reagan UCLA Medical Center called Operation Mend, which was doing good work for wounded vets at no charge.
“After I had so many surgeries at Brook, I tell her, like, ‘Thank you but no thank you, I have had way too much. I just want to get back home and hang out with my friends.”
But after months of being depressed in Vista, his family and girlfriend urged him to contact Operation Mend.
“So I finally called them up and said, ‘Can I meet your doctor?’ ”
The graying surgeon with the wry humor and subtle smile sits atop the world. Living in a classy home near the crest of Mulholland Drive puts Malibu and the blinking forest of L.A. lights hundreds of feet below his backyard. It’s the rarefied Los Angeles that most people never see, and where far, far fewer live.
The home belongs to 73-year-old Dr. Timothy Miller and his wife, Mia. However, a bigger reason for contentment than the house is his career in reconstructive surgery at UCLA Medical Center, where he served as chief until recently sidestepping to emeritus status. He’s even a published novelist, but that’s weekend fun work. This man has it made, and he’s earned what he’s made.
Being one of the top plastic surgeons in the environs of Hollywood does not require a vow of poverty.
When life is this good, self-satisfaction can turn mental muscle to fat. But not for a man with a mission, which, as we shall see, is more important to Miller than stars, whether in the firmament above or in the waiting room.
Miller’s online résumé goes on for page after page listing surgery breakthroughs and achievements. Published articles with titles such as “The effect of biomimetic apatite structure on osteoblast viability, proliferation and gene expression,” show that his concept of plastic surgery goes far beyond boob jobs and face-lifts for starlets.
A rookie ‘grunt doctor’
It’s a long, long way from Linden Lane in La Mesa, where Tim Miller grew up and where, he says, “our whole house could fit in these two rooms,” indicating with a sweep of his hand his current large family room and adjoining den.
La Mesa of six decades ago is still clear in Miller’s mind. It becomes apparent when asked which high school he attended, Grossmont or Helix.
“Oh, Grossmont, absolutely,” he says with a wicked grin, revealing that the memory of school loyalty yet lives. But while reflecting on his home turf, Miller shakes his head with regret at the deterioration of other communities along state Route 94, at least from the way he remembers them.
Thanks to scholarship help from a San Diego attorney named Frank Kockritz, Miller was able to begin a higher education that started at UC Berkeley and continued at UCLA Medical School.
After finishing medical school and an internship, Miller joined the Army to get experience in a burn unit, which he did for a year. But when the war in Vietnam heated up, he spent ’65 and ’66 in-country. As a rookie doc, the Army turned him into a “grunt doctor,” assigned to go with the troops to where bullets flew. In the course of that, he earned his paratroop wings and a Bronze Star.
Of earning the medal, he smiles and says, “Oh, I just followed a bunch of special-forces guys around.”
Miller would accompany the elite troops into villages where he would give “hearts and minds” medical services to villagers. “I would give shots and do little minor surgery, and then the special-forces people would gather intelligence.
“To be among and help the people, dangerous as that was, that was the goal. And it was very successful, actually.”
Being a doctor on the front lines inevitably exposed Miller to the wounds and burns of battle, as well as the attendant terror and heartache. Those days changed him, and, years later, motivated him to help bind up the wounds of the spiritual grandsons of those Vietnam soldiers.
Talking about his war experience makes it come to life in his eyes. “In war, there is no resemblance to anything you’ve ever seen. All the rules of life are off. I was young. I didn’t know anything about anything, but I learned so much from those special-forces guys. You really realize what it takes to dedicate your life to being a soldier and the unbelievable risk. You lay it all on the line. That’s why taking care of those guys was so important to me. That was my purpose. That was the thing I was determined to do.”
After Vietnam, Miller returned to his civilian career, took a specialty in plastic and reconstructive surgery and built a national reputation at UCLA Medical Center.
Years passed and then war came again, as it always seems to do.
And the butcher’s bill of battle again changed Miller’s life and the lives of many burned and wounded veterans of the Iraq and Afghan wars. In 2007, Ron Katz, a Los Angeles businessman and philanthropist, saw a TV program that depicted the life of a badly wounded Marine. At the urging of his now-deceased wife, Maddie, he picked up the phone and got out the checkbook.
Miller says, “Katz called the dean of medicine at UCLA and said, ‘We would really like to offer these guys reconstructive surgery.’ I think within a minute the dean called me and said, ‘Would you like to operate on a very badly scarred Marine?’ I said, ‘You bet. I would love to.’ That’s really how it started.”
Why so eager?
“This was a Marine who had been terribly burned by an IED, who had put it all on the line for his country — for us — and I had the opportunity to make that right, to make that better. Not perfect, but to give him a face, a nose and a lip. I don’t pass that up.”
Thus was born Operation Mend, a charitable mission kicked off by Katz’s $1 million donation and his continuing involvement. It has enlarged to include all departments at the medical center, and works in cooperation with Brook Army Medical Center and the U.S. Department of Veterans Affairs. Fundraising for the program generated slightly more than $2 million last year.
The wounded servicemen and women treated by Operation Mend pay nothing, and, in fact, are paid a per diem while being treated. To date, 88 patients have been served.
Miller was its first surgical director and held that role from 2007 until last year. He says from the program’s inception, he has operated about 180 times on patients. And as professor emeritus, he will continue to perform surgery for Operation Mend.
“I had been shot at occasionally (in Vietnam), but for these guys, it was a daily event. You don’t know where the enemy is. You’re never, ever safe. These guys were out there in daily risk of death. And when they came home, they (with disfiguring wounds) couldn’t go into a market, couldn’t go into a store because they looked that bad. To me, the opportunity to make their life better, to make their appearance better, I’ve got to do that.”
While he’s thinking about all those warrior faces he’s operated on, I ask about Joey Paulk.
Miller’s smile is not a skin-deep flash, but one reached inside for. And I’m not sure what it means.
Paulk and Miller
Paulk recalls sitting in the bare, white examination room at UCLA Medical Center waiting for the surgeon. Finally, the door opens and an unsmiling, dignified older man in a starched white coat comes in.
“He was, like, staring at me, kind of like I was a puzzle, and I can see him kind of putting my face back together. Finally, he steps back, and says: ‘I can fix this. I’ll make you look 10 times better.’ ”
Miller’s recollection is that when he entered the room, “Joey was wearing big, dark glasses and with his head down, obviously depressed and pessimistic. He didn’t want to talk. At the end of the exam, I said, ‘Do you want to give this a try? Let’s do one operation and see how you like it, and decide if you want to keep going.’”
Paulk’s mother, Judy, who had been at his side since the beginning and didn’t want his disappointments piled higher, was more cautious, even challenging. Paulk remembers, “Mum being mum, she says to Miller: ‘What do you mean? What makes you so confident? What makes you think you can do this?’ ... And Miller smiles and says, ‘I’ve read a couple of books on this subject,’ and me being sarcastic and liking that type of humor, him being a veteran, a Bronze Star recipient, chief of plastic surgery at UCLA Medical and all, and he has a good personality — OK, I’ll let him cut up my face and see what he can do.”
From March 2009 until this past June, through seven procedures, Miller rescued Paulk’s face, transforming it from one he averted to one he could present to people while looking them straight in the eye.
Long process ends with a smile
What Miller saw on the operating table was the “Phantom of the Opera” with the mask removed. The scars of Paulk’s skin grafts had constricted like drying rawhide and forced his eyelids down onto his cheeks. His lower lip had bulged and flopped down on his undefined chin, and his nose was pinched and lacking shape.
Miller knew what he was seeing was what Paulk had to stare at a dozen times a day, and that would have given the Taliban a feeling of a job well done.
Each surgery showed progress, making Paulk look more like, well, Paulk. And each time, his spirits were lifted.
Miller explains the challenge he confronted: “His eyelids were pulled down from the scarring in the cheeks and the left eyelid was down about as far as I’ve ever seen an eyelid. That was from a shortage of skin, and in a burn, after scarring, there is almost always a shortage of skin.”
The objective was to relieve the tension that was distorting Paulk’s face by interrupting scars, adding skin grafts judiciously and re-forming features to bring his face back to as normal an appearance as possible, given the burn damage.
Choosing fresh skin had to be done carefully to minimize the patchwork visual effect. Miller says, “I added skin taken from behind his ear where there was skin that had not been burned, and other grafts were from the area above the clavicles, because any skin from there has a better color match for the face — a more orange, flesh-colored hue. By contrast, if you look at the flap on his chin (that had been grafted previously), it’s white.”
Slowly, one painstaking step at a time, month after month, the face of the old Joey emerged. At the end, Paulk could smile. He wanted to smile.
Operation Mend success story
In the past few years, Miller has devoted about half his practice to the veterans of Operation Mend. As he eases into semiretirement, his interest in them will not diminish. He has a great affection because they’re not strangers. He remembers them from when they first met, in a place named Vietnam. The bond has held.
Paulk is back in Vista and back to being Joey, smiling, joking and as quick with a dig as a compliment. He’s lost weight, cut back on the beer, got his edge back and is planning a future with his longtime girlfriend. He won’t have to worry about food on the table. His full-disability military pension is about 60-large for life. He remains a grateful friend to Miller, and makes fundraising appearances for Operation Mend wherever he can spread the word. He’s still pondering the direction he wants for his life.
He still has to decide if he wants finger transplants, but he’s leaning against it because he’s developed remarkable facility with the stubs of his hands. He can drive, write his name, throw a baseball, tie his shoes and buckle on a snowboard.
“Every time I see Dr. Miller, I thank him with a big hug. He’s like M&Ms: tough exterior, (but) the sweetest guy on the inside. Now I go to movies, bars and ballgames. I’m very happy.”
As the years pass, one thing will remain constant in Paulk’s life. When people ask him who he is, he can always say: I’m a soldier.
They will drift apart, soldier and surgeon, each a better man for having met the other. The soldier goes his way with a repaired face that can now smile, and a renewal of his innate toughness to turn himself into the winds of life.
The surgeon? He reached into his past and his beliefs and decided there was work undone. Because he did, a platoon of mangled soldiers and Marines now have a stiffened gait and thrown-back shoulders.
Link to a video on Joey Paulk, from U-T Video:
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