On duty: Paul Salem in uniform. Photo by Brownie Harris
On duty: Paul Salem in uniform. Photo by Brownie Harris

War Stories

For most in the Duke community, the wars in Iraq and Afghanistan are theoretical: a topic for classroom discussion or the subject of scholarly papers. But for some—students, graduates, researchers, faculty members, and families—these wars are an immediate reality.
Writer: 
August 1, 2010

Bill and Angela Lynch wonder whether their son, Matthew, was aware of the university’s veterans’ memorial, which, when Matt was in school here, was inscribed with only the names of Duke alumni who died in World War II. Though it stands along a well-traveled sidewalk in the quad between Duke Chapel and the divinity school, the memorial is a low stone wall and is easy to miss.

On October 23, the Lynches attended a rededication of the memorial, at which the names of fifty-four alumni who died in wars or otherwise on active duty since World War II were added. Angela Lynch recalls arriving at the memorial, watching as students passed, absorbed in a day in academe, and asking herself, “How many times did Matt walk by here, and maybe he didn’t even know this was here?”

On that breezy, unseasonably warm October morning, Secretary of Veterans Affairs Eric Shinseki A.M. ‘76 honored those from Duke who had served, telling the 250 or so assembled, “The families and friends gathered here today have given someone precious and irreplaceable in their lives, and we are here to honor and to thank them.”

No one from Duke has yet been killed in Afghanistan, and there are only two names now inscribed from the Iraq War: James Regan ‘02 and Matthew Lynch ‘01.

For most in the Duke community, the wars in Iraq and Afghanistan are more theoretical in nature than real—a topic for classroom discussion, the subject of scholarly papers and op-eds. But for some, these wars are an immediate reality: those who have served or whose family members have done so, and those who remain in service. There are physicians and researchers at the university, the medical center, and the Durham VA who minister to the injured or whose work is aimed at alleviating the pain and struggles inherent in the experience of war.

Young soldier: Salem spent his nineteenth birthday in boot camp; his twentieth, in Iraq. Chris Hildreth

Paul Salem '12, a former Marine, has, for the most part, refrained from talking about his military experience. Not out of reticence—just because it’s the past. But if it comes up, he doesn’t avoid the conversation. “Generally speaking, people who found out, it didn’t make a difference, really; not that I could tell.” So far, no one has tried to engage him in a political discussion of the war, “which I really, really appreciate.”  

“It’s nice to just put it behind me,” he says, “and be whoever I want to be now.”

Salem, twenty-four, grew up in Washington’s Adams-Morgan neighborhood. His mother was born in Iraq and works for the United Nations Foundation; his father, born in Egypt, works for the World Bank. He attended Maret, a well-regarded private school. The military wasn’t a part of his world. “My family really didn’t think it was a legitimate career path at all,” he says.

He didn’t view himself as a patriot; in fact, he considered himself somewhat countercultural. “If I could have voted in 2000, I would have voted for Nader.” But he’d become consumed by news of the wars and felt the need to act. “I was concerned that the war was going to be over if I didn’t go right in, and I didn’t see the point of going in if there was no war,” he says. College could wait. “I didn’t see the point of learning Latin declensions or calculus when there was something this big going on.”

The Marine Corps infantry was his choice. “I wanted to feel like I was having a direct impact. I wanted to be on the edge of it.” His parents’ reaction: “ ‘You’re going to die. This is stupid. This is completely insane.’ I said, ‘Listen; that’s a possibility. But I’ve got to do this.’ Physically, he was prepared: He’d just run a marathon and had been lifting weights, but, “it was a cultural adjustment, a far cry from my high school.”

Salem spent his nineteenth birthday in boot camp; his twentieth, in Iraq. “The first night that I slept there,” he says of Camp Fallujah, “I was probably the happiest I have ever been. I was so excited. I felt like this was it; I was there.” But he wasn’t happy with the infantry. “I felt like the war was really being fought by the sniper platoons. I mean, they were really doing the work. They were out there killing insurgents.” So, upon his return, he trained as a sniper and was then redeployed, to Kuwait and to Kenya, along the Somalia border. Returning to the States again, he trained snipers in the Mohave Desert. He mustered out in July 2008 and arrived at Duke in August for the start of the fall semester.

Salem says he decided to become a doctor after watching medical teams in Iraq doing “amazing stuff” amid sandbags and rubble. He’s now studying  evolutionary anthropology, with plans to attend medical school. In the fall semester, he worked with Duke EMS.

It’s a long way from Camp Fallujah to Cameron Indoor, a distance Salem has no trouble reconciling. He’s not at all troubled that life here can go on far removed from concerns of war. Most probably, very few around him will experience it.

He says he thinks it’s great that few of his classmates will have to make the sacrifice of serving. “Absolutely. They can just live life and not worry about it. That’s a beautiful thing. I don’t resent it at all.”

For Jonathan Kuniholm, sacrifice was the mother of invention. Though an engineer by training and inclination, Kuniholm understands that if your objective is to steer revolutionary thinkers into a niche market—and you’re really very passionate about it—you must also be a proselytizer. That’s why he’s spending a Monday evening talking to a Sanford School of Public Policy graduate seminar called “Designing Innovation for Global Health.”

Kuniholm, now working on his Ph.D. in biomedical engineering at the Pratt School of Engineering, is both a designer of innovative prosthetic devices and an advocate for new approaches to advancing the technology. On New Year’s Day 2005, while serving in Iraq as an engineering officer for the First Battalion, Twenty-third Marine Regiment, Kuniholm was injured by the blast of an improvised explosive device. His right arm was later amputated below the elbow.

At Walter Reed Medical Center, Kuniholm was fitted with three types of prosthetic arms. One is a myoelectric prosthesis that uses sensors on the skin to detect the electrical impulses of muscles and is trained to recognize movement as voice-recognition software is trained to recognize words. Another is a shorter arm used to hold a pen or, perhaps, a guitar pick. The third, and the one Kuniholm uses almost exclusively now, is a body-powered arm, the type we all are most accustomed to seeing—a split hook with aircraft cables and rubber bands that works by extending the forearm or shrugging the shoulder. The device was patented in 1912 and first used by amputees returning from World War I, and has changed little since then.

Kuniholm says he found the myoelectric arm heavy, slow, uncomfortable, restrictive, and inconvenient to recharge. It wasn’t that the military was providing him with inferior options—in fact, says Kuniholm, they would have spared no expense in providing him with whatever he wanted. “The problem,” he says, “was there was nothing I really wanted.” Though the body-powered device is a “primitive technology,” Kuniholm says, he’s found it to be the most functional available.

That, Kuniholm says, is primarily owing to a lack of competition: The market for prosthetics is simply too small to provide the incentives for innovation. So he is working toward two objectives: to make improvements to the most advanced prosthetics and to help germinate new ideas. He’s one of more than 300 engineers at thirty institutions working for the Department of Defense’s research and development office—the Defense Advanced Research Projects Agency, or DARPA—on a project called Revolutionizing Prosthetics. And he’s a founder of the Open Prosthetics Project, through which new designs can be downloaded, at no cost, and modified to meet individual needs. Through the project, he’s also working to develop a video-game controller that he hopes might help further open the door to innovation.”The best way to really move prosthetics research forward is to hitch a ride on a real market,” he wrote in the online magazine IEEE Spectrum. He believes the $37 billion video-game market could be the avenue for bringing more innovators aboard.

Engineering innovations: Kuniholm’s injury led to a quest for better prosthetics. Chris Hildreth

“What we’ve done in the last 100 years in prosthetics hasn’t worked,” he told Shinseki during the secretary’s visit to campus. “That’s why I’m wearing this,” he said, indicating his hook device. “I still haven’t found the [solution] that’s going to make me want to give this up.”

But he’s working hard to find it and welcomes all input. In wrapping up his comments to that Sanford School class, Kuniholm said he often gets asked, “Aren’t you afraid someone will steal your ideas?” “No,” he said. “I’m afraid they won’t.”

VA Secretary Shinseki can relate to Kuniholm’s resourcefulness and resolve. His own ability to change course without losing stride in the face of adversity is what led him to Duke as a young Army captain.

Having lost part of his foot in a land-mine explosion, but committed to a career in the Army, Shinseki accepted an offer to teach English at the U.S. Military Academy at West Point. “I had just come back from Vietnam—second tour, and an amputee,” he says.

He had his eye on several choice operational assignments, as did many other returning young captains, “and with that many good guys, you don’t need a guy that’s hobbling around.” So he decided to accept the teaching offer, but a master’s degree was required. Duke accepted him. An engineering major at West Point, Shinseki had a lot of reading to do.

Clearing hurdles: Shinseki’s challenge is updating an agency with an antiquated infrastructure and a less-than-stellar public image. Patrice Gilbert

In the comments he delivered for the dedication ceremony, Shinseki said that after West Point and two combat tours in Vietnam, he believed he’d “cleared some of life’s most challenging hurdles. And then I encountered the English department. Wow.” He spent “every waking moment” reading books undergrad English majors had read by the time they were sophomores. But he adapted, passing what he calls “two memorable years of study and reflection” and moving on with his master’s to the West Point faculty position and then back into operational commands. He became chief of staff of the Army, the highest military position ever held by an Asian American, before retiring in 2003. On January 21, 2009, he was sworn in as head of the Department of Veterans Affairs.

Shinseki is accustomed to shepherding change. As Army chief of staff, he championed new concepts and technologies to meet the realities of modern warfare, fashioning a force that was more mobile and responsive. His objective today is similar: to transform the second-largest bureaucracy in the U.S. government (after the Department of Defense), an agency with an antiquated infrastructure and a less-than-stellar public image.

Paul Rieckhoff, founder of Iraq and Afghanistan Veterans of America, told The New York Times in November, “He faces one of the greatest rebranding challenges in American government. When I came home [from Iraq], my father, a Vietnam-era vet, said: ‘Don’t go to VA. I wouldn’t go unless I was on fire.’ “

As Shinseki told the veterans he met with on his visit to campus, when President Obama asked him to take over stewardship of the VA, “I spent a couple of days thinking about it,” before deciding to do it “to give back to the people I went to war with in Vietnam, who’ve had a pretty tough row to hoe for forty years, and to give back to you, those I sent to war.”

“We all carried baggage,” he told them of his return from Vietnam. “Most of us dealt with it pretty well. Some needed help.” Shinseki’s newest challenge is to reshape the agency responsible not only for providing that help, but also for conveying a culture of caring.

Change is long overdue at the VA. Among other things, the agency has faced persistent criticism for its backlog of disability claims and for failing to acknowledge and provide adequate care for veterans suffering mental illness. Shinseki is embracing the challenge. He’s working to expedite claims and leverage information technology to create a more comprehensive and timely system of record keeping. He also has made a commitment to improve outreach to veterans who’ve been particularly underserved: those with mental-health issues, the homeless, and the unemployed. This past October, he convened a mental-health summit in Washington with Secretary of Defense Robert Gates to hear and discuss concerns.

But improving mental-health care for veterans will be a daunting task. Diagnosed symptoms of post-traumatic stress disorder (PTSD), depression, and traumatic brain injury are rising among returning veterans, and mental-health experts point to certain characteristics of the wars in Iraq and Afghanistan as likely contributing factors. Among these: the toll of multiple deployments; the rapidity of the return home, often within hours, with little or no time to decompress; the nature of the combat (as in the Vietnam War, it’s unclear who the enemy is and almost impossible to anticipate an attack or detonation); and equipment that’s more protective, resulting in fewer fatalities, and, thus, more survivors with severe injuries.

“We see all those symptoms definitely going up, and we know them to be associated with suicide,” says Dan Blazer HS ‘75, the J.P. Gibbons Professor of psychiatry and behavioral sciences in the Duke Institute for Brain Sciences. Since the late 1980s, Blazer has served on task forces and committees that have examined military and veterans’ health issues; he currently sits on a committee on the readjustment needs of military personnel, veterans, and their families convened by the Institute of Medicine, an office of the National Academy of Sciences.

In 2009, the military reported its highest rate of suicide since it began keeping track nearly thirty years ago. The VA released data in January indicating that suicides among male veterans between the ages of eighteen and twenty-nine had risen 26 percent between 2005 and 2009. And Shinseki said in October that since 2001, more veterans had committed suicide than had died in combat in Iraq and Afghanistan combined.

“When reports came out that there was perhaps underreporting of suicides,” Blazer says, “that really put the spotlight on the VA. And once the spotlight was placed on them, the VA really started paying much, much greater attention. I think they’ve greatly upgraded their programs now.” Congress passed legislation in 2007 requiring the VA to implement a comprehensive program to try to prevent suicides, including more readily available twenty-four-hour care, as well as improved outreach and education, a hotline, and a chat service with counselors who determine the level of support a caller may need. Only time will tell how effective these programs can be, Blazer says.

Meanwhile, Christine Marx M.D. ‘93, a psychiatrist and researcher with both Duke Medical Center and the Durham VA Medical Center, has made a breakthrough in the treatment of PTSD. Marx studies neurosteroids—compounds produced in the brain that are associated with responses to stress­—and her research has shown that the low levels of these compounds correlate with symptoms of PTSD. Marx believes that by elevating the neurosteroid levels of those suffering from PTSD with medications, including one called pregnenolone that is available over the counter, those symptoms can be moderated. Previous research conducted by Marx and her colleagues indicated that pregnenolone could lessen the symptoms of schizophrenia.

“We’re doing a larger study with patients with schizophrenia and hoping to do a larger study with PTSD and traumatic brain injury to try to replicate those findings in a larger cohort,” Marx says. If the results from those studies are encouraging, “this could be a novel therapeutic approach for the treatment of PTSD, traumatic brain injury, schizophrenia, and other disorders,” she adds. “It also has some possible ramifications for biomarker development. Having the ability to understand a little bit better who might benefit from specific treatments would be helpful in identifying patients who are at higher risk.”

Marx says she’s cautiously optimistic. “We’re very excited that our findings are consistent with our hypotheses and with the data that’s accrued so far. There’s such a great need to develop better treatments.”

What’s also required in the reintegration process is a sense of vitality. A recognition of this is what led Eric Greitens ‘96 to found the nonprofit The Mission Continues.

Surviving loss: Matt Lynch, right, was killed in Iraq; his parents, Bill and Angela Lynch, left (Chris Hildreth)

The seed for The Mission Continues was planted when Greitens, a Rhodes Scholar, was doing volunteer humanitarian work during his summers away from Duke—with refugees in Bosnia and Croatia and survivors of the genocide in Rwanda. Greitens says he learned that people who have lived through incredible tragedy or trauma find hope in serving others and rebuilding a sense of purpose.

But the experience that would give shape to The Mission Continues took place in the streets of Fallujah, Iraq. Greitens was then a Navy Seal commander assigned to target and assist in the capture of senior Al Qaeda leaders. While on a mission, he and his team were hit by a suicide truck bomb. Greitens’ injuries were minor, and he was able to immediately return to his duties. Others around him were less fortunate.

When Greitens returned to the States, he visited some of his friends who had been injured. He also went to the National Naval Medical Center to talk with recently returned injured Marines. Without exception, says Greitens, they wanted to return to their units. For most, that just wasn’t possible. “Short of that,” he asked them, “what would you like to do?” Again without exception, they expressed the desire to otherwise serve—to somehow contribute to society.

“It just became very clear to me that all of these men and women had a long stream of visitors coming to the hospital to say thank you to them,” Greitens says, “but that what they also needed to hear was, ‘We still need you.’ “ The Mission Continues now helps veterans respond to that need, extending fellowships that allow them to team with community organizations throughout the country, including those assisting other veterans.

Greitens says that for so many returning vets, the most urgent question is, How do I rebuild a sense of purpose? “What we do is ask something of them. We ask them to find a way to continue to serve, and then we help them meet that challenge.”

A fundamental lesson he learned as an officer in Afghanistan and Iraq is that “you have to take care of your people,” says Greitens. “And I don’t see any reason why that obligation ends when we come home. People who have been wounded and disabled still have to carry on their fight, and I think we should be right there with them.

Bill Lynch says that what a Marine does when told a best friend has been killed in battle is pick up his gear and keep going. That’s what he says a Marine does, and Bill Lynch is a Marine, having served as an officer in the early 1960s. One of his duties was going to the homes of the families of Marines to break the news of the loss of a loved one. He had, in fact, written his regional headquarters’ standing operating procedure for those “casualty calls.”

Both of Bill and Angela Lynch’s sons—Tim, the elder, by two years, and Matt—served in the Marine Corps. Tim did a tour in Afghanistan and another in Iraq; Matt served three tours in Iraq. “Five episodes of angst,” is how Bill Lynch describes the waiting. Five times he and Angela had waited for the return of their sons. “It’s like having had twenty-six cups of coffee, because you’re like this,” he says, indicating jittery hands. Four times their sons returned. “And then on the fifth, of course, Matt didn’t come back.”

The Marine in Bill Lynch keeps going; the father looks back. But only selectively. The rededication of the veterans’ memorial at Duke was an occasion for the Lynches and others to honor Matt. Escorted by Secretary Shinseki, they laid a wreath by the inscription of Matt’s name. “You try to get away from that feeling, that horrible day,” Bill Lynch says of the memory of Matt’s death. “But there are some things that you know you have to do, and this was one of them. You have to represent your son, and say thanks to the people who honored him.”

Matt Lynch was a versatile athlete. Baseball was his first love; he was a catcher—a born field general, his dad says—and a power hitter. But it was as a swimmer that he truly excelled, breaking every record at Jericho High School on Long Island in New York and finishing third in the state in the 100-yard freestyle and the 200-yard individual medley. At Duke, he was a solid performer on both the varsity baseball and swim teams.

Matt was patriotic. Though he’d already made the decision to follow his father and brother in the Marine Corps, September 11, 2001, cemented his resolve. He was in a dentist’s chair that morning, having his wisdom teeth pulled. “He sits in the chair,” his father says, “we’re at peace. They knock him out; when he wakes up, we’re at war.” Matt, commissioned a second lieutenant, was an exemplary officer, according to his best friend and fellow officer Shawn Maurer. Some guys want to lead troops into battle for the glory or to pad their résumés, Maurer says. “Matt’s Marines knew that he was there for them.” Matt’s Bronze Star cites him as an “unshakeable, courageous leader…. He led his platoon from the front in the face of enemy fire.”

“Some people are stripped of their identity when joining the Marine Corps,” Maurer says. “But the sign of a true leader is when you are able to blend your true nature and inherent leadership abilities into a Marine officer.” In battle, Maurer says, Matt was “a rock, very calm, collected. And he projected a persona of a quiet professional.” But he could also break the tension with a wise-ass comment or a “wink of an eye or a glance that could bring you down off your adrenalin high and get you back to the task at hand.”

Matt was protective of his parents, always painting a rosy picture of the state of things in Iraq. “Not too much else going on over here,” he wrote in his last letter home, having volunteered to return to combat a third time. “The latest plan has us getting relieved mid-March, and home by April 1st…. I’ll be a civilian on September 1, just enough time to take all my leave…. Honestly, do you know anyone else who can repeatedly fall, ass-backwards, into great situations?”

Only recently has Bill Lynch been able to look at photographs of his son. He says he’ll never again be able to watch home movies. “To see it too vividly is to long,” he says, “and to long is to grieve.”

Since Matt’s death, the Lynches have moved to the coast of North Carolina. When they still lived on Long Island, where Matt is buried, his mom would regularly visit his grave; his dad, from time to time. “But I found it very difficult,” he says. “Again, that longing. I’m looking at a stone. Why do I want to look at a stone? I want to see a young man who was running like the wind.”

Sisk is a North Carolina-based writer and editor.