U.S. Navy neurosurgeon Steven Cobery looks at an X-ray of a bolt he removed during surgery at the NATO hospital near Kandahar.
A 3-inch-long, threaded steel bolt was buried deep inside the man's head.
"I thought, this poor guy is doomed," recalls Navy Cmdr. Steven Cobery, 44, a U.S. military neurosurgeon in Afghanistan.
Insurgents are creating more destructive roadside bombs this year by packing them with nails, screws, bolts, metal coils, ball bearings and other materials, according to doctors treating wounded U.S. and coalition troops here.
The number of casualties suffering multiple wounds from these objects has increased from about a dozen in March to around 100 each month this summer, according to Navy Capt. Michael Mullins, spokesman for the NATO hospital operated by the U.S. Navy outside Kandahar.
The casualties include not only U.S. soldiers and Marines, but also coalition and Afghan troops and Afghan civilians hurt by roadside bombs, Mullins says. About half of the casualties are American servicemembers, he says.
Cobery says he has seen several instances of household objects used in bombs. An Afghan soldier lost his left eye to shrapnel made of leather from the tongue of a shoe, he says.
"I've taken (centimeter-wide) ball bearings out of someone's spine," he says. "It's crazy."
The wounds complicate treatment and can cause excessive bleeding and infection, says Canadian Air Force Maj. Cathy Mountford, an emergency room doctor who has worked at the NATO hospital for five months.
"Through July definitely we've noticed that there are more objects and things, coils and stuff that would become implanted in the body" of a casualty, Mountford says. "They (wounded troops) just get peppered."
Marines fighting in nearby Helmand province report the same trend, uncovering roadside bombs stuffed with ball bearings, nails, screws and bullets, says Lt. Col. Michael Manning, a battalion commander.
The U.S. military is preparing new medical guidelines for the treatment of these wounds, says U.S. Air Force Maj. Randy Snoots, a trauma specialist here who tracks trends in casualties.
The bombs, he says, "are getting bigger and bigger and more full of stuff."
In July, Cobery spent six hours in surgery removing the 3-inch-long bolt blasted into the skull of the Afghan soldier.
It entered through the right side of the soldier's face near his nose and lodged in the second vertebra of his spinal column. Destruction of the spinal column at that high level would result in death instantly, Cobery says.
"The guy turning his head could end up killing himself," he says.
With the patient immobilized, "I took a chisel and gently tapped it out of the spinal canal," Cobery says. He then used a clamp to slowly pull the bolt through the man's face, out the direction it had entered.
When the soldier regained consciousness, he shook the doctor's hand. The soldier had to wear a metal framework to keep the head stable and allow the spinal column bones to heal, but he eventually was able to walk out of the hospital for further care at another medical center.
"I told him that if the bolt had gone 2 to 3 millimeters more to the right or if his head was turned in a different way, he wouldn't be standing there talking to me," Cobery says.