'Don't judge a book by its cover' is perhaps the most common phrase in the English language used to convey the idea that one should not judge the worth of something based on outward appearance. A wounded warrior, friend, and colleague of mine recently related an event that happened to him. It caused me to again appreciate the wisdom of this old English metaphorical phrase.

Recently the annual Army 10-miler was held in our nation’s capital. An article in Military.com began with, “Arlington, VA —More than 50 wounded, visually impaired, and amputee athletes signed up for the 2010 Army Ten-Miler Sunday, competing against each other in categories of their own for the first time ...” If you were to meet my friend on the street you would not initially label him as a wounded warrior. However, I have the benefit of knowing his history. I have seen the photograph of the mangled vehicle he was in when the improvised explosive device ripped it apart. I am aware of the burst fracture he sustained to his third cervical vertebrae, the fractures to his face (Le Fort I & II), the bleeding in his spine (epidural and subdural hematomas), and the moderate traumatic brain injury.

Although the external manifestations of his injuries have healed, he continues to struggle with the long term consequences of his wounding. He has worked very hard, with the help of federal medicine, to recover and continues to wear the uniform as a productive member of our armed services. As he puts it, “I can hang with, if not beat my SOCOM (United Stated Special Operations Command) brethren and I take pride in that.” Perhaps most importantly to this story, he is a runner, and he has relied on running as a measure of his recovery progress.

At the recent Army 10-miler this wounded veteran was stopped and removed from the race three times by security guards. Granted, he did not register for the race. As he noted, sometimes you register, sometimes you don’t, but in 25 years of running both military and civilian races he had never been removed just for running in a race. If you fail to register your time is not official, you do not get the photograph at the finish line, and you are out the ‘official’ race shirt. He did not show up to the race for any of these, just for the recovery affirming joy of running with fellow warriors.

In the Army 10-miler the year before he had not registered (after being blown up) and he ran the race course without incident or conflict. He notes that the military security was just following their orders and that he should have registered. That said, he asked me a question that struck home, “Do they honestly expect a guy/girl with a traumatic brain injury to remember to register six months in advance?” He went on to express his concern about turning away a young injured warrior who has had their life turned upside down and does not have the outward scars to show for it. I am assuming my friend’s experience was likely related to some new security policy governing the race. This ‘security’ decision likely did not account for these finest citizens, without the clear marks of a wounded warrior, who may not yet have the maturity level or mental capacity not to be crushed by this rejection.

Admittedly, I do not have all the facts surrounding my friend’s story but his experience did not meet my standard of common sense and offended my sense of fairness. Is there really a threat from a guy with military identification in running clothes who just wants to unofficially run the course? Is some other person being hurt or offended in some way? Would the answer have been different if he had been in a wheelchair or had a prosthetic arm? Rhetorical questions certainly, but they illustrate a point. I, for one, believe this new policy needs another re-think by the organizational leaders. No warrior, regardless of his condition or status, should ever be stopped from joining his comrades in a military sponsored run.

As federal medicine providers we must always be aware of these issues in our patients. Not all the wounded necessarily carry the ‘red badge of courage’ that comes from obvious external signs of battle trauma. Though not as apparent, the lifelong impact of post traumatic stress, mild traumatic brain injury, chronic pain, and other injuries is no less challenging to these warriors. Like warriors with prosthetics, the journey towards recovery for these wounded warriors often takes a lifetime. I am always inspired by the amputee who can overcome the challenge of a lost limb and now runs or turns a door knob. We should be no less inspired by those who accomplish similar goals with less obvious, but no less onerous, injuries. Federal medicine providers must help our leadership understand the special burden wounded warriors who have no external marks of war often contend with.

We certainly cannot afford to judge our patients from just their outward appearance now that we understand so much about the devastating wounds that leave no mark on the warrior’s ‘book-cover.’