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For two years Elizabeth Bowen watched her husband, Ryan, endure more than 40 surgeries, frequent nightmares and the devastating effects of Post Traumatic Stress Disorder.

Two years of a recovery that never seemed to follow a straight line.

So when her husband called distraught from a hotel room near Fort Stewart, Ga., she knew what to tell him: Go to the base hospital.

It was Oct. 26 and Ryan already had been in Georgia for six weeks, much of it spent waiting for word from the Army medical board that would determine his level of disability for injuries he received when a roadside bomb exploded under his tank in Baghdad during his second tour.

The 24-year-old Army specialist had just said goodbye to friends heading to Iraq for a third tour. "Some of these guys I've known since the first time," he said.

Back in his hotel room, his mind began racing. He started pacing, hyperventilating. Then he began to cry.

After talking to Elizabeth, he called a friend. The soldier, just days away from leaving the Army, gave him a choice. He could go to the hospital — or go to the bar.

There were countless nights over the past two years when that choice was no choice at all. Alcohol was his great escape.

But this time was different. This time Ryan Bowen chose the hospital.

"I didn't want one of those nights where I broke everything in the hotel or hurt myself," he said.

Sept. 16, 2005

Bowen was the gunner in the last of three M1A1 Abrams tanks patrolling a dangerous section of Baghdad. "There are two guys behind the berm. Keep an eye on them," barked a soldier in the first tank.

The first two tanks passed safely. Bowen's didn't. He awakened in the dirt, pinned beneath a critically wounded soldier.

Bowen, a 2001 Tecumseh High School graduate, was seriously injured, too — with a lacerated liver and a compression fracture in his back. But he was aware enough to know he didn't have on protective body armor. And he had no weapon.

"I was thinking, 'I can't afford to get shot,' " he recalled. "I was talking to myself the whole time: 'You're going to live. You're going to live. Everything is fine.' "

Despite a large shrapnel wound to his left thigh, he was able to move behind a chunk of the destroyed tank. As he scanned for insurgents, his leg gave out. For 10 minutes, not sure of what was around him, he played dead.

Finally, Bowen heard the voice of a soldier who had been in one of the other tanks. They'd returned to help the wounded.

The soldier who landed on top of him lost his right arm and leg and suffered a brain injury. Two other men in the tank died.

Just five days earlier, Ryan and Elizabeth, then 20, said goodbye after he spent two weeks of R&R in the Miami Valley, where the couple celebrated their second wedding anniversary.

They had arranged to chat online at 8 a.m. her time using Webcams.

When Ryan didn't show up online, she said, "I had a sick feeling all day."

Coming home

Elizabeth Bowling and Ryan Bowen were high school sweethearts. He was two years older but they shared the same homeroom because it was done alphabetically. He sat right in front of her.

They married on his birthday — Aug. 29, 2003 — after he returned from his first tour in Iraq. Like so many other young men and women, the terrorist attacks on 9/11 "sealed the deal" for Bowen. He enlisted and was sent to Fort Knox, Ky., for basic training.

Elizabeth had no training for what she was about to endure.

On the day her husband nearly died, she didn't hear from him for about 12 hours. When he finally called after 7 that evening, he was heavily sedated — and in Balad. There he underwent surgeries for a perforated liver and ruptured kidney, then spent 11 days at a military hospital in Germany. Elizabeth wouldn't see him again until he was moved to the U.S. Army Garrison at Fort Gordon, Ga.

His medical problems were far from over. His damaged liver developed pockets of infection, causing bile to leak into his stomach — a problem that initially went undetected. Feeling her husband would be better off home in Fairborn with family nearby, she worked to have him moved to Wright-Patterson Medical Center.

She credits Wright-Pat doctors with saving his life.

"As soon as he flew up here, Dr. (Heath) Dorian tapped on Ryan's stomach and said, 'That's fluid,' " she recalled. "The next day he drained five liters of bile out of Ryan's insides."

Surgeons put two stints in his liver to stop the leaking bile, which had entered his chest cavity.

From that first surgery through this past July, Bowen underwent 40 surgeries at Wright-Patterson, an unusual arrangement given that Bowen isn't in the Air Force. "Normally, we would not see an Army person assigned to an Air Force facility for two years," said Lisa Kliebert-Witt, a public affairs spokeswoman for the 88th Medical Group at the base.

Even Col. Thomas Palmer, the medical center's deputy commander, got to know the young soldier well.

"He'd always come down there and ask if I needed anything," recalled Bowen, who was awarded the Bronze Star Medal and Purple Heart. "One day I was joking around about the little TVs because I couldn't see that good. My eyesight was blurry. And I woke up from one surgery and there's a big TV right there, with a remote."

But the two years Bowen spent moving toward medical retirement would be marked by frustration with long bureaucratic delays, missed Army paychecks and frequent changes in mental health doctors — many of whom would have to leave on their own overseas deployments.

Bowen and his wife would see the best of the military system and the worst.

And military officials would see the worst of him.

Classic symptoms

Some call it the invisible injury.

Post Traumatic Stress Disorder, or PTSD, can cause "significant distress or interfere with work or home life," according to the National Center for PTSD.

Twelve percent to 20 percent of military personnel who serve in Iraq suffer from the anxiety disorder, the center estimates.

At Wright-Pat, PTSD treatment became "a huge portion" of Bowen's care, Dr. Greg Haack, an internist who was Bowen's primary care physician, said last week. "The PTSD is the overriding issue for his current and future care."

Bowen displayed classic symptoms: Trouble sleeping. Sudden anger or irritability. Difficulty concentrating.

Nightmares haunted his sleep. In one recurring dream, he was being shipped back to Iraq and had to argue with his commanders that he couldn't go because he was injured.

Elizabeth said Ryan would sometimes go days without sleeping. Doctors prescribed Seroquel, a powerful sedative. He was also on antidepressant Zoloft. Even so, she watched him spiral into a deep depression. It fell to her to get him out of bed in the morning, and to make sure he was taking all his medications.

Bowen began drinking more, often during the day while his wife was in Springfield, where she worked as a pharmacy technician. "I never had nightmares when I was drunk," he explained.

Elizabeth's grandmother, Cyrena Henson of Fairborn, was disturbed by the changes she saw in Ryan. The "pleasant, happy-go-lucky person" she remembered had lost his sparkle.

"You can tell he's in a very depressed state of mind by the way he talks," she said. "He's a very sad person and that's not Ryan. That's not Ryan."

On Feb. 2, 2007, Bowen's psychiatrist noted that the soldier had "long periods off Zoloft which lead to increase in depression, irritability, and re-emergence of PTSD symptoms."

Eight days later, the soldier snapped.

Feb. 10, 2007

Elizabeth tried shaking him about 2 a.m., thinking he was having another bad dream.

"He wasn't waking up so it scared me," she said. "When I finally did get him awake, he got really, really angry and it didn't seem like him."

Ryan stormed off. "Five minutes later, he comes in with a great big bucket of ice cold water and dumps it on me in our bed," she said.

It wasn't over. For the next three hours, he went on a rampage, swinging a hammer and destroying everything in sight throughout their trailer. "I mean everything," Elizabeth said. "Every dish. Every glass. Everything out of our refrigerator. He threw eggs at me."

He stopped only after downing 12 Trazadone tablets, an antidepressant/sleeping pill. He collapsed on the shattered glass covering the bed.

About 8 a.m., while her husband slept, Elizabeth drove to the base medical center's emergency room.

"They told me they couldn't send anybody out," she recalled. Base officials later told her she should have called 911.

"At the time, it didn't cross my mind," she said.

Mental health officials, fearing for her safety, encouraged Elizabeth to move out.

"I was devastated," her grandmother recalled. "I was frightened for her and I was frightened for Ryan."

The couple separated for six weeks and began seeing a counselor at the Family Advocacy Center on base.

Bowen got a part-time job filing records at the base medical center.

The incident proved to be a turning point. He says he regrets what he put his wife through but had been "on edge" for so long.

"To be honest, in a weird way, I'm glad that I did it because it relieved some stress, like it was just built up," he said. "The first time I went (to Iraq) I bottled everything up."

A fresh start

Bowen cleaned up the mess he made in the trailer, and by summer he had made progress repairing his marriage.

The Bowens put most of the $75,000 in insurance money he received for being wounded toward the purchase of a four-bedroom home in Fairborn, five minutes from the base.

"It just seemed like a perfect opportunity for us," Elizabeth recalled.

Bowen had just undergone his 40th operation at the base: plastic surgery to reduce a small jumble of scars on his forehead and the larger ones on his abdomen. He began wearing his uniform to work, maintaining an outward appearance of a typical, healthy soldier.

But he was anything but healthy. Back pain, a lingering injury from the tank explosion, made it painful to stand in place for more than 15 minutes. Bowen said he was now on "so much narcotics it would put down a horse. I can't be on that medication the rest of my life."

At Wright-Pat, he talked to a surgeon about the possibility of a risky spine-fusion surgery. The surgery was initially scheduled for Sept. 14, but was put on hold, with the surgeon wanting him to get a second opinion.

Bowen began acting up again, battling with his supervisor and missing important appointments. Frustrated base officials gave him two appointment lists — one to keep in his pocket; the other to keep at home. And they gave one to Elizabeth.

He received written warnings for back-talking.

"They gave me five of those in a week," said Bowen, recalling how he argued with his supervisor about having to work more than the 12 hours per week his back surgeon suggested.

In September, Bowen missed another appointment, this time with a new mental health doctor.

"They got really, really upset," Elizabeth recalled, "and that's when the talk of Fort Stewart came along."

Palmer, the medical center's deputy commander, denied Bowen was sent to his home Army base in Georgia to get him out of the Air Force's hair. Bowen, he said, needed to appear in front of the Army's Medical Evaluation Board before his medical retirement could be processed.

"I told him before he left, 'I don't know how long it's going to be,' " Palmer said. "It's the Army; your guess is better than mine."

Back to Georgia

It didn't take Army doctors long to confirm the Air Force's diagnosis: After two days of tests, the medical board found Bowen had 14 "medical conditions/defects." Among them: PTSD, depression, back and spinal pain, burns on his right tricep and continued pain in his left leg.

Bowen would spend nearly eight weeks at Fort Stewart. He was initially placed in an empty barracks room, later renting a hotel room that charges soldiers $5 a day. After the tests, the Army had little contact with him.

"I felt like Fort Stewart forgot about me" when I was in Ohio, he said. "And then I get to Fort Stewart recently and it's like Wright-Pat is just trying to get rid of me. I was like, nobody cares. Everybody wants me out."

Bowen was feeling more alone by the day. One of his close friends was leaving the Army, and the unit he served with, Charlie Company 4th Battalion, 64th Armor Regiment, was heading back to Iraq.

It was after the goodbyes and the hugging on the day they left — Friday, Oct. 26 — when Bowen wept in his hotel room and dialed the phone to his wife.

"I felt that rage that she witnessed," he recalled of the night he destroyed their trailer.

As he waited for his ride, Bowen wrote a letter to the attendants at the base hospital. He wanted them to know what he was feeling. When he arrived at the emergency room, "I slipped it under the door and they read it."

The letter told how he had just said goodbye to "all my guys" heading back to Iraq. That he was having an anxiety attack and knew the symptoms because he's had them before.

And that the last time he had destroyed his home.

He was admitted.

Nov. 11, 2007

Sixteen days after Bowen checked himself into the base hospital at Fort Stewart, he rose with other veterans — young and old — to great applause from the congregation during Sunday morning services at the Lake Avenue Christian Church in New Carlisle.

It was fitting because it was Veterans Day. It was also fitting because this congregation helped bring him home.

Two weeks earlier, Senior Minister Randy Warner announced during church services that Elizabeth was heading to Georgia to be with her husband. Members pitched in on the spot, donating money to fly her down and cover her lodging.

In Georgia, Elizabeth and Ryan met with base officials, and they agreed to let him use whatever leave he had left. The couple drove home together, arriving on Nov. 6.

As the congregation stood to pay tribute to the dozen or so veterans five days later, Warner singled Ryan out.

"You all know the struggle Ryan Bowen has gone through," he said. "He's still in the battle and needs our support."

Later, Bowen was invited downstairs to the church basement, where children — ages 4 through sixth-grade — spent the previous half-hour creating a long thank-you banner, stamped with their hand prints.

"If ever you're feeling alone, this is a wall of hands saying thank you," Heather Fleck, the children's director, told him.

After his leave ends Monday, Bowen will remain in Ohio, checking in daily with his staff sergeant in Georgia. When his medical retirement papers are finalized, he will sign them at Fort Knox, the nearest Army base.

Where he started his training, he will end it. "Six weeks after I sign them, I'm a civilian," Bowen said.

Technically, he'll be placed on the temporary disability retired list. He'll continue to be evaluated over the next five years to see "if his injuries are getting better or worse. At the end of the term, they'll adjust his disability percentage on how that's changed," said Army Maj. Robert McRae, who oversees the Warrior Transition Unit at Fort Stewart.

Bowen is already making the transition to the Dayton VA Medical Center for his care. As for a career, he hopes to use the GI bill to pursue a degree in nutrition at the University of Dayton.

Elizabeth knows the struggle isn't over.

"I'm just scared," she said. "We've never been through this before."

But, she added, "To me, I feel blessed he's alive. No matter how he came home to me, he's alive. By him getting injured, he will never have to go back to that country again.

"That makes me feel very good."

Contact this reporter at (937) 225-2094 or mkissell@DaytonDailyNews.com.