Sgt. Patrick Cummings suffered his second traumatic brain injury when a 155mm shell exploded midbarrel as he and other soldiers fired a howitzer against the Taliban. The blast should have killed everyone within a 100-yard radius, but here was Cummings, sitting on a table at the All American Tattoo Company outside Fort Campbell, spending his Valentine's Day night alongside two fellow soldiers who also survived the blast.

The tattoo the men will share memorializes the searing experience they shared, a time-honored military tradition for commemorating brushes with death. But a new deadly danger has been waiting inside Fort Campbell for those preparing for or returning from war, an epidemic of suicides that has shown how ill-prepared the military is to deal with the psychological and emotional injuries of nearly a decade of conflict.

"The problem is you are drilled on these tests from boot camp, 'Suck it up. Be a soldier,'" said Kat Cummings, who accompanied her husband to the tattoo parlor. "They come home, they went through their surgery, the very last thing they thought about was counseling for what they went through," she said. "I understand why these guys are knocking themselves off."

Home to the 101st Airborne, the Army's most often deployed contingency force, Fort Campbell sprawls across 106,000 acres of western Kentucky and Tennessee. The base and its inhabitants bear the scars of nine years of constant warfare, the air thick with equal measures of adrenaline and trauma, soldiers preparing for war, soldiers trying to recoup.

For many, it's too much.

Since 2006, 51 Fort Campbell soldiers have killed themselves, including three from Minnesota. The 21 suicides by soldiers serving here in 2009 were the highest of any base in the Army, prompting an emergency three-day shutdown by alarmed commanders.

During past periods of war, suicides were considered a cost of doing business for the military. Today, everyone at Fort Campbell recognizes they instead pose a crisis, said Joe Varney, who has been put in charge of a new suicide-prevention program at the base. "Once we got engaged in a two-theater war, back-to-back deployments, the stress and strain started to manifest itself," he said.

Under Varney's direction, Fort Campbell is the tip of the spear for a new fight, a proving ground for suicide-prevention programs. Varney is the military's first full-time suicide-prevention program manager and Fort Campbell has created a clinic, unique in the Army, to treat, track and monitor high-risk soldiers. The clinic has hired 50 care assistants, who interview returning soldiers and direct troops to further counselling or back to their unit based on how they answer questions about their mental health. New arrivals at the fort and family members on base are given handfuls of mental health literature and enough magnetized confidential numbers to cover a refrigerator. When 270 soldiers recently returned from a yearlong deployment, the weeklong program they were required to attend mentioned suicide 23 times.

The military and the community surrounding the base have become involved in soldiers' lives like no other employer. Clinics make sure unit leaders know when a soldier misses a medical appointment. Soldiers considered at-risk are contacted while on leave. After many suicides, the base conducts a "psych autopsy," interviewing family members, neighbors and commanders to see if there is a pattern or a red flag that was missed.

"High risk potential is now tops on our list,'' said Maj. Gen. Francis J. Wiercinski, until recently Fort Campbell's acting senior commander. "We're starting to identify that before people redeploy. By the time they come back, we've already got an idea. We don't single people out or make them feel like they are different, but we try to focus and watch."

But all the behavioral care providers and brochures cannot change some of the core elements of the stressful, adrenaline-fueled atmosphere on and around a military base that can make life seem intolerable - injuries, post-traumatic stress disorder, repeated deployments, financial strains, wives and children who've become strangers.

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'Completely different'

At places like the Woodlands housing complex inside Fort Campbell, Army families live in a world that might strike an outsider as a throwback to the '50s and '60s. Built within the last two years for higher-level enlisted soldiers and their families, the side-by-side duplexes look like a metro suburb. Pizza delivery drivers make their way through the winding streets at dinner time, and toys and ATVs take up spots on driveways. Children wander from house to house, searching for playmates, and it's assumed someone will always look out for them.

Behind almost every front door live anxieties and demands that anyone outside this world might find difficult to comprehend, let alone live with.

Lauren Williams, whose husband returned from Afghanistan in February as a flight medic, qualifies for food stamps because of the relatively low pay of a soldier with the rank of specialist -- $23,000 to slightly under $28,000 a year, depending on experience.

After three deployments to Iraq, two to Korea and one to Kuwait, Amy Blackston has calculated that she and her husband have been together only five of the 11 years they've been married. During her husband's last deployment, her parents moved to Clarksville from Georgia to help with her five children. She was an Army medic herself before giving up her military career after the birth of her third child. When she and her husband were deployed to Iraq, they signed over guardianship of their two oldest children to her parents. By the time she and her husband returned, the kids didn't know who they were.

"When I experienced that, I was, like, 'I'm done,'" she said.

About a year and a half ago, a soldier in the same unit as Blackston's husband became mentally unstable and fired an entire clip of bullets into his wife, killing her. A few months ago, a soldier in the rear detachment of Brandi Beattie's husband murdered his wife on post.

Williams said the stresses of multiple deployments manifest themselves in many ways.

"You're under the limelight, negative and positive, and that wears a toll on all of our husbands," she said. "They come home, and it's completely different than when they left."

The toll is so well understood that it's largely accepted in silence.

Beattie, whose husband is serving in Afghanistan, has started a Facebook page called Diapers and Deployments as a way to connect with other families in the Fort Campbell community. The links have proved invaluable, not just for trading shopping tips or setting up a play date, but also for when something bad happens far away. When the phone calls, texts and e-mails from overseas suddenly stop, one wife will call another to see if that couple is still in touch. If a chain of calls reveals that no one has had contact, they know there has been a casualty or injury and the base is on blackout.

"Somebody is hurt, you already know that,'' Beattie said. "As selfish as it is, you just sit down and you pray it's not your soldier."

As much as 25 percent of Clarksville attorney Michael Williamson's practice consists of handling disputes related to soldiers from Fort Campbell, from divorce and child custody cases to property troubles. Williamson has filed divorce papers against soldiers he's never met; the paperwork comes back from a combat zone, signed. The case of one of his clients, an Army captain sent to Afghanistan, is an example of how muddy domestic life can become in the military. The captain's wife took the couple's 3-year-old daughter home to Alabama and the captain is struggling for shared custody. The wife claimed in a deposition that she discovered him one night crawling around the couple's house, thinking he was hunting for the Taliban. She maintains he suffers from PTSD. The captain produced paperwork from the Army saying he doesn't suffer from the stress disorder, but the wife's attorney is claiming the Army is covering for him.

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Fort Campbell and next-door neighbors Clarksville, Tenn., and Oak Grove, Ky., are inextricably linked. With 23,000 workers, the base is the largest employer in both Kentucky and Tennessee.

Since 2009, 35 percent of the suicides among soldiers based here have occurred in the cities surrounding the post; 35 percent have occurred elsewhere while soldiers were on leave; 16 percent have occurred in a combat zone, and 13 percent have occurred on base.

Clarksville's leaders walk a fine line between demanding soldiers toe the line in town, and knowing that the town plays a critical role in spotting and throwing a lifeline to struggling soldiers. Clarksville Police Chief Al Rivers Ansley meets quarterly with base commanders, exchanging information about trouble spots in town that may have to be declared "off limits" to soldiers. A former member of the military himself, Ansley said it's not uncommon for his cops to give a ride home to a drunken soldier who hasn't committed a crime or to contact the base when they respond to a call involving a soldier.

"This is a military town, many of us are ex-military, so I have a strong bond for what they do, and I respect the fact that the general wants to hold his people accountable, cares about them, doesn't want them to get in trouble," Ansley said. Police "have to understand what some of these guys have been through," he adds.

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No Army of One

On a recent overnight shift in the district that abuts Fort Campbell, Clarksville police officer Keith Jones responded to a report of people smoking pot in a pickup outside a house shortly after beginning his 7 p.m. to 7 a.m. shift. Cops pulled the truck over after a short chase. Inside the cab, police found marijuana seeds, several bullets and an empty magazine for a semi-automatic rifle. The driver didn't have a license. One passenger was on probation. The other passenger was a 20-year-old woman, pregnant. The truck belonged to her husband, a soldier on a deployment.

Police Sgt. Dave Gailbraith, a former Army master sergeant, said the scenario was typical of the scenes that confront police, and sometimes returning soldiers.

"The guy comes home from war, his wife is pregnant and it may or may not be his. Maybe his checking account is cleaned out. Maybe someone new is sleeping in his bed and wearing his clothes. You think those are the kinds of things that would lead someone to hurt himself?"

On another call, the wife of a deployed soldier had returned to their Clarksville home to find the front door kicked in.

Jones, who has been with the department three years, is one of the few members without military experience. But his wife is a supply sergeant on base with a deployment to Iraq scheduled. His first week of solo patrols brought his first dispatch to a military suicide, a soldier recently returned from a deployment, drunk and despondent over the friends he'd lost. Friends took one gun from him but didn't know about the other he kept.

"It was definitely a life-changing event for me, something that no one can be prepared to see," Jones said.

While suicides are down on the base so far this year, the Army doesn't know if that's due to its new efforts or the simple fact that so many soldiers are away at war. As many as 24,000 soldiers are expected to return to Fort Campbell from Afghanistan and Iraq by the end of the year.

At Fort Campbell, Army leaders now believe that part of the answer lies in teaching soldiers that sucking it up is no longer the time-honored tradition it has been for centuries.

The short-lived "Army of One" recruiting slogan has been replaced on the base with posters that vow "No Soldier Stands Alone."

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'Band of brothers'

Despite the Army's efforts and its use of the latest in technology, there is no simple test that can predict when a soldier will commit suicide.

"But we can see people having problems at home, people having problems with their finances," Varney, the suicide-prevention coordinator said. "We can see people showing up late to work. We can see people living their entire weekend for the sole purpose of getting drunk. If we can educate our community that these are the key warning signs that an individual is at risk, I sincerely think that we can save lives."

Back at the All American Tattoo Company, the finishing touches were being put on Sgt. Cummings' arm. It combined an eagle, an American flag, the Japanese symbol of the 101st's Third Brigade Combat Team, and these words: "We few, we happy few, we band of brothers. For he today that sheds his blood with me shall always be my brother."

Mark Brunswick • 612-673-4434