I spent a few days at Landstuhl recently, one of a group of writers from the Writers Guild Initiative, part of the Writers Guild of America, East Foundation (Full disclosure and just to add to the confusion: I’m president of the Writers Guild, East, the union with which the foundation’s affiliated).

For the last four years, the foundation has been conducting writing workshops. The project began with professional writers from stage, TV and movies mentoring veterans from the Iraq and Afghan wars, working with them on writing exercises and projects ranging from memoirs and blogs to children’s books, screenplays and sci-fi novels. Recently, in collaboration with the Wounded Warrior Project, the foundation started similar workshops with caregivers, the loved ones of veterans helping them through the aftermath of catastrophic injuries.

Now, Wounded Warrior had asked some of us to come to Landstuhl to meet with the medical staff there. Some 3,000 strong, military and civilian, they work ceaselessly in what has become one of the busiest trauma centers in the world, helping between 20,000 and 30,000 patients a year (not just from the battlefield, but also military and their dependents from all over Europe, Africa and much of Asia).

Landstuhl is where the victims of the 1983 bombing of the U.S. Marines Corps barracks in Beirut were brought; Bosnian refugees from the Sarajevo marketplace bombing in 1994, too, wounded from the American embassy bombing in Kenya in 1998 and the 2000 attack on USS Cole. During the first Gulf War, more than 4,000 service members were treated at Landstuhl, as have been men and women fighting in the Balkans and Somalia. Since 9/11, the hospital has treated coalition troops from 44 different countries.

They compare this hospital to the center of an hourglass; it’s the midpoint between a combat injury and treatment in the field and then subsequent care back in the States or other home country. Or it’s where a service member is treated and then sent back into battle.

The staff at Landstuhl sees the wounded at their worst. Many who arrive suffer from multiple injuries – “polytrauma” so extensive that several teams of surgeons with different specialties – neurological, thoracic, ear and eye, facial reconstruction and orthopedic, among others — may work on an individual patient, often simultaneously. Bodies are blown apart or crushed by IEDs, grenades and suicide bombs, but so skillful are the medical teams there, so advanced the techniques and technology, Landstuhl’s survival rate runs as high as 99.5 percent. (The survival rate among American wounded in World War II was 70 percent.)

But all that success takes a toll. One of the little discussed but potent side effects of war is what’s called combat and occupational stress Rreaction or secondary traumatic stress disorder. Compassion fatigue.

After all the years of fighting in Iraq and Afghanistan, many of the doctors, nurses and other staff at Landstuhl are exhausted or worse. Given what they’ve seen — the horrific wounds and amputations, the infection, agony and grief – some walk around “like zombies,” one therapist said. Feelings of empathy and kindness yield to loneliness, despair and burnout.

Many of the compassion fatigue symptoms are similar to post-traumatic stress disorder  – physical effects like headaches, gastrointestinal problems, reproductive troubles, as well as mental  — nightmares, flashbacks, anxiety, emotional distance, isolation and more.

Working with physically damaged men and women who are so deeply traumatized rubs off. The emotional rawness is contagious. A hospital handout on PTSD understatedly reads, “When life-changing events occur, perceptions about the world may change. For example, before soldiers experience combat trauma, they may think the world is safe. Following combat, a soldier’s perceptions may change — a majority of the world may now seem unsafe.”

That’s why returning vets may reflexively search alongside a U.S. interstate highway for roadside bombs, only shop at Walmart at 3 in the morning, or worry to excess that their children’s school will be attacked by terrorists. And it’s why after hearing the stories of their patients, reliving the horrors of war, watching them endure pain and sometimes countless operations, medical practitioners can suffer from the same fears — whether it’s the surgeon who heals the wounds, the psychiatrist who probes the mind for the source of anguish or even the clean-up staff decontaminating and removing the blood from surgical tools.

Combine that with homesickness, the high operational tempo of Landstuhl, the low tolerance for mistakes, the downtime when the mind takes over and remembers every awful experience. It’s a dangerous, often unhealthy mix.

And so, on a Saturday morning, we writers sat down with a bunch of men and women who work at Landstuhl and other nearby medical facilities. There were 14 of us and t32 or so of them. We broke into small groups – two writers working with a group of two to four hospital staff.

My colleague Susanna and I mentored four – a male Army nurse and a female Navy nurse, a physical therapist and a developmental pediatric psychiatrist. We weren’t there to interview or pry; they would tell us what they wanted us to know when they wished, their stories slowly emerging from conversation and the brief writing exercises we gave them.

The male nurse had been in Special Ops, the Navy, Marines and Army; he was reluctant to talk of what he had experienced but wanted to examine themes of good and evil in an epic novel. The physical therapist told us she wanted to explore the mind-body connection, perhaps with a blog; the Navy nurse spoke of her feelings for the soldiers she took care of from the Republic of Georgia, the former Soviet state, now independent. (By the end of the year, Georgia, aiming at membership in NATO, will have some 1,500 troops in Afghanistan.) She had learned how to bake for them the Georgian national dish, khachapuri, a cheese-filled bread; now she wants to write a cookbook.

For two days, we talked and they wrote, we recommended books and movies, they told us about the ones they loved. Tears were shed as stories and memories came to the surface, many too private to relate here. Over the coming weeks and months, we’ll stay in touch via email and meet again; trying to be of assistance as they write to express their thoughts and feelings, to tell their stories.

Do the workshops help? Hard to measure, but intuitively it feels as if they do, that in the talking and writing comes self-awareness and some measure of equanimity. And selfishly, for those of us who serve as writer-mentors, the benefits are enormous and fulfilling.

But the statistics are alarming. According to NBC News, “The Pentagon counts more than 6,300 American dead and 33,000 wounded in action in Iraq and Afghanistan. A Rand Corp study estimates that as many as 300,000 post-9/11 veterans suffer from PTSD or major depression, and about 320,000 may have experienced traumatic brain injuries, mainly from bombs.” The number of civilian fatalities in Iraq and Afghanistan remains uncertain but a Brown University study last year reported at least 132,000.

Meanwhile, there are still nearly 90,000 American troops in Afghanistan.  More will die and be wounded. President Obama has pledged their complete departure in 2014.

But even after that, the work at Landstuhl will go on. There are still nearly 300,000 American military personnel overseas, plus family members. Landstuhl will take care of many of them. And, says one of the hospital’s surgeons, with a sigh of resignation, “There will always be the Middle East.”

Her junior coalition partners the Free Democrats did manage an impressive comeback, securing a surprise 8 percent and managing to return to the state parliament thanks to its dynamic leader in the state, Christian Lindner. However, the disastrous performance by the CDU will allow the Social Democrats and Greens to form a stable coalition, after operating as a minority government for the past two years.

The SPD won 39 percent of the vote in what had been its traditional heartland, largely thanks to the huge popularity of its leading candidate, state governor Hannelore Kraft. The Greens only fell back slightly, down from 12 to 11 percent, a relief given the strong showing of the Pirates who stormed into their fourth regional parliament after securing almost 8 percent. The post-communist Left Party only attracted just over 2 percent, compared to over 5 percent in 2010, and thus failing to enter parliament.

North Rhine-Westphalia is often a strong indicator of the national mood. When former SPD Chancellor Gerhard Schroeder suffered a defeat there in a state vote in 2005 he called an immediate snap general election, which paved the way for Merkel’s rise to power.

Now, seven years later, could the bruising defeat in that state again be a harbinger of change at the federal level?

Even though the CDU had been braced for defeat on Sunday, the extent of the drubbing left the party reeling. “We have been bludgeoned,” said Peter Altmaier, the CDU’s chief whip in the Bundestag, on Sunday.

Their campaign had been a disaster, with their leading candidate Norbert Roettgen infuriating voters by failing to commit to giving up his current job as federal environment minister to lead the state opposition if the CDU were defeated. As such yet another possible internal rival to Merkel has been eliminated. Yet this also signals a defeat for a man who represented the moderate center of the party, and particularly for a possible coalition with the Greens.

While the CDU in North Rhine-Westphalia are left to lick their wounds, Merkel and the party strategists in Berlin will have to assess the vote’s significance for the party’s chances of holding onto power after next year’s federal election.

The party had been working on the assumption that the FDP would continue to implode and that the CDU would need to form a new alliance either with the SPD or with the Greens, who it was assumed would fail to muster enough support for a coalition of their own.

Now the victory in a state that is home to one in four Germans points to a possible resurgence of the SPD and Green alliance. However, it might be unwise to assume that the parties could achieve a similar result on a national level and revive their coalition of 1998-2005.

After all much of the victory on Sunday is being attributed to the successful duo of the SPD’s Kraft and the Green party leader and deputy governor Sylvia Loehrmann. The two women worked extremely well together, managing to form alliances with the other parties on a range of issues, and seemed to present a less harsh, more socially oriented governing style. “We put people at the heart of this election campaign,” Kraft said on Sunday.

The SPD at a national level is far less popular, and it has still not decided who will challenge Merkel at the next federal election. The current troika of leaders, Peer Steinbrueck, Frank-Walter Steinmeier and Sigmar Gabriel lack the common touch and warmth displayed by Kraft. They are also more associated with the severe welfare cuts and labor market reforms of the previous SPD-led government, which alienated much of the party’s traditional base.

While Kraft is increasingly being touted as a possible rival to Merkel in 2013 based on her triumph on Sunday, she has so far insisted that she has no desire to switch to federal politics.

Nevertheless the North Rhine-Westphalia election has given both the SPD and Greens a much needed boost. The SPD suffered its worst ever election defeat in the federal election of 2009, attracting only 23 percent of the vote and it has struggled to make headway against the ever popular Merkel.

Their strong performances both in North Rhine-Westphalia and in Schleswig-Holstein the previous week could encourage the opposition to be more forthright in demanding more concessions from Merkel when it comes to her austerity policy in Europe.

Merkel needs a two-thirds majority in the Bundestag in order to ratify the so-called “fiscal compact” which would see EU states commit to strict budget discipline.

The SPD and Greens, already emboldened by the victory of Socialist Francois Hollande, are demanding that the vote be delayed until the French and German leaders agree to some form of growth package to complement the fiscal rectitude ordained by the pact. While the SPD and Greens have largely backed Merkel’s euro policies, they are increasingly complaining that concentrating on austerity alone is not only failing to cure the euro zone’s ills but proving to be counter-productive.

While Merkel has insisted that no more debt can be taken on as part of any growth package, Hollande’s victory and the defeat in North Rhine-Westphalia may prompt her to show more flexibility on going beyond strict austerity in Europe. However, she has insisted that any growth strategy cannot be achieved by taking on more debt and she will not see the pact itself renegotiated, considering that it has already been ratified by a number of countries as is up for a public vote in the Irish referendum on May 31.

What remains to be seen is whether Merkel’s clout in Europe will be affected by her party’s election debacle back home.

After all, the austerity versus growth debate was very much a part of the North Rhine-Westphalia campaign, with the CDU campaigning on the merits of belt-tightening and budget consolidation, while the SPD and Greens advocated a looser approach to state finances.

Kraft’s government had fallen over its budget, which envisaged taking on more debt in order to help out cash-strapped cities dealing with the long-term effects of post-industrialization in a state which has a long tradition of steel production and mining. Roettgen had sought to portray the SPD and Greens as profligate spenders, not unlike the much maligned southern Europeans. In North Rhine-Westphalia at least, it seems German voters were happy to see the purse strings eased.

Nevertheless, polls still show that over 60 percent of Germans do not want growth policies in Europe to involve taking on more debt. And around the same number approves of Merkel’s firm handling of the euro crisis.

Yet, that popularity it seems is not translating into support for her party, despite a relatively strong economy and the lowest unemployment levels in 20 years. And if the euro crisis starts to really impact the German economy, then Merkel’s own popularity, never mind that of her party, could rapidly evaporate.