Grunt (12 page)

___________

*
In the same way amputees feel phantom pain in the space where the arm or leg once resided, penile amputees sometimes feel phantom pleasure. This, and phantom erections, were first described by the coiner of the phrase “phantom limb,” Silas Weir Mitchell. What gave Mitchell his particular expertise? He worked with Civil War amputees at the “Stump Hospital” in downtown Philadelphia.

Oh, for the titular economy of yesteryear. The Stump Hospital is gone and in its place we have the likes of the Veterans Affairs Center of Excellence for Limb Loss Prevention and Prosthetic Engineering. Though all is not lost. We still have a Foot & Ankle Center in London, a Breast Clinic in New Delhi, a Kidney Hospital in Tehran, the Face & Mouth Hospital in Calcutta, New York’s Eye and Ear Infirmary, and the Clínica de Vulva in Mexico. The poor penis has no hospital to call its own.

†
An exception is made for Dr. H. W. Bradford, who, for cosmetic purposes, transplanted a rabbit eye into the socket of a sailor who’d suffered a childhood eye injury. “The nature of the man’s calling,” wrote Bradford in the 1885 case study, “made it undesirable to use a glass eye.” I don’t know the precise occupational risks of the seafaring eyeball, but the prevalence of eye patches among pirates suggests they do exist.

Despite some clouding, the operation was deemed a moderate success. Though rabbits have larger pupils, their eyes are otherwise unnervingly similar to our own, as a Google Image search will quickly establish. I can’t recommend this activity, however, as the search results will include a photograph of a plastic-lined box captioned “Rabbit heads: no neck, no skin, with eyes. 100 grams each. Please contact me for price quotation.”

Carnage Under Fire

How do combat medics cope?

T
HE CALL TO PRAYER
can be heard from the Carl’s Jr. parking lot. You can hear it at the Wells Fargo drive-through and outside the offices of the San Diego County Water Authority. The attentive listener will notice that something is off. Rather than five times over the course of a day, you may hear it six or seven times in a morning. Other days it is absent. If, perplexed, you were to follow the sound, you would find yourself not at a mosque but at a spread of movie studios and sets known as Stu Segall Productions. By all means, knock on the door and have a look around.

Segall was born a Stuart, but on his movie credits and in my mind he is always and very much a Stu.
*
Chest hair can be seen, and some necklace in there. There are whiskers, sparse and longish, somewhere between beard and I-don’t-feel-like-shaving. He has a wife but spends more time in the company of Bob, an agreeable Rottweiler who naps on the black leather couch in his office. Segall dives in and out of careers with glee. Writing, directing, producing (most recognizably, the TV crime drama
Hunter
). He owns a diner next to the studio. He doesn’t cook, but occasionally he names menu items, and you can pick them out without too much trouble—for example, the Boob (chicken breast) Sandwich.

Early in 2002, with Hollywood’s appetite for action dramas dampened by the events of 9/11, Segall began repurposing his talent for gore and violence. He founded a company, Strategic Operations, to produce loud, stressful, hyper-realistic (the coinage has been trademarked) combat simulations for training military personnel: the fog of war, in a box. Many of the trainees are corpsmen (Navy medics who deploy with Marines and SEALs)—men and women whose job may require them to perform emergency procedures while guns are going off around them and people are screaming and dying and bleeding like garden hoses. The underlying concept is “stress inoculation.” If you’re thrown into a staged ambush in Stu Segall’s Afghan village mock-up, the thinking goes, you’ll be calmer and better prepared when the real shit hits overseas. For medics, being calmer matters a lot. The fight-or-flight response is helpful if you’re fighting or taking flight but, as we’ll see, fairly catastrophic if you’re trying to stanch the flow of blood from an artery or cut an emergency airway or just generally think fast and clearly.

Forty future corpsmen for the 1st Marine Division, headquartered in nearby Camp Pendleton, are here today as part of a combat trauma management course. Over the course of two and a half days, the trainees will administer pretend emergency care to role-players, most of them Marines, in six varieties of military pandemonium, beginning with an 8:00 a.m. insurgent attack in the Afghan village.

The village, the largest of Segall’s sets, consists of two dozen ersatz mud-brick buildings, a small market, a rusting swing set, and, until recently, goats. (The goats were dismissed, because someone had to come in over the weekend to feed them, and more often than not it was Segall.) To get close to the action, I requested a role. I will be playing myself: a reporter who gets in the way and distracts people from their jobs. They’ve placed me in a sparsely furnished two-room house with a seasoned medical role-player named Caezar Garcia.

Under a torn pant leg, Caezar wears a simulated skin sleeve—silicone encrusted with mock gore and plaster bone fragments. A simulated severed artery will bleed via a small pump connected to three liters of house-brand special effects blood that Caezar wears in a concealed backpack, a sort of CamelBak for vampires. The flow is controlled by a wireless remote, so it can be stopped or slowed or allowed to continue unabated, depending on how competently the corpsman has placed the tourniquet. Originally the instructors, who hover on the fringes of the action during scenarios, held the remotes. Caezar, wanting a more nuanced bleed, petitioned to control it himself.

“I said, ‘Look, once you bleed me out—’” Caezar stops to listen. The call to prayer has started. The recording, being played over a set of speakers on a tower at the center of the village, is the signal for the role-players and the pyrotechnics guy to take their places. Through a window to our left, the trainees can be seen entering the village. They walk in formation, armed and armored, looking unrelaxed. The tape-recorder muezzin finishes his call, and for a moment it’s quiet. I can hear the soft, plasticky thrum of Caezar’s blood pump.

And then I can’t. First comes the familiar high whistle of an explosive-powered projectile, a sound that, depending on your life experience, presages pretty lights in the summer sky or a rocket-propelled grenade explosion. Rifle fire follows. The ammo is blanks, but you wouldn’t necessarily know that, because the pyrotechnics guy sets off an accompanying “dust hit” on the ground or wall.

The muezzin’s voice has been replaced by a recording of whizzing, ricocheting bullet noises and panicked soldiers yelling. It sounds like it was a hell of a battle. (I asked Segall about it later. “Vietnam?” “
Saving Private Ryan.
”) You wonder what they make of it over at the Water Authority.

“OOOOOH, FUCK! AAAAAAOHH HELP ME!” That’s Caezar. He’s very good.

A trainee steps into the room. His gaze drops to the floor, to a foot, in a boot, nowhere near a leg. Bone and mangled flesh—the remnants of a lower leg, sculpted by “wound artists” working from photos of a real injury—protrude from the boot. The corpsman blurts out, “Are you okay?”

Years ago, crossing a street with my friend Clark, we looked down to see a smear of blood and feathers marginally recognizable as a pigeon. Clark bent over and yelled, “Are you okay?” The line is less funny now but equally ludicrous. A small blood lake expands on the floor. And here is where things go hyper-realistic: Unbeknownst to this corpsman, Caezar is an amputee.
†
He wears the silicone sleeve over the stump of his leg. When he jerks it around, as he is doing now, it trails an arc of blood. Blood is flying like champagne in the locker room after the big win.

Outside the door, instructors are yelling to get the other wounded “off the X”—out of sight, out of the kill zone. They’re dragged into the room adjoining ours. The floor is men: role-players on their backs and trainee corpsmen crouched around them. One figure stands out for being unusually barrel-chested. This is the Cut Suit actor. You may be familiar with “patient simulators” like Resusci Anne, upon whom first responders practice their skills. The Strategic Operations Cut Suit is a “human-worn” patient simulator. The actor dons a vestlike rib cage with an insert tray of abdominal organs and, over this, a kind of flesh-tone wetsuit—simulated skin that bleeds when it’s pierced, via the same pump-and-tube system Caezar uses for his stump. (It also “heals,” with help from the Cut Suit Silicone Repair Kit.) It’s as though someone crawled inside Resusci Anne and gave her the one thing patient simulators, for all their bells and whistles, will never have: humanity. SimMan may bleed and pee and convulse, his tongue may swell and his bowels may rumble, but he will never sit up, drill his gaze into a student’s eyes, and plead, as Caezar just did, “Get me out of here, this is a
bad
neighborhood, man!”

Today’s Cut Suit actor isn’t yelling, because his character has been shot through the chest and his lung has collapsed. He takes shallow panicky breaths while a trainee, whose uniform identifies him as Baker, gets ready to do a needle decompression. When a bullet or broken rib punctures a lung, inhaled air begins to fill the cavity that houses the lung. The air builds up and soon the lung can’t expand, and breathing becomes a struggle. It’s called pneumothorax, from the Greek for
air
and
chest
, and it is the second most common cause of combat death. Baker’s task is to insert a needle catheter to release the air and relieve the pressure. He’s sweating. His glasses slide down his nose. He holds the needle near the role-player’s collarbone, which is not between any of his ribs, or even part of the Cut Suit.

“Are you FUCKING SERIOUS, BAKER?” You know the exaggerated TV clich
é
of the scary yelling Marine instructor? It’s not exaggerated. “That’s his
clavicle.
You almost actually stabbed him.”

Presently the needle finds its mark, an occlusive bandage is applied, and the role-player is loaded onto a stretcher. Baker picks up the stretcher’s front handles without alerting the trainee at the other end, causing the patient and the $57,000 Cut Suit to tumble onto the ground.

“What the fuck is wrong with you, Baker?!”

Nothing, in fact. Just his sympathetic nervous system doing its job. Anything perceived as a threat trips the amygdala—the brain’s hand-wringing sentry—to set in motion the biochemical cascade known as the fight-or-flight response. Bruce Siddle, who consults in this area and sits on the board of Strategic Operations, prefers the term “survival stress response.” Whatever you wish to call it, here is a nice, concise summary, courtesy of Siddle: “You become fast, strong, and dumb.” Our hardwired survival strategy evolved back when threats took the form of man-eating mammals, when hurling a rock superhumanly hard or climbing a tree superhumanly fast gave you the edge that might keep you alive. A burst of adrenaline prompts a cortisol dump to the bloodstream. The cortisol sends the lungs into overdrive to bring in more oxygen, and the heart rate doubles or triples to deliver it more swiftly. Meanwhile the liver spews glucose, more fuel for the feats at hand. To get the goods where the body assumes they’re needed, blood vessels in the large muscles of the arms and legs dilate, while vessels serving lower-priority organs (the gut, for example, and the skin) constrict. The prefrontal cortex, a major blood guzzler, also gets rationed. Good-bye, reasoning and analysis. See you later, fine motor skills. None of that mattered much to early man. You don’t need to weigh your options in the face of a snarling predator, and you don’t have time. With the growing sophistication and miniaturization of medical equipment, however, it matters very much to a corpsman. Making things worse, the adrenaline that primes the muscles also enhances their nerve activity. It makes you tremble and shake. Add to this the motions and vibrations of a medevac flight, and you start to gain an appreciation for the military medic’s challenges.

On top of caring for the wounded, corpsmen are expected to return fire if no one else is able. Like any precision task, marksmanship deteriorates in high-stress situations. The average police officer taking a qualifying test on a shooting range scores 85 to 92 percent, Siddle told me, but in actual firefights hits the target only 18 percent of the time.