IT IS easy to get lost on the way to the Strategic Operations bathroom, and very entertaining. You might pass a rack of freshly painted excretory systems hanging in the sun to dry, or a man seated at a workbench, trimming the seams of a molded silicone Cut Suit penis.§ You might overhear a person say to another person, “If you use different blood, it voids the warranty.” At one point I take a wrong turn and find myself in a storage area. A filing cabinet drawer is labeled “Spleens.” “Aortas,” another says. On the top of the cabinet, Cut Suit skins are folded like blankets. When I finally find the bathroom, the sign on the door, which uses the military slang “HEAD,” confuses me in a way it would ordinarily not have.
Making my way back, I pass a Cut Suit training tutorial and decide to sit in. A woman with creamy tanned skin and variegated blonde hair stands at a table with the suit’s various components, which she is demonstrating, like Tupperware, to two Marines from Camp Pendleton. (The Marine Corps had just purchased one of the suits, and the two Marines, Ali and Michelle, were training to be Cut Suit Operators.) The teacher, Jenny, shows them how to unsnap the “visceral lining” to access the abdominal organs. “You can do an evisceration,” she says pleasantly, and notes that a slashed latex lining can be simply discarded and replaced.? Visceral Linings are available for purchase in packages of two hundred. It seems like a crazy amount of evisceration.
Jenny picks up a loose intestine and tells Ali and Michelle that they could, if they wished, fill it with simulated feces that they could make themselves, using oatmeal dyed brown and scented with a party novelty called Liquid Ass. The Cut Suit training coordinator, Jaime de la Parra, used to travel to conferences with Liquid Ass in his luggage, for demonstrations. Other employees, including Jenny, do not, and recently Jaime asked her why. “I told him: ‘Because no one will come to our booth.’”
Segall, the Cut Suit’s inventor, is proud of its realism, and justly so. Still, no matter how rank the intestines smell or how realistically the amputee’s stump is bleeding, students must know it’s not real. No one hacks off a limb to train a group of medics.
Or not a human limb, anyway.
AS FAR back as the 1960s, students of combat trauma medicine have practiced life-saving procedures on anesthetized pigs and goats. There would be no issue here, except for the fact that barnyard animals don’t naturally wind up in situations where they’re shot or stabbed or blown up by an IED. So the only way to train students on them is to hire a company to do the shooting or stabbing or leg-removing. There’s one of those companies not far from here.
Live tissue training is the topic of conversation at lunch today, on the back deck of Stu Segall’s diner. Stu and I are joined by Kit Lavell, the company’s executive vice president. Lavell fills me in on legislation that would require the Department of Defense to reduce the number of animals used for live tissue training from the 2015 level—about eighty-five hundred per year—to somewhere between three and five thousand. An animal rights organization called Physicians Committee for Responsible Medicine is behind the push. Advances in patient simulators—and high-drama Cut Suit demos before members of Congress—have made it harder for defenders of live tissue training to make their case.
Unfortunately for pigs, the layout and size of their viscera approximate ours, as do their blood pressure and the rate at which they bleed. Goats are better for practicing emergency airway procedures, as there’s not four inches of neck fat to slice through.
I watched a YouTube clip purporting to be part of a live tissue training class that someone surreptitiously filmed. A group of men stand around a folding table on a rainy day. A makeshift roof with a tarp drips overhead. Two or three men at a time lean over an inert pig laid out on the table. Their backs are to the camera. They chat quietly. They look like pit masters at a whole-hog barbecue. A veterinarian is there, and you can hear someone ask him to give the animal a bump, meaning more anesthesia. The leg amputation happens off-camera, but you can see the instrument the instructor uses: a set of long-handled shears of the sort one might use to cut through chain link. It sounds ghastly but gets the job done quickly. Assuming the anesthetic was competently administered, the proceedings struck me as no more upsetting than what goes on in slaughterhouses every day in the name of bacon and chops and short rib ragu.
For that very reason, Siddle feels, it’s an incomplete “stress inoculation.” “While it’s a good experience to work on something live, something that pumps, it’s not a human. It’s not screaming.” To gain experience with actual screaming humans, Camp Pendleton’s corpsman trainees may spend time observing and helping out in an emergency room in a gang-saturated Los Angeles neighborhood. “That’s our equivalent of Iraq or Afghanistan,” Ali said earlier. “Gunshots, strafings, stabbings.”
Michelle, the other Cut Suit Operator-in training, experienced both live tissue training and a stint in an emergency room. She found them helpful in different ways. Live tissue training provides a controlled teaching environment. Students can try things out, grab a slippery artery between two fingers to stanch a bleed. “You’re not,” she said, “going to be doing that with a patient in an emergency room.”
With its bleeding, wheezing, cursing role-players, Strategic Operations tries to be one-stop shopping: something pumping, human, and screaming. “It creates a willful suspension of disbelief,” says Stu, disarticulating a fried fish. I don’t quite understand that phrase, but I do understand what he says next. “We’ve had students wet themselves, soil themselves, vomit, faint.”
Lavell shares that Dennis Kucinich lost his congressional lunch at a Cut Suit demo. The representative from Ohio was sitting in the front row with his wife, Elizabeth, the prominent DC vegan and animal rights advocate. “When the actor started screaming and the blood started spurting, Kucinich went white. You could see the reverse peristalsis beginning.” I glance at neighboring tables, half expecting to see some here. “His wife got up and helped him to the door.”