THE MAIN stressor of combat medicine is absent from every training simulation. No one is shooting real bullets at or anywhere near you. “Training is limited by liability,” said Siddle. He sounded a little mournful.
“The high number of returnees diagnosed with PTSD suggests we are not doing enough,” scolds Colonel Ricardo Love in his paper. Love hailed the ancient Spartans’ approach to “building psychological resilience in their forces.” Pelopidamus, looketh upon these novel strategies for building resilience. “On several occasions [the] war games were deadly and some boys were killed.” According to Sparta scholar Paul Cartledge, other military resilience-builders included the stalking and killing of random slaves and “the braving of whip-lashing seniors# in order to steal the largest possible number of cheeses from the altar of (Artemis) Ortheia, a goddess of vegetation and fertility.”
Many years ago, reporting a story on killer bees, I experienced a kind of stress inoculation. I accompanied a team called out to remove a hive on a farmer’s land in south Texas. The venom of “killer” honeybees is the same as that of ordinary honeybees, but the bees are far more aggressive in their defense of the hive and their pursuit of interlopers. The larger the hive, the more defensive the bees. This hive filled a fifty-five-gallon oil drum. I wore a bee suit, but I hadn’t attached the veil properly and bees began getting underneath it and stinging me. Later that day I and my throbbing welts visited a keeper of ordinary honeybees. While we talked, bees would light on my arm. My normal reaction would have entailed flailing and girly alarm noises. Instead I calmly watched them crawl around. Fear of bees: gone.
But would it have worked in reverse? Would exposure to regular honeybees have inoculated me against the fear I felt inside the killer bee swarm? Caezar’s theatrics and Tom Hanks yelling and the hectoring instructors—these are regular honeybees. Still, as Siddle allows, “Anything that narrows the gap is good.”
The other way to train medics is to have them practice a skill so many times that it becomes automatic. So when the prefrontal cortex goes AWOL, when reasoning drops away, muscle memory, one hopes, will persist. Do it enough times, and you can administer first aid in the ultimate survival stress scenario: when the gore is your own. Recall the combat engineer from chapter 4 who’d stepped on an IED. “Without thinking”—as he aptly put it—he pulled out a tourniquet and placed it perfectly on what remained of one leg.
CAN THE carnage of an explosion ever really not be stressful? Does a disarticulated head ever come to seem normal? Apparently. “After a while,” Ali told me during a break from the tutorial, “it’s just a head. You get on with your job.” Michelle told a story from her deployment in Iraq. She was carrying part of a Marine’s leg that had been blown off by an IED. The foot was still in the man’s boot, and presently his buddy went to pull it out. When the boot relinquished its hold, the foot smacked Michelle in the face. She made a face that led me to assume the foot had started to decompose. “It wasn’t decomposed,” she said. “It was a brand-new, blown-off foot.” She leaned closer. “He wasn’t wearing socks.” What repelled Michelle was not blood or gore, not the foot’s detachment from the rest of the body or the awful deadness of it, but the smell and feel of the sweat on her cheek.
And that will serve as my lurching segue to the miraculous, reviled excretions of the human eccrine gland. In a place like Afghanistan, sweat keeps more people alive than corpsmen do.
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* Except when he’s a Godfrey, as he is in many of his 1970s movie credits. Godfrey Daniels produced ten titles in the long-forgotten genre “soft core,” paying loving if needless attention to his plots, one of which could be a chapter in a Mary Roach book: “A research facility uses state-of-the-art equipment to test sex dolls.”
? And the founder of Missing Something, my second-favorite amputee organization name, after Stumps R Us. I attended a Stumps bowling party in the 1990s, which served as my official introduction to the awesomeness of Hosmer Upper Extremity Prosthetics sporting attachments. In addition to the Bowling Attachment, Hosmer makes a Baseball Glove Attachment, and the pole-gripping Ski Hand/Fishing Hand. The Hosmer-equipped bowlers kicked my ass.
? But not your iPhone. Smart smartphone thieves use the startle reaction to their advantage. They come up behind unsuspecting texters and whap them on the back of the head. The startled victim’s arms bend, launching the phone, which is effectively tossed to the thief.
§ More formally known as the “optional integrated phallus,” available in Caucasian and African American (different colors, same size).
? Expendable items like Visceral Linings, Replacement Veins, Foreskins (for the Nasco Circumcision Trainer) and Laerdal’s Concentrated Simulated Vomit are known in the industry as “consumables.” In the case of the Simulated Boluses of chewed food that get stuck in the esophagus of the Laerdal Choking Charlie manikin, the term is doubly apt.
# I suppose that by “seniors” Cartledge means people older than the boys; however, Spartan senior citizens weren’t the courtly walker-pushers of current stereotype. “Tribal elders” would screen babies for military worth; those deemed unfit were hurled into a chasm called “the deposits.” Nothing in antiquity makes much sense. Who gives cheese to a goddess of vegetation?
Sweating Bullets
The war on heat
FORT BENNING, GEORGIA, HAS three key ingredients for heatstroke: humidity, intense sun, and Army Ranger School. Rangers, like their better-known cousins Navy SEALs, are part of the US Special Operations forces. To borrow the words of their creed, the Ranger is an “elite soldier” expected to “move further, faster and fight harder than any other soldier.” Josh Purvis would seem to be maximally elite in that he was, when I met him, an instructor at Army Ranger School and a contender for the annual Best Ranger Competition. The competition falls into the category of a multisport event, surely the only one to include a Bayonet Assault Course and a litter carry. (They don’t mean trash.) Competitors march and run twenty-plus miles with a sixty-pound pack, and every year, a few will experience a second litter carry, in the horizontal position. In 100-degree heat, “further, faster” can be a lethal undertaking.