Mary Roach - Grunt

The sight of smoke from a smoke machine is our cue to action. Five of us lie on racks in the dark, emoting amateurishly. I tell the trainee who comes to my aid that it hurts to breathe. He helps me out of my rack and steers me out to the hall. “Right this way, ma’am,” he keeps saying, as though my table awaits. He shouts ahead that I’m going to be the priority. “Ma’am, we’re going to have to crike you. Do you know that that means? We’re going to make a small incision right here.” He touches the front of my neck. Crike is short for cricothyrotomy. They’re going to pretend to cut an emergency airway for me to breathe through.

“You are?” My symptoms only call for oxygen.

“Yes, we are. Because you can’t breathe.” I’m lifted onto the sick bay exam table.

“Well, it’s more that it hurts to breathe.” I’m trying to give a hint. “It burns .”

The trainee picks up a scalpel. A voice sounds from above, like God calling to Abraham. “Stop!” It’s one of the instructors. “She’s talking to you, right? Then she’s breathing. She doesn’t need that.”

Someone else yells, “Blood sweeps!” A corpsman trainee reaches under my back and slides both hands from shoulders to hips. He looks at his hands, checking for blood, for a wound that might have been overlooked. If you don’t happen to be wounded, blood sweeps feel lovely.

My massage is short-lived. I’m carried back out to the hallway and set down beside another amputee actor, Megan Lockett. I saw Megan in the makeup room earlier. The special effects gore was still wet on her stump. She sat with her legs crossed, idly scrolling on her phone. It was like lions had come and gnawed off her foot while she checked Facebook.

The floor is slick with blood. Megan is having a bleeder malfunction. A pair of trainees skid and slip, trying not to drop the latest priority victim, a man wearing a tourniquet on his lower leg where a sock garter, in more civilized circumstances, might go. They plop him down on the exam table.

“And why is this guy so important?” yells God from on high.

“Open fracture!” someone tries.

“Is he dying? No, he’s not!” More loudly now: “Who’s dying, people? Who is the most likely to die?” No answer. God’s hand points at Megan. Megan raises her stump. Hello, boys! “What does this patient look like she has?”

Two trainees rush over to get Megan, while Open Fracture joins me in the hallway of survivable maladies. I try to make some room, but my pants are sticking to the floor. I learn later that Karo syrup is the main ingredient in special effects blood. This makes life safer and more pleasant for actors whose role calls for them to cough up blood, but if it dries while you sit or stand in it, you will fuse to the floor like a candy apple on a baking tray.

When it’s all over, the trainees are called to a debriefing on the pavement outside the set. An instructor named Cheech starts it off.

“That was godawful. You lost your minds. A woman who’s missing a leg should have been the number one priority.”

Excuses are offered. It was dark. Smoky. She was down on the floor.

“There was one patient standing in the middle of the room,” Cheech says. “ Standing in the middle of the room. And no one paid any attention to him. You need to make your bubble bigger. Don’t get fuckin’ tunnel vision.”

The technical term for fuckin’ tunnel vision is attentional narrowing. It’s another prehistorically helpful but now potentially disastrous feature of the survival stress response. One focuses on the threat to the exclusion of almost everything else. Bruce Siddle tells a story about a doctor who had some fun with an anxious intern. He sent him across the emergency room to sew up a car crash victim’s lacerations. The intern was so intent on his stitching that he failed to notice his patient was dead.

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. [23] More formally known as the “optional integrated phallus,” available in Caucasian and African American (different colors, same size). 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. [24] 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. 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.