Grunt (31 page)

For the past four decades, submarines have run on a watchbill known as “sixes,” which divides sailors’ time into six-hour chunks: six hours on watch, six for other duties and studies, six for personal time and sleep, then back on watch. The creation of an 18-hour day saw each sailor putting in six extra hours of watch time every 24-hour period. The problem is that his activities ceased to align with his biological rhythms. He’s now working when his body badly wants to be sleeping. “It’s like flying to Paris every day,” Kate Couturier said. Without Paris. “It’s a quadruple whammy,” said Couturier’s colleague Jerry Lamb, when I met with him and other Navy sleep experts before boarding the
Tennessee
. “We flip around their sleeping and working times, we work them like dogs, we give them very short periods of sleep, and we wake them up for drills.” He turned to his colleagues. “Did I miss anything?”

Lamb was involved in the push for the new “circadian-friendly” watchbill. There has been, as there always is, some resistance. Sixes is how it’s been done for fifty years. “As flawed as it is, we’d perfected it,” commanding officer Bohner said one morning as we sat in his stateroom. “Now we’re going to shake the ball and throw the pieces back down again.” I tried to picture what game that might be.

The problem resides mainly with the midnight to 8:00 a.m. shift—the dreaded “mids.” You come off watch and instead of sitting down to dinner, you’re having breakfast. You’re sleeping from 4:00 p.m. to 10:00 p.m., when there’s often, despite Nathan Murray’s best efforts, something that you have to get out of bed for. To more fairly distribute the suck, the crew swap watch schedules every other week. Instead of flying to Paris every day, it’s every two weeks. The switchover happens on a Sunday, its being normally—that is, when riders are not coming aboard creating extra work for everyone—the quietest day of the week.

Today is that Sunday. Lieutenant Kedrowski, the man on the periscope platform, the officer of the deck, is switching to mids. It’s his birthday. Happy birthday, Kedrowski. You get to scramble your circadian rhythms and get three hours sleep—in a rack that smells like someone else, because you had to give yours up to some writer from California.

“I’m really sorry, by the way.” I would have been happy to sleep among the warheads.

“It’s no problem,” says Kedrowski, with unforced bonhomie. Almost everyone I’ve met down here has been easygoing and upbeat, especially given how tired they must be. I am, to quote the Dole banana carton in the galley pantry, “hanging with a cool bunch.” If everyone in the world did a stint in the Navy, we wouldn’t need a Navy.

Up above Kedrowski’s head, a red light is flashing. Kedrowski explained this alarm box earlier. It’s the one that goes off if the President of the United States orders a nuclear missile launch.

“So this is another drill then?”

“No.” Kedrowski finishes writing something in a three-ring binder and looks over at the box. “It’s kind of broken.” He puts down his pen and listens. “They’re supposed to say, ‘Disregard alarm.’” They don’t, and soon it stops. “They need to fix that,” he says.

The missile alarm is mildly unnerving (good god,
what if?
) but not particularly frightening. In the queer logic of war in general and nuclear conflagration in specific, five hundred feet underwater on an undetectable Trident submarine is the safest place you could possibly be. The crew of the modern ballistic missile submarine endures long hours and grueling tedium, homesickness, horniness, and canned lima beans, but they are spared the thing that keeps most of us out of the military: the nagging awareness that you could be shot or blown up at almost any moment. Better dead-tired than dead.

___________

*
In military slang, there’s a friendly epithet for everyone. I, for example, am a “media puke.”

†
By weight, a submarine carries more paperwork than it does people—despite the best efforts of Vice Admiral Joseph Metcalf III. Metcalf, who led the invasion of Grenada, waged an equally headstrong campaign for shipboard computerization—“a paperless ship by 1990,” he told the
New York Times
in 1987. He calculated that even a smaller surface warship carries 20 tons of technical manuals, logs, forms, and shelving—tonnage that could be used for fuel or ordnance. Metcalf’s battle cry (“We do not shoot paper at the enemy”) attracted some media attention and probably one or two spitballs, but—if the USS
Tennessee
is any indication—no serious commitment to change.

‡
To reduce troops’ load, the Army adds caffeine to gum or mints or foods that soldiers are already carrying, like jerky. Natick public affairs officer David Accetta feeds a Caffeinated Meat Stick to reporters who visit the food lab. To me, it tasted just like you’d expect caffeinated meat to taste. Accetta was taken aback. “Brian Williams loved them.”
Or did he
?

§
Though not, as correspondence in the Nathaniel Kleitman Papers reveals, without its challenges. To avoid “the danger of rats jumping up,” the researchers’ beds were outfitted with special five-foot-high legs with “tin rat guards.” Alas, there was no rat guard for publicity-seeking tourist attraction managers and noisome reporters. Kleitman had made clear he wanted no press involvement, but about a week into the experiment, Mammoth Cave general manager W. W. Thompson sent a note down with the evening meal saying that reporters had
somehow
,
mysteriously
, found out about it and were clamoring for access. Kleitman did not go quietly. He asked to review the copy. He made
News of the Day
state in writing that they would “in no way ridicule the experiment.”
Life
magazine got the last laugh: A “printer’s mistake,” the editors claimed in a letter of apology, caused Kleitman’s title (“Dr.”) to be “transposed” with the “Mr.” before the name of his grad student.

¶
It’s not just alertness that waxes and wanes. Gut motility also follows a circadian pattern. Healthy humans rarely crap after midnight, unless they’ve just arrived in a distant time zone.

Feedback from the Fallen

How the dead help the living stay that way

I
T IS NOT THE
blood in news photos of people shot dead or killed by bombs that gets to me. It’s the clothing. Here’s a man who got up in the morning and went to the closet with no inkling he was pulling on his socks for the last time, or adjusting his tie for the coroner. The clothing becomes a snapshot of a person’s final, poignantly ordinary day on Earth. You see at once the death and the life. In autopsy photographs of US military dead, you also see what came between the two. Defense Department policy is to leave all life-saving equipment in place on a body. You see the urgent work of medics and surgeons—the pushing back at death with tourniquet and tube.

In military autopsies, medical hardware is examined alongside the software of organs and flesh. The idea is to provide feedback to the men and women who worked on these patients. Did, say, the new supraglottic airway device work the way the manufacturer promised? Was it placed correctly? Could anything have been done differently? The feedback happens via a monthly combat mortality teleconference, part of the Armed Forces Medical Examiner System (AFMES) program Feedback to the Field. In the past, solid, quantified feedback took the form of published papers. In the time it takes to have a study peer-reviewed and published in a medical journal, a lot of lives can be lost. This is so much better.

The System comprises two low tan brick buildings, mortuary and morgue. The mortuary being the one with the lovelier landscaping. Which is not to say that the morgue is bleak or depressing. It isn’t (certainly not by comparison with what you have driven through to reach it: Dover Liquor Warehouse, Super 8 Motel, Chik-fil-A, Applebee’s, Adult Probation and Parole, McDonald’s, Wendy’s, New Direction Addiction Treatment, Boston Market, and a giant blow-up rat advertising extermination services). A walkway connects the two buildings, but an ID badge is needed to open the door from one into the other. You don’t want family members to take a wrong turn and end up in the autopsy suite.

Or, this morning, the conference room. The 7th Combat Mortality Conference is just getting under way. Eighty teleconnected individuals are taking part: thirty or so here at AFMES, about an equal number phoning in from Afghanistan and Iraq, and a few in San Antonio, Texas, at the US Army Institute of Surgical Research. They interact by audio only. There is a video screen, but it is used to display not the speakers but the soldiers being spoken about.

The body in the photograph on the screen is on its back. Black bars have been added over the eyes and groin. I want a third one to hide the feet, which are flopped strangely, wrongly, off to the same side. They’re like feet in an ancient Egyptian frieze or under the bedding at one of those hotels where the maids aggressively tuck the sheets. A man speaking from Afghanistan recites the prehospital care scenario. “CPR was in progress when he arrived. Treatment included JETT tourniquet, sternal intraosseous IV, plasma, two doses epinephrine. Upon arrival at the medical treatment facility, no cardiac activity was noted. CPR was ceased. Over.”
Over
is of course the military man’s habit of denoting the end of a radio communication, not, as I at first heard it, a dramatic editorial flourish.

The medical examiner (or ME) who performed the autopsy delivers his summary next. “. . . Extensive head injuries, skull fractures. Laceration of the brain stem. Hemorrhages. Multiple facial fractures. Extensive injuries to the upper extremities. Also fractures of both his tibiae and fibulae. Facially again, his maxilla and mandible are fractured.” The blood has been cleaned away, so most of what I’m hearing doesn’t register visually. What registers is this:
His mustache is on crooked.
It calls to mind the old slapstick gag—the false mustache slipping its glue and hanging askew on the actor’s face. It wasn’t that funny then, and it’s very much not so now.

Like a sensitive editor, the medical examiner begins his feedback with positives. “Crike was performed adequately and perfectly placed.” Crike is short for cricothyrotomy—puncturing an emergency airway through the cricothyroid membrane. The ME moves on. “Placement of JETT.” The Junctional Emergency Treatment Tool is a new type of tourniquet for compressing the femoral arteries at the junction of the leg and the torso. “JETT was possibly moved in transport . . .” This is polite shorthand for the fact that it is not where it should be. Great care is taken at these meetings with how things are phrased. The medical examiners don’t want to lay blame or criticize the people who provided the care. Rather than refer to them by name or classification, they say “the user of the device.”

A man at the army surgical research institute has something to add. “It’s a rookie mistake,” he begins, “to place the JETT too proximal. The femoral artery is more easily compressed slightly distal”—farther out—“to where this device was placed.” He backtracks. “Though it’s possible the device moved proximally in transit.” He can’t help adding: “Though it’s not likely that happened. I’ll send the instructions to everyone. Thanks.”

The next case is easier to look at, too easy. There shouldn’t be a situation in which you find yourself admiring the build of a dead person. When all is right with the world, corpses look ancient, weak, worn out. You know at a glance there was little living left to be done with that body. “You can see the sternal IO has been placed properly,” the ME is saying. IO stands for intraosseous. It’s the cousin of IV—intravenous. IO refers to a blood transfusion via the bone marrow rather than a vein. When someone has lost a large volume of blood, the vessel walls lose the tautness that makes it possible to find them and pierce them with a needle. It’s the difference between poking a pin into a newly inflated balloon and one that’s kicking around in the corner a week after the party. The bone—often the sternum, which puts out a lot of blood—is breached via a small drill or gun, or a determined twisting by hand if the batteries are low.