Rhabdomyolysis also turns up at the other extreme of the bodybuild spectrum. Morbidly obese patients immobilized on their backs—say, for lengthy gastric bypass surgery—run the risk that their bodies will press down on the muscles of their backsides so hard that circulation is cut off. After four to six hours, the dying cells of the muscle tissue break open and leak, and when the patient finally moves, or is moved, the blood rushes back in and sweeps the breakdown products into the bloodstream in a sudden, overwhelming gush. Being pinned under rubble in an earthquake or in the wreckage of a car poses a similar risk. As does passing out drunk and lying without moving for six hours. This was explained to me by rhabdomyolysis researcher Darren Malinoski, an assistant chief of surgery at the Portland VA Medical Center. He added that rhabdomyolysis is one reason people roll over in their sleep. “The muscles are getting ischemic, and they make you move.”
“Look: Even your thighs are starting to flush,” says Dianna. All that overheated blood being shunted to my skin. “Do you want to try to keep going a full half hour with the pack on?”
Not even slightly. “I think I get it.”
Dianna asks the lads how they’re feeling. Josh’s fellow instructor, whose name is Dan Lessard, replies that he’s bored. Josh doesn’t hear the question because he’s got earbuds in. He removes one, and a tinny musical aggression leaks out. It’s Five Finger Death Punch, a metal band that from what I can tell uses synthesized machine-gun fire in place of a drummer.
Josh says he and Dan plan to do “a real workout” later in the day.
“Mary stopped after seven minutes with the pack on,” Dianna volunteers. Hey!
Josh defends me. “You don’t come out of the womb with a rucksack on. The first time I put it on, I hated my life.” He seems like a good person who has been handed a lot. His frivolity, his pep, whatever innocence we’re all born with, became something tougher in Iraq. War denatures people.
At 11:30, we’re released from the cook box. “And now you can go take out your friend,” says a lab tech named Kaitlin, referring to the probe. Earlier, in the midst of a conversation about idiosyncratic sweating patterns, Kaitlin raised both arms as though she’d just won Wimbledon and announced, “My right armpit sweats way more.” This we confirmed. Which bring us to the point of Dianna’s work: Genetic differences in thermoregulation—efficient/inefficient, left side/right side, you name it—are surprisingly large and well worth paying attention to, given our seemingly permanent posture of fighting extremism in the Middle East.
Dianna suggests heading to a nearby Walter Reed cafeteria to continue the conversation. Josh seconds. “Sustenance. Let’s get it.”
THE PIZZA at Warrior Café does not look healthy. By that I don’t mean that it’s unhealthy to eat it—though it possibly is—but rather that the item itself looks in poor health. The edemic crust. The sweating cheese. The scabs of pepperoni. I follow Josh and Dan to the salad bar. Like many in the US military, they are disciples of CrossFit, a workout that emphasizes real-world, or “functional,” strength over isolated muscle development. And lots of garden greens.
“Everybody wants to get big and look strong,” Josh says between mouthfuls, after we’re seated. He eats with purposeful intensity, the way he speaks or strides on a treadmill. By “everyone” he means today’s infantry. “There are different ways to do that. You can work hard, or you can do the bodybuilding thing, because you don’t care about anything other than looking good. Nobody wants to work. They experiment with steroids. They want to be bigger, faster.” The eyes fixed on the salad. “But that’s not functional strength. And they have to lug it around, that muscle, and they have to cool it…”
“And the supplements themselves increase the risk of heat illness,” I hear myself saying.
That’s not Josh’s concern. His concern is this: Unfit soldiers put the rest of the unit at risk. He places it in context for me: a hypothetical mission to clear and secure an insurgents’ compound. “How about this. In the middle of a firefight, where you’re already physically sucking, one of your buddies gets shot. You’ve got a casualty collection point in the first room that you cleared, but to get there, you have to drag him in his body armor. You’re already smoked, and now you’re dragging dead body weight, so now you’re really smoked.” He jabs at salad. Lunch is a syncopation of hunger and spite. Stab, shovel, chew, speak, stab. “Are you ready to deliver some first aid to this guy who’s depending on you to save his life after you just got your ass handed to you, because you wanted to go do some curls at the gym?”
There is quiet at the table. I’m thinking this story maybe isn’t hypothetical. I’m adjusting to the concept of a “casualty collection point,” to the horrible fact that there can be enough casualties for a “collection.”
“So,” Dianna says after a moment. “Back to heat.”
“I’m sorry.” Stab, stab, shovel, chew. “I have very little to say about heat. People used to ask me, ‘What it’s like in Iraq?’” A garbanzo bean dies on a tine. “Open your oven and crawl in.”
Dianna persists. “So Josh, I hear stories of guys superhydrating ahead of time so they don’t have to carry water. So they can carry extra ammo.”
Dr. Adolph looked into this. “By predrinking,” he wrote, “man converts his interior into an accessory storage tank. A man on foot can thus carry as much as a quart or more of additional water.” Adolph had a group of men fill their tanks by drinking two pints of water, and then sent them out into the heat on a “dehydration hike.” By checking the dilution of their urine, he was able to conclude that only 15 to 25 percent of the “predrunk” water had been peed out. The rest was available to become cooling sweat.
However, desert survival scenarios aside, the US Army does not advocate predrinking. Exerting oneself on a sloshing stomach is uncomfortable and compromises performance. And soldiers who get carried away in their effort to fill the “storage tank” risk water poisoning: overdiluting the body’s salt levels and throwing the system fatally out of whack.
Also, it may not be manly. “If you take extra ammo,” says Josh in response to his mother’s query, “you don’t take it at the expense of water. You just take it. You man up, and you take it.” Somewhere Josh found blueberries for his salad. He goes at them with brisk, well-centered stabs. He’s going to ace the Bayonet Assault Course.
Speaking of hot-weather military dilemmas: Let’s talk about body armor. The current ensemble weighs 33 pounds. You are weightlifting just going up a flight of stairs. Josh had a buddy who was killed on a rooftop without his body armor on. “His command was ridiculed for it. But in all reality, I wouldn’t have had my body armor on, either.”
“Do you take it off because it’s too hot?” I’m like a fly buzzing around his head. A little yapping dog at his ankles.
“I take it off because it makes sense.”
Dan steps in to lighten the tone. “Mary, we’re walking up and down mountains with a hundred pounds on our backs, fighting guys in sandals and man-dresses. The Army’s answer to a lot of things is to give you more equipment, more stuff, most of which takes batteries, and there’s only so much you can carry.”
The Army’s other answer, one they have flirted with for over a decade now, is a wearable hydraulic exoskeleton to help with heavy loads. Lockheed Martin posted a video of its entry, the HULC (Human Universal Load Carrier), on YouTube. Soldiers are shown bounding across gullies and taking cover behind boulders while wearing articulated metal braces on the outsides of their legs, as though the Army had taken to conscripting 1950s polio victims. The HULC was tested at Natick in 2010, on a “prolonged march” with an 87-pound load. One of the comments posted for the YouTube video comes from a participant in that test: “Everyone was pretty much done at forty-five minutes due to shin splints. ” Others questioned whether fighters could move quickly under fire or even pick themselves up if they fell. Patrick Tucker, the technology editor for the website Defense One, tripped over the battery life: five hours, provided you’re moving slowly (2.5 mph) and on level terrain. He doubted HULC’s usefulness in places without a steady power supply—“like, basically any place where soldiers might, you know, have to fight.”