“Do you want to know why my friend got killed?” says Josh. “Somebody probably heard him going into the building, because he couldn’t be quiet enough, because he’s carrying too much shit in the first place. There’s all kinds of restrictions that risk-averse people are making. They have good intentions but they have bad effects.”
Dianna points to my tape recorder. “You can probably turn that off.” Heat isn’t going to be a topic, just a mood.
DRIVING BACK from lunch, Josh and Dan sit in the back, planning their workout. I hear Dan say, “one hundred snatches,” which hits my ear like a Dr. Seuss title. Up in front, Dianna and I talk science. I tell her about my recent visit to Natick Labs. They have a manikin that sweats! And “water-needs prediction equations”! You plug in the weather report and the fighters’ loads and activity levels, and it tells you how much water you’re going to need to haul to the battlefield. How excellent is that, I want to say, but I know Josh is listening.
I understand his scorn. I understand there’s always a factor left out of the equation, something unknowable to someone who’s not out there, inside the madness. I know every mission has unique requirements and risks. I know why there are derogatory names for people who sit in air-conditioned offices making rules for people out humping artillery across an open courtyard at noon in Afghanistan. Though at the moment, I can’t remember what those names are.
“Chairborne Ranger?” offers Dan. “Pogue?”
“Scientist,” says Josh. Dianna taps the steering wheel with one thumb. She glances in the rearview mirror. “I love you, son.”
Josh stares out the window. “I love you too, Ma. No shame.”
A few words in defense of military scientists. I agree that squad leaders are in the best position to know what and how much their men and women need to bring on a given mission. But you want those squad leaders to be armed with knowledge, and not all knowledge comes from experience. Sometimes it comes from a pogue at USUHS who’s been investigating the specific and potentially deadly consequences of a bodybuilding supplement. Or an army physiologist who puts men adrift in life rafts off the dock at a Florida air base and discovers that wetting your uniform cools you enough to conserve 74 percent more of your body fluids per hour. Or the Navy researcher who comes up with a way to speed the recovery time from travelers’ diarrhea. These things matter when it’s 115 degrees and you’re trying to keep your troops from dehydrating to the point of collapse. There’s no glory in the work. No one wins a medal. And maybe someone should.
8. LEAKY SEALs
Diarrhea as a Threat to National Security
SHOULD YOU ONE DAY travel to the overlooked desert nation of Djibouti, you will see from the window, as you land, what appears to be a large construction site adjacent to the airport. In fact, it’s a US military base, Camp Lemonnier: 3,500 people who live and work in retrofitted shipping containers, some stacked, some side by side, a Tetris of unadorned rectangular boxes. Other than the shrubs that grow in the drip from the air-conditioning units, there is no landscaping. Interior décor takes the form of emergency instruction placards (“Stop and listen to the Giant Voice…”) and framed chain-of-command portraits. In three days on base, I’ve seen a single item that one might class as luxury: one indulgent, cushy, costly item shipped here for no other reason than to add a little comfort to a soldier or sailor or airman’s life. Captain Mark Riddle requisitions Charmin Ultra Soft for the container that belongs to Naval Medical Research Unit 3. The sign on the door explains it: Diarrhea Clinical Trial.
The word alone makes people want to laugh: diarrhea. Riddle doesn’t fight this. On the contrary. He recruits study subjects through GOT DIARRHEA? signs on the backs of restroom stall doors. One of the photographs on the Stool Grading Visual Aid he created for participants in the current study comes from a Campbell’s Chunky soup ad. (“Look closely,” he’ll confide, “there’s a spoon sticking out.”) Nevertheless, for reasons you will come to understand, Riddle takes diarrhea very seriously. As he has put it, intending nothing funny, “I live and breathe this stuff.” I have heard him use the word sacred to describe a collection of frozen stool samples. Riddle would like military brass to take it seriously, too.
In past centuries, this took no convincing. Dysentery “has been more fatal to soldiers than powder and shot,” wrote William “Father of Modern Medicine” Osler in 1892. (“Dysentery” is an umbrella term for infections in which the pathogens invade the lining of the intestine, causing cells and capillaries to ooze their contents and creating dysentery’s hallmark symptom, the one that sounds like British profanity: bloody diarrhea.) For every American killed by battle injuries during the Mexican War of 1848, seven died of disease, mostly diarrheal. During the American Civil War, 95,000 soldiers died from diarrhea or dysentery. During the Vietnam War, hospital admissions for diarrheal diseases outnumbered those for malaria by nearly four to one.
Once germ theory gained acceptance and the mechanics of infection became known, microorganisms—and the filth they breed in, and the insects that deliver them—became targets of military campaigns. Suddenly there were Fly Control Units, sanitation officers, military entomologists. The US military has been involved in most of the major advances in preventing, treating, and understanding diarrheal disease. Cairo’s NAMRU-3, the parent unit of Mark Riddle’s humble container lab in Djibouti, has a four-star antidiarrheal pedigree. Its first director, Navy Captain Robert A. Phillips, figured out that adding glucose to rehydration fluids enhances intestinal absorption of salts and water. This meant rehydration could be achieved by drinking the fluids rather than making one’s way to a clinic to have them administered intravenously. This has been a lifesaver not only for people who fight in remote, medically underserved areas but for people who live there. A 1978 Lancet editorial called Phillips’s discovery “potentially the most important medical advance this century.”
The full name of Riddle’s study is Trial Evaluating Ambulatory Treatment of Travelers’ Diarrhea (TrEAT TD).[29] “Travelers’ diarrhea” is another catch-all term. Most of it—at least 80 percent—is bacterial, with 5 to 10 percent viral (vomit typically joining the waterworks here) and a miscellaneous percentage from protozoa like amoeba or giardia. All of it is caused by contaminated food or water. There used to be a separate category called “military diarrhea” (military referring to the patients, not the explosive nature of their evacuations), but if you look at the responsible pathogens, the breakdown is almost the same. Military diarrhea is travelers’ diarrhea, because service members are travelers—in places where you don’t want to be drinking the water. A survey conducted by Riddle, David Tribble,[30] and others with the US Naval Medical Research Center revealed that from 2003 to 2004, 30 to 35 percent of military personnel in combat in Iraq experienced situations where they lacked access to safe food and water. In the early days of a conflict especially, combatants are like backwater backpackers, crapping in the dirt and waving the flies off whatever food the locals are peddling. In that same survey, 77 percent of combatants in Iraq and 54 percent in Afghanistan came down with diarrhea. Forty percent of the cases were serious enough that the person sought medical help.
29
By the fair play rules of acronyms, this should be TEAT TD. Never mind, though. It’s hard enough for diarrhea researchers to get the respect they deserve without bringing teats on board.
30
Here is my diarrhea research statistic: When you are communicating with a pair of diarrhea researchers named Riddle and Tribble, there is a 94 percent chance you are going to slip up and refer to one or both of them as Dribble.