Wednesday, October 5, 2011

Punching Bag Woes

So this is a complaining post. I’m complaining about the fact that there are no good punching bags in any of the gyms I’ve been in on Fort Bragg, and I’ve been in most of them.

I’m serious, this is an issue to me.

You would think, on a military installation a punching bag, in fact, multiple punching bags, would be standard equipment. They had one hanging up in the student gym at the medic school, but it was pretty worthless. It was one of the kind that hangs up on the metal frame with the two support pipes running to the floor on either side of it. Perfect for breaking your foot on if you do a round house kick just a little off target. It needed to be weighed down with several hundred pounds worth of weight plates just to keep it flying across the floor. But it was better than nothing. Then the cadre got angry at us for denting the floor by dropping weights on it so the closed the gym to students and it became the cadre gym.

So then I brought my own personal punching bag in and hung it up in the quad by the barracks. It was a perfect set up. Alas, there was a small cut on one surface of the bag, and with too many people abusing it and not using it properly and constant exposure to the elements, it ripped open. I took it down planning on repairing it, but the Sergeant Major had it thrown away because it was an “eye-sore”. My punching bag! The one that I paid good money for.

A gym just across the street came to my rescue, though, They opened up a boxing room and a grappling room. The grappling room is a 20’ x 20’padded room with good quality matts, and the boxing room had six short bags and two long bags hanging from two stands. As soon as I saw the stands, I knew they wouldn’t last long. Each stand consisted of a single steel post going straight up into the air and branching into a four sided frame. It stood on a 12” x 12” metal plate, held in place by four bolts into the concrete. The leverage was so obviously too great for the bolts that I couldn’t believe anyone had seriously paid money for it. Some fat civilian contractor who has never thrown a punch in his (or her) life probably okayed that purchase. At any rate I used the heck out of it for about a month and a half before the kicking accumulated, and then came the one kick so hard that the bolts ripped clean out of the concrete. After that the gym took down the bag stands and has not responded to any of my inquiries about when they will replace them. The people at the desk tell me I should, “Take it up with the committee.” Something about budgeting. Please! They have the bags. I’ll go down to Lowes and pick up all the stuff I need to hang them so that they will never break, and it would cost me about fifty bucks.

I bought another punching bag and hung it up again in the quad, and I did a lot of good training on it. Then somebody took it down while I was on clinical rotation, and I have no idea what happened to it. Probably another “barracks cleanup”. How by any stretch of the imagination does a punching bag constitute a non-military appearance? A barracks without a decent punching bag is the disgrace, in my opinion.

The gym tried to set up a punching bag stand with a water filled base, but I kicked the top off of it with my third kick. It was a lousy design.

Now they have fallen back on the muscle guy dummies. These are not as good as a bag for hitting because of two flaws. The rubber they are made out of is too soft, and if you hit them too hard they fall over and you have to pick them back up again. Still, better than nothing.

So yesterday I threw 800 punches on one of those dummies. My left hand is a little bloodied. The space between the knuckles of my pointer and middle fingers blistered and ripped, and I got a small rip on the knuckle of my pinky. That’s the problem with punching rubber, it creates more friction, and my left hand wasn’t ready for it, but my right hand is still like a rock.

I sometimes say that the perfect fitness program requires very little equipment. At a minimum you need something to lift, something to hang from, and something to hit. Of those three, hitting things is possibly the most satisfying. There is just something about a solid, perfectly placed punch that pleases me. Deep down inside I enjoy it. When every muscle and bone in my body works together as a single unit, all contracting, twisting, tightening and cracking like a whip, in perfect cooperation as fast as you could blink, and the whole force and weight of my 210 lbs smacks into the leather focused behind the point of a single knuckle, it’s just satisfying. It really is. You have to experience it to understand it.

But it is important to me, both as an esoteric exercise and as a practical skill. I firmly believe that every man needs to know how to throw a proper punch at a bare minimum. How much more every soldier? Can you, then, explain to me why a punching bag is not a standard fixture in every barracks in the army?

I can’t.

Monday, October 3, 2011

Patients are More Fun when they Aren't Drama Queens

One evening a little girl came into the ER. She was about nine years old, and she had fallen on her outstretched hand while roller-blading. Her right arm was in a sling and she had abrasions on both her knees, but what really struck me when I walked in the room was the fact that she was sitting contentedly and quietly on the edge of the gurney, kicking her legs and looking around with interest. She was little and cute in the way that only little girls are, with messy brown hair done up in a sort of pigtail. She was still wearing shorts and a t-shirt, although someone had thrown a man’s zipper jacket over her shoulders, because the room was cold. Her parents were standing on either side of her, looking anxious, but she had a bright, intent, wide awake look. Her eyes were open all the way and a little extra as if she was perpetually amazed that there was so much in the world to see. She grinned at me as I walked into the room in my scrubs with my beard and that reminded me just how awesome my job was.

“Hello,” I said cheerfully. “What brings you in here tonight?”

“Oh,” she said casually, as if it had just suddenly occurred to her, “I fell while I was roller blading.” Her voice was cute too, very high pitched and squeaky. She said it with a perky attitude like, “Oh, if you must know. It’s probably not even worth mentioning, but you asked.”

I knelt down in front of her and examined her knees very carefully. “Hmmm, yes, I see. Wow. Well, you know, I think we can take care of this. I can call a surgeon and well get you scheduled in. We’ll probably take them off right about here.” I made a slashing motion across her legs right above her knees.

She laughed and squealed, “No!”

“What? You don’t want us to take off your legs? Really? Then why are you here?”

“This!” she laughed and held out her arm in the sling.

“Ohhhhhhhhhh!” I nodded, because it was all so clear now. “So that’s why your arm is in a sling. Oh, I get it. Okay, so what happened to that?”

“I fell on it,” she giggled.

I got her to describe how she had landed, and to point out exactly where it hurt, but she assured me that it didn’t hurt very much at all. I made her go through all her ranges of movement with her wrist and elbow, and then poked and prodded and pinched and squeezed. “Does it hurt here?”


“Does it hurt here?”


“Does it hurt here?”


“How about here?”

“Not really.”

“You know what? I’m not even going to ask you any more questions, because you’re too tough. You could probably be lying on the floor with your hand cut off and I’d ask, ‘Does it hurt’ and you’d say, “No, not really’.” I said the last part in a high, squeaky voice to illustrate how she would say it.

She just laughed at me. Her parents relaxed a little bit when I explained to them that she might have a small fracture but it didn’t look serious and we’d get some x-rays to see exactly what was going on.

For an adult I wouldn’t even have needed an x-ray, although in a civilian hospital I probably would have gotten one just because it’s expected. Since she was a child, though, I wanted to make sure there was no crack in the growth plate. In the ends of every bone in a child’s body is a thin plate of cartilage sandwiched between the end (epiphysis) and shaft (diaphysis). The area where it attaches is called the metaphysis. As the child grows the cartilage grows and gets longer and longer, while at the same time it is being replaced by bone which does not grow. At some point, usually in the teen years, the bone replacement catches up with the cartilage growth and then that limb stops growing. When this happens in all bones of the body the person has reached his or her full height. However, if the plate is damaged while the child is still growing this can cause the growth to be lopsided or deformed or even to stop altogether. Hence the reason I ordered an x-ray.

As it turned out her growth plates were fine. The only damage was a torus fracture of the radius and ulna. Another characteristic of children’s bones is that they are softer and more flexible than an adult’s bones. Under stress they tend to bend and wrinkle rather than crack, somewhat analogous to the difference between a green twig and a dry stick. A torus fracture (also known as a buckle fracture) occurs when the outer layer of the bone, the cortex, wrinkles under pressure. It's pretty easy to see in this example from medscape. Follow the long bones up towards the wrist and you will see a buckle in each side of the bone. Hers looked very similar. She thought it was pretty cool that she could see it on the x-ray.

So we put her in a short arm splint to immobilize the wrist and signed her up for an orthopedic consult a week later. She was still chatting it up with the nurse as she fitted the splint, and I just had to go in to watch. If only all my patients had a sense of humor like that.