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.

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?”

“Nope.”

“Does it hurt here?”

“Nope.”

“Does it hurt here?”

“Nope.”

“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.

Afraid of the Dark, Part 2:

Part one, which explains why I was afraid in the first place, is here.
So once I realized I couldn't go back to sleep I picked up my rosary and started saying it. I keep a loaded pistol with a tac-light on the floor by the head of my bed (there are no women or children in the apartment) and a large, razor sharp kukri knife strapped to the head board (no, it’s not paranoia. It’s just a convenient place to keep these things.) And I always have my rosary hanging from the handle of the knife. I say it to fall asleep, or if I wake up and can’t go back to sleep. If I’m awake I may as well be doing something useful, right? Ten decades later (this went on for a bit) I’m feeling a little better. I’ve thought it through pretty well. It’s kind of fun to think about fear as an intellectual exercise while you’re in the middle of. I’ve done that an awful lot and I was doing it this morning. I knew, of course, that this was not a fear with an object. There was no dangerous thing presented to my senses. It was just a fear of the diabolical. I presented the scenario to myself, “What would I do if I did open my eyes and the demon lady was standing there?” Well, honestly I think that would have been less frightening. Sort of a, “Finally. I wondered when you were going to do something,” sort of feeling. It’s always easier when you finally look your enemy in the face and dare him (or her) to do the worst.


I would have reached for the knife probably. I wouldn’t have used the pistol as a first option, because first, it probably wouldn’t accomplish anything, and second, I would be firing in the direction of my roommate’s room. Even with hollow points, I wouldn’t want to bet on the wall stopping my hollow points. On the other hand a knife stirs up a fierce warrior spirit which lessens fear. I realized that if some sort of incorporeal visitor did show up, the primary threat is simply fear. If I can’t hurt it physically, it probably can’t hurt me physically. All it can do is terrorize (this seemed crystal clear to me at the time.) Fear is a painful emotion. It feels toxic, like a burning in my throat, a jittery, unsettled feeling. I control it by long habit, but it is not pleasant. Even jumping out of an airplane is exactly the same. The fear is the primary threat, not the jump. I am consciously aware of this, especially when I am in the middle of some frightening situation, and it allows me to shove the fear off to the side and evaluate it objectively. Eventually I can force my nerves and muscles to respond to my will, despite their reluctance to do so. Breaking out of that freeze is the hard part, after that doing nearly anything can’t be worse than doing nothing at all.

After about an hour of this I finally decided to go and turn on the AC. I did stick the pistol in the back waistband of my shorts. Not that I thought it would do any good, but it is primarily a “just in case” thing anyway. Once I had a clear line of fire, i.e. with no roommate’s room in the background, if something had appeared I probably would have put a couple of rounds right in the center of where it would have had mass, if it were a mass-having type of creature. Purely on the principle of the matter, you understand.

It’s remarkable, though, how much difference it makes having the temperature right. Once the AC was going and the temp started getting down into the sixties, I was able to get comfortable and fall asleep in about one more decade.

I don’t mind not sleeping that much. When I woke up at 0345 I knew that it was likely I wouldn’t get back to sleep again, but I had already gotten about five hours and that would be more than enough to get me through the day. A night or two of poor or no sleep is not something I worry about. Eventually I will get tired and go to sleep. I don’t even really mind the fear. It isn’t so much something I feel as something I look at. It is an inconvenience that will go away eventually.

What I really mind is people who make movies like that and stick previews of them in front of quite a different kind of movie. I don’t like horror movies like that, the supernatural evil type films. I take supernatural evil quite seriously. There really is a devil, he really does hate you and he really can terrorize people. I know some people who have experienced minor levels of it in real life. I know he exists, and that he is stronger than I am, and that if he could he would like nothing better than to terrorize every living person until they went mad from fear. This is not funny. It is not a joking matter.

It does not worry me. He may be stronger than I am, but God is stronger than he is, and I am confident that God will never allow me any trial I cannot bear. To put it another way, no matter what trial He allows me, He will also give me the strength to bear it. That’s what the rosary is about in situations like that, reminding yourself of His faithfulness and trying to pass that on to whoever you’re praying for. But I have to ask, why would you think that’s a good thing to make a movie about? It’s not like jumping out of an airplane or off a bridge into a river for a thrill. This is something evil and ugly you are deliberately exposing your mind to. Why would you want to watch it or encourage those who make it? When it comes right down to it, why would you want to feel afraid? I expect I’ve done my share of frightening things, and when it comes right down to it I’m usually able to gut through it, by the grace of God. Why anyone would want to feel it for its own sake is a mystery to me. Fear sucks. Live without it when you can, face it when you have to. Filling your mind with artificial, pointless human suffering, fictional as it may be, and dosing up on the real fear it produces is a toxic, soul numbing, stupid thing to do.

That’s just my opinion. Does anyone reading this like horror movies? What is your experience of them? Why do you like them?

Afraid of the Dark

I had a very unpleasant experience this morning. Back track, though, to what started it. Yesterday afternoon I went to see a movie. It was an action film, and not a particularly great one, but good enough for a matinee. One of the previews, however, was kind of a shocker. At first it was just a home video of two little girls playing in the backyard of a ordinary American home, one jumping on the trampoline, the other hanging around the edge of it. The dad who was taking the video was trying to get the girl on the ground to smile when suddenly the picture changed. It was a brief flash, not enough for me to see what the new picture was. It went right back to the home video footage, but it was fast, dark and disturbing. It turned the back yard and the home video and everything else sinister. Then the dark disturbing music began and rapid flashes of sinister images. I covered my ears and closed my eyes, but there were two things I remember from the rest of the preview. First was the quote, “I don’t remember. We didn’t know what it was, we just knew it thrived on fear. The more we paid attention to it, the stronger it got.”


The second was a long scene of the two little girls playing around in the bathroom. They had a camera set up to look in the mirror, and they turned the lights off so all you could see was the power indicator light from the camera. Then they said the phrase, “Bloody Mary” three times together, and waited to see what would happen. It turned out the older one had set it up as a prank on the younger one because she had a flashlight and after a couple of seconds she turned it on so it lit just the lower part of her face and yelled. Of course the younger girl screamed and then laughed, but as the flashlight swung around the bathroom, and they chased each other out the door, for a split second you could just make out a tall female figure standing in the dark behind them. It was nothing more than a silhouette with long, tousled hair hanging all around its head, but when I saw it (I had opened my eyes) three thoughts immediately crossed my mind. First was, “Saw that coming.” Then I thought, “That’s a really cheap, simple, and powerful movie effect.” Then I said ruefully to myself, “Well, that’s going to keep me awake tonight.” Apparently it was the trailer for Paranormal Activity 3. I haven’t seen the first two, and what do you know? Looks like I’m going to plan on never seeing the third one either.

Fast forward through to about 3:45 this morning. Thus far I hadn’t even thought about the movie. Then I woke up, hot and thirsty and with two hours before the alarm went out. Usually I just use the bathroom, drink some water, and go back to sleep. Unfortunately, as I lay back down something kicked that scene, with the tall lady standing in the background, into the front of my mind. It was not a pleasant thought. The window was a little open, but the air outside was humid and still. The air conditioning was turned way up, and I always have trouble sleeping when it’s hot. Ideally I like it to be in the sixties or I just can’t get comfortable. I’ve slept outside in sub-freezing weather, and in 90+ weather. I would pick sub-freezing for sleeping any day.

So there I was, trying to sleep and being unable to. Every time I opened my eyes I was scanning the room for a tall, ragged female shape, and every time there was a noise outside the window I keyed in on it like a cat. Now, I don’t usually have night fears. I operate in the dark all the time, and usually it gives me a feeling of being at an advantage. But every once in a while I’ll have a night like that, where for some reason it just feels like there is disembodied fear in the air. Nothing to do about it, but just endure it.

Scope of Practice

One night the EMS brought in a girl who was found unresponsive in her home. By the time she arrived at the ER she was answering questions, mostly appropriately, albeit with a significant delay. We were able to get a complete but contradictory history from her. She denied remembering anything, although she said she had had one drink and some marijuana with her friends that morning. We told her this looked like a drug overdose but she didn’t respond to that. She was a very pretty 21 year old, but she was far too thin for her body type and her forearms were crisscrossed by dozens of fine white scars. Physical exam was mostly unremarkable, except for a general lethargy and delayed/weakened motor responses in her extremities, and her pupils which were pinpointed, no focused and sluggishly reactive to light. She did not have the ability to follow a light with her eyes. All ocular movement was erratic and saltatory.


We did a urinalysis (UA) tox screen on her and it came back hot for barbiturates. Looking back in her file I found that this was her fourth time in the ER for prescription drug use. To top it all off, she was a pharmacy tech.

We had a long discussion with the ER doc about what we could do. We were all agreed that she shouldn’t be working in a pharmacy, but he said there was nothing we could do without violating patient doctor privilege. I argued that the laws contain a clause that states that if the patient is in imminent danger of causing harm to herself or others we not only have a right but a responsibility to report it to the appropriate authorities. In my view if a druggy is handing out drugs, her dipping into her own stock is the least of my worries. My worry is that she’ll be high at work and she’ll mislabel a bottle or put the wrong pills in it, or the wrong dose, or give it to the wrong patient and that could literally kill someone. Has it happened yet? No. I don’t think waiting for it to happen is a good plan. She needs to get fired for everyone else’s safety.

And what about her? Why the drugs and the alcohol and the cutting? Her mother showed up at the ER and wanted to take her home against her will. The charge nurse explained to her that we could not release her into anyone’s custody because she was not a minor. We could not keep her if she didn’t want to leave, we could not sign her over to her mother if she didn’t want to go. Her mother argued back, unable to see the plain facts of the situation through her grief and frustration. Didn’t we see that if she went back to her own house she would just get stuck with her friends again, and these friends were really bad. It was all their fault her daughter was doing drugs. If the patient could come home with her she (the mother) would keep the bad influences out of her life and she would turn around. Why couldn’t we just see that?

I couldn’t help but wonder, if that parental love hasn’t been sufficient thus far, what makes her think it’s going to become magically effective now? Regardless, legally there was nothing we could do. Like it or not, she was 21 years old. She was legally responsible for her own decisions and we could no more remand her into her mother’s custody than we could detox her. She was not in danger of her life. She was not overdosed, she was just stoned. That’s what those drugs are supposed to do. Even if she had been in danger the only treatment is to stick a tube in her stomach and pump out any pills that haven’t been absorbed, dilute with activated charcoal and support heart rate and respirations until the effects wear off.

What was up with her? The problem was far beyond emergency room scope of practice. Did her parents not love her? Had she been abused as a child? Had she not been able to find any good friends? Whatever the myriad single elements that made it up, they all came to one thing. The problem was that she had a deep, throbbing, aching, abysmal hole in the depths of her soul. That is beyond my scope of practice.

Pineland Bivouac

Pineland Bivouac




Light on the cheekbones

Strong fingers of airy gold

Bright, blazing, baked smell

Of soft, sharp, sunkissed pine straw.

Carpet thick like thatch

Fallen on forest floor.

Dusty, drifted, dry

Burning, bright blanket

Myriad acupuncture needles

Under bare, bruised, battered, butchered feet:

Glorious after the march.

Spiritual Stomachs: Rambo Style

I came up with a theory of spirituality this weekend, based on a quote from Rambo: First Blood. I think I made a real stride forward in spiritual understanding.
We all know some people who just can't seem to thrive spiritually. Whether it's in our church or our family or a larger circle of acquaintances, they just can't seem to draw any nourishment. A sermon or homily that inspires and ennobles me leaves them cold and somewhat put off. A book that I think is wise and profound seems to them harsh and uncaring. C.S.Lewis is too stuffy, JPII is too learned, the parish priest is not understanding enough, the deacon is too pre-vatican II, the youth group leader is too post-vatican II, etc.

I am not talking about the people who simply live to find fault with whatever they are hearing or reading. That is a different problem. I am talking about people with real emotional or intellectual hangups that make them unable to draw nourishment from something. Maybe the person preaching is reminding them of the emotionally abusive preaching they heard as children. Maybe the book is echoing overly rigid parental moralizing, or duplicating guilt trips taken as a teenager.

See, when you are a teacher (and we are all teachers at one time or another) there is more to teaching than the truth you are saying. There is also the intent with which you say it, which is sometimes very hard to come to terms with. Nothing makes a more effective battering ram than the truth, precisely because the one using it as a weapon can quiet his conscience with the fact that what he is saying is true. Or mostly true. Or based on the truth. Or very likely true.

Even more important is the person receiving what you are saying. Not everyone can receive everything right now. Some people simply aren't ready yet. This requires the teacher to listen, really listen, far more than he speaks. It is only by listening, not just with ears but with mind and heart and whatever intuition you are gifted with, that you can begin to understand how your listeners are hearing you and whether you are helping or hindering them.

It's like cooking a meal for someone. Some people are allergic to wheat, or dairy, or peanuts, or yeast. Some unfortunate people are allergic to everything except white rice and water. No matter how delicious the food you buy, it can be ruined if you don't cook it well. Even if the food is good and you have cooked it perfectly, it is worse than useless if your guest dies of anaphylaxis after the first bite.

In the same way it isn't enough to ensure that what you are saying is true. That's the necessary starting point, since no one can cook make mud nourishing, no matter how good a cook you are. But also you must learn to present it in a pleasing manner, and makes sure that you are cooking it so that your recipients can eat it.

I have been singularly blessed in this matter. My spiritual stomach is almost as solid as my physical stomach, which is all but unshakeable. I have eaten worms from a pit that a hundred men had been rolling around in for days. I have eaten road kill. I have eaten raw meat, grass and bugs, drunk creek water, and eaten food off street shops in Iraq, Afghanistan and Korea. Nothing upsets my stomach (except too much caffeine, weirdly enough). It's like cast iron. I have almost no food hangups either. There is only one food I have ever come across that makes me gag trying to swallow it and that is soggy bread. For some reason I still can't eat that.

Spiritually my digestion is very similar. I can read any book and draw something from it, including, but not limited to, the Leveyan Satanic Bible, Fight Club, and Once and Future King, (words cannot describe how much I loathe that book. Given the choice I would re-read "Fight Club" before I resubjected myself to Once and Future King.) There have only been a few books in my life that I've thrown out without finishing. I once ordered all the works of DeSaad and threw them away without even opening them because I read a summary of his life before they arrived. There are limits to what I can and will imbibe and I am getting pickier, especially when it comes to movies. But when it comes to people, I can't remember the last time I was unable to stomach something someone said. There is always something useful, even in the most abusive, or angry, or foolish, or pigheaded opinions, even if the benefit comes simply from suffering them gladly and praying for them.

I can eat things that would make a billy goat puke.

When we share the faith we are serving a banquet for our brother or sister. Let the food we serve be nourishing, let us cook it to the limit of our skill, doing justice to the greatness of the substance by presenting it well. And let's not douse it in hot sauce if our guests don't like spicy food. That's only courtesy.

I know what you're thinking, "What does this have to do with Rambo?" To answer that I embed the following clip from what is pretty much the most awesome cheesetastic movie ever: