Bloody Clots of History

The New York Times article on the torture and murder of two detainees in American custody at Bagram in Afghanistan had a particular resonance for me, as the direct cause of death for both men appears to have been blood clots in their lungs, something that almost killed me a couple of years back.

The jailers at Bagram used a technique called the peroneal strike, hitting a nerve bundle a few inches above the back of the knee, typically with a baton or a kick. One site giving advice to potential protestors has this to say about it:

[A] common peroneal strike could be used to slow an attacker without having to shoot him; sometimes a good thing. But it’s also a good to inflict unjustified pain without leaving much in the way of evidence. It also makes a good defense in court when a cop has knee-capped a victim: “Your Honor, I was attempting a harmless control tactic addressing the common peroneal when the suspect raised his leg. It isn’t my fault my baton contacted the knee, shattering it.”

When a clot blocks a blood vessel into the lungs it causes a pulmonary embolism. A pulmonary embolism commonly results from the formation of a blood clot in a large vein in the legs, a deep vein thrombosis (DVT). If you remember stories a couple of years warning people to get up from their plane seats and walk around every so often, that’s because a DVT can form from just sitting too long in cramped quarters, although an injury or someone “pulpifying” your legs will do.

When the DVT breaks up, pieces of it travel through the venous system to places like the lungs where they may create a pulmonary embolism. As the blood vessel (or vessels in the case of more than one embolism) is restricted or blocked, blood no longer flows into that portion of the lungs and it begins to die. If enough blood vessels are blocked, not enough oxygen will reach the brain, heart, or other organs. That’s generally a bad thing.

In my own case, the clot formed because of damage and reduced activity that resulted from a broken leg and angle. About seven weeks after surgery, I switched from crutches to a cane, then started to have some difficulty breathing that I attributed at first to the increased amount of work I had to do to get around. Two months to the day after breaking my leg, I passed out at the foot of the stairway to my office, and likely survived the multiple embolisms in my lungs only because of the quick actions of my wife, Barbara, and our proximity to excellent medical facilities, where I spent a night in critical care and a week in the pulmonary ward. I was on a regimen of blood thinners and testing for a year.

Less than four months after my episode, NBC correspondent David Bloom — just a year or so younger than myself — died of a pulmonary embolism while riding with US forces on the drive to Baghdad, likely from sitting in the cramped quarters of an armored vehicle, which could easily have been exacerbated by hitting his leg on something getting in or out of the vehicle.

I can tell you from experience, the week between the onset of my symptoms and the day I passed out was not a pleasant experience. I was constantly out of breath, it was difficult to concentrate, and as the week went on, getting up the stairs to my office became a trial. Even scooting around in my office chair, my preferred method of transport at the time, was tiring. On the stairs before I collapsed, I felt as if I was suffocating.

That, of course, is as nothing compared to what those poor bastards in Bagram experienced. Nobody was beating me. Nobody was tying me to the ceiling. Nobody was forcing me into stress positions for hours on end. Nobody was depriving me of sleep.

I cannot fathom the widespread cruelty depicted in the government report quoted by the Times story. I can’t understand, given everything that’s known about the effects and causes of DVT, why guards, interrogators and superiors at Bagram thought repeated blows to a prisoner’s legs were acceptable technique.

Not everyone dies from an embolism, although it has a fairly high risk of death. In my own case, with multiple embolisms, I was quoted anything from 30% to 70% chance of death (the numbers the doctors and nurses mentioned got higher the more likely it looked like I was going to make it). Presumably, other detainees at Bagram received the same treatment. In all likelihood, some of them developed lesser cases of pulmonary embolism. I doubt whether anyone’s followed up to see how many of them might have died after being released.

The amount of suffering the two men mentioned in the article is beyond my imagining. I can only extrapolate from my own minor experience, cosseted as I am in a familiar and safe environment with quality medical care available and people looking out for me. And man, it still really sucked.