I make no secret of my enthusiasm for eye trauma.
All summer long, as I’ve been pursuing my Emergency Medical Technician certification, I’ve waited patiently through lectures on circulation and respiration and spinal cord damage, anticipating the moment when we discuss eye injuries. It finally arrived during lab, when we were taught bandaging techniques for things like burns, amputations, and penetration wounds. Those are all pretty dramatic injuries, requiring special methods and a deft touch, so by the time we got around to eye trauma, people were deeply absorbed in their attempts to hold an occlusive neck dressing in place with a figure-8 bandage. Thus when the instructor asked us, “OK, are we ready to talk about eye injuries?” I was the only one who frantically waved both hands and yelled “YEEESSSSS!”
There was no need for me to make a spectacle of myself, of course; we were bound to study eyes sooner or later. They’re in the textbook. But eye injuries hold a lot of sentimental value for me, and I can’t help getting excited about them. For one thing, they’re a form of trauma I’ve experienced repeatedly, so I feel like something of an expert on the patient experience. But the main reason my heart warms to the thought of eye trauma is that, from a self-defense perspective, the stuff is pure gold.
In most physical self-defense situations, your goal is to disrupt the attack and get away, and damaging the eye is by far the most effective way I’ve found to accomplish that. It’s incredibly easy to damage an eye, even if you’re not trying to. Eyes are readily available targets, and they’ll sustain permanent damage from trivial amounts of force. Eye attacks work beautifully against much stronger assailants—everyone’s eyes are equally vulnerable, no matter how big and muscular their bodies are—so targeting the eye is an ideal tactic for women.
Most importantly, the cost-benefit ratio of eye trauma is huge. Gouging an eye takes very little effort, but trust me, the freak-out effect it produces in the traumatized is spectacular. As our textbook puts it, “Aside from the pain, injuries to the eye cause emotional distress as the patient thinks about the possible loss of vision.” This tallies exactly with my own experiences of eye trauma, which are indelibly imprinted on my memory: excruciating pain, heart-stopping emotional distress, and the word “Cyclops” flashing in bold letters through my brain.
Treating eye trauma turns out to be fairly simple—in a pre-hospital setting, at least. Lacerations and other open injuries are covered with a wet dressing, and both eyes are bandaged (humans move both eyes together, so you need to keep the good one quiet too). Then you take the patient to the hospital, where his eye becomes the doctor’s problem.
There are a few cases where emergency care is a bit messier. Take extruded eyeballs, for example. They often result from gouging or blunt force trauma, and require special packaging before transport. Given my long and vociferous advocacy of eye-gouging, I felt a special obligation to master this skill, which involved placing a paper cup over my lab partner’s (perfectly healthy) eye, then wrapping a sterile bandage roll around his head to hold the cup and its contents in place. It wasn’t easy, and it seemed like it would be an awfully fussy procedure to attempt on someone who really had an eyeball hanging down his cheek.
As I struggled with my eye-in-a-cup technique, another student two desks ahead of me (whom I’ve dubbed the “Martha Stewart of Wound Care”) had already mastered it and progressed to impalement injuries. I watched him use tightly rolled gauze pads to build a tiny log cabin around his partner’s faux injury site, bandaging the whole edifice firmly in place to allow transport, as our instructors had directed, with the impaled object secured in place. Do I really need to learn that? I asked myself. I don’t anticipate ever stabbing someone in the eye with a weapon. I’d most likely use my thumb, and I’m pretty sure I wouldn’t leave that behind.
Since I’m not a natural at executing the medical skills we’ve learned in EMT class, I comfort myself with the knowledge that I’m probably better than average at causing many of the injuries we’re treating. Still, having spent years training myself to hurt people, it’s fascinating to regard trauma from a fresh perspective. I’ve spent some happy evenings this summer learning about the zygomatic and sphenoid bones and the maxilla of the face, comparing their most common fracture patterns to the places where my own face has been forcibly reconfigured, and thinking about how I might adjust my own punching technique to increase or decrease damage. EMT training has given me a new way to think about my martial arts and self-defense skills. I feel like a humble Florentine statue cleaner who has finally taken an art appreciation class.
It’s a whole new world I’m being exposed to, and it takes some adjustment. A lot of the practice scenarios in our book, for example, ask us to do things like calculating the pulse pressure of a patient in hypovolemic shock from an open femoral laceration and pelvic fracture. I have trouble answering these questions because I’m thinking, “This person is bleeding to death, for god’s sake; why is everyone standing around doing math?” Action comes naturally to me; thoughtful action, I have to kind of dig for. I know this about myself.
I’ve survived in the course so far by dint of obsessive studying, along with dogged practice during open lab. I’ve spent solitary lunch hours hooking up ventilation devices and suctioning imaginary vomitus from the mouths of plastic dummies, which may sound forlorn and pathetic but isn’t really much worse than eating at Wendy’s.
It’s a lot of work, and I didn’t undertake it lightly—I’m fitting this in around a full-time job, arriving home at 10 or 11 most nights, and using vacation time to do my clinical rotations. All because, after focusing for 15 years on how to gouge out eyes, I decided it was time to ask: What happens next? Who cleans up the mess, and how?
These are practical and ethical questions. I don’t doubt the morality of eye-gouging itself, when it’s done in self-defense. It’s my opinion that people who attempt murder, rape, or serious physical assault should consider blindness an occupational hazard. But eye trauma can be, as our textbook describes it, a life-altering injury. If I alter someone’s life, even someone who tried to kill me, I want to know what I’ve done. I’m not willing to simply tell myself they got what they deserved and let it go at that. I want to know about every suture required, every ice pack applied. I want to know how the influence of my hands and feet will affect this person every day thereafter. In other words, while I believe everyone has the right to protect themselves, I also think that using our force requires us to look, closely, without flinching, at the consequences of what we’ve done.
This summer I’ve learned, to my surprise, that I can look quite calmly at images of traumatized eyes and burned bodies and amputated limbs. That’s not to say that I enjoy viewing pictures of extruded eyeballs. I don’t. It’s pretty horrifying. But here’s the thing: When you teach self-defense, you’re preconditioned to regard physical force as a solution—albeit one that works only in very limited circumstances. However, even in those rare cases when force is a solution, it’s also a problem—one that someone, somewhere is going to have to solve. To me it seems important to educate myself about that end of the equation.
I mean, during lecture we regularly see photos of bodies that I wouldn’t consider poking with a stick, and yet it turns out that the people in those images survived the horrendous injuries they sustained. Someone stopped the bleeding, administered oxygen, stabilized the spine, provided blood, repaired the heart, re-inflated the lungs, prevented infection, grafted skin—performed any number of interventions that repaired the damage and preserved a life. It’s incredible what we can do with emergency medicine these days.
A curious fact about these techniques: virtually all of them were developed in war theaters. Blood transfusion was perfected during World War II. Helicopter evacuation of trauma patients was pioneered in Korea. The Iraq wars have gifted us with better methods of treating traumatic brain injury and limb loss—tourniquets, for example, which fell out of favor in the 70s, have in fact proved to be much more effective than we realized, and are now part of standard emergency care in the case of life-threatening blood loss.
This means that every individual receiving medical care in the United States these days benefits directly from a body of knowledge gleaned in part from the wounded and dead of past wars. If you survive a car crash or a shooting, you may well owe your life to the thousands of American servicemen and women killed in the Middle East between 2003 and 2011 (when we “withdrew” from the Iraq), and the tens of thousands wounded in action. Iraq is far more unstable now than it was before we invaded it, despite all those claims that war would make us safer. And yet, ironically, you and I are safer for the Iraq war, because the deaths of those who fought in it have improved our medical care.
I don’t want to extrapolate too much from my own modest experience with bloody eyeballs, but it seems to me that people who habitually advocate the use of force ought to spend some time looking closely at the aftermath of what they’ve advocated. People like the politicians who supported the war but voted against funding for veterans’ healthcare, turning a blind eye to a shameful system that left 120,000 vets waiting for care.
Or people (I use the term loosely) like Dick Cheney, who has recently warned that we need to apply more force in Iraq, because “weakness and retreat are provocative.” Given that Cheney’s approach to threat reduction in the Middle East has been a disaster, you might think he’d reconsider the efficacy of force. But then again, given that the man is currently sporting a heart that used to belong to another human being, you’d also think he might have some dim awareness of the concepts of sacrifice and gratitude. Instead, he declares, “it’s my new heart, not someone else’s old heart. I don’t spend time wondering who had it, what they’d done, what kind of person.”
Look, I like smashing shit up just as much as the next person—maybe more. The knowledge that I could maim someone with my bare hands gladdens my heart. But that kind of behavior has consequences. Sometimes force works, sometimes it doesn’t. Either way, someone has to put the pieces back together again.
“For the eye sees not itself,” Shakespeare reminds us, “but by reflection.” Gouging eyes and starting wars is easier than you might think. Rectifying the damage is a lot harder. Spout all you want about weakness being “provocative”; if you turn a blind eye to the damage you do, you’re betraying your own weakness.