OPINION
DOCTORS ' Lounge
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BACK UNDER THE DESK
Mary G. Barry, MD Louisville Medicine Editor editor @ glms. org
During the Cuban Missile Crisis, I was nine. But even before that( the nuns said we were close to Fort Knox and so those warheads were forever aimed our way) we had atomic bomb drills. Fire drills were more fun; you got to rush outside, in an orderly line of course, and see which class was fastest. Bomb drills initially involved crawling under your desk, with arms cradling head. Then they decided the safer plan was for us to line the hallways, away from windows, sitting cross-legged with heads down on ankles( the tornado drill was identical). I had no faith even as a first grader that any maneuver would help.
But I did stockpile canned goods in the basement in case of attack. It felt like something as opposed to nothing. I did all the laundry for many years, so the basement was my domain. I placed milk jugs full of water in the corners and also a library book about Hiroshima, as a reference. Mother was appalled and my sisters scorn – they had a grittier world view.
Now, with nuclear threats rapidly escalating( in fact I hope we are alive to read this) we are all shivering in our shoes and praying for peace, and wondering if we actually want to survive an attack or not. The International Committee of the Red Cross in 2013 wrote about the medical effects of a nuclear attack, and they are the grimmest yet.
People within a few kilometers of the impact zone are vaporized. People not vaporized are blast victims, directly or buried by falling objects; those not blasted to death can then be incinerated by the firestorms created. The firestorms consume all available oxygen, so even if not burned, you get asphyxiated. In Hiroshima, 13 square kilometers were totally destroyed.
The immediate radiation deaths come later: with ruination of the GI tract, one dies of diarrhea; with ruination of the bone marrow, one dies of bleeding and infection within several weeks. The peak deaths come with the nadir of cell counts. Burn wounds kill up to months later. Lungs swell with pneumonitis and fill with infection. The central nervous system, if exposed to certain levels of radiation, fails within 48 hours. With a smaller dose, one suffers blindness, convulsions, heat stroke, respiratory failure, delirium.
In Hiroshima, 270 of its 300 doctors died or were injured, and 1,654 of 1,780 nurses, the same. But even if many more had lived, they had nothing to work with. They could not transfuse the bleeding or bind up the wounded or relieve the burned of their pain.
We can all recall the attacks of 9 / 11 and the devastation of the surrounding neighborhood. The toxic cloud of ash killed slowly, but has ruined the lungs of many a Ground Zero worker. If there were numerous bombs worldwide, numerous firestorms would result, causing the nuclear winter. In 1983, the famous TTAPS paper( authors Turpo, Toon, Ackerman, Pollack and Carl Sagan) described the effects of multiple megatons of explosions. Within 1-2 weeks, sunlight ceases to penetrate the soot and ash clouds, and temperatures drop to-20 C. Vegetation dies, water supplies are poisoned, animal food sources die, typhoid and cholera run rampant. The TTAPS abstract concludes,“ When combined with the prompt destruction from nuclear blast, fires and fallout, and the later enhancement of solar ultraviolet radiation due to ozone depletion, the long-term exposure to cold, dark and radioactivity could pose a serious threat to human survivors and other species.”
This is why the latest must-have for the leisure classes is the customized bunker. Yacht designers are frantically drawing up plans for those both terrified and rich. Ironically, decommissioned nuclear silos go for top dollar. Bill Gates has built into his Norwegian bunker the largest cache of seeds
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