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I was amazed at how sick or hurt some people can be without any understanding of the danger they face.I was covering a community hospital ER on a Friday night in upstate New York during my residency and a 16-year-old high school football player walked in about midnight saying he was told to “get checked out.”I asked him what happened and he explained he had tackled another player head first and noticed his hands were numb and tingly after the hit. He sat out a few plays, then felt fine and went back in the game.The next time he had contact, he noted the numbness and tingling was worse and lasted longer. He was told by the coach or trainer to “get it checked out.”I’m sure the game ended well before midnight, but at least he eventually showed up. I asked if he had any head or neck pain. “No pain anywhere,” he replied.I told him I was ordering a neck X-ray to be safe and went to examine a middle-aged male with chest pain who I thought might be having a heart attack.About 15 minutes later I walked into the radiology room to check the X-ray and saw the teenager had fractured his fifth cervical vertebra and it had slipped out of position (similar to the illustration above, just a level higher).I told him not to move, sand-bagged his neck and called the neurosurgeon on call. I was very grateful I hadn’t checked his neck range of motion before getting the X-ray or he could have become paralyzed from the neck down (quadriplegic). Once he was surgically stabilized, he made an uneventful recovery.The scary part of the story was the possibility that he broke his neck with the first hit and went back into the game, not having any idea how risky that was.

When I was in high school, in the early 90’s, I really, really wanted to join the football team. So, when sign-up for try-outs came up, I signed my name, along with three other girls, much to the dismay of the coach, the principal, and the boys already on the team. Especially, a boy named Brian.Brian had bullied me for the better part of my Freshman year, with name-calling, pushing, shoving, grabbing my ass, my breasts, and tripping me when I tried to walk by. He threw chewed food at me in the café, and followed me home, many times, just to repeatedly ring my doorbell, and upset our dog.None of that mattered to me, though. I just wanted to play football. I loved the sport. I was passionate about the Cowboys, and I played touch/tackle football on the weekends, with my friends, all the time.The coach, and the principal both tried like hell to talk me out of trying out. We had many meetings with the school counselor, a few board members, and even a lawyer for the school, who told me that I “..would be a disgrace to the game” and I “ should stop being so selfish, and think of the embarrassment” I would cause our town.However, since the school didn’t have a women’s equivalent team, I was allowed to try out.I ran the two miles in 18 minutes, I could run simple plays, throw, catch, and take the hits, just like the guys. In fact, some of the boys already on the team, were very impressed with me, and joked that maybe I should be the new quarterback, instead of Brian, since I could put a much prettier spin on the ball, and my throws got where they were going, every time. Brian was… livid.So, I was given a spot on the team. I was Center, every third home game. Essentially, I was a benchwarmer, but I had my jersey, and I was happy about it.Until one afternoon, when Brian got me alone in a hallway by the locker rooms. There was a huge plate-glass wall, and drink machines behind it. After calling me some really awful names, like cunt, bitch, whore, and ‘lesbo’, Brian tackled me into the glass wall, and it shattered around us. We hit the Snapple drink machine, and it fell over onto my left leg. I felt my patella shift upward, and I screamed in massive pain. Brian, who was bleeding, but fine, ran off, leaving me under the machine. I fainted.When I came to, EMTs were lifting me onto a gurney, and one of them was strapping my leg down with a kind of safety belt. I screamed, again, because the pain was unbearable. The EMT brushed some glass out of my hair, and told me he was so sorry he’d hurt me, but that I was going to be alright. I fainted, again.I had three surgeries, the following weeks, and PT for a few months, afterward. Brian was suspended from school for a week, and he was benched for two games. Nothing else.However, his next game was the Bell Game. If you know anything about high school football, you know that a Bell game is huge. Bell games are between rival schools, and the prize is, literally, a big copper bell with the winning team’s name, and date of the win, etched onto it, under the winning teams’ names from previous years. Our Bell Game had been a tradition for almost 40 years, and the Bell was ours far more than our rival’s. Anyway, I had many friends on the rival team. Guys I’d played football with, for years. Three of them were as close as brothers, to me, and they were pissed the fuck off.Brian was sacked four times, in a row, at the beginning of the game. Each time he went down, someone said my name. Eventually, the coaches called a time out, and told everybody to knock it off, and just play the damn game. It didn’t matter. My guys kept it up, until they were pulled. Because of all the penalties, my team won the Bell, but it was clear that the rival team had thrown the game, so they could hurt Brian.Then, one morning, about two weeks after my last surgery, my mom came in to wake me up. Her eyes were like saucers, and she was kind of shaking. She said Brian had been in a car accident, and he’d broken his left leg in three places. She told me he was in surgery, at that very moment, and his uncle (my mom’s coworker) said that the surgeon was trying to reattach his patella, and insert pins. She said Brian was in a massive amount of pain, and that he fainted a few times, while they were trying to get him into the ambulance.Brian had been hoping for a football scholarship to Syracuse. Scouts had been out to visit a few times, and it looked good. Full ride and everything. Until that day, he had his whole life mapped out.Today, Brian is working at his dad’s used car dealership, in Upstate NY. He had a pretty bad pill habit, for a few years, but I hear he’s clean, now. He never did make it to college; not even community. He, also, never apologized to me. I moved away from that town, shortly after I met my (late) husband, and I’ve never been back.I don’t think fate dealt Brian a shitty hand because of what he did to me. I think he was a reckless driver, and the roads were icy. Though, I am honest enough to admit that I felt vindicated. I know it’s petty and childish, and probably, really cruel to feel good about what happened to him, but I’ll allow it.

I often wonder if people in the US and China understand what it means to use a nuclear weapon. Yes, China can destroy the US. My hope is that this essay will give the reader an idea of what that is like. Targeting each other’s population is what deterrence is all about.I grew up during the Cold War. We did civil defense drills in school once a month. This meant old fashioned air raid sirens warning us of impending doom. The teacher closed lead-lined asbestos curtains called flash curtains in each classroom. The students squatted under our desks. We knew we had less than a minute before impact when the air raid sirens emitted a wavering tone. Such a thing would not have saved me because my school was only a few miles from an important Air Force base. The purpose of the exercise was only to provide morale to a population under threat of annihilation.No one really knows what can happen in an attack or what China will do. This is my educated guess; an imagining. Let’s suppose a single missile, a DF-41 with 10 x 150 kt MIRV bracketing the Newark-New York-Jersey metropolitan area. Let’s think about what this small attack does before we decide what the two brigades of DF-41 displayed in China’s military parade can do. Let us also suppose the US does not retaliate and total war does not ensue. The one missile destroys the United States. It takes a couple of years but the wound festers and takes the country down.Figure 1. Sixteen DF-41 launchers on display in China’s military parade. China conducted 7 test launches so far of the DF-41.First, a little about the DF-41, China’s most modern intercontinental ballistic missile. The DF-41 is the most advanced ICBM in the world, carrying up to 12 MIRV per missile to a target of 15,000 km. It is similar to the Russian RS24-YARS, a MIRV'd Topol-M but has longer range, more warheads, and is extremely accurate with or without GPS. Launched from 9,300 miles away, the missile can hit within an area the size of a football field. The DF-21 launches from the back of a truck. Time from a launch near Mongolia to arrival in the New York area is 21 minutes.The DF-41 warheads are very similar to the US W-88 having a yield that is selectable between 20 kt and 150 kt. The MIRV vehicles are designed to penetrate the US missile defense system which means they may actually be MARV.I used an online tool to make the following map.[1]Figure 2. Simulated attack on the Newark-New York with 8 150 kt surface blasts and two air bursts all from one ICBM. The large orange rings around the impact zones are everything on fire, the gray areas are overpressure that breaks windows, roof, doors, etc. The green rings are everyone dies there within 24 hours from radiation never mind the fire, the inner rings are the fireballs than vaporize everything. The darker gray around the airbursts is an overpressure that squashes everything flat.Let’s imagine how this plays out. It is 1:00 PM in the afternoon in Shanghai when, during spiraling tensions, the US attacks and destroys a PLAN aircraft carrier with a nuclear torpedo that was conducting operations in the South China Sea.At 4:00 PM, in response, a single truck launches a DF-41 ICBM, the time is 3:00 AM in New York time. The weather in New York is clear with a light wind from the Southwest. At 20 minutes from impact, the first stage of the ICBM has MECO and the second stage begins firing. At 18 minutes from impact, the second stage has SECO and the third stage begins its burn. The fairing of the rocket jettisons to reveal 12 cone-shaped objects mounted in a pyramid. Two of these objects are penetration aids that act like chaff.NORAD detects the launch 16 minutes before impact. NORAD does not have ABM in a position that can intercept this launch, it can only monitor what happens in horror. Fifteen minutes before impact the third stage has TECO. Fourteen minutes before impact, NORAD determines that the ICBM is targeting the East Coast, probably New York City or Washington DC.Thirteen minutes before impact, it is 3:08 on the East Coast and 12:08 AM on the West Coast of the US, and the Emergency Broadcast System warns everyone in the US that a missile impact is imminent. Of course, most people are asleep.The sharp cone-shaped objects decorating the top of the ICBM separate from the MIRV bus. The third stage of the ICBM continues on a ballistic trajectory moving at 25 times the speed of sound as it deploys penetration aid to create a dozen dummy warheads following the ballistic trajectory.The real warheads change course like the DF-21 warhead is known to do. A second penetration aid creates a large number of dummy warheads over the target.At 4 seconds from impact Pilots of a Boeing Dreamliner on approach to Newark Liberty International Airport observe a light show as the hypersonic warheads glow white-hot streaking through the atmosphere. It looks like meteors to them and then there is a light like no other. Everyone on the plane is dead before the plane bursts into flames and falls out of the sky. All non-military electronics in New England permanently cease functioning due to an EMP released by the two air bursts.Figure 3. Ground zero at Trinity, the 22 kt test at Alamagordo.At impact, each of the 8 surface blasts creates a fireball 1.1 km in diameter vaporizing everything into ionized gas. All buildings are demolished by 20 psi overpressure in an area of 2.2 km in diameter. Everyone gets a lethal dose of radiation in an area 4 km in diameter and will die of excruciating pain. Everything not reinforced steel and concrete is flattened in 5 km diameter. Everything is in the process of burning, including people with 3rd-degree burns in an area 10 km in diameter. All glass and roofs are blown in an area of a diameter of 12.5 km. Remember all of this is times 8 from a single launch and we haven’t covered the airblasts, which are similar but with wider overpressure effects and a huge EMP.It is impact plus 1 second 2.5 million people are Dead. The blast on Manhattan alone kills 750,000 and injures another 750,000. Lights go out over most of the East Coast.At impact plus one minute, 3.5 million are dead. Seismographs around the country detect a swarm of ten 5.8 Earthquakes in the New York area. So begins a disaster, a holocaust, a war, destruction like nothing the US has ever seen. All from one truck-launched rocket.At impact plus 2 weeks 8 million people are dead, 12 million are homeless and injured. A Hellish round water-filled depression reaches from Hell’s Kitchen to 3rd Ave and 52nd str to 38th st. Tall buildings reduced to broken girders and large chunks of concrete sticking out of a sickening pond.All ATM machines across the nation cease functioning. Banks close, credit cards don’t work. The heart of the world’s financial system no longer exists. Because the wind came from the South West, people in upstate New York and New England are rained on by radioactive ash. People on the West Coast and all over the country do not have enough food because the just in time food distribution system is broken. The attack shatters the US economy and plunges the world into a financial meltdown.Impact plus one year, the fires are still burning. The entire state of Connecticut is abandoned permanently and much of upstate New York is a forbidden zone. Power is not restored yet in New England. The US government fails miserably addressing a disaster, orders of magnitude worse than Katrina. One hundred thousand people died from exposure during the Winter following the impact. Skeletons and rotting bodies of people and animals lay in the streets of the once-great metropolitan area and a thousand people a day die from injuries. There is an outbreak of medieval diseases among the millions of homeless. People are randomly killed by accidentally wandering into random no go zones in perfectly green fields and forests of upstate New York.At impact plus 2 years the political entity, formerly known as the United States ceases to exist. The West Coast goes its own way. Texas goes another. The Southern part of the United States makes Bangladesh look like heaven. Tens of thousands of US servicemen are stranded all over the world. The US Navy cannot buy fuel for its ships and planes.Figure 4. One of 10 warheads, a surface blast in Midtown Manhattan kills between 750,000 to 850,000 people and injures another 700,000. The one warhead alone is the worst disaster in US history by two orders of magnitude.Now, it is known that China can replicate this scenario 24 times in the US largest metropolitan areas. The 24th largest metropolitan area is the San Antonio area just to give you an idea. The second largest is in Southern California. DF-41 is just one kind of nuclear delivery system that can hit the United States; China has others.Footnotes[1] NUKEMAP by Alex Wellerstein