Knife Edge: Life as a Special Forces Surgeon Read online

  KNIFE EDGE

  Life as a Special Forces Surgeon

  By Richard Villar

  To Louise, Ruairidh, Angus, Felicity

  and

  To those I could not save

  Contents

  Author’s Note

  Acknowledgements

  List of Illustrations

  1 A Brilliant Idea

  2 Surgeon or Soldier?

  3 Press the Bleeding Button

  4 The Bastard Jungle

  5 Desert Impotence — My Secret Cure

  6 Do They Pay You By the Body?

  7 The Month I Should Have Died

  8 Great Heights

  9 Terra Incognita

  10 Tortured Lebanon

  11 The Forgotten People of Sarajevo

  Illustrations

  Copyright

  Author’s Note

  Work with the Special Forces, and as a surgeon, makes me doubly restricted. Medical confidentiality and State secrecy are both vitally important. Lives do depend on them. Please therefore understand why I have chosen to fictionalize many names, change patterns of disease and injury, and alter place names, operational codenames and the like. How would you like your disease to appear in print? I wouldn’t, and I imagine you would feel the same. Lean back now, relax, read on and enjoy yourself. There is a whole world of adventure out there.

  Acknowledgements

  Those who have written a book will understand what an enormous task it involves. Those who have not, may not. It has been a lifelong desire to write this and it would have been impossible without the help of so many individuals, particularly in a book that covers twelve countries, six major conflict zones, and a whole host more besides. Some have assisted without realizing it, perhaps by casual comment, others have given knowingly and willingly of their time. Owing to the book’s content, certain more secretive individuals have been delighted to assist, but would prefer not to be overtly associated with the end result. Having been in the same position, I understand their worries. As all of you are equally special to both me and the book, I have decided to acknowledge no one by name. Those who have helped, all seventy-three of you, will receive a signed copy on the day. You are each wonderful, brilliant in fact. I am indebted to you.

  List of Illustrations

  SAS Selection - sometimes you just walk too far.

  Mount McKinley’s West Buttress - I am at 5000 metres and climbing.

  Treating a goat in the Middle East.

  Examining a Bedouin’s mouth with an improvised light source.

  The holding area for our highly secret operation during the Falklands War.

  Hard at work cooking an inedible meal at Everest’s Roadhead Camp.

  Everest’s major-wobbler kit. Something for every emergency.

  Everest’s North Face.

  Pushed for bed space in the Third World - sometimes you just have to share.

  Hundreds queue to see me in central India.

  Gross bowing of the shin-bone present since birth.

  Central India - operating on a polio victim (Photograph by Nicola Townley).

  Louise, the paediatrician, at work in the Far East.

  Examining a Palestinian knee in Southern Lebanon.

  Trying to undo the after-effects of war in Lebanon.

  One high-velocity bullet can cause immense damage.

  Sarajevo’s Swiss Cheese Hospital (Photograph by Roop Tandon).

  Teheran - I operate under the close scrutiny of local surgeons.

  All photographs not credited are the property of the author.

  CHAPTER 1

  A Brilliant Idea

  ‘Doc! Get over here! Someone’s been shot!’

  I could not believe it — it had to be a joke. My first day as SAS medical officer and there had been a shooting. Was this really a taste of things to come?

  The moment I reached the building, medical pack in hand, I realized this was no test, no trial run. The soldier lay there, blood pumping viciously from a massive wound in his buttock. He looked terrified. Still conscious, he glanced up at me imploringly. ‘I’ll be OK, Doc, won’t I? I’ll be OK?”

  I was on autopilot by then, mentally checking off the vital functions I had to perform to ensure the man’s survival. ‘Airway, breathing, circulation - airway, breathing, circulation,’ I whispered to myself. I muttered reassurance as best I could, unsure whether or not I could stop the bleeding. Uncertain which nerves, if any, the blast had destroyed.

  It had been a shotgun, accidentally discharged six inches away. Most of the buttock was missing. What remained looked dirty, contaminated with grit and pieces of clothing. Around me stood several tall SAS operatives, each one totally relaxed. They had seen it before. A real-life situation it may be, but I was still on test. They inspected my every move. ‘How will he do under stress?’ I could hear them thinking.

  I tried hard to stop my hands shaking as I ripped open the shell dressing, stuffing it firmly in the wound. ‘Lean on it!’ I instructed the medic who had joined me in my dash to the building. With enough pressure applied, I knew that any bleeding could be stopped. It was important not to lift up the shell dressing to see how things were doing. Keep on stuffing them in, one on top of the other, as hard as you can go, until the bleeding stops, I thought. I had seen many gunshot wounds before. My record had been fourteen dressings to stem the tide. This one needed three.

  The soldier survived, thanks to both prompt treatment and his own strength. With a major artery ruptured it can take only thirty seconds to die. Life-saving must therefore be reflex. As a doctor you act first, think later and trust to God that your medical training keeps you right.

  I delivered the man to hospital one hour later, an intravenous infusion running fast to replace the blood he had lost. Once the surgeons had taken him over I sat, exhausted, on a wooden bench in the hospital grounds. I felt shattered, both physically and emotionally. Join the SAS? It had seemed a good idea at the time.

  I had always wanted to be a surgeon, from the moment my mother gave me a plastic stethoscope on my seventh birthday; I played with it until the toy was chipped and cracked beyond recognition. My only sister, six years my junior, would be exposed to all manner of imaginary operations, homemade splints and carefully applied bandages. For hours I would daydream and ponder, glued to any and every television programme or book that covered the subject. Was there really a breed of person who cut people open for a living? How did they do it? What actually happened during an operation? There had never been a surgeon in my family, even if I went back 300 years, so there was no close relative I could ask. The only exception was an uncle, a charming New Zealander living in South Wales, an eminent chest doctor. He had been decorated following his time as a prisoner of war in Greece and had endless stories of life as a doctor that filled me with passionate enthusiasm about the medical profession.

  My father was a highly successful naval officer, having been a sailor since the age of thirteen. My mother, a part-time broadcaster and writer, would chase round the globe in his wake, supporting and holding her restless family together. A thousand times I remember being asked the question by any and every visitor to our various naval homes:

  ‘What do you want to be when you’re older, Richard?’

  ‘A surgeon,’ I would answer, steadfast in my determination.

  ‘A surgeon? My, that’s interesting,’ would come the reply, followed by a friendly pat on my head. I soon realized that my ambition was a conversation-stopper. No one knew anything about surgery, so discussing it was impossible. I would have to find out for myself.

  To be a surgeon, you have to become a doctor first, so t
hroughout my schooling I concentrated on the sciences. Of all such subjects, biology was my favourite, particularly dissection. Dissection involves cutting open some poor animal to gain a better understanding of how the body works. In retrospect it seems cruel, but in those days I knew no better. You would take a small, unsuspecting frog and insert a needle forcibly into it, just below the base of its fragile skull. This would pith it, such that it was technically dead, or so we were told, but its heart would continue working. You could then cut it open to see how the tiny body functioned. There would beat the firm, pea-sized heart, pushing blood round the animal’s circulation. The guts would wriggle and writhe, driving the motions onwards. I was riveted by such things, particularly the act of opening the beast up with the tweezer-like surgical forceps and curved, tiny scissors. From a young age I learned that opening and closing bodies, however small, was not a simple act. It took time and effort to practise. If you were not careful, your scissors could slip and damage an artery or nerve. I learned to rest the edge of my hands on the table while dissecting, to eliminate any sign of tremor. I learned, too, that surgical errors can be fatal. It was with this background, and a now fierce determination to become a surgeon, that I entered my London medical school. I was damned sure what I wanted to be.

  At medical school I was exposed to every aspect of doctoring imaginable: general practice, cancer therapy, children’s medicine, X-rays, the lot. One specialty, above all others, stood out for me - orthopaedics, the art of operating on bones and joints. I remember the day I decided it was for me. I had barely started my training and had been allocated a two-week period attached to an eminent orthopaedic surgeon’s practice. I was by myself in a huge, empty room containing little more than a wooden desk, two rickety plastic seats, and an X-ray viewing box screwed to a dirty wall. Decor has never featured highly on the National Health Service’s list of priorities. Outside I could hear the hubbub of conversation as dozens of patients waited to be seen, all comparing breaks and sprains, and the inconvenience of months spent in plaster. I sat nervously in my seat, jammed underneath the viewing box, awaiting the arrival of my consultant.

  Consultants? These were powerful, terrifying people, particularly when seen from the position of a junior medical student. You called them ‘Sir’, bowed and scraped copiously, and prayed they asked their questions of others, not of you. I did not have to wait long. Within minutes a tall, tanned figure strode into the undecorated room, confidently taking his place in the wobbly seat behind the chipped mahogany desk. He did not spare me a glance.

  I sat silently, praying this God-like creature would not turn and notice me, even though I was only feet away. Please, I thought, please come and join me, someone. Please come and keep me company. There were meant to be at least a dozen students attending this particular clinic, but I had been the only one to appear. If I stay very, very quiet, I thought, perhaps he will leave me alone. It was a foolish idea, as only seconds later the powerful, white-coated frame turned and looked me hard in the eye. For a brief second I lurched backwards, as if braced for some unexpected assault, but only succeeded in wedging myself still further under the viewing box. The hard, rectangular frame prevented any retreat. He’s going to ask me a question, I panicked. A question! I won’t know the answer! Please, someone, help! But no question came. Instead, the hard eyes softened, and a smile appeared. ‘You’re Villar, aren’t you?’ came the quiet voice. ‘First day?’

  I nodded frantically, scraping my head against the underside of the unfriendly viewing box, though I could sense my fear subside. There was something in the voice that made me relax.

  ‘I thought so,’ the consultant continued, still smiling. ‘The Dean told me you would be here. I hope you enjoy your time with me. Remember one thing, Villar.’

  ‘Sir?’

  ‘Orthopaedics is fun.’ Then he turned and the clinic began, as he smiled and chatted, greeting each patient as a long-lost friend. I was hooked, firmly and securely. Orthopaedics has been fun since that day.

  It is a young specialty when compared to medicine overall. It was only in 1894 that it became recognized in its own right. Until then, bones and joints were handled by general surgeons, who would also deal with the abdomen, chest and other body parts. The situation persisted in the United Kingdom well into the 1950s, and still continues in certain parts of the world.

  As a student, I began also to realize that not all surgeons work in major teaching hospitals. Many operate from very primitive establishments, often in basic, unhygienic parts of the world. Third World countries are classic examples. Perhaps it was my restless childhood - my father’s postings had sent us to North America, Greece and Malta - but I decided within three months of starting my medical studies that teaching hospitals were not for me. They were too laborious, too political, over-constrained affairs. Or so I thought. I laugh about it now, working in one of the most eminent centres in the globe, but in those days I had set my heart on orthopaedics in the Third World.

  How to do it - that was the problem. A London teaching hospital prepares you for many things, but Third World orthopaedic surgery is not one of them. A large part of orthopaedics involves the management of broken and shattered bones, injured as a result of accidents. I not only had to train myself to deal with such things, but also to cope with them when facilities were non-existent or sparse. I thought about it for months. How much easier it would be, I reflected, to be less restless and stay in teaching-hospital surgery. I even felt guilty in the presence of my instructors for considering life outside that of a spotless white coat and gleaming hospital corridors. Then, one day, something happened to send me on my way.

  As with most medical students, I seemed permanently short of money. Educating and enjoying oneself always appear to cost more than the sums coming in. To supplement an appalling student grant, I decided to join the University of London Officer Training Corps, the ULOTC. A part-time Territorial Army unit, they not only paid me for what I did, but took me away from London at weekends. This prevented me from spending what I had.

  I was surprised to find that I enjoyed the ULOTC. Joining them had initially been a purely financial exercise. Yet here I was having fun on ranges, heavy-goods driving courses and cross-country navigation tests. My time with them reinforced my ambition to do something different with my life. What the ULOTC could not do was show me how to realize my ambition - until my Commanding Officer decided I should parachute. I was horrified. Parachuting. What a pastime. To think that some do it for pleasure.

  I was sent on the military light-bulb course. The light bulb is a parachutist’s badge, not proper wings, issued to soldiers from non-airborne units after seven static-line descents. Thus it was that I found myself hanging on for dear life in the back of a C-130 Hercules, waiting to leap through the door into the thin air beyond. With me, along one side of the aircraft, lurching round the skies over RAF Abingdon, sat a handful of equally terrified men. Jim T, a good friend from Hull, was one of them. A solid, muscular man, he had approached our earlier ground training with real determination. Right now even he looked scared. Opposite us sat four very confident men. Chatting to each other in a relaxed way, they could have been on the London Underground.

  They were dressed differently to us, in blue boiler suits, oxygen masks hanging loosely around their necks. Their parachutes were also different: steerable Paracommanders in their thin, compressed packs rather than our bulky, standard-issue affairs. We were the basic static-line course, scheduled to be thrown out over Weston-on-the-Green at any moment. Eight hundred feet was as high as we would go. They were the HALO group - High Altitude Low Opening - scheduled for a 12,000-foot freefall, learning advanced parachuting techniques for infiltration behind enemy lines. I had naturally heard of them, but never seen them. I thought again. Here were SAS men in the flesh. SAS? Of course! What a brilliant idea.

  The parachute jump instructor, the PJI, barely gave me time to think further. The moment the red light glowed to one side of the exit, he pulled
open the door. When that happens, your insides work overtime. I was terrified. My legs shook as I felt the slow trickle of urine down the inside of my thigh. Jim also looked bad as I saw him struggle to control a vomit. We were both very frightened. We knew also that we could not go back. I looked across at the HALO team. One of them, the taller of the group, sensed my distress. Smiling, he winked and gave me a cheery thumbs up sign. ‘Go for it, lad!’ I heard him shout over the din of the aircraft’s engines. It was his encouragement that got me out the door, of that I am certain.

  A static line is a broad webbing strap attaching the parachute apex to a thick wire hawser inside the aircraft. Naturally, but unnecessarily, I checked that my own was still firmly attached. Behind me I noticed Jim still looking pale, concentration etched on his petrified face. Then the light changed from red to green. ‘Go!’ shouted the PJI at the top of his lungs, as he thumped me on the shoulder. That was not the time to turn, as I have seen done, and ask ‘Do you mean me?’ I jumped firmly through the door, feet first, arms folded on top of my reserve. The brave-hearted look back up as they depart, to be sure the main parachute opens properly. I did not. My eyes remained firmly closed throughout. Before I had time to think, I had plunged through the buffeting slipstream into the quieter air beyond. Slowly, hesitantly, I opened my eyes and looked upwards. Thank God! There above me was the perfect hemisphere of my open parachute. The relief was overwhelming. Unfortunately, full parachute deployment does not always happen. A number of things can go wrong.

  The commonest problem is the ‘twists’. This is what happened to Jim. As he exited the aircraft, the slipstream spun him like a top, rotating him rapidly as his parachute opened. This narrowed the canopy’s dimensions, making him fall faster and the parachute impossible to steer. He hurtled past me, thrashing his legs wildly in an attempt to untwist himself. Ground training had taught us to do this, emphasizing how important it was not to panic. Jim seemed to be doing well. As I drifted downwards, I felt how unfair it was that his first aircraft jump should face him with an air emergency. With less than eight hundred feet to go he had to untwist himself fast.