Bad Medicine

by Terry Ledgard

  Integrating into the navy ethos was very different, to say the least. My vocabulary underwent a rapid transition yet again. Although the base was located on dry land, the front gate was known as the gangway. I felt like I was abandoning ship every time I left base. Floors became known as decks, and walls were referred to as bulkheads. Food became SCRAN (Shit Cooked by the Royal Australian Navy), and left and right became port and starboard. I memorised the lingo through mnemonics such as What do you do with a drunken sailor? Send him to his bunk because there’s no port left.

  Despite the traditional rivalry between army and navy, the UM course had a knack for fostering a deep respect between its students from either camp. Although it’s a well-known fact that the army spanks the navy in every single Anzac Day drinking contest, I can honestly say that some of the navy people I came to know on that course are among the best in their chosen field – and good people to boot. Mad respect, but they can’t drink for shit!

  The UM course was the most interesting field I’ve ever been involved with. I learnt all kinds of nifty medical treatment tricks, ranging from dealing with decompression illness, barotrauma and nitrogen narcosis to dangerously invasive surgical procedures such as intubation and chest-tube insertion. At the time, dysbaric medicine was still an evolving field of study, based upon the hard-won lessons from the previous decade’s mistakes.

  Back in the day, hyperbaric chambers were made of wood but they soon realised that the combination of pressurised oxygen and wood only needed a small spark – such as static electricity from turning the page of a newspaper – to turn the chambers into a gigantic bomb. The exploding wooden chambers killed a ridiculous amount of people before they were modified to a steel hull.

  In the 1900s, pioneering Canadian divers paid a hefty price for the safe diving recompression protocols we use today; they were repeatedly sent a thousand leagues below to push the limits of the human body, but the experts of the day took forever to figure out why divers returned to the surface looking drunk, unconscious or dead. Their staunch efforts have saved an untold number of lives with the safe diving practices developed from their courage. After learning the history, theory and practical skills of the UM profession, I was sent on clinical placements for practical reinforcement.

  St Vincent’s Hospital, with its close proximity to Sydney’s Kings Cross, proved the perfect training ground. On my first shift in the emergency room (ER) in September 2006, I was greeted by a man who had a certain aura about him. Gordian Fulde, the St Vincent’s ER director and public figure for drug- and alcohol-abuse awareness, gave me a quick tour around the facility, in between calmly offering advice to interns who were freaking out over their patients. Gordian finished the tour with a quick chat about the perils of drug abuse, but especially ice, and advised me that I was about to be schooled on the subject as soon as my induction was over. Acting as an ER respondent, I soon realised what he meant. Most cases that presented to the department were drug related – which usually meant ice related.

  Ice is one cunt of a drug. It only takes one hit and your soul can be addicted for eternity. I couldn’t count the dozens upon dozens of ice cases that I dealt with during my two-week tenure, but two stand out clearly in my mind. One bloke severed his femoral artery (in his thigh) trying to cut his lawn with a chainsaw while on ice. He was lucky to survive. Another fell from a third-storey balcony and had a displaced fractured femur (thighbone). Still high as a kite while waiting for the X-ray results, he bounced up and down on his broken leg in ER to prove that he was okay, resulting in his shattered femur stabbing through the skin of his thigh. He collapsed like a sack of spuds on the ER floor – but still wanted to be discharged because he thought he was fine. He survived, but the resounding message for me was that ice is an evil drug. Don’t even think about trying it.

  While the ice epidemic was certainly eye-opening for me, nothing compared with my placement in the surgical ward. I was scheduled to watch brain surgery – not to participate, but to observe the goings-on. I followed the hospital protocols and scrubbed up like a madman; bacteria didn’t stand a chance. Unbeknown to me at the time, this particular procedure was going to be filmed by Australian Story on the ABC. The surgical room looked like a mix between a high-tech Star Trek movie set and an old nanna’s plastic-covered lounge room.

  The attending surgeon was a surgical rock star. He wouldn’t even touch a brain-surgery case unless it was high risk. As I stood in the operating room dressed like a ninja medic geek in my hospital-issued scrubs, the rock star entered the room. He wore pharmaceutical logos on his scrubs like an athlete endorses a sports brand, and had an entourage trailing in his wake. He was a god in the surgical world, acutely aware that he was being filmed, and that he had a military-medic jube in the room, yet remaining fully focused on the job at hand. He juggled these respon­sibilities like a boss (and I don’t use that term lightly). His name was Dr Charlie Teo, and he remains one of Australia’s most famous surgeons.

  After removing the outer layer of the patient’s skull, Charlie started dissecting the patient’s arachnoid mater (middle of three membranes of the brain), momentarily pausing while blood pooled underneath the membrane.

  ‘Where’s Terry?’ he asked calmly, making the complicated surgical procedure look like child’s play.

  I didn’t quite know what the norm was for a Special Forces medic, in terms of public exposure, so I hesitantly moved towards the operating table – and the cameras. The intern hangers-on gave me severe stink-eye because I was somehow circumventing the natural order of surgical ass-kissery. I was masked, so not worried about anyone recognising me, but I wasn’t quite sure how the ‘Special Forces medic’ thing would be portrayed on TV – I was sweating the legalities and fallout back at the Regiment.

  ‘See this, Tell? This is what a subdural haematoma looks like. This is intracranial pressure. I want you to see this so that you can picture what intracranial pressure is actually doing without having to imagine it,’ Charlie explained. ‘What signs and symptoms would this patient be displaying right now, in the field?’ he asked.

  ‘Well, he’d probably have a low GCS [Glasgow Coma Score] and neurological responsiveness, plus widening pulse pressures?’ I half-explained and half-enquired.

  ‘Correct, Tell,’ said Charlie. ‘But what if you’re in the middle of a combat situation, hours away from a hospital. How can you treat it pharmaceutically?’

  ‘All I can really do is manage the body positioning and fluid intake, and maybe administer mannitol, if indicated,’ I said, hoping to fuck I was right.

  ‘If they’re the drugs that you’re taught to use, then that’s all you can really do, Tell. If you can do that, you’ll save more lives than you lose,’ Charlie schooled me.

  A more perfect training ground for Afghanistan didn’t exist; this man was a certified gun. His surgery was flawless and the patient survived. I marvelled at his ability to hold a broad range of conflicting and complex ideas in his mind, yet still drill down to specifics when he was teaching the junior players like me who were on the periphery of the task at hand.

  In October 2006, the UM course drew to a close. Two of the initial seven students dropped out due to failing grades. Another student was incredibly lucky to scrape through with a bare-minimum pass mark. I got a combined total of ninety-three per cent for my efforts; I worked my ass off for that result. The top student (also an SAS medic) got ninety-four per cent. Being an SAS medic had inspired me to actually apply myself for the first time in a long time. The role came with a high level of responsibility. I was supporting the best, so I needed to be the best I could possibly be at my job. But if there’s one thing the UM course taught me, more than any other lesson, it’s the value of taking your time to assess a situation. We were now qualified to administer some pretty funky drugs. If we diagnosed incorrectly, we might administer the wrong treatment and accidentally kill our patients within a matter of seconds. But if we took the time to get it right, our patients stood a better ch
ance of survival.

  My precious few days of leisure after the UM course were cut short when I was called back early to the SAS to cover their Combat Survival course. At first, I was pissed about this, but I soon realised that the course was awesome to observe – yet not so fun to be a part of. Without revealing too many details, I will say that nearly half of the group (students and instructors alike) fell victim to a particularly virulent strain of gastroenteritis that threatened to end the course before the students had had a chance to graduate, meaning they’d have to do it again at a later date. Never one to enjoy prolonging people’s suffering, I came to the party and intravenously cannulated twenty blokes around the clock within forty-eight hours to keep the course limping along. And although I hadn’t slept in seventy-two hours and the victims were in even worse shape, they cowboyed up and heartily thanked me for not having to repeat the course when it was all over.

  In early 2007, I started building myself up again for a shot at SAS selection. I felt ready, more than ever. I knew the course; I knew the program; I knew the selectors: I was ready. But the SAS medical cadre was short-staffed, which presented real problems for my intentions. I was asked to go to Afghanistan as a medic instead. This was a real quandary for me. I’d done the work twice for SAS selection already, but the Afghan trip was a very juicy carrot dangling in front of my face.

  I consulted my confidants in the SAS training wing and discussed the dilemma. They were extremely encouraging about my chances of passing selection but their consensus was that I should roll Afghan, arguing that I could do more good as a young, fit, level-headed medic now than I ever could as a shooter later. I was still young, so I had plenty of time to attempt selection, but I was needed for Afghanistan now.

  I agonised over this decision for weeks but eventually chose Afghan. I felt an obligation to my tight-knit group of medic mates that overrode my compulsion to have a crack at selection. I didn’t want to let the team down – selection could wait another year. The more experienced medics had just come back from Afghan, so they’d be staring down the barrel of combat stress if they had to go back now. The less experienced medics didn’t have the UM course under their belts, so they didn’t have some of the more advanced trauma skills that would come in handy on deployment. I was on deck.

  This was a second decision that I’m still struggling to come to grips with. Although my motivations for choosing Afghan seemed like the right ones at the time, with the twenty-twenty vision of hindsight, I think my subconscious fear of failure was a larger factor than I would’ve cared to admit. The fear of failure was fast becoming a regrettable theme in my life. I’d just settled for second best, yet again.

  5

  THE ’GHAN

  With my selection desires cast aside, I agreed to ramp up the whole Afghan thing in 2007. My buddies threw a drunken and immoral going-away party of historical proportions the night before I was due to ship out. The following day, I was lining up for a pre-deployment gee-up speech from the political dignitaries of the day. Hungover like a motherfucker, I sat in my designated seat, three rows back from the Minister of Defence (MinDef), Brendan Nelson, as he launched into a charismatic and heartfelt speech about what we were going to do in Afghanistan. Every now and then as he was addressing the room, his gaze would momentarily stop on me, a hint of acknowledgement registering on his face. He could probably see the alcohol fumes rising from my pores. After an amazing address, the MinDef made a beeline for me.

  Please just leave me to die in peace.

  ‘Big night, mate?’ the MinDef asked, heartily shaking my hand.

  ‘It’s always a big night when the police are involved,’ I embellished. I smelt like a brewery and looked like sin.

  ‘Hehe, I’d expect nothing less. You’ve already done us proud,’ he said, with an entirely knowing and genuine smirk on his face.

  I couldn’t believe it. He came across like a straight-laced suit on TV but in reality he was just another degenerate lad. I love that dude; I wouldn’t entrust my taxpayer dollars to another. Vote Liberal.

  After my blood-alcohol content subsided to a non-deadly level, I found myself at an Australian airport waiting patiently on the gangway to board the plane to an undisclosed destination in the Middle East. After a long series of flights, three other Special Forces medics and I, amid a sea of troops, landed safely on the Tarin Kot airstrip in Afghanistan. The group was made up of 4th Royal Australian Regiment (4RAR) commandos and SAS that, together, formed the Special Operations Task Group IV (or SOTG 4, for short). Regardless of which unit we hailed from, Special Forces medics were given the call sign ‘Kilo’.

  As the ramp of the C-130 aircraft lowered, a wave of heat and sand smacked our faces. It was forty-five degrees out; wavy heat lines distorted the view of the horizon. Lugging our personal gear down the ramp and onto terra firma, we soon had beads of sweat leaking from every pore. Before we had a chance to think, the Special Forces doctor collared all the Kilos and dragged our jube asses into the disaster lock-down bunker.

  The Doc’s wild eyes darted around beneath his Armageddon helmet as he taught us the rules of the base safety game. He was an incredible physician but one of those highly intelligent people who lack street smarts – he was like Chicken Little, constantly worried that the sky was about to fall down. And he’d been in Afghanistan for a few weeks at this point, so he was flapping that his premonition was going to come true at any moment.

  Within minutes, huge blasts reverberated around the base, sending tremors through the earth. What the fuck have I got myself into? I half-expected a mortar to land right in my lap. Maybe the Doc was on the money!

  The blasts didn’t appear to be close but the noise was overwhelming. What the hell was going on? I peered around the corner of the safety bunker, only to notice that blokes were walking around normally without a care. This can’t be right.

  With the sound of explosions echoing in the bunker, the Doc explained that the base was a hotbed of pure death. The Taliban was infamous for sporadically bombarding the place with long-distance mortar attacks and then melting away into the background. Further (non–panic attack) investigation, though, revealed that these explosions were caused by the friendly mechanised artillery cannon located nearby, and not by the enemy. While we all appreciated the Doc’s medical expertise, this was the first and last time we’d follow his nonsensical tactical advice. So embarrassing.

  The Tarin Kot base had a rare and unappreciated beauty. Between sandstorms, the distant grey-bluish hues of the vast mountain ranges of the Baluchi Valley were clearly visible from our living quarters. The base itself was a sprawling mass of American, Dutch and Australian forces almost as far as the eye could see. Beyond the confines, the region was spectacular. If not for all the death, destruction and stifling heat, it would be an oasis.

  Living in fibro-clad multi-person huts, we began to build the Special Forces Regimental Aid Post (RAP), which looked like it had been decimated by an enemy bomb right from the outset. The makeshift RAP was our medical headquarters, a mix between a resuscitation bay, pharmacy and GP centre, all rolled into one. As our group was getting ready for business, an allied nation’s Special Forces unit requested our medical help for an operation that had the potential for mass friendly casualties. While we Aussie medics readied ourselves for the mission, the official word hadn’t been received from the Australian government yet, and we couldn’t help these boys without the bureaucratic green light from the powers that be.

  In a stroke of less than perfect timing, the green light was given two days later, long after we’d been ready and even further from when our allies needed help, after the mission had been executed. Luckily, no one was seriously injured, and our help wasn’t ultimately needed, but it could’ve been a damn-sight worse.

  With the excitement of that mission snuffed out, we kept busy by sorting out the shit-fight that was our RAP. The place was a disaster zone. We needed a stable medical platform to support the Special Forces blokes on their various
missions. The most abundant resource was ammo containers, so we used them as a filing system for our drugs. By week’s end, the RAP looked like a mix between an armoury and a trauma surgery. It was pretty cool in comparison to what it had looked like. More importantly than its aesthetics, it functioned superbly.

  While Special Forces operations geared up, the RAP started a slow metamorphosis into full functionality. The SAS were initially hesitant to bring me along for dangerous operations because I was an untested entity. I’d performed well in supporting training tasks back home, but active operations were a different story altogether. It took me a long time to earn their trust, as well it should. If I’d gone out undercooked, I could’ve got myself killed or, even worse, put my mates in jeopardy. I didn’t give a shit about myself, but the thought that I might let the lads down was so scary that it kept me awake at night.

  A week after touching down, the Aussie medics were needed just around the corner at the American Forward Surgical Base (FSB). The FSB was the first port of call for emergency trauma cases in the region – treating both Afghan locals and allied forces alike. When work was slow, the Americans were all over it, but when they were inundated with mass casualties, they needed our help. I vividly remember my first mass-casualty scenario at the American FSB, because it was such a dog’s breakfast. I was sitting on my bed, shooting the breeze with the lads, when the doctor burst into the room, eyes wide with excitement. The emergency bat phone from the FSB had rung and we were needed sooner than yesterday for a round of mass casualties that were inbound on an evac chopper.