Unconquerable

by Boris Starling

  In the Salisbury coffee shop, we both laugh as Josh tells me this. Such a male reaction, to want to know the fate of your old boy above all else. Yet the laughter covers a serious point: ask any soldier what he’d prefer to lose ahead of and instead of his genitals, and the list will be long: arms and legs for sure, maybe eyes, maybe even life itself.

  In that respect, Josh was lucky. Other soldiers at the time were being caught in blasts which weren’t just taking out the perineal area where the two legs meet but going all the way into their pelvic cavities and severing the intricate urinary and other systems located there. An American naval surgeon deployed to Bagram Airfield three months after Josh’s injury said, ‘Nothing in my experience prepared me for the catastrophic nature of these injuries’ – this from a former resident at a Level One Trauma Centre and seven years at hospitals in the US and Japan.

  Every battlefield surgeon out in Afghanistan had tales of operating on men who’d wholly or partially lost their genitals, with all the scarring that entailed. The physical effects of losing testosterone-producing testicles were bad enough: among them, and in no particular order, osteoporosis, increased blood pressure, high blood sugar, excess body fat around the waist, abnormal cholesterol or triglyceride levels, cardiovascular problems, hormonal fluctuations and obesity.

  But the psychological effects of such literal unmanning were even worse. You’d have no chance of kids unless you’d frozen your sperm beforehand. But in the rush to be deployed, who thinks of that? Even if they do, they might see it as a hostage to fortune, a superstitious irrationality: If I do this, if I freeze my sperm, that means I expect something bad to happen to me, and if I expect it to happen, then it will happen.

  Sure, surgeons can do amazing things with penile reconstruction these days. To rebuild the urethra, which carries urine through the penis from the bladder, they use oral tissue from the patient’s lips or the inside of the cheek, because it’s hairless and used to being wet. For the outer layer of the penis they can graft skin from the thigh or groin nearby.

  But rebuilding genitals and making them work properly – erection, orgasm and ejaculation – are two different things entirely. Besides, many surgeons who operate in this area are sex-change specialists, which in itself makes soldiers wary – I ain’t goin’ to no sex-change doctor. The bottom line was simple: losing a leg or an arm made you a war hero, losing your nuts made you a freak.

  Yes, in that respect, Josh was definitely lucky. Not that he felt it at the time. One of his colleagues called in a medevac from Bastion, describing Josh’s condition as ‘T1’ – ‘the most serious you can be without being dead.’ Some of the soldiers cleared a secure landing site for the helicopter. Others waited with Josh, cradling his head, keeping the tourniquets tight, keeping him conscious, keeping him talking, giving him grief for short-touring – ‘Some people will do anything to get home early’, ‘You lazy bastard!’, that kind of thing. Even – especially – in times like this, that was the Army way of showing you cared: there was nothing and no one you wouldn’t take the piss out of.

  The Chinook arrived, a giant airborne monster with vast rotors front and rear, which sounded like machine-gun fire as they blatted against the wind. Fading in and out of consciousness, Josh remembers his mates putting him on the Chinook and shouting ‘Airborne!’ His last coherent thought was, ‘I’m still in this fight.’

  The next thing he knew, it was a week later and he was in Birmingham’s Queen Elizabeth Hospital (QEH). What he’d missed was a medical performance which was both mind-boggingly brilliant and yet entirely routine. Those were the standards to which Bastion’s battlefield medics worked. World class was their baseline.

  It was an unspoken rule that if you were still alive when the Chinook got you then you would survive – the medics were that good. More than that, in fact. For the Chinook crew, it was a question of pride that they delivered you to the field hospital in Bastion in better condition than they’d found you. It didn’t matter how long or short the flight was, or whether they were being thrown about the interior like rag dolls while the pilots jinked and banked as they came in fast and low through incoming Taliban fire, the medics worked with the split-second efficiency of a Formula 1 pit-stop team. They weren’t about just keeping you in a stable condition, they were already beginning that process of making you better, no matter how far off eventual recovery you were and how severe your injuries looked.

  And Josh’s injuries were severe, make no mistake. His right leg was stripped from the knee down, his left leg was back to the bone, and the underside of his ulna (forearm bone) was completely destroyed – ‘It was the first time the surgeon had ever seen an ulna twisted so badly.’

  At Bastion they put Josh in an induced coma, cut off all dead tissue, closed up his major vessels, cauterised the smaller ones and sent him on a transport plane back to Birmingham. It was in Birmingham where he regained consciousness, and in Birmingham where his dad, the man in whose Royal Engineer footsteps Josh had followed, broke the news as gently as he could.

  Bad news: both Josh’s legs were gone. His right arm would have to be amputated. And he’d broken his back.

  Good news: he still had his nuts.

  The staff at QEH kept Josh in intensive care for a week in order to be sure that he hadn’t picked up any infections from the blast – the Taliban had been known to defecate on devices before covering them up, in order to add bacterial infection to the list of problems injured soldiers would have to deal with. When he showed no signs of infection, they moved him to the military wing. He wasn’t the first triple amputee there, and he wouldn’t be the last.

  A week before he’d been a young soldier in the peak of health, doing the job he loved. Now he was a bedbound midget. It was quite an adjustment. There were some problems which were pretty obvious – phantom aches and pains in limbs which no longer existed, the psychological shock of needing to rely on someone else for the smallest of things – but also others which would never have occurred to anyone until it happened to them.

  Temperature control, for a start. Much of the body’s natural cooling system comes out through the soles of the feet and the palms of the hands. Josh had only a quarter of the normal amount of hands and feet left, not to mention much less surface skin area now his legs were gone. There were cases in which you could – and this was ironic, given the circumstances – you could have too much blood.

  Then there was balance. You spent so much time lying down that it became hard to sit up, and when you did sit up, you were all out of kilter because you could no longer do what able-bodied people do instinctively and without thinking: move your legs and arms to ensure you’re always in equilibrium.

  ‘I had to accept that my life had changed for good immediately, and that wasn’t easy.’ But then again, Josh knew that if he’d wanted an easy life then he wouldn’t have joined the Army. He began to tot up the positives. His head was fine, for a start. No mental problems – ‘It helps sometimes, being an idiot’ – which meant he could concentrate fully on returning to physical health. Those first six to eight weeks he did a lot of thinking, processing what had happened. He knew he had the capacity to do this processing, and he knew too that this ability was priceless. There were guys in the wing whose heads were messed up, and so they were fighting recovery on two fronts: mental and physical.

  He thought of the Royal Engineers’ motto: ‘Adapt and overcome’.

  His military liaison officer brought him McDonald’s. The first Big Mac barely touched the sides, Josh ate it so fast.

  Adapt and overcome.

  Josh was happy to be alive, that was for sure. He wasn’t one of those guys who thought they’d be better off dead, he was definitely happy to be alive. But alive meant living, not just existing. He wanted to be as normal as possible. But he had a wheelchair. A wheelchair wasn’t normal for him.

  Adapt and overcome.

  Then one day he saw someone walk past the door to his room. It was one of the other soldiers, a
nd he was wearing prosthetic legs. Josh called out to him. The man turned round and came into his room. Josh asked him everything he could think of about the prosthetic legs – how they worked, how they fitted, what did they feel like, where had he got them, and so on.

  And finally, the most important question of all: ‘Would they work for me too?’

  The soldier looked at the stumps which had once been Josh’s legs.

  ‘I was just like that too,’ he said. ‘If they work for me, they’ll work for you.’

  Adapt and overcome.

  A few months after coming home early from Operation Herrick XIII, Josh had another mission: Operation Walk Again.

  Sarah Rudder could never escape that day in the Pentagon. Inside and outside, she carried it with her wherever she went. She could never escape it because it was part of her.

  And that’s right where she kept it, bottled up tight inside. For nine years she didn’t tell her family she’d even been inside the crash site, let alone mention the unspeakable horrors she’d seen there. But even so it was becoming increasingly clear that something was badly wrong. She never lasted more than a year or two in any job. She did a college degree, but it took her nine years to finish it. She was finding it increasingly hard to deal with the usual minutiae of life, the things which most people navigate without even thinking about them.

  Someone standing too close behind her in a line at the supermarket? No. Couldn’t do it. Couldn’t deal with it. So she became adept at going to the supermarket during the quiet times, when she could get in, do her shopping and get out with the minimum fuss and in minimum time.

  Loud sudden noises? Definitely not. Which didn’t make her much fun during Fourth of July celebrations.

  How about continuous, repetitive noises? No, not them either, which was even harder when she had a son, who like all small children liked to repeat things over and over. For most parents that can get annoying, but for Sarah, it was a lot worse: sometimes she had to walk away before her head exploded.

  She couldn’t cope with fire or the smell of fuel, so backyard barbecues were out of the question too. All these things, little things which people took for granted and so found it hard to understand in her. Sometimes she felt she wasn’t much of a mom to her small boy or much of a friend to her friends.

  And so she did her best to avoid as many triggers as she could, but even that could be hard. Besides, the need to avoid triggers ended up imposing on her life quite as much as the triggers themselves did. She developed severe obsessive-compulsive disorder (OCD), endlessly labelling and organising things, forever tidying away the toys which her son had left strewn over the floor. She knew that it wasn’t his fault – that’s what small boys do – but she couldn’t deal with it.

  Anxiety hung above her like a cloud or twisted itself in her gut, even when she didn’t have anything specific to be anxious about. As for sleep – what was that? Night after night she’d find herself staring at the ceiling in the small hours while the memories chased each other through her head.

  That was the inside. On the outside, her ankle still hurt like fury. Pieces of bone had come loose and were tearing up the cartilage. Sometimes the pain was so debilitating that she honestly thought she couldn’t stand it any longer. She was taking so much pain medication that she got kidney stones and had to have her gall bladder removed.

  She had one operation on her ankle, then another, then another: five in all. They took cartilage from her knee and put in her ankle. They put metal rods in and then took them out again. They cut her Achilles tendon and lengthened it. They vacuumed out pieces of bone. Each time she thought, hoped, prayed it would fix the problem, and each time the disappointment came crashing down on her when she realised sooner or later that it was just as bad as it had ever been. Her ankle swelled up like an elephant’s trunk, and sometimes she couldn’t even put a sock on as the slightest touch made it feel like a firebolt.

  Eventually she figured that if she was having treatment for her ankle, she should have treatment for her mind too. In 2010 she went to a therapist, who diagnosed her with post-traumatic stress disorder (PTSD) and suggested a couple of treatment methods. The first was prolonged exposure, where she was basically forced to deliberately expose herself to the triggers in the hope that she would eventually get used to them. The second was a sort of constant monologue, where she would record herself saying everything she saw, heard, touched, smelt and felt before listening to the recording at night while she slept.

  Neither worked.

  Just as frustratingly, her husband’s job as a drone programmer meant that the family had to move frequently, and so each time they upped sticks and landed in a new place, Sarah would have to start afresh with everything that entailed – new people who didn’t know her history, a new school for their son, a new therapist for her.

  In 2014, they moved to Temecula, south-west California. Another town, another doctor … She’d had good doctors and bad doctors, ones she’d liked and ones she hadn’t, but she’d never had one who really understood the problem. Not until now.

  The doctor in Temecula examined her. He told her that the mental and physical sides of what she was going through were linked, which she already knew: the effort she had to put into managing the pain in her ankle directly affected her mental capacity to deal with her post-traumatic stress symptoms.

  He could help her with the stress. He’d seen the kind of techniques she’d tried before, and he had some ideas as to what they could try differently: something a little leftfield, maybe, a little out of the box, not conforming to any prescheduled programme. Sure, Sarah said. She was good with that – it was worth a go at least.

  As for the ankle pain, the doctor added, that was a different kettle of fish. If it hadn’t got better after five surgeries, chances were it wasn’t going to get better at all. Unless …

  Unless what?

  Unless Sarah decided to amputate it, that was what.

  It wasn’t long after the Chemox incident that Stephan Moreau knew something was wrong with him – ‘I became really agitated at work. I couldn’t sleep at all, I started to isolate myself. I didn’t want to do activities with my friends or family anymore. I started to withdraw from everyone.’ When he and his wife were invited out to parties, he’d tell her he wasn’t feeling too good, and while she went alone he watched sports on TV or surfed triathlon sites on the internet.

  For someone like Stephan, usually so upbeat, this wasn’t just a brief blip in his behaviour, it was a sea change in his very personality – ‘I was passionate about my job, hard-working – and then the accident happened and I became this person that was going in the other direction. Instead of going up, I was going down and at a fast pace, too. I became very defensive and emotional as well. I was fragile, I’ve never been that fragile.’

  He had a spell off the Algonquin in an onshore office – ‘Not deliberately, just the way the rotation went’ – and being away from where it had all happened helped him a bit. But soon he was deployed back to the Algonquin, where there was no escape. The incident was haunting him, brief intense flashbacks which railed his senses: the sight of the flames, the sound of Joe’s screaming, the smell of the chemicals. He was afraid to be alone at night, because it was then that the memories, tangled and hallucinatory, haunted his nightmares, jolting him from sleep, wide-eyed and sweat-soaked, in the small hours.

  He didn’t tell anyone. Not a soul, not even his wife. He’d always brought himself up to deal with his own problems, with no father in his life and his mother always at work, trying to provide for him, and he wasn’t going to change the habit of a lifetime. Besides, talking about this wasn’t the kind of thing you were encouraged to do in the Navy. From inside and outside, the message was the same: be strong enough to deal with it on your own, be strong enough to put it behind you, accept that it happened and move on.

  Stephan wasn’t strong enough.

  He needed help, and if he couldn’t find it with a therapist then he’d fin
d it in a bottle. He began to drink, but soon found it was a vicious circle: the more he drank, the more he needed to drink to keep himself numb, and even that didn’t always work.

  His superior officers may not have noticed his post-traumatic stress symptoms, but they did spot his drinking: it was affecting his work and making him put on weight. They told him to cut down on the booze. But he couldn’t. They told him to stop altogether, and he couldn’t do that either.

  And so the bottom of the bottle became rock bottom in every way – ‘I didn’t have hope, or I didn’t think I had hope.’ A few years after the Chemox incident, Stephan tried to kill himself with an overdose. ‘Thankfully it didn’t work out, and I’m still here today.’

  Two separate investigations were held into the original Chemox incident. Both confirmed that the canister Stephan had used was defective. The investigators recommended removing the automatic emergency activation and overhauling the entire rebreathing system itself. Stephan was explicitly absolved of blame: it wasn’t his fault, it had never been his fault. He knew that, but he also knew that logic had little or nothing to do with what he was suffering.

  He began getting in trouble where he had never done so before – nothing huge, just little incidents of insubordination. But, combined with his drinking and substance abuse, for the Navy this was the last straw. In 2010 they offered Stephan an honourable discharge due to medical conditions – ‘They pretty much told me: “Your career is over with us, but if you want, we are going to send you to a treatment centre before we release you.”’

  Stephan did want. Six years after the Chemox incident, he went to see a therapist. Their first priority was to deal with his alcohol and substance abuse, but the moment he told her what had started it all off, she smiled. ‘I’ve seen more than 10 people from that single incident come through these doors,’ she said. ‘I’ve seen so many that I actually put the firefighting kit on and did that section of the training to try and understand it from the position of all you who were there.’