Medic: Saving Lives - From Dunkirk to Afghanistan

by John Nichol

  Flight Lieutenant Damien van Carrapiett relaxed while he could. He had years of experience in emergency medicine. He had worked in an NHS casualty department and then for an airambulance company, neither of which was challenging enough for the action man in him. As an RAF nurse, he had served in Sierre Leone, the Balkans and Iraq. But Afghanistan was turning out to be different, by far the riskiest of all. He knew the dangers, though he kept them from his wife. Not wanting her to worry, he told her his four-month tour there was behind a desk, far from the action. ‘She didn’t know I was spending my time in the back of a helicopter under fire, coming down in the middle of hot landing zones, and that somebody right next to me had been shot. My dad knew the truth, so when I needed to get some of the tension off my chest, I wrote and told him.’6

  It was twenty past midnight when the phone rang from Joint Operations Command Centre, and they scrambled into the Land Rover and raced fast down a gravel track to the landing site, where a Chinook was squatting, its rotors already rolling. The force-protection squad, whose job was to throw a defence cordon around the helicopter the moment it landed, were already on board in flak jackets and helmets, and gripping their rifles. Yellow plugs were stuffed in their ears to drown out the roar of the engines. The air crew arrived from their briefing. ‘We didn’t have much information,’ van Carrapiett recalled. ‘We all knew there was a big fight going on, a TIC, Troops In Contact. We were told there was a casualty with an arm injury, and that was all that we had to go on as we took off.’

  The Chinook is a wonderful workhorse of a helicopter in a war where the front line is constantly shifting. It can ferry in dozens of troops in battle order and take out casualties. It is a huge beast, the size of a couple of double-deckers, but travelling in it is no bus ride. It lurches and yaws like an out-of-control Underground train, and the noise batters the senses until eyes glaze and nerves strain. It is also vulnerable. Its bulk makes it an attractive target for any enemy, as inviting to a gunman as a barn door. The men who fly in it are fully aware of the danger, particularly on landing and take-off, when it is wide open to an RPG attack. If this happened in Afghanistan, the disaster would be twofold – not just the catastrophic loss of life but the immense boost in morale the Taliban would derive from such a score. To down a helicopter was a prized ambition of theirs. It would mean history was repeating itself. Every Afghan guerrilla knew that it was acquiring the means to knock gunships out of the air (with Stinger missiles, supplied, ironically, by the Americans) that had brought victory over the Russians. ‘If an RPG hit us, we were toast,’ said van Carrapiett. The guerrillas would also blaze away with their rifles and, though bullets alone were unlikely to bring down a Chinook, they could pierce the sides and cause serious injuries, even death.

  As the Chinook scooted across the desert towards Sangin, the medics, shouting through the bells-of-hell din from the howling engines and the massive rotors front and back, drew up a plan of action. With just one casualty to pick up from a site that was known to be ‘hot’, it made sense not to go for the full landing procedure. The protection force would not be deployed. Instead, as soon as the ramp went down, van Carrapiett and the anaesthetist, Colonel Griffiths, would run off with a stretcher, shove the casualty on it and be back inside in seconds. The Chinook came to ground and, as it settled, they dashed out into the pitch-black night. Dust from the down-draught was swirling everywhere. They were all but blind. The loadmaster, hanging from the rear door, pointed them into the gloom, towards a figure he had spotted. A soldier was waving his hands in the air, but not to guide them towards him but to tell them to go away! ‘Get back on the fucking helicopter,’ he yelled. They had come down in the wrong place, into a contact zone. Fortunately, the man signalling at them was friend not foe – he could all too easily have been a Taliban fighter, with disastrous consequences. ‘We got back on, the helicopter took off again and we spent forty-five minutes in the air, circling. Sitting in the back, we didn’t know if we were lost or what was happening.’

  In fact, they were in the right place but the area was simply not safe to land a Chinook. Taliban gunmen were in the woods bordering the pick-up zone and sniping at the picket line of soldiers that had fanned out to protect Stockton until he could be ‘cas-evaced’7 out. There was a delay, therefore, until an Apache gunship arrived from Camp Bastion and raked the edge of the trees with machine-gun fire. Stockton and Gary Lawrence cowered in the back of the Land Rover as, for twenty minutes, the air outside shook with the ‘phenomenal noise’ of the gunship in action. ‘An Apache hovering above you with the chain gun going is pretty scary,’ said Lawrence. But it was also a welcome noise because it meant rescue was near. The firing ceased after twenty minutes, and then they heard the Chinook. Suddenly, Lawrence recalled, Stockton was all action again. He snapped out of the advanced stage of shock he had been in and stepped out of the vehicle, a cigarette glowing in his good hand, as the helicopter, like some giant insect, touched down on the ground.

  For van Carrapiett, it was the same drill as before. ‘The ramp dropped and we dashed out into the dark. I was on the front end of the stretcher, the colonel on the back.’ Only afterwards did it occur to anyone what an astonishing spectacle this was, one that confounded centuries of military tradition. Two officers, one of them a colonel, racing to the rescue of a front-line casualty – it was unheard of in previous conflicts but, in twenty-first-century warfare, was now normal practice. ‘We spotted a Land Rover and sprinted towards it. I saw a guy and I reached out to grab his arm so I could lean towards him and shout in his ear above the deafening noise from the helicopter. There was no arm there! I found myself shaking his humerus, his bone. This had to be the casualty, then. He refused the stretcher. He walked towards the helicopter, which was quite remarkable, considering.’

  Before reaching the Chinook, Stockton stopped and turned. ‘Cheers, Loz,’ he called back to Lawrence. ‘Thanks very much.’ Then he walked up the ramp. Once inside he was made to lie down on a stretcher and strapped in as the Chinook took off and headed to Bastion, ‘head down and fast, because this guy obviously needed to get to an operating theatre quickly’.

  Back on the ground, Gary Lawrence ducked down against the blast of wind and dust from the helicopter. He was relieved to see the sergeant major on his way. He had done what he could, and done it well. Crucially, he had contained the bleeding. Otherwise, Andy Stockton’s bones would have quickly joined those of the thousands of other British soldiers whose blood, over the centuries, has seeped away ‘on Afghanistan’s plains’, as the poet of British imperialism, Rudyard Kipling, put it. As the sound of the helicopter died away, the medic still had work to do. The rescue force was strung out in defensive lines, waiting for the chance to make the dash back to the reinforced walls of FOB Robinson. Lawrence moved from man to man, ‘checking on the guys to see if there’s any injuries, if anybody needs anything. It wasn’t until I’d gone down one side and was just coming back up the other side that an officer stopped me and asked me, “Loz, have you eaten, have you had anything to drink?” I hadn’t, so he ordered me to take a rest. I lay down and just collapsed. I was absolutely knackered. I’d gone four or five hours without food or water, running on adrenalin. In the heat of it all, you just forget about those things. It was Andy’s life that mattered.’

  That life, and the preservation of it, was also now concerning van Carrapiett. As the helicopter bumped and bucked its way to Camp Bastion, ‘I checked his ABC – airway, breathing, circulation – which may sound silly, since his problem was obvious: his arm was hanging off. But there is always the danger that a gross injury like this sidetracks you from some other life-threatening problem, gunshot wounds in the chest, for example, something that he may not even be aware of. You have to make sure he’s not leaking blood from another hole.’

  Small metal fragments were devils. Undetected and left in the chest, the risk was peritonitis; in the buttocks and the result could be a perforated rectum; in the neck and the patient might die from a
blood clot. So van Carrapiett checked thoroughly en route. It was not as easy a procedure as it sounds. Lawrence had had enough difficulty treating Stockton in a slow-moving Land Rover. In the air, in the vibrating hull of the Chinook, with no lights and the deafening noise blotting out everything else, it was next to impossible. ‘You’re wearing a helmet and, for most of the time, you can’t hear anything,’ said van Carrapiett.

  A stethoscope isn’t much use because you have to be able to hear the heart beating or the lungs inflating, and at 50 feet off the ground and more than 100 miles per hour, that’s just not going to happen. Even taking a pulse, the most basic of clinical checks, is incredibly hard. And these difficulties are multiplied tenfold when it’s the middle of the night or when you’re under fire. I was proud of myself just for getting a cannula [a needle for delivering fluids] into a wounded soldier. In a casualty department in the NHS, it’s fairly simple. In the dark in the back of a helicopter, believe me, it’s bloody difficult.

  He managed to get a line into Stockton and put him on an intravenous drip of pain relief and antibiotics. ‘After that we just did our best to make him comfortable and to reassure him. We talked to him, told him he would be all right. It was a couple of hours since he had been hit. If people are going to die from unsustainable injuries, then, generally speaking, they do so within the first thirty to forty-five minutes. That he was still with us was an important clinical indicator that he was going to make it.’

  But, even now, nothing could be taken for granted. The injury was a catastrophic one and needed urgent attention. The Chinook was hardly the most soothing of ambulances to ride in, but the sergeant major, with the morphine kicking in, recalled the flight back to Bastion as ‘pretty comfortable’, though, not surprisingly, he was hazy about the detail.

  The medics moved around me, making sure I was okay. As we landed and the ramp came down, I saw an ambulance backing up to the door, so I made to get up off the stretcher, whether from shock or bravado, I’m not sure. I remember thinking that stretchers were for sick people, not me! They made me lie down again, and they carried me off. Suddenly, I felt really cold, and as I got into the emergency room, my legs started to shake uncontrollably as delayed shock set in. The doc stood over me and introduced his med team. It seemed bizarre. I had just been airlifted out of a firefight where people were trying to kill me, and the next moment I’m in this place where everyone is so civilized, calm and professional, no shouting or screaming or yelling of orders. The doc explained that they were going to have to take me straight to theatre and that it didn’t look good for my arm. ‘Do what you have to do, Doc,’ I said. The anaesthetist leaned over, and told me I would soon be asleep… and then everything went black.

  The ‘Doc’, as Stockton called the surgeon about to wield a scalpel on him, was Lieutenant Colonel Paul Parker. The thing about soldiers, he remarked to his colleagues as they took up their positions around the sergeant major’s comatose body, was that they were ‘like lab-rats, they’re very difficult to kill’.8 They were young and fit and capable of handling the sort of trauma that would completely pole-axe others. ‘They’re muscular, and their arteries are muscular too. When an arm is blown off by an RPG or a mine, the little muscles in the artery walls constrict and go into spasm, and that can save them. A shot in the groin or the armpit is much worse and can be a killer, because you can’t easily get to the artery to control the bleeding.’ Stockton’s injury, for all its obvious gore (not to mention the devastating implications for him and the rest of his life) was a classic war wound, an injury that could have been sustained any time in the past four hundred years – ‘a musket ball could have done it, or a cannonball.’

  There was no chance of saving the arm whatsoever, Parker concluded. ‘The hand was cold and blue and facing the wrong way. It had to be amputated, and you just get on with it.’ (Just to be on the safe side, however, he had photographs taken showing that the arm was completely unsalvageable. ‘I didn’t want him going back to the UK and some fancy young surgeon, far from the battlefield, saying, if I’d been there, I could have saved your arm.’) Parker now snipped the sinew still holding the lower arm and a medic carried the severed limb away. Then Parker removed the combat tourniquet – which, for all the trouble Gary Lawrence had had with it, had proved very effective – tied off the artery, then went to work with a saw on the bone, just as army doctors did under similar circumstances in the Crimea or the American Civil War a hundred and fifty years ago. He cut swiftly through the bone, then turned his knife on the raw pieces of traumatized muscle. ‘Anything that looks like hamburger is bad, it has no blood supply and is dead and has to be cut away. Fillet steak is best – well-defined tissue with a good blood supply!’ It was all done in forty-five minutes. Parker tidied up the skin around the stump but left it unstitched for now. Finally, the wound was loosely dressed. It was not stuffed with swabs or tightly bound, as a lay person might expect an injury of this severity to be and as surgeons would have done before the Second World War. Modern military medicine dictates that the flesh be left open to the air and given a chance to heal naturally. ‘I was taught,’ Parker declared, ‘that wounds of war need to be packed lightly and with soft, fluffy things, like a lady’s handbag’. Cotton wool, gauze and a crepe bandage now covered the spot where Andy Stockton’s lower arm had once been.

  *

  In the home in Wiltshire she shared with Andy, Emma had gone to bed with the dog for company. It was a hot summer’s night and she slept fitfully.

  Then I thought I heard a knock at the door, but the fan was on and making a racket and the dog didn’t stir so I thought, no, I’m half asleep, dreaming. But the knocking was persistent. I looked at the clock and it was 3 a.m. I was a woman alone in the house and thought, ‘I’m not going down to answer it. I’ll peep out of the bedroom window.’ On the porch below was a man in a suit – and for the life of me I couldn’t think what he was doing there, in a suit, at 3 a.m. I shouted down: ‘What do you want?’ And then from out of the darkness I saw a young lady in military uniform. That woke me up. I could see that the man in the suit was a captain Andy and I’d served with in Iraq. Then I knew – this is the moment we all dread.

  From her window, Emma called out the question that instantly formed in her mind. ‘Oh my God, is it the worst?’ The captain shook his head. Relieved, she ran down the stairs and let them in.

  I was shaking and I had gone all cold but I wasn’t hysterical. He said that Andy had been shot. ‘Shot, where?’ I asked. ‘In his arm.’ ‘Which arm?’ ‘I don’t know.’ ‘Is his arm still there?’ ‘I don’t know.’ I thought, ‘He knows, but he’s not telling me.’ Being ex-military, as I am, it’s worse, because you know what a bullet can do. My mind went into overdrive, trying to think through what was happening. I didn’t scream or cry. I was just sitting on the corner of the sofa and I was shaking. He said he’d just spoken on the phone to the chief surgeon out in Afghanistan and that Andy was stable and just about to go into the operating theatre. They didn’t tell me at that point that he was going to lose an arm.

  The captain and his colleague didn’t stay long. Emma told them to go. She wanted to be on her own to digest the news. ‘I sat out in the garden in the dark, back on the lounger. The dog was pottering about and I was just sitting there thinking, “Oh my God, what’s just happened?” I was holding on to what they’d told me – “He’s stable.” I remember telling myself, “He’s stable, so that’s all right… even though it could go one way or the other, at the minute he’s stable… and I’m sure he’s going to be fine… he’s going to be fine.” ’

  And Stockton was indeed fine, and proving himself as hardy as any laboratory rat. He had woken from the operation as the orderlies loaded him on to the trolley to take him to a ward. There he asked the nurse: ‘Can I have a fag, please?’ Not surprisingly, the request was denied, and it was a while before he managed to wangle a smoke. Lt-Col. Parker got up for breakfast after snatching a few hours back in his bunk after the operation
. ‘Outside the entrance to the hospital, I saw Mr Stockton calmly smoking a cigarette. One of his mates passed by and called out, “Hey, Andy, what’s the time?” He made to look at his watch, but of course it wasn’t there, and they both fell about laughing. Typical squaddie black humour!’

  Flight Lieutenant van Carrapiett saw him too, later the same day, and could hardly believe it. ‘He was outside, having a fag, having a chat. It was great to see him, because it meant the whole medical system was working. He was in a bad way when we brought him in, and a few hours later he’s on his feet, having a ciggie and a laugh. I read a few months later that he’d taken up one-arm water skiing. Brilliant – that’s what our job is about.’

  In England, the phone rang in Emma’s house at 9.30 that morning. She’d already been on to the army welfare staff and thought it was them calling back. Instead, she heard a familiar, chirpy voice: ‘Hiya, babe, it’s me.’ On the other end, Andy was chatting away as if nothing had happened. ‘He didn’t say anything about being shot – he was making small talk.’ Finally, she asked him outright about his arm, though she didn’t actually use the word. ‘Is it still there?’ ‘No.’ ‘It’s gone then?’ ‘Yeah.’ ‘Are you all right?’ ‘Yeah, yeah, I’m fine, it’s gone, I’m all right, really lucky, could have been dead. I’m fine, I’ll be coming home soon.’ ‘How much has gone?’ ‘Just below the shoulder.’

  ‘He didn’t seem down or anything,’ said Emma. ‘My initial reaction was Thank God he’s still alive. He’s lost an arm, but that doesn’t matter at the minute. A little bit selfishly, I also thought, “He won’t be going back there to Afghanistan again now.” A pretty hefty price to pay, mind.’ It was after she put the phone down that, for the first time since that 3 a.m. knock at the door, she began to cry. ‘I was wandering round the house and seeing all the pictures of him. There was one in the lounge with both his arms round me, and I was thinking, “Oh, that arm’s not there now. He’s never going to put both his arms around me again.” And that’s when the tears came.’