Medic: Saving Lives - From Dunkirk to Afghanistan

by John Nichol

  When he came to in a marsh beside the wreckage of the crash-landed glider, Vaughan had no idea where he was. He thought for a moment that he had woken up in his bed in the officers’ quarters back in barracks on Salisbury Plain. The sound of automatic fire disabused him of that comforting notion. As he rubbed mud from his eyes, ‘I realized the area I had landed in was bristling with offensively disposed Germans.’ He heard terrible groans – ‘the like of which I will never forget’ – and staggered to the wreckage, where a man was trapped. Though still groggy, his hand went automatically to the pocket in his battledress where he kept his syrettes (single-dose, disposable syringes) of morphine, and he jabbed a needle into the casualty. ‘I tried to reassure him and told him I was going to go and find a stretcher-bearer. I staggered off.’ Vaughan looked around and saw other upended gliders. He also spotted the bridges – already, he was glad to see, in British hands, but not totally secured. From the second of these, a metal roll-up-roll-down contraption over the canal,13 the sound of shooting was coming… and also the chilling heavy rattle of an approaching German tank. On the roadway, an airborne sergeant knelt, aimed his anti-tank gun and squeezed the trigger. The tank stopped in its tracks and burst into flames. But others were queuing behind it. The battle to hold the bridges was on.

  The doctor set up an aid post and tended some of those already wounded, though, sadly, most were beyond his help. Suddenly a Mercedes staff car came hurtling towards the bridge. A German officer, refusing to accept the truth of what was happening, was attempting to get a close-up view of the situation. The car was quickly cut to ribbons by a Sten gun, and a snarling Major Schmidt was pulled from the wreck and taken prisoner, promising that the impudent British invaders would soon be thrown back into the sea. His badly wounded driver wasn’t going to be throwing anyone anywhere, though. Both his legs were appallingly shattered, and there and then Vaughan amputated one of them, using a pair of scissors. It was his first battlefield operation – and it was on an enemy. It was not a success. ‘Not having a couple of bottles of blood for transfusion about me at the time, I wasn’t in the end able to save the poor fellow’s life,’ he noted later.

  Dawn broke over the Orne that morning accompanied by the boom of big guns from the direction of the coast. Naval ships were bombarding German defences. D-Day proper had begun, and soon those swarms of landing craft would be beetling across the water to Sword, Omaha and the other beaches. As the day wore on, the Germans were desperate to destroy the bridges, which would hold the key to the Allied advance. The doctor watched from his aid post as a Luftwaffe fighter-bomber swooped in and dropped a bomb, which hit the canal bridge but failed to go off. German frogmen were spotted swimming towards it with explosives and were dealt with. A gunboat full of soldiers was sent packing by the anti-tank gun. But gradually airborne resistance around the bridge was being worn down, ammunition was running out and the doctor was at full stretch, with growing numbers of casualties. ‘Suddenly I became aware of the most absurd sound – bagpipes!’ A file of Royal Marine commandos was approaching along the road from the coast, led by its commander, the flamboyant Lord Lovat, striding along with a walking stick and a piper. The relief had arrived. The doctor went to greet a young commando, ‘and he dropped before my very eyes, slid down into the ditch, and lay still. He had been shot through the head by a sniper.’ The line between victory and defeat, life and death, was paper-thin, a heartbeat.

  Now, more gliders were arriving in the area, some bringing in jeeps and trailers to form field ambulances. Captain J. C. Watts, surgical veteran of North Africa and Italy, commanded one such unit and made sure he had plenty of the magic ingredient that he knew from experience would save lives. Each of his men carried two bottles of blood plasma in his pouches, giving the doctor an opening store of two hundred pints for the emergency operations that began almost as soon as he had landed. He set up his advanced dressing station (ADS) in a large and grand country house and chose the cellar for his operating theatre – dark and dismal, maybe, but safer from bombardment. Soon Primus stoves were roaring away with hot water to sterilize instruments and the first casualty was on the table, an officer of the Royal Ulster Rifles with severe mortar wounds that once would have cost him his arm. Watts cut out all the damaged muscle and fixed the limb with plaster of Paris so he could be evacuated without suffering more harm in the move. The next soldier was not so lucky. His foot had been pulped in the same mortar attack and it had to be removed completely. But, where another doctor might have been tempted to amputate the rest of the man’s leg, Watts opted to leave it intact. Out on the battlefield, he felt, it was right to do whatever was strictly necessary to keep a man alive, and no more. Haste was dangerous. In the less frantic atmosphere of a hospital ward, surgeons were better able to make the decisions that would so drastically affect the patient’s future and his quality of life.

  The cases piled up. A man with a fractured femur was brought in, and Watts introduced the novices in his surgical team to the Tobruk splint. He had picked up such tricks of the trade over a number of years but, as he was very aware, his men were learning war surgery the hard way, ‘under terrific pressure’. He was astonished by their prowess. ‘I never had to show them a procedure twice. They were veterans in an afternoon.’14 A medical student administered anaesthetics, while triage – the initial sorting out of casualties according to the severity of their injuries – was skilfully undertaken by an orderly who had been a barber in civilian life but who now sifted out the priority cases and kept the flow of patients moving smoothly into theatre.

  The battle was never far away. Suddenly, the Germans launched a counter-attack in the area and shells shook the house. Windows smashed, plaster rained down, but in his cellar Watts kept his head down, eyes firmly fixed on the table and whichever lacerated human was on it. When he did manage to take a short break, he went upstairs, looked out of the window and could clearly see German soldiers on the march across open fields nearby. To his horror, he realized they were to the west of his dressing station, in the direction of the sea – which meant he must now be behind enemy lines. His position was surrounded and could be overwhelmed at any moment. In the event, this German counter-attack was pushed back, but the truth was that, for a while, he, a doctor, had not only been up in the front line but way beyond it on the other side. Medics, so often the Cinderellas of the military services, were as exposed as the next man to danger – if not more so. With casualties to tend, they could not manoeuvre their way out of trouble or run and hide. The doctor returned to his table and carried on.

  An exhausted Watts now had to deal with a complicated case. It was late at night and, by the light of a hurricane lamp, he examined a patient with almost no pulse and dressings over his stomach.

  When I removed these, I saw a ghastly sight. He had apparently been almost eviscerated. There was a deep trench furrowing across his abdomen from side to side and no bowel to be seen. All through the busiest times of the North African and desert battles I had never had to refuse a case, but I had ten cases awaiting operation, all of them with a reasonable chance if they were operated on in time. This man’s plight seemed so desperate that even if operated on he would have little chance of survival. Despondently I arranged for him to have a large dose of morphia to ease his pain, and instructed the stretcher-bearers to put him in a corner to die.

  Watts worked through the night, cleared his cases and was astonished next morning to find the same man still lying on his stretcher, very much alive and complaining that no one was treating him. ‘I inspected his enormous wound again and, by the light of day, I could see that he was an immensely fat man, and that an anti-tank shell had furrowed across his belly wall, inflicting the deep trench I had noted. But so thick was the fat that the shell had not actually opened the peritoneal cavity. The injury, which in my tired state and in the poor illumination of the previous night I had conceived to be hopeless, was merely a large (and easily stitched) flesh wound.’

  But, despite this for
tunate outcome, Watts never lost his wariness of belly wounds. He was comfortable treating limbs and chests in the front line but, as he observed, ‘the abdominal wound presents a very difficult problem for the war surgeon. The patient’s chances of survival are slight without operation, but after operation he must be held and nursed for about ten days until normal bowel function is restored.’ This was difficult to do in the confines of an advanced dressing station, especially if a battle was raging outside. ‘We were severely mortared one day when we had some abdominal cases still with us four or five days after their operations. Shelling is unpleasant enough when one is fit, but its effect is disastrous on a desperately wounded man lying on a stretcher unable to move, a tube in his nose leading to his stomach, and another giving him saline through a needle in his arm. Two of these poor patients, who had been progressing well until this shelling, deteriorated, paralysis of the bowels set in, and in spite of all measures they died from toxaemia within twenty-four hours.’

  Most patients were evacuated as quickly as possible from the ADS to casualty clearing stations that, as promised, had now been set up on the beaches. Stretcher-bearers and ambulance drivers in any vehicle they could seize were constantly on the go, back and forth, dashing along unfamiliar roads in darkness and wet weather and through mortar and shell fire. On the day of the German counterattack, a convoy of seven ambulances, led by a motorbike, was on its way to the beaches and, at a crossroads, was waved on by a sentry. Only as they passed and he took pot shots at them did they realize he was German. So quickly was the situation changing that, on the way back, they saw German bodies lying at the roadside at the same spot after the successful British fight-back.

  The fighting continued to swirl close to Watts’s house for the next fortnight, causing endless problems. ‘Spasmodic sniping and stray machine-gun bullets restricted our movements, even when we were not the object of any concerted attack,’ one medic remembered.15 Stretcher-bearers risked their lives constantly to bring in casualties. They would crawl forward into the heart of contact zones in twos, one carrying a stretcher, the other waving his red cross armband in the air. Many of these stretcher-bearers were conscientious objectors, who, on religious and moral grounds, refused to fight or carry weapons but were willing to save lives and ease suffering. Lieutenant David Tibbs, a doctor in the Parachute Regiment, had six of them in his unit and thought them ‘excellent men’. He was touched by their strong faith, even when it was foolhardy. One, he recalled, sat in a deckchair outside the regimental aid post to read his bible, fully exposed to enemy fire, and when the doctor advised him to get inside, replied stoutly, ‘If it is the Lord’s will that I shall die, then I shall die!’ He changed his mind when the first seriously injured casualties arrived and he could see close up the reality of the risk he was taking. Piety could go too far. ‘He quickly moved his deckchair inside and never sat out there again.’16

  In that desperate post-D-Day battle to consolidate the landing against an enemy equally determined not to give ground, no one was immune from danger and death. Tibbs was put in charge of a large barn filled with wounded paras, many of them dying in the straw where they lay. Their only ‘protection’ was a large red cross flag but, since a British anti-tank-gun position had been set up close by there was little chance of it being respected. German shells and mortars came in, followed by the rat-tat-tat of small-arms fire close by. A panicking ambulance driver burst through the door of the barn and shouted, ‘German soldiers are at the bottom of the lane, fifty yards away!’ A badly wounded Glaswegian sergeant pulled himself up, pointed his Sten gun at the driver and snarled, ‘Stop yer blathering, ye fucker, or ye’ll be the first to get it!’ What astonished Tibbs was how all the wounded men now struggled to lay their hands on their guns. By rights they should not have had them inside the aid post. But they did, ‘and here they were fully prepared to shoot it out, even though one grenade tossed in by the Germans would set the straw ablaze and all would die.’

  The doctor wondered what he should do, where his ultimate duty as a medic lay. ‘I had a 9mm automatic which I could use well. Should I join in the shoot-out, or try to prevent a slaughter by indicating [to the enemy] the red crosses on my arms?’ The question was mercifully never put to the test. ‘There was a sudden fusillade of shots outside, some loud explosions and then silence. The German infantrymen had retreated when their two supporting tanks were knocked out.’ Tibbs took the opportunity to try to clarify the situation as he saw it. ‘I told my orderlies to collect up and hide all weapons. There were grunts of annoyance but I am sure I was right that the wounded stood a better chance if I depended on the red cross to protect them.’ That was his hunch, but a hunch was all it was. He had nothing to confirm that his interpretation of military law was correct. ‘Oddly, we had been given virtually no instruction on the red cross and the Geneva Convention.’

  The ambiguity that always surrounded medics on the battlefield remained. That they were as vulnerable as the next soldier to enemy action was underlined the very next day when a mortar bomb hit a tree outside the RAP (regimental aid post). ‘The orderly beside me fell to the floor with a large hole punched out of his thigh from the shrapnel. I called to my corporal to hand me a dressing but there was no reply. I turned and saw he was lying silently on the floor. The only mark on him was a small puncture over the heart but it was enough to kill him. He must have died instantly. He was a grievous loss.’ Medics were paying a high price for where their duty took them – to the very heart of the battle.

  *

  By now, the Normandy beachhead had been secured but the way ahead for Allied troops was blocked. The key town of Caen, ten miles inland, was scheduled to be rolled over within a day of the landings, opening up the way for a penetrating advance into the French countryside. But it was heavily defended, and it would take six weeks of an artillery and air bombardment, followed by street-by-street fighting, before it fell.

  Bill Helm arrived in France a week after D-Day to join an advanced dressing station five miles from Caen and a mile from the front line. Twenty-five-pound guns were positioned all around and shelling the town ceaselessly. The ground heaved beneath him and the constant concussion made his head ache. As an infantry attack was ordered forward, he was on stand-by for casualties, and then, as the wounded flooded back to him in large numbers, he had to improvise the procedures to deal with them because, despite the training, ‘all of us were out of our depth.’ A sensible routine took time to emerge, but eventually the orderlies were instructed to deal with the minor injuries – dressing light wounds, giving anti-tetanus injections and handing out sulphonamide tablets – leaving the doctors free to stop haemorrhages, splint fractures and set up transfusions. But they were in danger of being swamped as stretcher jeeps pulled up outside to drop off their loads from the front and numbers piled up in the waiting area, some already dead, some dying, some urgently needing transfusions. Seven hundred casualties passed through the dressing station over the next day and a half, many of them German. Helm recalled badly wounded SS snipers who had been up in trees for days. ‘They were a tough and dirty bunch. One young Nazi had a broken jaw and was near death, but before he passed out he rolled his head over and murmured “Heil Hitler.” ’

  The British conscripts were nowhere near as battle-hardened as the enemy soldiers. Helm recalled the sight of a group of terrified, disorientated lads, ‘exhausted, jittering and yelling in a corner’. No one was immune from terror. Another man, a cook, went into shock when shells fell nearby. The doctor was sympathetic. ‘I knew he was a brave lad, and this confirmed for me that battle exhaustion was totally involuntary and had little to do with cowardice.’ The horrors were enough to turn any man’s mind.

  A young tank officer was brought back slung over a tank. ‘He had compound fractures of both legs and had lost a foot. He was conscious but very shocked. I tried to transfuse him but his veins had contracted to cords with the shock and I couldn’t get a cannula into him. We sent him back to the Casualty Clea
ring Station but he died.’ It was possibly an unnecessary death, brought on by the good intentions but misguided actions of those who had put the man on a tank and brought him in for treatment. Helm recalled his father’s advice, gained the hard way in First World War trenches, that it was better to leave a casualty with severe fractures where he lay until medical help could reach him rather than move him back unsplinted. He himself learned another valuable lesson from his very first ‘action’ – the necessity, as he put it, ‘of keeping calm’.

  This stood him in good stead as he and his medical team moved up into the front line to set up a CCP, a Casualty Collecting Post. It was initially little more than a hole in the ground in one of the sunken country lanes for which the Normandy battlefield became famous. Positioned between high hedges, with a field of dead, bloated cows on one side, it stank to high heaven. Enemy snipers were just down the track. The main dug-out was big enough to hold six stretcher-cases, and there were other dug-outs to sleep in. Helm’s was walled and roofed with planks and blankets, but he had to bend double to crawl inside. It had room for a camp bed and a box, on which he placed a mirror and his shaving kit, but its greatest attribute was that it never leaked, for all the torrential rain that was to pour down on the armies facing each other in Normandy that summer. The doctor took in a small stray dog as a companion and marvelled that he never had to feed it ‘because he was never hungry’. He opted not to dwell on what the mutt was clearly doing for food in that village of death and destruction. The job of those at the CCP, the furthest forward of any aid post, was to deal only with dire emergencies. Casualties were picked up by stretcher-bearers and brought in by ambulances, and Helm took a quick look inside and directed them on if he thought they were fit enough for the bumpy four-mile journey to the dressing station. One in ten he could not risk letting go. He had to stop a bleed, splint a fracture or dose them with morphine before it was safe to send them on.