Medic: Saving Lives - From Dunkirk to Afghanistan

by John Nichol

  17. Shifting Sands

  When she hit the town, back home in Swansea, for a Saturday night of partying with her old schoolfriends, Rachel McDonald always wore her ‘killer heels’. They gave the petite paramedic a lift. But she needed no boost to her stature as she did her job in Afghanistan. In combat gear, carrying a rifle and in desert boots rather than sling-backs, the RAF sergeant was a towering presence as she dashed between hospital and battlefield in the back of a Chinook. Her presence too was more evidence of the growing part women were taking in the wars of the twenty-first century. In Britain’s armed forces – unlike those of the United States – they were still denied an aggressive role as fighting soldiers. In theory, they were kept at a safe distance serving in support units behind the front line. In reality, there was no longer any such thing as a front line. In Afghanistan, as in Iraq, the sands were continually shifting.

  Rachel had little idea of what to do when she left school except that she’d had enough of studying and wanted to see something of the world. She had been an army cadet, and was attracted to a military life. She applied for training as an RAF nurse but was persuaded instead to join as a medic. ‘I didn’t really know what I was letting myself in for. I knew I’d travel and maybe not to the nicest of places all the time. But it never occurred to me that I’d end up quite as close to the front line in a combat zone. I never imagined that I’d be running off the back of a Chinook under fire.’

  In the Iraq invasion of 2003, she was based in Kuwait and, though she saw the results of the fighting, she didn’t experience the immediacy of battle. ‘The casualties had been through many medical points of aid before they got to me.’1 But, three years later, as she prepared to deploy to Afghanistan, she saw a newspaper report describing Camp Bastion, the place she was heading for, as the deadliest place on the earth. ‘I remember being really, really nervous. I talked to my parents about what I was embarking on, but not in any great detail, to be honest, and I didn’t tell them how scared I was. My mum was desperately worried. I didn’t want her to know too much.’

  Flying into Bastion was the first of many eye-popping experiences. The fine, ash-like dust, churned up by hot desert winds and swirling in plumes through the camp, was an immediate shock to the system. ‘We stepped off the plane into the middle of a sandstorm. I could just make out some tents in the distance, and that was it. What had I let myself in for?’ Apprehension took the edge off her excitement at being on her first operational tour as a full-fledged paramedic, a step up from the medical assistant she had been in Iraq. She knew she would have to shoulder more responsibility – she would be leading a four-man team – but had not reckoned for the degree of human suffering she would encounter. ‘If you’re a paramedic back home in the UK, you’re unlikely to have to deal with gunshot wounds to the head and with someone whose brain is hanging out. Nothing can prepare you for that. The first few incidents were very nerve-racking.’ She felt extra pressure being a woman in this aggressively male world. ‘There was no way I was going to let anyone think I couldn’t do as good a job as the guys. You have to keep up a pretty tough exterior. Underneath, you’re as emotional as everyone else. But you can’t show it, not in that environment.’

  Her first major ‘shout’ – an alarm call – came from Forward Operating Base Robinson, just outside Sangin, and at Bastion, she and her team raced for the Chinook and threw themselves and their gear into the ‘cab’. Then they were on their way, a helterskelter ride across Helmand, the province’s pretty lakes and landscape (as well as its pulverized villages) flashing past less than a hundred feet below. Conversation was difficult above the din. The combat troops who would pile off first to secure the landing site were crouched around her, rifles at the ready. Nobody knew for sure what they were heading into. They never did. As usual, information was sparse – just that a detachment of Afghan Army and coalition soldiers had been ambushed in a village. Apparently, women were among the attackers, spotted on rooftops directing the fire. So she wasn’t the only one of her sex fighting in this war.

  The platoon had made it back to FOB Robinson, but this too was now under attack. How many casualties? No one knew. Could be a dozen or more, maybe two. How bad were the injuries? Not sure. Better prepare for the worst, she told herself as the helicopter scooted through the air, getting closer every second to what would be her first major contact. ‘Don’t think about fear, just think what you are going to do. I go through the procedures in my head, the checks to be made. Just concentrate on the job in hand. Go over those procedures again and again.’

  This one was going to be hairy from the start. There was flak coming in, and bullets flashing around the helicopter as it came in to land. ‘We’d been told the Chinook could take quite a bit of small-arms fire, but what if someone out there had an RPG? That thought petrified me.’ Suddenly they were down on the ground and, without thinking about it, Rachel was on her feet and running off the back. She could see puffs of smoke coming from a nearby bluff – gunfire! The compound was ahead of her, a good half a mile away. She set off towards it with one of the doctors, then turned in her tracks to see the Chinook climbing back into the air. This was a shock. They had been expecting the pilot to wait, but with so much gunfire around, he had decided his aircraft was too tempting a target to sit on the ground. He radioed that he would return in twenty minutes. She would have to have her first batch of evacuees ready by then.

  She ran on, and was now breezing into Robinson, veering past its protective Hesco blast walls, into the central compound… and into a chaotic scene of hurt and frightened humanity. She had never before seen so many casualties together in one place. ‘They were everywhere, moaning and groaning, some leaning against walls with bandages on arms and heads and legs, others on stretchers. I counted more than twenty. How the hell were we going to handle all these?’

  The answer to her own question was to start at the beginning of the line and, coolly and calmly, examine them one at a time in order to make a preliminary assessment of their injuries. ‘I started at one end and the doctor at the other, and we worked our way along.’ Most were from the Afghan Army and didn’t speak any English, which made communicating with them an additional problem. But if she felt overwhelmed (and for a split-second she did), she wasn’t going to show it. ‘You can’t just walk away. You’re there. You’ve got to do your best.’

  She had twenty seconds to examine each patient and come to a conclusion about his condition; then she had to move on to the next one. ‘There was no question of trying to treat them. We just had to establish how bad they were and work out how to get them out of there.’ One had chest wounds that were urgent and life-threatening – Priority 1 – five were serious (P2), and eighteen were P3s, with less serious bomb-fragmentation wounds. All were shocked and in pain. ‘We knew we had to get them out of there as quickly as possible and on to the helicopter. Only then would we able to start treating them. But first we had to get them to the landing site half a mile away.’ From outside, the snap of rifle fire made it clear that the enemy was not going to give them an easy ride.

  Two flat-bed trucks were found, and the stretcher-cases were loaded on to them and driven off. There wasn’t room to take everyone, and some of the walking wounded had to do just that – walk. They plodded out from behind Robinson’s protective walls in single file, trailing blood and bandages. Rachel was on one of the trucks with the most serious cases, moving between her patients as best she could over the rough ground, securing dressings, making sure they weren’t too tight or too loose, ‘in my own little world, not thinking about what was going on around us, the gunfire or whatever, totally concentrating on the casualties’.

  Waiting at the landing site, tucking down behind whatever cover he could find, was RAF nurse Flight Lieutenant Damien van Carrapiett. He had come off the Chinook with Rachel and the doctor but stayed put so he could guide the helicopter in when it returned. He had watched the two of them head off to Robinson but then lost contact with them. His radio sig
nal wouldn’t penetrate the Hesco blast walls, and he had no idea what was happening until he saw the convoy of makeshift ambulances and limping men emerging out of the dust and sand in the distance and making their way towards him. ‘It was a bit of a shock to see so many of them,’ he recalled.

  He summoned help and, within minutes, two Chinooks were flying in. Rachel took all the stretcher-cases in the first one. The rest piled into the second helicopter, followed by the Paras of the protection patrol who’d been on picket duty around the landing site. The cab was overflowing, more than forty men in helmets and body armour swaying with every turn, hanging on as best they could on that high-speed, low-level dash back to Bastion. All were crouching, trying to keep their heads down, in case of attack, knowing that in the past, soldiers riding in Chinooks had been shot by bullets from the ground.

  Van Carrapiett was one of the strap-hangers in the back. ‘You just couldn’t move, let alone start treating people. There was a guy with multiple frag wounds in his thigh, another with bullets in his arm. When I joined the RAF in 1999, I never imagined I’d be picking up casualties in conditions like this. What we did in Afghanistan really was very unexpected. It wasn’t playing at being soldiers; it was the real deal, believe me.’2 The age of those he treated always gave him pause for thought and admiration.

  I’d done ten years in conventional Accident & Emergency departments, dealing with broken, dying and dead people pretty much on a daily basis. I wasn’t a stranger to violent death or the idea that people could inflict violence on each other. But what really got me was how young some of these guys were. You take the casualty’s date of birth, and you think, Christ, they’re just teenagers, born the year I was doing my O-levels. Yet they are putting their life on the line for Queen and country and, for me, there’s the real difference from somebody who’s been mashed to bits in a car accident on the M5. It ups the ante. It adds an extra dimension to looking after them.

  Despite his familiarity with death and violence, he never underestimated the effect the sight could have on others. ‘Sometimes casualties with bad injuries would be groaning and leaking blood all over the place, and we’d be beside them on the floor trying frantically to save them. And I’d see the looks of horror and disbelief on the faces of the force protection guys and those not so badly wounded, all of whom were watching. It could be harrowing for them to see somebody badly wounded on a stretcher fighting for his life and, perhaps, a dead body lying next to him. That’s really tough to get your head round. Even some of the younger medics were shocked.’

  Rachel McDonald, at twenty-six, was older and more experienced, but even she shuddered at the memory of the British soldier she tended who had been shot clean through the head, an entry wound at the front and an exit one at the back. ‘Soft tissue – his brain, in fact – was hanging out, and I was holding it in place and trying to pack it back into his head. The training does kick in, and you do it, but it was still a shock. We picked him up and got him into the helicopter. He was still conscious. I was talking to him, reassuring him.’ Another casualty had burns over three-quarters of his body.

  His injuries weren’t compatible with life, and we didn’t think he’d make it. We couldn’t even get a cannula into his veins, because they had all shut down, so we couldn’t give him blood or fluids. But he did survive. And that’s when what we do is really gratifying, when you know you’ve made a difference. But there is another side of the coin, and I was gutted when a patient died, especially if it was one of our troops. I never got used to that. Medics are humans too; we get emotional, and after a death I always needed time alone. I’d go out of the back of the tent, tell people where I was, but I needed to think, to give way to my grief and to compose myself.

  There was one particularly dreadful day, when two soldiers died. The first had taken serious wounds to his stomach and chest, and his heart stopped beating in the back of the helicopter. Rachel resuscitated him and banged at his chest, and she got him back… but he later died in theatre. ‘His injuries were just too much. Poor lad. He was only twenty-three.’ Later that same day, she nursed a young Afghan farmer on the flight back from Sangin, but he died too. Then, in the early hours of the next morning, she held the hand of another British lad on the via dolorosa flight back to Bastion. He’d been shot in the neck and, crouching beside him in the dark in the Chinook cab, she cupped her hand and spoke softly into his ear, trying to calm his fears. ‘I built quite a rapport with him,’ she recalled of their brief encounter, and she was glad to have helped ease his suffering with her calmness and closeness. But as he was lifted from the helicopter and rushed into the bright lights of A&E, with nurses and doctors scrambling around him, she feared the worst. ‘I just hoped his brain hadn’t been penetrated.’

  She willed him to live, to put up a fight. And then she ran four miles round the Bastion perimeter wall as fast as she could, punishing herself, releasing the tension, simply coping with all the emotions of sadness and loss which were never far below the surface and which at times like this threatened to overwhelm her. She trained four days a week – jogged and cycled and did sit-ups by the score. Exercise was an answer of sorts, personal fitness a means of control in a world where so much else was arbitrary and awful and out of her hands. ‘I WILL go home a size ten!’ she wrote in her diary.

  That diary is a fascinating insight into her world, full of girly interests and intimacy, as if she were on a fun spree with her mates in Ibiza, but interwoven with grisly everyday events of staggering solemnity, violence, courage. It is High School Musical meets Apocalypse Now. ‘Very nice welcome,’ she wrote on returning to Bastion for her second tour in mid-2007. ‘The girls in my tent had already made up my bedspace for me. Wow – even got mattresses here now! Knackered! Good night’s sleep. Zzz…’ But within forty-eight hours she was reporting: ‘Four casualties. One a young Afghan girl, approx. 12 years old. Shrapnel wounds on her chest, very distressed. Reassured her, held her hand, but she wouldn’t have understood me. Nightmare getting her out of the ambulance. Rear doors wouldn’t open, had to pass her through the front hatch. She deteriorated in hospital – developed haemo-pneumothorax [lungs flooded with blood]. Docs inserted chest drain. Bless her, only a small girl and caught up in this mess. War is ugly.’ After twelve hours of non-stop activity, she finished work at 11 p.m. and could think of only one thing. ‘Sleep, sleep, sleep!’

  There were days when she could relax – ‘sunbathed, went to the gym (bike, plus cross trainer), treated myself to chocolate pudding for tea’. She had her eyebrows dyed and her nails manicured by a captain named Zoe who, in civilian life, was a qualified beautician. But then the Americans dropped a bomb on a school and she was summoned in early to A&E. ‘Fifty casualties, nearly all poor innocent children.’ On an emergency flight into the outpost at Sangin, the Chinook circled ‘for bloody ages’ while an Apache attack helicopter cleared out a nest of Taliban snipers on the ground. ‘By the time we got to the casualties it was pitch black, and I was quite nervous of the surrounding threat. We got in and out OK, though; no shooting at us this time.’ On that one shift alone she was on three ‘shouts’, an almost continual cycle of scrambling into the cab, arrowing across the desert, giving first aid, returning with casualties, administering oxygen, morphine and antibiotics, and then, no sooner back at base than going straight out again to repeat the procedure. ‘Two very poorly children, one with part leg amputation, the other with gunshot wound to chest and possible penetrating brain injury.’ It was hard on the body and the emotions. No wonder that on her Sunday off she ‘just chilled’.

  When she wasn’t flying, she helped in A&E. Choking back her own distress, she comforted a Marine lying in one of the bays. He’d been ‘top cover’ in an armoured vehicle, standing in the turret, when it was attacked by a rocket, and his armour burst into flames. He had burns on his face, arms and legs. His mate, the driver, was in a worse way. He had been trapped at the wheel and been pulled out, more dead than alive, from the wreck. What was so gutting
the first Marine, he told Rachel, his eyes full of tears, was that he should have been the one driving at the time. Guilt and self-recrimination were the flipside of the intense camaraderie that bound the soldiers to one another. Their physical wounds were almost always compounded by the mental anguish of wondering if they could or should have done more.

  One of the strangest aspects of the Afghan fighting was that, unlike the military encounters of earlier eras, the ‘real’ world, the one beyond the confines of the war, was never far away. To those who fought in the foreign wars of the nineteenth and twentieth centuries, in places such as Afghanistan, India and Africa, home and family were a long-distant memory, coupled with the hope that you would see them again one day. But the coalition forces could regularly speak to their families on the satellite telephone. News, and sport in particular, was beamed into televisions in the mess. You could be fighting for your life one moment and the next be sitting down with your mates and watching a live feed of England going out of the World Cup in a penalty shoot-out. On television, Kevin Pietersen was smashing fours and sixes off the Sri Lanka bowlers at Edgbaston while, outside the camp walls, an altogether more serious struggle – for life and death – was underway. If it felt surrealistic, that was because it was. For Rachel McDonald, the internet (when it wasn’t down) was her route to the real world. ‘On for a whole hour! Ordered some running shorts from M & M Sports.’