Medic: Saving Lives - From Dunkirk to Afghanistan

by John Nichol

  As a serving soldier, Andy Stockton had thought about dying, but not about being wounded. When he was on active service he always made sure his insurance payments were up to date. ‘I knew I might come back in a body bag and I wanted to leave something for my family. But it never occurred to me I would come back maimed.’ With soldiers, it never seems to. But now it had happened he accepted it as part of the deal. ‘If you take the Queen’s shilling, you take the chances too.’ He ‘moved on to new things’, as he put it, without a glance over his shoulder at what might have been. No regret and no resentment. But not everyone returning maimed or disfigured from Iraq and Afghanistan can cope with what has happened, and who can blame them?

  Gradually, society – though, sadly, not so much the state – has woken up to its responsibility for these young men and women damaged in the service of their country. Active publicity for places like Headley Court has helped. So has the involvement of figure-heads such as fellow-soldiers Prince William and Prince Harry in their cause. But it is noticeable that the burden of after-care and rehabilitation has had to be taken up largely by charities. Once a wounded man or woman leaves the service, the state turns its back. The skiing trip that put sparkle back into the life of Adam Nixon was organized by BLESMA, the British Limbless Ex-Service Men’s Association, which is funded totally from voluntary donations. Long may organizations like this continue. They will have to, because the wounds sustained in the wars in Iraq and Afghanistan will not quickly heal.

  When then prime minister Tony Blair took Britain to war with Iraq in 2002, he spoke gravely of the ‘blood price’ the nation must pay. Those who did the paying in lost limbs and shattered minds and were then cast adrift may wonder whether they were grievously short-changed in this transaction. The reality of learning to live without a limb, possibly two, is harsh, for all the jocularity among mates and the public displays of Bader-like grit and determination in front of visiting princes and dignitaries. On parade, the wheelchairs and crutches are inspiring symbols of courage, but in private they all too often mean broken dreams, disappointment and despair, a mental torture harder to bear than the physical pain. There are no quick fixes. However good and high-tech modern prosthetic limbs may be, adapting to them is an arduous process. ‘It’s an ongoing drama with the legs,’ said Shannon Hale of husband Stu. ‘You think, oh, you lose your leg and you get a prosthetic one. But it’s not as easy as that. For the first two years, the stump keeps shrinking, which means going back for new fittings all the time. Just when you think he’s OK and he’s walking really well, the stump has shrunk again, the leg is moving in the wrong way and he has to go back for some more adjustment.’

  Ironically, the problems of this growing army of war-wounded are the direct result of the very successes of medics. In Afghanistan, through their bravery under fire and the new discipline of emergency medicine, lives are being saved that, without a doubt, would have been lost just a few years ago. Colonel Tim Hodgett’s ‘unexpected survivors’4 are a phenomenon to be proud of. There is an internationally agreed points system for assessing the severity of injuries, and a total of seventy-five used to mean certain death. Not any more. ‘We are now getting survivors with injury scores of seventy-five and saving more lives than ever,’ said Hodgetts. ‘But that, of course, has implications for future care.’ The catastrophic need no longer be fatal. The challenge thrown up by the Falklands War to get more men home alive has been met and answered. The new challenge is to make sure those saved lives are worth living.

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  For medics, suppressing their emotions is vital if they are to do their job properly. They cannot give in to anger and aggression, as fighting soldiers often do in battle. They are the calm in the middle of the storm. They cannot move on to the next firefight when someone is hit by a bullet or a bomb, as fighting soldiers do. They must stay and confront the pain and the gore. They are the ones who cradle the frightened and the dying, cursing their own inability to save them, to perform the hoped-for miracles. The horror – for that is what it is – cannot easily be absorbed.

  It is no coincidence that a disproportionate and rising number of medics are on the books of charities that help veterans who have problems adjusting back to ordinary life. The stress of dealing with incredibly horrific trauma is having a lasting effect, says Toby Elliott of Combat Stress, the Ex-Services Mental Welfare Society, another voluntary organization having to take the strain of after-care when governments draw the line. All the anger that Gary Lawrence, the medic who rescued Andy Stockton under withering Taliban fire, managed to hold in at the time came flooding out when he got home to England. The adrenalin dried up, leaving a void that was filled by nightmares. ‘I couldn’t sleep at night. I’d just be fidgeting.’

  For another young soldier, the recurring dream was of a small child sliced in two when a British unit fired into a crowd at Basra in Iraq. He would wake in a panic and, though nineteen years old, climb into his parents’ bed to find comfort in his mother’s hug. It hadn’t been his bullet that killed the boy, but he could never get out of his head the picture of the little lad’s father sitting on the street and hugging what was left of his son. The soldier’s mother would rub his nose, just as she had when he was a baby, and soothe him back to sleep.5

  For many others, drink eased the anguish, if only for a while. Gary Lawrence would sup with his mates until he could no longer stand their belly-aching about the trivial irritations of army life. As he sank the pints and shots, he remembered clearly how, one morning, he had gulped down tea with a bright young officer and then, later the same day, pulled his ashen-faced corpse, a bullet through his brain, from an ambulance. Among a crowd he would find his mind straying away from the conversation and back to the butchery of the battlefield. The memories were as alive as ever. As he talked about them, he struggled to hold back the tears. He was trying to work these matters out on his own, but he was not too proud or dismissive of ‘shrinks’ and counsellors to know that, if and when he needed help, he would ask for it.

  These days, it is there for the asking. It was heartening that the recruits the authors observed on the training ground at Aldershot6 had no illusions about the horror they might experience in Afghanistan but were confident they could ask for and get help to deal with it as a matter of course. There was no bravado on display, just an honest appreciation of the damage that war can do to the mind of even the strongest man or woman.

  To an extent they are the beneficiaries of a long overdue shift in military medical thinking. The reality of the suffering caused by PTSD – Post-Traumatic Stress Disorder – was now acknowledged.

  That was not the case in 1982, when Para doctor Captain Steven Hughes returned from the Falklands, his brain refusing to deal with the human destruction he had witnessed at Goose Green. ‘On the boat coming back, there was no sense at all about how many people would be affected by their experiences. We didn’t realize what was brewing up for the future.’7 In his own case, he believed he had looked death in the face and stared it down. He was not afraid. But one Saturday night two years later, in a London teaching hospital where he was the casualty surgeon on call, he snapped. ‘I suffered a profound, incapacitating, panic attack. For no obvious reason, I was suddenly overwhelmed by a crescendo of blind, unreasoning fear, defying all logic and insight.’8 The terrors had caught up with him. He was sedated and admitted to a closed psychiatric ward that was all too reminiscent of One Flew over the Cuckoo’s Nest. After a month of treatment, he went back to work, but the same thing happened again – he panicked to such an extent he thought he was going mad.

  It took an old military friend, a Royal Navy psychiatrist who had been on the task force that sailed to the Falklands, to tease out the problem. After they talked, Hughes ‘suddenly found myself back at Goose Green, in the rain and the smoke and the horror. I felt again the fear, the despair, the grief, and the anger; an overwhelming maelstrom of emotions long since buried deep in my soul.’ The cat was out of the bag. He had PTSD. It was a con
dition he had begun to identify in other Falklands veterans and even written a paper about for a journal, but he had missed the symptoms in himself. ‘I then started to address what I had never acknowledged, let alone come to terms with – the hidden memories and feelings of those black days of 1982. I had never had the time to release the suppressed emotions that I dared not show as I fought to keep alive those gallant young men, Argentinians and Brits, friend and foe. Aware of the eyes of my medics on me, their leader, I had got on, seemingly impassively, with the job at hand, even when the bodies of some of my closest friends lay only yards away. Whatever snapped did so in the burning gorse at Goose Green.’

  He now realized that he had never taken the time to come to terms with the death of friends. ‘We came home to a society that had simply watched the Falklands as if it were another war movie on television. I never grieved and, as time passed, I supposed and hoped that so had the need. It was as if I had erased the emotion from the tape in my head that records those memories.’ The only treatment to return him to mental health was to go back into his past and confront the demons, which he did by talking to those who had had similar experiences. ‘Sharing disperses the hurt.’

  He realized, too, that what had happened to him must also have struck others who had fought in the Falklands. The psychological damage of that ugly conflict was, he did not doubt, extensive, badly affecting, he calculated, a quarter of the troops, while a further quarter showed milder signs of the hyperactivity or lack of focus that comes from stress. ‘Many, like me, will not even be aware that they have a problem.’

  He kicked himself for not spotting what, in retrospect, seemed so obvious. The signs had always been there. A few weeks after getting home from the Falklands, he and some army friends had gone to the Farnborough Air Show and found themselves instinctively ducking when the aircraft roared over. In their heads, they were still in a combat zone. A year later, on a posting with the Paras in Belize, the lads were involved in a major punch-up, sparked by unresolved frustration and anger. Hughes looked round at his mates and realized how few of them were managing to have stable family lives or decent relationships. It didn’t seem normal, which was why he began to research the issue of post-traumatic stress. From GPs who treated the soldiers’ wives, he heard stories about their menfolk disappearing off to the garden for hours on end, drinking a bottle of whisky in one go and then refusing to talk about what was going on in their heads. At work the men were flogging themselves to a ridiculous degree, ‘beasting’ themselves. ‘That and their excess drinking were classic signs of PTSD, though I didn’t recognize it at the time.’

  Somebody should have. There had been warnings in the past, as this piece of gossip, one army wife about another, indicated. ‘Back only a fortnight, and she doesn’t know what to do with him. He sits in the back room by himself. Won’t speak to anybody, won’t go out, won’t read. Won’t do nothing. She doesn’t know what to do. There’ll be trouble there.’ The year of that observation was 1945, and the anecdote was related in a paper by Lieutenant Colonel T. F. Main, wartime psychiatric adviser to the Director of Military Training at the War Office.9 He foresaw the serious problems men returning from war would have readjusting and, though the phrase would not be coined for another thirty years (in America, in relation to the Vietnam War), PTSD was part of what he was referring to. Military psychiatry then being a Cinderella discipline, and the country beset by huge social and economic difficulties in the aftermath of a catastrophic world war, Main did not hold out much hope that his advice would be acted on, though he had no doubt that it should be. ‘It would be folly to assume that this is a problem too small for consideration and which time will heal,’ he wrote.

  Folly, however, was to win the day, and the problem was ignored and left unresearched, with the result that four decades later, Steven Hughes was at a loss to work out what was happening to his depressed and out-of-control comrades and had to start virtually from scratch. Nor did he cotton on that any of the behaviour he observed in other Falklands veterans applied to him – not until that night on duty in the casualty department when his past caught up with him.

  That his problem identified itself and he was able to have treatment for it may have saved his life. Others simply went under. In the quarter of a century since the Falklands, more veterans of the war have committed suicide than were killed during it. ‘It’s a horrifying statistic,’ Hughes says. ‘After all these years, men who fought in the Falklands still seek me out for advice about it. I’ll hear down the grapevine that Private X is having a problem, and I’ll arrange to see him and try to get him some help. They know I was the doc, and so they’ll talk to me, but the truth is that this is a long-term problem, and the military should be taking care of it. Instead they dump the problem over to the NHS once a soldier has left the service, and the NHS facilities for treating PTSD are sporadic.’

  There was a further difficulty, in that civilian psychiatrists had little clue about military life and no concept at all of what it was like being in combat. Nor would other patients an ex-soldier might be lumped in with for treatment. In therapy groups, he might find himself with people whose levels of stress in their ordinary lives seemed trifling and inane compared with the hell of battle he had been through, and that would serve only to make him feel more isolated. The solution, as Hughes discovered in his own case, was to open up not to strangers or even to loved ones but to those who had been where he had been, had seen what he had seen and knew how he felt because they had felt it themselves. Who else could comprehend the scenes on the blazing Sir Galahad that were burned into the retinas of RAMC sergeant Peter Naya, the last medic off the scorching hulk of the landing ship in Bluff Cove? He could never forget the pain he witnessed that day. The memories still catch him unawares, especially at night, and ‘a thousand emotions rage through me. But I bottle it up. Many others who were there do the same. We can’t really describe what we went through, not even to our wives. There are certain things I will never talk about.’10

  The smallest thing can trigger waves of remorse. Medic Andy Poole had to give up watching motorcycle racing, a spectator sport he loved, because the smell of exhaust fumes from the two-stroke engines set off memories of burning flesh on the Galahad. ‘It was twenty-six years ago, but I still have flashbacks.’ He suspects he always will, however hard he tries to put the horror to the back of his mind.

  For Bill Bentley, the overriding Falklands’ memory was of the hollow sound a dead comrade’s head made as it bounced against his knee when he carried the body off the battlefield at Goose Green. He had also been on medical duties in Bluff Cove when the Galahad was hit. But it was twenty years later before the stress of these occasions came back to ambush him. He had back problems, one remedy for which was taking long soaks in the bath instead of his usual shower. Lying in the water, he was gripped by the sensation of being on fire. Images of the Galahad carnage came flooding back. Then other symptoms appeared. ‘I started knocking things over and couldn’t concentrate, all classic signs of PTSD.’ Unable to work because of sickness, he got into debt and, to raise money, was forced to sell his Military Medal, awarded for saving a man’s life at Goose Green. He felt alone with his problem. ‘The army doesn’t want to help, and the organizations I’ve been to have been a waste of time. Basically, you just try to get yourself through it.’ And he did, but it was tough going.

  It was tough too for Simon Weston, the Welsh Guardsman so horribly burnt on the Galahad that he wished he had died. The surgeons had worked wonders to keep him alive. He was so damaged he was not expected to survive the journey back to Britain. He did, and then came through scores of operations and skin grafts, fighting off septicaemia and infections. ‘I looked like a bubbling mass of scab,’ he recalled. ‘It was frightening, because you are on your own. The pain is happening to you, and you can’t stop it or avoid it. It’s just something you have to get through, and it’s very lonely.’ His career was finished. He was classified as ‘P8U8’, off the scale for mil
itary fitness, or ‘physically and totally useless’, as he himself describes it. Two years after roasting at Bluff Cove, he was medically discharged from the army, cut adrift into a civilian world where he felt even more frightened for his future. ‘I’d lost my face, I’d lost my hands, I’d lost me. An officer told me I was totally unemployable, which hurt. I didn’t know who I was or where my life would go.’11

  Not surprisingly, the depression he fell into was profound, and the only remedy liquid. ‘I would drink ten or fifteen pints a night, then be back at the pub for opening time next day. I also had a near dependency on hospital drugs and became lazy and lethargic. I hated my looks, my life, everything. I simply stopped caring about myself.’

  In the end, it was mates who pulled him back from the brink. Before his injuries, he had played rugby for the regiment. Now his melted hands were so wrecked he could no longer hold a ball, but the team was going on tour and they invited him along. ‘For the first time since the war there was no sympathy for me. I was just one of the lads.’ They gave him no special treatment but they did make demands of him. ‘There was an officer and I went to shake his hand. But I had got into the idle habit of not raising my thumb, and I presented him with what must have felt like a stump. “Shake my hand properly!” he bellowed at me.’ Weston was mortified, but stood corrected. ‘I was letting myself become disabled in something as simple as a handshake. I was allowing myself to be something I wasn’t. It was a moment of truth, a none-too-gentle kick in the pants.’

  From that point, his recovery began and he started not only to get his life back on track but to create a new one for himself. He took up charity and media work and became a public figure. More importantly, he came to terms with who he was. And he stopped feeling sorry for himself, remembering that, for all the disfigurement of his face and the stares he sometimes still gets from people in the street, he was alive. ‘There were forty-eight guys on that ship who never had that chance. I’m a lucky man, very, very lucky.’