Knife Edge: Life as a Special Forces Surgeon

by Villar, Richard

  Dear Doctor,

  This man has been vomiting for 24 hours. I do not know why.

  Please see and advise.

  (Signed) R. Villar

  When you refer a patient as a doctor, you like to give the impression of comprehensive care. Single-line referral notes, such as I had written, are frowned upon. I had not suggested a diagnosis, nor had I described what there was to find on examination. To any receiving hospital doctor, it looked as though I had not bothered to give the problem more than a second’s thought. The truth was that I had no time to perform a full examination, and had no clue what was wrong.

  Leaving the note with him, I made a brief telephone call to my RAMC medics to arrange his transport to hospital and went on my way. It was a frenetic day as I was out on the hills with Selection, dealing with the many injuries that such a course can create. It was when I returned in the evening that I received the message to ring the hospital. I recognized the extension number immediately as that of Intensive Care. Intensive Care? Who did I have on Intensive Care? Surely not? But yes. The man had just made it in time. Life-threateningly ill, his vomiting had been a sign of kidney failure. Urgent dialysis, blood cleaning, had been required to save him. He was the first-ever case of kidney failure caused by over-exercise reported in the world. His condition was subsequently widely reported in the international medical journals. Toxic chemicals, released by over-exerted muscles, had coursed through the bloodstream and clogged up his kidneys. He had been lucky to survive. Had I ignored my sixth sense he would surely have died. Dead and no one would have known why.

  Diseases did not always affect one patient at a time. My record was forty-seven. Again it was a Selection course. Soldiers from throughout the world had come to pit their might against the mountains of South Wales. For me, the day started routinely with my normal clinic, or sick parade. Lumps and bumps, piles, varicose veins or the odd runny nose — nothing particularly challenging. At least my London training had prepared me for these.

  In designing Bradbury Lines, the architect had obviously not had the welfare of the doctor in mind. The MI Room was positioned immediately beside the helicopter landing pad. This made it impossible to hear anything a patient was saying and totally impractical to use a stethoscope. It was as well that heart and lung conditions were rare in the SAS. I could not have diagnosed them had they appeared. Whenever a helicopter was landing or taking off, you either had to abandon the clinic altogether or shout instructions to your patient at the top of your voice. On this occasion, fortunately, the helicopter had decided not to fly.

  An hour into the clinic, quite unexpectedly, I heard the sound of vomiting outside my window. It was a painful, forced, almost projectile affair. I looked out to see the large figure of a Parachute Regiment soldier clutching his belly, writhing on the tarmac in agony. He was in obvious, extreme pain. By the time I had dashed outside to help him, a four-ton military lorry pulled up. In the back lay a dozen further bodies, groaning loudly in their misery. Vomit was everywhere. The floor of the lorry was awash with the stuff. The stench made even my cast-iron stomach heave. Nappy changing and vomit are two things I find very hard to tolerate as a doctor. Within seconds another lorry appeared. Then another and another. Each contained the same sorry story. Large, highly-trained soldiers, clutching their bellies in pain.

  This was gastroenteritis in full flood. The men had barely made it to the Brecon Beacons before the first casualty occurred. Only a handful escaped the agony. Forty-seven were returned to Bradbury Lines. My quiet, routine day had suddenly turned to chaos. MI Room staff had to work fast. Drips, stool specimens, blood tests and the opening up of extra latrines. I soon realized that the ones to escape had been those who had missed breakfast. Few bugs attack the gut so viciously and suddenly as this. One that does is called ‘staphylococcus’, named thus because it looks like a bunch of grapes under a microscope (Greek staphule=grape). Each victim recovered rapidly, though not without significant misery and discomfort. It was then that the witchhunt began. In the Army, and that includes the SAS, there is no such thing as bad luck. Everything must have a reason. It seemed likely the bug had come from contaminated milk. My casual suggestion to MI Room staff was instantly passed up the line. Before I knew it my idea had become fact and the cook was being disciplined in the Kremlin, Regimental Headquarters. The poor man. We never did prove he had infected the milk. For that matter we never proved the milk was the true source at all. Despite this, judgement was instant. The cook was out and negotiation impossible.

  I could always guarantee Selection would keep me busy. Not only did I have to provide medical support on the hills of South Wales, but my clinics would be full of ailing candidates at the end of every day. Many were seeking an excuse to fail. A few had serious injuries they could not ignore. The determined candidate would not go near a doctor for the duration of Selection, whatever his state of disrepair. Pain was inevitable and injury likely. To pass SAS Selection without one, other or both was impossible.

  One evening, after a lengthy clinic was nearing its end, I looked out of the MI Room window. There was no sign of life, save for one lonely, uniformed figure walking slowly towards the Selection billets. I could see the man was in pain. Dragging his feet, barely able to lift them more than a millimetre from the ground, his rounded shoulders slouched terribly and his head hung low. He looked awful.

  ‘What’s wrong with that guy?’ I asked the MI Room Sergeant. ‘He doesn’t look too well.’

  ‘He’s not, boss,’ came Sergeant R’s clear reply. ‘We can’t get him to see you. God knows we’ve tried.’

  ‘What’s the problem?’

  ‘Blisters, boss. Terrible ones. The silly bugger wrapped all of his body, and his feet, with sticky tape at the start of Selection two weeks ago. He hasn’t taken the stuff off since.’

  ‘So?’

  ‘It hasn’t worked. He’s developed blisters under the sticky tape. We can’t take it off without removing most of his skin.’

  ‘Ask him to come and see me,’ I encouraged. ‘I’ll think what I can do to help. Maybe we can soak the tape off.’

  ‘We’ve suggested that, boss. He won’t have it. Says he’ll put up with it until Selection is over.’

  I rolled my eyes Heavenwards. There was no point in arguing or forcing the man to see me. For better or for worse, the candidate had set his own course of action for attempting Selection. He would have erected his invisible shield, determined to pass, irrespective of the consequences. The fact his overladen Bergen rucksack had worn the skin of his back away to underlying flesh, the fact the blisters on his feet now exposed tendons and bone, was irrelevant. If he needed plastic surgery to heal the damage once Selection was over, so be it. That was the price of ambition.

  I can understand such determination. It was no surprise to learn the man passed with flying colours. It took us three days to remove the sticky tape once Selection was over. Under it lay massive, infected, oozy sores that took several weeks to heal. Such tenacity shows why some die in their efforts to become badged operatives.

  It was not a requirement that the Regimental Medical Officer took 22 SAS Selection. Nevertheless, I volunteered to do it. It made good sense. For credibility’s sake it seemed right. You are open to criticism when you make a decision like that. Some saw it as my attempt to be a soldier rather than doctor. My MI Room staff, none of whom had taken Selection, thought it an excellent idea and I believe were proud once I passed it. Having earned my Regular badge, however, I decided never to wear full SAS uniform when in camp. My self-appointed style was a badged SAS beret and RAMC belt. It meant a lot to me. In particular, it allowed me to address the hordes of candidates eager to take Selection and speak with the voice of both experience and authority.

  I, too, developed blisters. My rucksack’s lumbar strap would dig away at the low spine until the skin eventually gave in. Once the skin was broken you could not afford infection to enter. With so much mud, filth and mire, this was not an easy task. My so
lution, at the end of a long day’s Selection walk, was to go to my MI Room staff, expose my bare raw back and ask them to pinion me face down on the examination couch. They would then pour neat iodine on to the Bergen sores while I screamed, and screamed, and screamed. I never did ask if they enjoyed mugging their boss. I imagine their answer would have been ‘Yes.’

  The rucksack had a lot to answer for. The shoulder straps in particular would pull forcibly downwards on each collar bone. If the straps were not continually shifted in position by the soldier as he walked, the intense pressure would paralyse the nerves to the shoulder blades. Called ‘winging’, whenever you tried to push an object away from you, your shoulder blade would lift off the back of your chest like a bird’s wing. It usually improved, but only after months of rest and strict avoidance of heavy load carrying. If you wish to stay healthy, do not take SAS Selection.

  Not everything an SAS doctor does is medical. There are certain things that would make the General Medical Council squirm. None more so than providing medical assistance to the combat survival courses. Someone has to be sure that no soldier has hidden anything up his tail end. I was always the favoured choice. Doctors were supposed to enjoy such things. In my civilian days I had only to perform half a dozen rectal examinations in a day. Even then, I had found such things hard. Particularly so, as the Rectal Clinic I attended always took place on a Thursday morning, immediately after I had eaten a full fried English breakfast. On combat survival, however, with upwards of a hundred runners from assorted countries, everyone had to be examined. No one was exempt. Worse, they all had to be seen within thirty minutes. I hated it. The only way of dealing with the large number of soldiers was to take everyone’s trousers off, bend them across a table and get on with it. Down the line I would go, one backside after the other. Glove on, finger up, feel and pull. Glove on, finger up, feel and pull. It was terrible, both for me and the troops. Particularly the Italians. As a nation they did not seem to welcome rectal examinations on exercise.

  A most enjoyable part of the job was assisting with officer Selection. In the SAS, officers are called ‘Ruperts’, and are a very closely analysed and inspected breed. Ruperts were given an extra week of misery, over and above the normal Selection walks. During this so-called ‘Officers’ Week’ they were sleep-deprived, physically stressed and forced to perform in public. For example, an officer might have been kept up all night on a cross-country march before returning to barracks. Lulled into the impression he could then go to bed, he would suddenly, and unexpectedly, be ordered to attend the lecture theatre within thirty minutes, in full Regimental uniform and spotless boots. He would be tasked to give a ten-minute resume of his life story. The entire Regiment was at liberty to attend and frequently did so. They could interrupt, harass, insult and say what they wished.

  I felt sorry for the poor men, but despite this it was an important time. I was able to see things from a non-military point of view. Occasional weaknesses would appear in an otherwise unyielding exterior. I recall one officer who was performing excellently. He spoke clearly and succinctly, seemingly impervious to sleep deprivation. I could tell his SAS audience was hooked by the widespread silence. Something in his voice demanded attention. On this occasion it was my sixth sense that again spoke, as more than half of the life story he gave was describing his wife and family. For a potential SAS officer it sounded strange. It was more usual for an applicant to concentrate entirely on himself - some would regard this as selfish. I remember one very flamboyant individual telling the assembled throng how wonderful he was. How he could free-fall parachute, deep-sea dive, speak eight languages and defend himself against a second Dan black belt in karate. He was floored by a very senior member of the Regiment who stood up from the audience in the middle of the officer’s presentation. ‘Excuse me, sir,’ the operative shouted, ‘have you ever thought of becoming a spaceman?’ The poor fellow failed.

  Feeling uneasy, I whispered my misgivings to the selection team, but was overruled. The officer was through. I was not surprised, sometime later, to find he had left the Regiment, apparently unable to cope with the rigours of operational life.

  Medical tuition of SAS operatives was my overall responsibility, though in practice it was capably run by two Royal Army Medical Corps non-commissioned officers. Both were brilliant and much admired by the Regiment and me. I would often turn to them for medical advice, once I realized my civilian medical training was inappropriate for this new, strange life of mine.

  A major part of the medical course was an attachment to a civilian hospital. Before an operative could be fully qualified as a medic he had to complete one month working in a casualty department. We naturally did not advertise the fact the men were from the SAS. Arrangements were generally made directly, and informally, with the various casualty consultants involved. Some were openly hostile to the idea of SAS operatives working in their departments, but many were welcoming. For the most part, the intelligent SAS operative was an asset to a casualty unit, well able to give as much training to the civilians as they could give him. Sometimes their presence was life-saving, such as the letter of commendation I received from a hospital in the west of the country. It ran something like this:

  ‘We wish to acknowledge our grateful thanks to Mr W for his prompt action in saving the life of one of our nurses recently. A patient ran amok in the department, eventually taking the nurse hostage and holding her forcibly against a cubicle wall, a scalpel to her throat. Mr W capably and reliably disarmed the assailant, who is now in police custody.’

  I later discovered their letter was a gross understatement. Mr W was, in reality, Sergeant W, and an expert at unarmed combat. The poor hostage-taker would not have stood a chance. He could have been armed with a Samurai sword for all Sergeant W could have cared. Predictably, the Regiment’s response to this event was one of disapproval. Sergeant W should not have attracted attention in the way he did. My own approach, one I made known to those in power, was supportive. Sergeant W had done us proud and the hospital was delighted.

  It was important to make those civilian consultants who helped us feel involved, reinforcing the special position they held in our eyes. By offering their services they exposed both themselves and their departments to some risk. You can never truly tell what a terrorist will do next. In those days the media was not over-invasive. Now, the incident with Sergeant W would probably be headlined ‘SAS THUG ATTACKS DEFENCELESS HOSPITAL PATIENT’, or some such line. I therefore spent many hours visiting the various hospitals, updating their consultants on what we needed, and why. We also held meetings for them in Bradbury Lines, demonstrating our military skills for their interest and enjoyment. It was wonderful to see casualty consultants, and a handful of nurses, blasting away with Browning automatic pistols at terrorist targets in the killing house, our indoor range. They loved it. Perhaps there is a streak of aggression in everyone, however caring they may outwardly appear.

  As well as training others, I had my own career to consider. I knew that one day, however much I enjoyed it, my time with the SAS would end. Though I had done much practical surgery, I needed the qualification to go with it. The qualification is called Fellowship of the Royal College of Surgeons. Now a three-part examination, it was then a two-parter, involving book work night and day for months. An isolated SAS job is not the best training environment for such a qualification, so I would travel weekly to Birmingham to study alongside civilians there. My Birmingham colleagues had no idea what I did, but it was good to see there was life outside the military.

  Examination day eventually arrived. At the time I was very hyped up. We had just completed the successful Iranian Embassy assault and I had been required to go overseas for a short tour. Consequently, I was fit, very alert and looking unbearably healthy. The moment I walked into the examination room, giving the examiner a confident smile combined with a bone-crushing handshake, I knew I had failed. Around me were dozens of young civilian surgeons, each looking like death. For months they
had been burning the midnight oil and were now bulging with knowledge. I could not compete. The examiners failed me with dignity, but fail I did. Cheeky and impatient to the last, I asked our Adjutant to send a letter, on fully badged Regimental paper, requesting that I be considered a special case and allowed to pass. At the very least, I said, my examination fee should be refunded. The College of Surgeons, of course, had seen it all before. Unimpressed by such a request from the hard-nosed SAS, my failure was reaffirmed. For the re-sits six months later I made certain I looked the part. I read and revised endlessly, staying indoors for a complete fortnight. I drank endless whisky, smoked myself halfway to an early grave and attended the examination looking terrible. I passed with flying colours.

  One major advantage of its Hereford location is the physical separation from the rest of the Army given to the SAS. Medically, this was vital. The Army is rigid in the way it classifies diseases and injuries. Large books exist that contain the name of every disease imaginable and what it means to the service potential of a soldier. A knee-ligament injury, for example, means you are no use to them. Loss of an eye, or an amputated arm, makes you highly suspect, and so on. Physical grades, P grades, are given to every soldier, with P1 being superfit and P8 being disastrous. At P8 your next step could be the grave. For some reason no one can ever be P1, the best you can reach is P2.