Knife Edge: Life as a Special Forces Surgeon

by Villar, Richard

  Physical prowess is important to a man, no more so than his abilities in bed with the opposite sex. The Bedouin are a tough lot - sexual prowess is important to them, particularly as the men get older. In one clinic, towards the end of an interminable patient queue, I came to an elderly Bedouin. His face was as weatherbeaten as they come, his hands knurled and wrinkled, his walking unsteady. Sitting on a stool facing me, his legs apart and his body supported by an irregular walking stick, he claimed his love life was at an all time low. Now, at the age of seventy-three years he was unable to satisfy any of his five women. Was there anything I could do?

  I did not have the heart to explain that this was perhaps part of Nature’s ageing process, or that a man fifty years his junior would have trouble satisfying so many women simultaneously. It seemed fairer to let him work it out for himself. However, he looked undernourished, so I gave him a multivitamin injection, a treatment I was sure would do no harm. Unfortunately, I had not reckoned on Bedouin resilience.

  The moment I injected him, surrounded by twenty onlookers, his face perked up, his stature broadened and the walking stick was left to gather dust in a dispensary corner. Out he strode, much to the delight of the surrounding throng, shoulders drawn back, an even pace to his walk.

  For three weeks he barely emerged from his dwelling except to say, ‘That injection was marvellous, Tabib.’ Then, early one morning I saw him at the front of the queue, no longer his rejuvenated self. Back in his hand was the walking stick, his stature stooped, his head bowed. I took him to one side.

  ‘What’s the matter?’ I asked, after the usual sequence of mumbled greetings.

  ‘My wives, Tabib,’ he said. ‘Now they want your injection too.’

  The old man and his impotence was an excellent example of maintaining the confidence of one’s patients. The injection worked wonders and was something for which the patient will be for prospect of dozens of rampant Bedouin males, each trying out my new wonderdrug, that I called a halt to the idea immediately.

  You can find yourself up against formidable local, medical opposition. Cupping, or branding, even bloodletting, were all practised by unqualified Bedouin practitioners. Branding was the commonest. The principle is to take a hot stone, or glowing ember, and apply it to the painful area. Wherever there is pain, that is where you brand. I have seen it done. The smell of burning flesh is foul. If you have abdominal pain, then your belly is branded. If you have leg pain, so your legs are branded, and so on. Branding does sometimes appear to work, perhaps because the patient is so terrified of what is going to happen if he claims persistent discomfort that he tells lies to avoid further treatment.

  Unfortunately branding may do little for what is called referred pain. For example, it is common to feel the pain of a heart attack in the left hand, or that from gallstones in the right shoulder. Sciatica, the pain from a slipped disc in the low back, is classically felt in one or other leg. Branding for these conditions is worthless. Nevertheless, irrespective of one’s own feelings about such treatments, it is important not to belittle the local practitioners in the eyes of their own people. Wherever I go in the world I always put them on a medical pedestal, and keep them there. You gain their support and do everyone more good in the end.

  As a Squadron we felt it was important to win over the locals. To do so meant entering into every aspect of their lives and showing respect for their customs and traditions. So we ate with our right hands, not our left, and always took time off to have tea and sickly dates before discussing business. We would never show the soles of our feet to anyone and would not look at their women, which was the most heinous crime. The result was that we became gradually accepted by the Bedouin of the Ramlaat Bawiti, and were occasionally given presents. I remember one well - a huge, shark-like fish. We were very excited by this, having survived for weeks on military rations. Anything fresh was a Godsend. We cooked it immediately, spending most of that night around a fire telling each other stories as we digested the meal.

  It was at 3 a.m. that it hit me. Acute, colicky, central abdominal pain. Not only was I smitten, but many of the others were as well.

  One by one we succumbed to the most florid gut rot I have ever known. Within hours our supply of lavatory paper had been exhausted, the only paper left being paperback novels. By the time we had recovered there was barely any reading matter left in Haruj. Mixing with the locals had certainly taken its toll. We subsequently discovered that this particular fishmeat carried a high concentration of a chemical called ammonium. In our haste to celebrate the gift, we had not checked how it should be cooked. After we had recovered, the locals told us the meat should normally be buried in the sand for at least twenty-four hours before cooking, to allow ammonium to escape. The episode did not do my local reputation any good. In Bedouin society, if a doctor is any use at his job he will not become sick himself.

  One major reason for our base in Haruj was to prepare what the Army calls a ‘medical appreciation’. This is a detailed medical report that allows a complete view of an environment and its medical problems. The SAS may be excellent at looking after itself for weeks on end in a disease-ridden land, but if larger numbers of more routine troops are to follow, particularly those without desert experience, the Army will need to be fully informed about possible medical risks beforehand.

  In war, illness is the greatest cause of casualties. The second commonest cause is being shot by one’s own side. The least common is being shot by the enemy. If you are shot by enemy action the chances of death are even smaller. Contrary to belief, the majority of soldiers are fairly safe in a war zone. Preparing an appreciation is a time-consuming task. It goes on for pages. The document, typed finger by finger on a manual typewriter, took seemingly for ever to complete. My only consolation was the knowledge that I was bound to be handsomely rewarded before I left. Everyone was. I was certain I would not be an exception.

  The standard gift, for those who had pleased the local system, was a gold Rolex watch. All those at Hereford who had served in the Middle East sported a magnificent, sparkling timepiece. That, I thought, is unquestionably for me. Unfortunately I already owned a Rolex, though of stainless steel design, given to me by my parents on qualification as a doctor. Because of family loyalties I had no intention of displacing my stainless steel one, but having two, that would be wonderful. I knew my best chance of receiving the gift would be through the Minister of Health.

  It came to my last day in the Middle East. The Squadron had been extracted from its various locations and I had completed my laborious medical appreciation. When he had visited Haruj, the Minister had insisted I report to him on my journey back through Koussi. On this occasion I did just that, sprucing myself up with an immaculately pressed uniform, clean shaven and desert boots as smart as they come. I looked the immaculate British soldier. I did not wear my winged dagger beret as this was felt to be politically unwise. Consequently, I dusted off my little used Medical Corps hat and presented myself to his staff and secretaries, appreciation tucked under my arm. I was, of course, bare wristed, my stainless steel Rolex hidden firmly away in my trouser pocket.

  I was ushered into his massive office almost immediately. Rigidly I came to attention, cracking the most perfect military salute I can recall giving. The Minister, sat behind his desk, looked up and smiled. I could see confusion in his eyes as he struggled to recognize me. I appreciated his predicament.

  ‘Yes, sir,’ I said. ‘I looked different when we last met.’

  ‘You certainly did,’ he replied, smiling. ‘How have you done?’

  ‘Our report is complete. I have a copy for you here. With full recommendations.’ I handed the document over, feeling a huge weight lift from my shoulders as I did so. I was delighted to see it go but hoped my happiness was not too obvious. The Minister reached up to accept the buff folder, studying me intently.

  ‘Thank you,’ he said. ‘I imagine a lot of work has gone into this document. I will read it with interest. Do you have the
time by any chance?’

  I could barely believe what I was hearing. This was it. This was how it was done. This was when I would receive my gold Rolex. My anticipation was almost uncontrollable. Taking a firm hold of myself, and the increasing, overexcited tremor in my hands, I slowly and obviously lifted my bare left wrist towards the Minister, pretending to look at an imaginary watch.

  ‘I’m terribly sorry, Minister. I’m not wearing a watch. I can’t help you I’m afraid.’ My chest was bursting with anticipation. Any moment now, I thought, and the Rolex would be mine. Then I glanced at the Minister’s face. For a brief moment I thought I sensed amusement in his eyes. Then came the smile and I knew he was aware of what I was up to.

  ‘I do believe you were wearing a watch when we met in Haruj, Dr Villar,’ he observed. ‘You will not be needing one from us. If I need the time I shall ask those outside when you’ve gone. Thank you for your work. The country is very grateful.’ His eyebrows lifted slightly, almost in challenge. I had been caught out, well and true, and now felt barely more than a few inches tall. Humbled, I saluted and left the room. The gold Rolex was not for me.

  Much as I enjoyed and admired the Middle East, I was glad to return home to Hereford. It was important not to lose my civilian contacts. SAS service never lasts forever and I knew that I would one day have to leave the Regiment. In some respects it was adventurous and attractive to undertake covert projects and operations in far-flung lands. In others it was a disadvantage. To ensure some chance of progressing up an orthopaedic career ladder, I had to maintain the support of those outside the Regiment who could help me. What I needed was a reason for staying in the UK for a while. I thought hard on the problem before realizing the obvious answer. Antiterrorism. Of course — that was it. Antiterrorism it would be.

  CHAPTER 6

  Do They Pay You By the Body?

  ‘Go! Go! Go!’ Instantly I heard the sharp reports of the stun grenades as the teams went in. Glass shattering, earth shaking, smoke billowing from the building in front. Staying motionless beside the team commander, I waited for the order to move. With luck my medical skills would not be needed at all. My hopes were ill-founded. Sixty seconds later the call came through my Pyephone’s earpiece, ‘Starlight. You’re wanted. Come forward now.’

  Antiterrorist assaults were dangerous things, large numbers of high-velocity bullets, and high explosive, being used within confined surroundings. To be successful required split-second timing, rigorous training and luck. Today luck was obviously in short supply.

  I jogged forwards, breathing laboriously in my respirator. Already I could see one corner of the right-hand lens had begun to mist up. Damn! If it misted fully I would have to remove the thing. With the gaseous agents the teams had used, lack of a respirator would render me ineffective. The Kevlar body armour was heavy, particularly with the high-velocity protection plates worn front and back. My right arm felt wrenched out of its shoulder socket as I dragged the huge emergency medical pack towards the charred remains of the building’s back door.

  Steve, also in full antiterrorist kit, stood outside the door to greet me, his MP5 submachine gun still held ready. ‘The stairs are first on your right, Doc. The lads will meet you there.’ His voice sounded muffled and rubbery from within the respirator.

  Inside was chaos. Glass everywhere, scorch marks on the walls, broken furniture scattered around. Two bodies lay near the foot of the stairs, motionless. They were no longer a threat. Through the smoke I could make out the broad stairway on my right as it curved upwards to the first floor. Three operatives stood on the stairs, hugging the wall, one at the top, one centre, one at the bottom. I could not recognize the one at the bottom of the stairs, but as soon as I turned to climb them, he put a hand on my shoulder. ‘Wait,’ came the rubbery instruction, ‘they’re coming down.’ Immediately he spoke I knew it was Tom. Respirators and balaclavas made even good friends unfamiliar. All you could see was a large, threatening shadow. Then the shouting began. Loud, forceful shouts with screaming in the background, ‘Go! Get out! Go! Downstairs fast! Go!’

  I could see the stumbling shapes of several confused women being manhandled down the stairs, forcibly pushed from one operative to another. Finally, coughing and choking, they were expelled through the back door into the fresh air beyond. I could see how frightened they were. Though the siege had not been long they had begun to relax, trying hard to build an understanding with their captors. A desperate attempt to ensure their own safety. Then, unannounced, and with brutal aggression, the team had done its job. Within sixty seconds the task was complete, terrorists incapacitated, hostages secure. We had one casualty, not a major wound, whom I persuaded to limp out once the hostages were clear.

  I never understood how the SAS developed its skills in antiterrorist warfare. It is such a contrast to its original role, sneaking behind the lines in North Africa. It probably dates from the Aden conflict, where urban terrorism first appeared, both enemy and SAS operating in civilian clothes. The Regiment, its eye always on the future, realized this was the way of things to come. By the time of the 1972 Munich massacre, an event sending politicians leaping for answers, the SAS was well placed to offer one. The ‘team’ was created, one Squadron being permanently stood by as the country’s final solution, whether the crisis was at home or overseas.

  Planning had to start from basics. As the concept expanded so its technology also increased. Special weapons, communications systems, gaseous agents, tactics, transport and so on. Medicine, in the early days, was left behind. I think it was assumed that SAS medical training would be sufficient or that local hospitals would muddle through on the day. It was rather forgotten that actions often take place in major conurbations and were likely to expose civilian medical services to injuries they had never seen before. Casualties would most likely be contaminated with incapacitating gaseous agents — CS gas, for example — that could in turn contaminate civilian casualty departments as they attempted to resuscitate the wounded. This was certainly a problem after the Iranian Embassy siege of 1980.

  Until the 1980 siege, basic antiterrorist medical advice given to the Regiment had probably come from high-level Ministry of Defence sources. 22 SAS’s Regimental Medical Officer was barely consulted. Medical plans and tactics were often prepared by those without firsthand experience of SAS activities. Consequently, in my day, if you wanted to play a part in events, you had to invite yourself. My participation was based on keeping an ear to the ground and learning when the teams were summoned. I would make sure I was there, uninvited but medical pack in hand, insisting I should look after my patients.

  After the Iranian Embassy assault the situation changed. That year Delta had experienced a high-profile failure in Iran, while we had shown high-profile success at home. Political attention was unquestionably focused on antiterrorist warfare. ‘Doc,’ I remember the CO saying, ‘I want you to sort out the medical side.’ And so I did. From that moment I ensured the teams had their own, closely attached, medical support. I felt our role was clear. We were there for SAS casualties primarily - instant assistance at an operative’s side.

  Beyond the close support provided by SAS medical personnel, such as me, there also existed SMTs - Specialist Medical Teams. Officially they were not meant to exist, being tightly controlled from the Ministry of Defence. They were designed to work independently, and not alongside civilians. This would have been regarded as a security risk. The role of SMTs, in the eyes of the hierarchy, was to keep VIPs alive. Imagine, for example, the Prime Minister is taken hostage. After days of negotiation the SAS goes in, narrowly saving the day but wounding the Premier accidentally. These things can happen. For such people to die en route to hospital is not acceptable, so immediate on-site medical cover is required. These would offer consultant-level medical assistance at or near the action. Teams would come from all three Services, their equipment being on permanent standby in Hereford. The staff involved would go about their normal jobs, but would be ready to move at a mom
ent’s notice from wherever they happened to be. I had strong doubts about SMTs. Some were excellent, while others had no real idea of what was expected of them. It is one thing to be working in a comfortable Service hospital each day. It is another to be thrust into the back of a C130 Hercules at one hour’s notice, flown to a farflung land and asked to perform medical miracles under fire. You need to be physically and psychologically prepared for such things. Many of the SMTs were not. Nevertheless, those involved did take their job very seriously.

  Being on the receiving end of an SAS antiterrorist assault is not something I would advise. I have been through it on numerous occasions during training exercises. Such events are as real as they can get. The assault always happens when you least expect it. After all, the antiterrorist forces often have plenty of time to make their plans. The more a negotiator can slow talks down, the better prepared are the troops when the time comes. They can pick and choose their moment and have relays of freshly fed and slept individuals to do the task. The terrorist is surrounded by hostile forces and is unlikely to have slept or fed normally for a long time. Teams can get in anywhere. Through doors, walls, roofs or windows. You can be sure they will have been watching and listening to you intently by whatever means possible before committing themselves to an attack. By the time you realize an assault is under way it is too late to do anything about it. In come the flash bangs, the unofficial description of stun grenades, plus CS gas. Out go the lights and the next I would know was that I lay flat on my face, a large boot on top of me. It was a position I was forced to adopt on many different occasions with the Regiment. I was completely disorientated. I had no idea who was attacking, how many were attacking or from which direction they were coming. I was always utterly surprised, even though I was in the trade. With antiterrorist tactics being so finely honed worldwide, it astonishes me that terrorist groups still try hostage-taking at all.