Knife Edge: Life as a Special Forces Surgeon

by Villar, Richard

  ‘Can yer tell me where the hospital is?’ said the driver, in a broad Belfast accent, winding down his window as he spoke.

  ‘Of course,’ I replied, sounding terribly English. It is one of the perils of a public-school education. As I spoke I kicked myself. I would usually revert to Scottish when communicating with the locals as my attempts at mimicking an Irish accent are normally disastrous.

  The moment I opened my mouth I saw the eyes of each of the car’s occupants glaze over. Immediately they realized where I was from. No use my telling them I had operated on at least twenty of their countrymen in a local hospital during the past week. It would have made no difference. The driver looked me hard in the eye, then spat on the ground out of the window, his gaze never once faltering. ‘Don’t bother, yer monarchist bastard,’ he said as he drove off, loathing in every syllable. ‘We’ll get yer all in the end.’

  An unpleasant, but fortunately rare, duty of an SAS doctor is the handling of death and its aftermath. Though this is officially the task of a Commanding Officer, in reality it may be delegated to others. I hated it. I was dealing with some of the nation’s fittest people and yet had to tell their nearest and dearest they had died. Furthermore, the dead men had frequently been friends. I therefore had my own grief reaction to contend with, as well as a job to do. James R highlighted this particularly well. Deaths could occur at any time, and usually when you least expected it. Even the Det was not exempt.

  Late one evening, a particularly dark and damp one as I recall, I received a telephone call from Regimental HQ. A rising star in the covert world, no more than twenty-five years old, had been shot in the head by a high-velocity bullet. Despite an appalling injury, he had managed to survive the initial impact. Local medics had struggled to revive him, being sufficiently successful to evacuate him to a neurosurgical unit in Scotland. It was there I first saw him, surrounded by his family, later that night. We did not have a padre, so with me came a highly respected Regimental Welfare Officer, Robert P. The operative was connected to all manner of tubes and bleeping electronic devices to keep him alive. Despite these, a brief word with the neurosurgeons told me his chances of survival were almost zero. He would most likely die soon. Should he survive, brain damage was too severe to allow him to be in anything other than a vegetative state for the rest of his days.

  Breaking news like this to a family is one of the hardest things a doctor can do. Some choose to get on with it directly, calling a spade a spade. Others work up to it more slowly, fencing around the subject until the topic of death is eventually reached. Worse still, the young man’s family had no idea of the type of work in which he was involved and we were not allowed to tell them. As so often happens on these occasions, the father controlled his distress by asking questions about the incident and telling us of the outstanding abilities and ambitions of his son. The mother, quite naturally, was horrorstruck by the affair and could barely speak. Human distress presents in so many different ways. Medical training cannot prepare you for scenes like this. You must simply do the best you can. I often end up crying myself. Certainly neither civilian teaching hospital, nor Army, had given me any training in such counselling at all. When faced with a bereaved family, staying in control, and yet remaining supportive, is immensely difficult. You must be prepared for anything, including being blamed for the event yourself. It was during our discussions with the family that I realized how much a general experience of life helps. Robert P was many years my senior and medically untrained. What he had was an undefinable, enviable ability to reach into the hearts of those with whom he talked. I learned a lot from him that night. He handled the situation beautifully, allowing the family to talk as they wished, prompting them when they fell silent, holding a hand when needed. It was a brilliant display of counselling, unrivalled by anything I have seen either before or since. His manner permitted us to leave the family settled and content, though naturally still distressed.

  My time in antiterrorism was ideal for my planned surgical career. Though much of what I did was preparation and negotiation, it put me in touch with civilian medicine once more. I needed to know which hospitals in the land could cater for casualties we might create, what facilities they had and whether their staff were suitably trained. Much of this took place in the UK, so that I was in continuous contact with civilian colleagues. I needed this, for the break I would have to make one day from under the Army’s broad umbrella. So far, the training and experience I had received was excellent, particularly for medical organization and experience in the Third World. My SAS patients had exposed me to a wealth of conditions, many of which would never be seen by a civilian practitioner. Clinics were frequently stuffed full of patients with minor orthopaedic problems - torn knee cartilages, broken wrists, funny hips or ankles. However, as a doctor, working singlehanded from a basic medical centre, there were limits to the depth of treatment I could offer. If the situation became too complex, I would have to refer the patient to others. I realized it was time to move on. Flattered by the CO’s offer that I should extend my SAS service, I declined. He, too, was a hard-core professional and subsequently reached even dizzier heights in the Army. Nevertheless, he understood my reasoning. Thus it was I turned my back on Hereford’s Bradbury Lines, thinking I would never be involved in SAS activities again. I was desperately sad. With 21 and 22 SAS combined, I already had seven years of Special Forces’ activities to my credit. The Regiment was a second family. Something I had eaten, breathed and slept for so long.

  It is difficult to settle into normal routine once you leave the SAS. The Army posted me to a military hospital in London, where I began work as a junior orthopaedic surgeon. I found it both fun and professionally rewarding, but missed the unpredictability of Special Forces life. No longer was I required to be on thirty minutes’ standby to move, nor asked to dine with leading politicians. I was now just any old surgeon, in an ordinary hospital, struggling to climb the orthopaedic ladder. At least that is what I thought until I was asked by the RAMC to command an SMT. Having fiercely criticized such teams when RMO to the SAS I now did a complete about-face. Suddenly, to hear me speak, SMTs became the most indispensable items in the land.

  There were four of us, each based in my hospital, attached to our commitment by a long-range bleep. Though the Army had offered personnel for SMT service, it had not thought through how we were to reach the scene of the action physically. After much discussion, the hospital’s Commanding Officer, a kindly brigadier, offered his official car. If summoned, we would have first call on it, irrespective of his commitments.

  It was important to establish whether such a loose arrangement would work in practice. Late one night I decided to experiment. Gathering my three SMT colleagues together, I created an imaginary terrorist incident somewhere in north London. The system ran like clockwork. The team assembled in the hospital reception area and the CO’s driver appeared, somewhat overcome by events. He was quite convinced he was off on his first secret mission. Very quietly, and not daring to ask what we were doing, he drove us to a prearranged location thirty minutes away. I had dreamt the spot out of thin air, as I used to pass it on my daily jog. Good, I thought, once we reached our objective, no more than a dogpee-stained lamppost near an Underground station. At least the transport works, even if my SMT had yet to be tested in action. Satisfied my worries about SMT transport were ill-founded, I asked him to turn round and drive us back to the hospital again. All credit to him, confused though he was, he never asked the purpose of such an apparently pointless exercise.

  We returned to our beds, for a brief two hours’ sleep prior to the morning’s duties. Even so, the driver was not to be deterred. While we snoozed, he sat firmly in his car, for the rest of the day, refusing all orders to go elsewhere. The CO, with an important meeting in central London that morning, could not budge him and had to travel by tube. ‘I’m sorry, sir. I have a priority engagement,’ was all the driver would say. It was my fault, of course, failing to stand the man down wh
en we returned to the hospital. As a true soldier he was not going to move until I told him so. Villar was not a popular name with the hierarchy that day. It is the story of my life.

  Not long afterwards my SMT was called out for real. An African airliner had been hijacked and was sitting at a provincial airport. The call came from the hospital switchboard early one evening. ‘Captain Villar?’ it said.

  ‘Yes?’

  ‘I’m to say the words “Spanish Galleon” to you, sir.’

  ‘Spanish Galleon?’ I asked, having no idea what the man meant.

  ‘Yes, sir. Spanish Galleon.’

  ‘Sorry,’ I said. ‘Can’t help you. I haven’t a clue what you’re getting at. Got to go. Bye.’ I hung up. The hospital switchboard must be off its rocker, I thought. It was a frenetic day as I had at least eight young men with cancer to treat, all of whom required chemotherapy. As soon as I put the telephone down it rang again. Exasperated, and sighing loudly, I picked up the receiver. ‘Yes?’ I shouted.

  ‘Spanish Galleon, Captain Villar. Spanish Galleon is what I’ve been told to say.’ The switchboard operator’s voice was now somewhat hesitant.

  I was furious. I was well behind with my work and knew that cancer chemotherapy was not something you could rush. Spanish Galleon indeed! Then, in my anger, a brief thought flashed through my mind. Blast! Of course! A sick realization welled up in my stomach as I suddenly recognized the codeword for emergency SMT call-out. Spanish Galleon it would be.

  Despite all our plans, and dress rehearsal, the CO’s car was unavailable that evening. It was getting dark and I had trouble enough finding my three colleagues. Bleeps are not a guaranteed method of communication. Three hours later, we bundled ourselves and our mass of equipment into my tiny, gold Renault 5, setting off towards the airport. I knew the SAS would already be there, guided by police escort along hard shoulders, between crash barriers and the wrong way up many one-way streets. The waters would have parted for them. For their SMT medical support the situation was different. We jerked our way from London in my car, aided only by an Automobile Association Book of the Road. None of us had been there before, so we had no idea where to go.

  Two hours later, in the vague vicinity of the airport, I pulled to the side of the road to check the map. It was dark, very quiet and with barely any traffic to see. As we discussed which way to go next, each of us similarly confused, none of us noticed the flashing blue light of the police car draw up behind. It was only when the police officer leaned through my window that I realized he was there.

  ‘Evening all,’ he said in classic Dixon of Dock Green fashion. Apart from nearly jumping out of my skin at the shock, I had to kick one of my colleagues to stop him from laughing out loud.

  ‘Um… hello. We’re a little lost,’ I said.

  ‘Oh, are you, sir,’ came the reply. ‘And where might you be wanting to go?’

  ‘Um…’ I had no idea what to say. I knew SMTs were meant to be highly classified and did not know whether the policeman was aware the SAS were at the airport at all. I could see lines on his forehead as the poor fellow tried to work out what was going on. Then, suddenly, it dawned on him.

  ‘You’re SAS, aren’t you? That’s who you are, isn’t it?’ ‘Um…’

  ‘Come on, gents,’ added the policeman. ‘You’ve got it written all over you. You’re bleeding SAS. You must be.’

  ‘Um…’

  ‘Look, you silly buggers. Stop mucking me about. Just tell me. Are you SAS or aren’t you?’

  I decided to give in at that point. It was obvious the policeman knew what was happening, though I was not certain that four large men sitting in a battered Renault 5 was a recognized mode of SAS transport. ‘OK. Yes, we are,’ I said, not wishing to explain that I was the only one of the group who had had the opportunity to take SAS Selection. The remainder were sturdy fellows, but not truly badged. It did not matter in any event. It was much easier J that we each adopted the same mantle.

  ‘Well, why didn’t you say so? Stupid bastards,’ said the policeman, now thoroughly exasperated. ‘Follow me. I’ll take you in.’

  The airport was busy. The main passenger terminal had been shut off, with television cameras placed as far away as possible. Even so, you had to walk directly in front of them to reach the holding area — not a good introduction to antiterrorist security. One of the team whispered in my ear as we walked immediately in front of a large telephoto lens, ‘Hey, Doc! What say you and I turn round on the count of three and shout “Hey Mum, it’s me!”‘ I had to elbow him in the ribs, a well-known method of military control, to stop him doing it.

  By the time we had arrived, the airplane had been on the ground for several hours. SAS assault teams were busy making plans in case they were needed, their Regimental Medical Officer, Captain L, being with them. The SMTs were relegated to the main terminal area where we set about organizing a casualty evacuation chain. A chain involves the organization of several steps along which a casualty will travel after injury, treatment being available at every stage. At the time of wounding, the ‘buddy buddy’ system applies. The injured man will be cared for immediately by his military partner, assuming safety allows it. At this stage the object is basic life-saving manoeuvres - shell dressings to wounds, morphine injections, maintenance of breathing. The soldier is next treated by his Regimental Medical Officer. Either the RMO will go forward to the casualty or the casualty will be brought back to him. Either way, it is the RMO’s job to ensure basic life-saving manoeuvres are as good as they can be, before sending the injured man to the next stage in evacuation - the SMT. The SMT provided a further level of treatment sophistication. If we had to, we were in position to open a belly, split a chest, or apply electric-shock therapy to a failing heart. Once a casualty was stabilized, he would be evacuated to the nearest hospital, civilian or military. There he would stay until recovered.

  The object of this step-by-step evacuation was to ensure an increasing level of medical sophistication at each stage. Ideally, you would want the complete facilities of a major teaching hospital within 100 metres of an SAS assault. This was obviously impossible. A casualty evacuation chain was the next best thing.

  Successful evacuation is based on a procedure known as triage. Triage describes the separation of casualties into groups of differing priorities. It is the job of the most senior medical person present to run triage. He, or she, stands at the receiving door and immediately divides casualties into one of four categories: Priority 1 (treat as urgent), Priority 2 (treat as fast as reasonable), Priority 3 (take your time), Priority 4 (don’t bother). Senior people are needed for the task as they will generally have the breadth of experience needed to make rapid, accurate assessments. Just because a casualty looks badly injured does not mean he is classified as Priority 1. A gunshot wound to the head, for example, if it does not immediately kill the soldier, may still be classified as Priority 4. As the man is likely to die anyway, medical efforts are best aimed at those with some chance of survival.

  We planned that casualties should be brought to us from the aircraft, in whichever order they emerged, directly to the triage point. From there the triage officer would direct the casualty to one of a number of resuscitation stations. Ambulance crews would take the wounded thereafter to the nearest civilian hospital. I telephoned their casualty department to warn them of the likelihood of heavy casualties and left them to their own arrangements. I had to be careful what I said. If an assault went in, it depended upon an element of surprise. Telling a civilian hospital they could be overwhelmed within the next few hours is the type of information the media love. From there, to the terrorists being given advance warning of an SAS assault, is not a huge step.

  To our astonishment we discovered we were not the only medical team at the airport that evening. In the terminal with us was a civilian team, already setting up shop. I believe it was their first hijack. As we were not supposed to exist, and yet were physically in the presence of civilian medics, our cover was blo
wn. This breach of security did get me into trouble afterwards. An irate telephone call from the Ministry of Defence challenged my organization at the scene, particularly when the civilians later requested joint training with us. However, during the hijack we had to cope with the security implications as they stood. It had been the police who had positioned us. They had also summoned the civilian teams without talking to us first. There was nothing we could do.

  The other SMT members rapidly set up our resuscitation station while I went to find out what was happening aboard the aircraft. As is usual with these situations, it appeared there would be no sudden solution. Antiterrorist forces were busy establishing ways of best gaining the intelligence they needed, while the SAS already had their immediate action in place. The immediate action, or IA, is prepared from the moment troops arrive. It is the instant response to anything that might go wrong while more formal, effective plans are made. It is a high-risk option and best avoided.

  I learned the terrorists on board the aircraft had already shot the co-pilot, or claimed to have done so. Quite what their demands were I did not know. During such events the requirements of the terrorists are not a major issue to you. You do not enter into the politics of the situation. You assume that troops will assault and make preparations accordingly. It is better to waste effort than to be surprised by developments, creating unnecessary casualties on both sides as a result. On the one hand, such sieges will have police and negotiating teams trying hard to bring the thing to a peaceful end. On the other will be the SAS, ready and raring to go from the moment it arrives. Control and use of these two extremes is the key to successful siege handling.