Knife Edge: Life as a Special Forces Surgeon

by Villar, Richard

  Red Cross identification is a mixed blessing. Through an opponent’s telescopic sight, everyone should look the same. Around your neck you wear two metal identity discs, wrapped tightly in black masking tape to ensure they do not clash noisily together. On the discs are embossed your name and number. Red Cross armbands, good in theory, are out in practice. They can be seen for miles and can help identify the lines of communication for the fighting troops. In Bosnia, more recently, the Red Cross on the side of Sarajevo’s military hospital was used as an aiming point for Serb gunners. At times I was tempted to secrete my armband and rank epaulettes in a tunic pocket, to be miraculously produced in the event of capture. The temptation was strong, but military training took over. Nothing suggested I was a doctor.

  Once it became obvious the operation could happen any time between the next five minutes and the next five months it was important all concerned were kept busy. Physical training was our way, with frequent runs up and down the area’s tiny mountain extremely effective at keeping us fit. After all, we reasoned, if we had to keep pace with the SAS operatives, the medics could not be outdone.

  When alone, each would occupy himself in his own way. For me, it was revising for my next surgery examination, scheduled for later that year. I am sure the author of Lecture Notes in Surgery had no idea his book was being so avidly read on such a covert mission. Admittedly, memorizing facts was impossible, particularly when disturbed by yet another thirty-minute standby to hell.

  Writing to Forces’ penfriends was another activity, and strangely attractive it was. You would not believe the quantity of mail the Services receive, totally blind, from young ladies and young men in times of war. Tons of it. It is extremely welcome. Not every soldier has a loved one at home to whom he can write. Particularly so the SAS, which appears to have an unfair percentage of single, independently minded individuals. I cannot remember to whom I wrote, but the Doc is always regarded as fair game for such things. The operatives would line me up with the most provocative, suggestive missives and insist I replied. I enjoyed the challenge.

  By now it was becoming clear that life was still not going well for the fleet. Despite the main troops landing on East Falkland, the Naval casualty list was becoming longer by the day: Ardent, Argonaut, Antelope, Sir Galahad, Sir Lancelot, Coventry. These names do not include those struck by unexploded bombs, UXBs. There appeared a great disparity between what the media now reported and what was truly happening on the ground. Downing Street had to be sweating.

  Furthermore, our own operational security was now becoming a problem. A leak had been discovered in a nearby conurbation and our tasking was apparently being discussed openly. Occasional reports would also appear in various UK newspapers of likely SAS options. Most were wildly inaccurate, but a few, if they had but known, were perilously close to the mark.

  At this point I felt we were as close as we would ever be to the operation being launched. Again, we were on short standby to move. As if to emphasize the situation further, I was asked to update myself on a variety of weapons. ‘Just in case, Doc,’ I was told. I spent the best part of a day on a makeshift range firing an assortment of death-delivering devices. I loved the grenade launcher. It was a tubelike ‘lob and hope’ affair, attached to the underside of a rifle. You get quite good at it in the end, but I found accurate aiming an impossible task. The cartridges, however, do make excellent egg cups. With the upgraded training, and horrifying reports from the task force, all of us were convinced Downing Street was a hair’s breadth from letting us on our way. The operation must surely be launched?

  It never was and the reasons not explained. I imagine you feel as let down as us when you learn this. Probably, the sensitivities and the risks were too great. For those of us poised to strike, we had lived and relived the operation for weeks. My mind had pondered all manner of grizzly ends. Our masters, for most likely very good reason, had developed cold feet.

  By early June we returned to the UK, happy in some respects, disgruntled in others. My first port of call was to Major N. I told him my mind, even though tact, rank and diplomacy might have suggested otherwise. How could the Army, I asked, send its people on a projected suicide operation without warning them beforehand? Why were we not properly briefed? Why was I not stopped from taking married men with me? Of course, now the operation had been cancelled, I had no argument. It was as if it had never happened, that the idea had never occurred. Major N was shaken and there was not much he could say. My objections were passed up the line, though I do not know who received them.

  As for myself, this is the first time I have written this story. I always swore I would not. In many respects I still feel ashamed that I reacted as I did. That I felt such immense, sometimes uncontrollable fear. For years I avoided the subject of the Falklands completely. For those who knew I had been involved, I preferred to talk as if I had been part of more traditional activities. My true role is an aspect of life I wish to forget. Much has been said in closed Regimental circles about the operation that never was. Emotions do run very high. I have seen brief, partially accurate mention in the press of what we were supposed to be doing. I have seen outlines presented in several books. None effectively describe the terror and hopelessness felt by many involved. You do not need to be shot at to be scared.

  The Army left me little time for pondering when I returned. In my absence, a number of other hospital staff had been sent to the South Atlantic, doubling the duties I was normally required to perform. More on-call, more clinics and more surgery. I did not object. It felt good to take my mind away from what had been asked of me only days previously. In early June the landing and supply ships Sir Galahad and Sir Tristram were hit by Argentine air attack. The result was fifty-three dead and forty-six injured, many of whom passed through the military hospital where I was based. The majority were burns victims, some severe, some minor. Burns are awful injuries as they scar for life, however well you treat them. Your chances of survival diminish as the area burned increases. The main problem is infection. Once the skin has been burned away, underneath is revealed a raw, unprotected surface. At the scene of the incident, the best thing is to cover the burned area with something clean. Burned clothing is left where it is as the initial heat has probably rendered it sterile. The casualties from the Falklands returned to London, by sea and air, with their burned hands in antibiotic-lined plastic bags. The troops were also very fortunate as they had with them an exceptionally skilled plastic surgeon. It was thanks to his advice that complications were kept to a minimum.

  My task in London was to help perform countless skin grafting operations - hands, feet, faces, bellies — nowhere was exempt. The operation is called ‘tangential excision’, the burned region being gently cut away with a long, razor-sharp knife, until healthy tissue is found beneath. Skin graft is then taken from an undamaged area, usually a thigh, and transferred to the burn. It takes a week to ten days for the graft to join to the patient. It does not always join fully, so there may be a need to repeat the performance several times, over many weeks, until skin cover is complete. Sometimes burns can be so severe that the victim does not have enough undamaged skin available. This can be a major problem for plastic surgeons and a life-threatening issue to the patient.

  As well as burns victims, the Falklands conflict created many casualties due to gunshot and blast injury. Two in particular stick in my mind. The first was a bomb-disposal man, tasked to go on board a ship to defuse a UXB. Two of them had entered, only one surviving when the UXB had exploded unexpectedly. The survivor lost his arm, clean through the middle of its upper bone, the humerus. The injury, though horrific, was not what impressed me. For an orthopaedic surgeon, the traumatically amputated arm was relatively easy to solve. It was the man’s approach to life that astonished me. Only days earlier he had been staring death in the face, far closer than I had ever got, and yet he appeared completely relaxed and in total control. He had lost a good friend, had been maimed for life, but was as emotionally sound
as one gets. I cannot define the word ‘hero’ but he would be near to it if I could. I am unable to say whether he was decorated for his efforts - it would be a travesty if he was not.

  My other memory is of a young Scotsman who was the victim of a negligent discharge. This is what happens when a weapon is fired by mistake. The Services take great pains to ensure such events are kept to a minimum and make an ‘ND’ a punishable offence. Even so, NDs still remain one of the commoner ways of being injured in action. Twenty-five per cent of American injuries in the Gulf War, for example, were due to friendly fire. It nearly happened to me on one occasion, in the Far Eastern jungle. I had joined the SAS troops on a jungle range, as they practised skirmishing skills. We were using live ammunition from high-velocity Armalites with a lot of fire being put down. Perhaps one thousand rounds per minute were cracking through the air around me. Anyone who thinks bullets whine or whizz has simply never been under fire. At one point I dived to one side, taking cover at the foot of a flimsy tree, preparing to put down fire myself to allow my skirmishing partner to move forward. As I dived, splinters flew from the base of the tree, inches from my head, as several Armalite rounds punched home. It was my fault, as I had run directly in front of a colleague’s rifle without thinking. It is thanks to his quick reactions that I am here to tell this tale today.

  The Scotsman had suffered an ND in style. Not a rifle, not a grenade, but a missile from a jet. He was fortunate to survive. It had blasted away much of his shin bone and part of his foot. The shin bone - tibia - is not a good one to break. In its central portion the blood supply is poor, so damage in this area can be slow to heal. In fact, healing sometimes never occurs. The missile had removed at least a third of the bone, depositing it in a thousand pieces on the runway at Port Stanley. When we took an X-ray, there was a massive gap where the bone should have been. The Scotsman, like the bomb disposer, bore his injuries with immense strength. Our initial advice had been to amputate the leg as none of us could envisage the tibia healing. At times, however, it is good that patients prove you wrong. This was one such occasion. The Scotsman refused amputation and struggled onwards for months in a plaster cast. ‘Let’s see what Nature does,’ he would say.

  He was right. Six months later, with youth and Nature on his side, the bone started to recover, the massive gap in the tibia slowly reducing. Within a year the bone had healed. He walks today with his own leg, albeit with a limp. I would hope he is delighted to have proved the medical profession wrong. All credit to him.

  Once the last Falklands casualty had been discharged from hospital I had more time to reflect on life. I was still suffering badly from the shock of being asked to kill myself so overtly for Queen and Country. I decided to leave the Army as soon as the opportunity presented itself. Aware of my decision, the RAMC decided to post me to Aldershot, deep within the heart of the British Army. Aldershot, too, changed my life - in a most dramatic way.

  I was on the children’s ward. A young baby, no more than a year old, had been born with dislocated hips. I had surgically placed them back in socket, where God intended them to be. After surgery, the baby could not eat or drink. It sometimes happens after big operations, though only lasts a few days. During that period you feed the mites by drip, but their tiny bodies need minute attention to detail. You can so easily administer too much drip fluid and bump them off as a result. Exhausted from the operation, I sat at the nurses’ table towards one end of the huge, open ward, performing interminable long-hand calculations on how much fluid to give. I was struggling - perhaps due to tiredness, or perhaps due to a congenital inability to add two and two.

  As I tore up the twentieth piece of scrap paper, covered in illegible, inaccurate, mathematical jottings, a forceful, feminine voice disturbed me from behind. There was a trace of Scottish about it.

  ‘Why don’t you ask a paediatrician?’ it said. ‘We do it all the time.’

  I turned to greet the voice, ready to defend the rights of orthopaedic surgeons worldwide to solve their own problems. How dare she? I’ll show her, I thought. She wouldn’t know a hip joint if you hit her with one. What did she know anyway? There is a traditional, longstanding war between surgeons and physicians that has existed since the beginning of time.

  Then I saw her and knew instantly I could not argue. She was brunette and beautiful, with a smile as broad as they come. Her tight Army uniform covered an immaculate body, a major’s crown decorating each shoulder. ‘Hi!’ she said, before I could gather myself. ‘I’m Louise. Who on earth are you?’

  You never believe in love at first sight until it happens. It did for me. That very second I knew I was smitten. You sit in a pleasant, isolated tunnel, oblivious of the world outside. You forget everything that has gone before, sometimes cruelly so, and the future appears irrelevant. It is a most intense disease. One day I shall invent a tablet as cure, so deeply physical are the feelings.

  Over the next few weeks Louise and I saw each other regularly. The more I learned about her, the more involved I became. She was a living legend in the RAMC. The five simultaneous boyfriends in Hong Kong? That was her. Refusal to carry a pistol despite being a crack shot? That was her too. Wearing high-heeled shoes on active service, combined with her encyclopaedic knowledge of all things medical, made me realize what a formidable creature I had met. Asking her to marry me - and thank God her acceptance - was the most natural act of my life.

  Since that day we have stayed as tight as tight can be, which is something of a record in modern society. We have had differences by the dozen, and misdeeds when we should not. Even so, Louise is, and was, the girl for me.

  My remaining months in the Army passed in a haze. The girls take over once they agree to marry you. I still had residual duties to perform with the SAS and would somehow have to fit them into my now very changed life. For the first time I had to think of someone else, not just my self-important ego. The duties on this occasion were not concerned with armed conflict, so the chances of being shot were nil. They were nevertheless very hazardous. High mountains, my next port of call, can be the most vicious opponents on earth.

  CHAPTER 8

  Great Heights

  The damned knee would not come straight. I had tried everything I knew, but it was still locked tight, bent in its agonizing position. Mark was one of our best climbers and had been doing well on the approach to Alaska’s Mount McKinley. Disaster had struck suddenly when he had unexpectedly twisted his knee.

  ‘Come on Doc! Pull the bastard!’ he shouted as I struggled to manipulate his knee in the tiny tent. As I heaved hard I could tell I was hurting him, pain written on his face. It was a simple condition, a torn ligament. Split in two it had displaced into the centre of the joint itself, locking it from any movement. Why here, I thought? Stranded in the middle of McKinley’s Kahiltna glacier.

  Though I had ketamine anaesthetic with me, I was frightened to use it. Fearful what would happen if Mark lost control of his breathing, something anaesthetics were prone to cause. I needed him to relax, to eliminate the power of his huge thigh muscles, which were preventing me from applying the necessary force on his joint. My eventual compromise had been a mixture of rum and sedative. I had hoped this would overcome his impressive muscle tone, but it did not. Mark simply insisted I drank some too. He was a social type of man. The result had been an intoxicated doctor trying desperately to unlock the knee of an unanaesthetized SAS operative. Needless to say I had failed.

  ‘I’m sorry, Mark,’ I eventually confessed. ‘There’s not a hope. We’re going to have to evacuate you from the mountain. You’re no use to anyone like this.’ I could tell he was disappointed despite his acceptant nod. Mount McKinley, at 6200 metres, is America’s highest peak. Reaching the summit was vital for those of us who wished to try Everest’s North Face the following year. I was partly to blame for Mark’s predicament, making me feel even more guilty. I had known about the ligament tear before we had left Hereford but had taken a gamble it would not displace. I had been wr
ong. My friendship with the popular SAS man had overridden medical considerations. I resolved to be more self-disciplined should the same happen again.

  It had started with a simple question from Bronco two years earlier. I had been coming to the end of my time in full SAS service. ‘How about Everest?’ he had asked. Bronco was a remarkable individual. You would be forgiven for thinking he was the SAS. He had been everywhere, done everything and knew everyone. The wealth of experience he had amassed after many years in the Regiment was impressive. In 1976 he and Brummie had slept the night out near Everest’s summit, surviving perilous temperatures with the loss of several fingers and toes. Despite this, they both wished to return, though on this occasion with a team drawn entirely from the SAS.

  I was astonished to be asked, knowing almost nothing about climbing and being terrified of heights. I was well able to experience vertigo on top of a bunk bed. Everest? No way. That was stupid. I think Bronco noticed my initial hesitation. ‘Have a think on it,’ he added. ‘Let me know.’

  As he walked away I had to smile. He knew very well I would eventually accept. From my first day with the Regiment I had resolved always to say ‘Yes’, whatever was asked of me. Saying ‘No’ might mean I would miss an important part of life. Within hours I had decided to support the 1984 SAS Everest attempt, irrespective of the fact I could not distinguish a karabiner from a kettle, nor a rope from a rucksack. I had several years to learn.