Knife Edge: Life as a Special Forces Surgeon

by Villar, Richard

‘The Commander of British Forces wants to send in an aircraft to pick you up,’ he said.

  ‘What? Into Lhasa?’ I asked.

  ‘Yes. He’s negotiating with the Chinese now.’

  ‘There’s no real need, sir,’ I replied. ‘Peter is doing pretty well now. I’m sure he’ll recover.’ I could tell I was saying the wrong thing by the hesitation at the other end of the line.

  ‘As I said, Richard,’ came the top brass’s reply. ‘The CBF will send in an aircraft. He thinks it’s important.’

  ‘But… but…’ I was interrupted.

  ‘The aircraft will come. He’s talking to them now. The CBF says it’s vital. I’m sure you can understand what I’m saying.’

  Politically it would be desirable to have an RAF aircraft landing on Chinese soil, at a time when such things were diplomatically forbidden. To use Peter as an excuse would be perfect. I was having none of it, irrespective of the consequences. There are times in one’s medical life when you must make a clear decision between what is best for the patient, and what is best for everyone else. I have always chosen the patient. Peter was recovering, I was in control and the Chinese were doing well. I bade the top brass farewell, ignored the politics and had the climber in Hong Kong within thirty-six hours. I was damned if any patient of mine was to be used as a political pawn.

  Six days after the avalanche I managed to talk to Louise by telephone for the first time. I told her I was alive, uninjured and on my way home. Wasn’t that good news? No one could accuse my wife of being passive - perhaps it is her Scottish roots. Her reaction was typical. ‘Do you mean you’re giving up?’ she asked incredulously. ‘Seems a waste to me.’ What else, after all, would you expect of an SAS spouse?

  Despite her initial doubts, by the time we reached the UK’s Brize Norton airfield, she had accepted our failure. As I burst through the terminal doors to greet her, my arms spread wide for a welcoming hug, I saw the look of disbelief in her eyes. Her usual smile had disappeared, replaced by a tiny frown that puckered the middle of a normally smooth forehead. What’s wrong, I thought? Hasn’t she missed me? Isn’t she pleased to see me in one piece? I slumped my arms in disappointment. Then I realized the problem. The beard! I had grown a respectable, hairy affair that now covered most of my face. Recognition slowly dawned as she peered through my heavy disguise to see her husband beneath. Together we spread our arms, big grins on our faces as we now hugged. ‘Darling,’ she whispered in my ear, ‘I do love you. It’s wonderful to see you again.’

  It is difficult to re-enter an orthopaedic career after climbing Everest. Your mind dwells so much on other things. If I were to succeed, taking absence from mainstream surgery would not be possible for a few years. You have to become part of the system, and the system is not found perched on the world’s mountainsides, even though by now the high-altitude life was firmly in my blood. My ambition to work in the Third World still remained, but for the time being I had to become familiar with a wide range of orthopaedic operations to be of any use. Fractures, replacements, funny feet, funny knees, funny hips and so on. There was much to be done. I resolved to stay based in the UK for several years, learning the various tricks of my trade. However, I would still visit the Third World on occasion, both to refresh my ambition to make a life there and to teach others what I could. In my shaky stumble up the orthopaedic career ladder I spotted what I thought was an ideal surgical job in Cambridge, that unusual centre of learning in an otherwise barren landscape.

  The Cantabrigians did not make it easy, giving me an interview that made interrogation seem like child’s play. I struggled through it, relieved when it came to an end. Most of the questions asked were impossible. Having sent me from the room, the panel duly deliberated, summoning me from my cold cup of tea to receive their decision. I was sure I had failed. I entered the room, took my seat and waited for the axe to fall. Before me sat the eight, sombre-looking men who had grilled me. The chairman spoke first.

  ‘Mr Villar, we are delighted to offer you the post as an orthopaedic surgeon here in Cambridge. Do you accept?’

  ‘Me? Are you sure?’

  ‘Yes, Mr Villar. You. We’d like you. Do you want the job?’ I nodded enthusiastically at that point, detecting an irritated tone in the Chairman’s voice.

  ‘Excellent.’ I saw the sombre heads nod sagely, their faces still serious, though one did wink. At least I think it was a wink, it might have been a nervous tic. ‘Do you have any questions for us, Mr Villar?’ the Chairman added.

  This was a strange turn of events, the interviewee asking the panel questions, rather than the other way around. What was I meant to say? Ask them about orthopaedics? The time? The weather? The pay? I struggled to think of a question, if for no other reason than to look intelligent. ‘Yes, I do have one,’ I eventually said to the eight pairs of raised eyebrows sitting before me. ‘Your mountains. Where are they?’ I could not imagine life without them.

  The eight faces looked simultaneously shocked and confused. I saw them look left and right, conferring in low, deep voices. Slowly each shook its weary head. One even raised its eyes to Heaven, as if to beg forgiveness for the error they had made in offering me the job. The Chairman eventually spoke.

  ‘Mountains, Mr Villar? We don’t understand. Cambridge doesn’t have any mountains. Surely you are aware of that? You might mean the Gog Magogs. Keep driving south-east from Cambridge. You can’t miss them. That will be all. We look forward to you starting one calendar month from today.’

  I had been dismissed. Nodding my thanks, I departed rapidly from the room, returned to my car and drove hastily south-east. I drove for miles and saw nothing that remotely resembled a mountain. Not even a mole hill. After thirty minutes I reached Haverhill, a major conurbation southeast of Cambridge. That, too, was flat. Perplexed, I drew the car slowly to a halt beside an elderly lady, pushing a ropy pram stuffed with shopping bags. In her tatty tweed overcoat she turned to give me a toothless smile as I wound down the window.

  ‘Excuse me!’ I shouted across to her, raising my voice to overcome the noise of passing traffic. ‘Excuse me! Can you tell me where I might find the Gog Magog Mountains?’

  ‘What luv?’ came the reply. ‘Gog Magog Mountains? We ain’t got no mountains ‘ere. The Gogs? Yeah. Little pimples just aht of Cambridge. You’ll drive past ‘em if you blink. But they ain’t no mountains. We got none ‘ere.’

  Cambridge, how could you do this? I thought, as the terrible realization hit home.

  CHAPTER 9

  Terra Incognita

  Pain shot up my left arm like an electric shock the moment the needle stabbed my finger. ‘Sod it!’ I yelled, as I disturbed the peace of the normally quiet operating theatre. It had been a difficult, lengthy operation. A rabid boar had attacked the man, thrusting one tusk deep inside his chest. The lung had collapsed and bleeding had been heavy.

  By good fortune the attack had occurred near the hospital, so we had been able to treat the patient before blood loss had been too severe. It was as we were closing the wound at the end of the operation, a normally simple task; that the accident happened. The hospital was so poor that I had to reuse the surgical needles. Single-use, disposable needles, commonly used in the West, were unheard-of here. The one I had selected had been used so often it was now blunt. Picking up one edge of the skin wound with my toothed surgical tweezers, surgeon’s forceps, I had tried to plunge the curved needle through it. It would not go. Then, unexpectedly, the skin had given way and the needle had shot through - directly into my gloved fingertip, impaling me, and now buried almost to the hilt.

  Such injuries, needlestick injuries, are part of the normal hazard of surgery. Provided neither you nor the patient have some ghastly disease, they are not a problem. But rabies. This man had been assaulted by a rabid boar and rabies was a killer. There was no known cure and no guarantee the inoculations I had received before leaving home would protect me. If any killer virus was left in the wound, however carefully I had cleaned it, there w
as a strong chance I would be a goner. This was the terra incognita, the jungles of India’s Madhya Pradesh state, perhaps the most medically hazardous environment in the world.

  I had been surprised by Cambridge. Surprised because I enjoyed it. I had not expected such tolerance of my peculiar ways. Having recovered from the shock of the 100-foot Gog Magogs being considered mountains (there is even a mountain-rescue team, would you believe), I settled into my new life as a fully fledged civilian. For the first time in over a decade I had no involvement with the SAS at all. Occasionally an ex-colleague would arrive in my clinic, seeking opinion on the delayed effects of some earlier war wound. Now and again I would receive strange telephone calls from unidentifiable voices, asking about peculiar tropical conditions that few in the UK had seen. Such contacts served to make me restless. My mind would repeatedly wander, as I gradually amassed experience in orthopaedic surgery.

  To my horror, I found my ambitions changing. Whereas I had initially wanted to live and work as an orthopaedic surgeon in the Third World, I began to feel there might be alternatives. Cambridge, a major teaching and research centre, was giving me many opportunities. The chance to pioneer new operations, to instruct enthusiastic juniors and to set up specialist orthopaedic skills. Hips and knees I found particularly interesting, I suppose because so much of my SAS experience had involved injuries to those areas. The operatives were forever twisting knees and banging hips, so I knew a fair amount about them even before I became fully civilianized. Perhaps I would remain based in the UK, offering my services to whichever Third World country needed them, but for limited periods. That way I could maintain the UK connection, yet still be useful to the primitive peoples of the world. Louise also preferred the idea. The last thing she wanted was to be stuck in a mud hut overseas for the next twenty years. I had to sympathize.

  After much deliberation, I thought I would try out my modified ambition. I wrote to dozens of charities, some of which are household names, while others are rarely heard of. ‘If it is of any use,’ I wrote, ‘I can give you six months of my time. I am happy to do anything. You do not need to pay me.’

  To my astonishment, of the 190 envelopes I posted, only two agencies replied. Voluntary service was obviously harder to enter than I had anticipated. Many of the charities had standing rules that did not allow anyone to work for less than a year, or eighteen months in some cases. Perhaps it was my SAS background, I do not know. When the first offer did arrive, it came as an unexpected telephone call, during a clinic in an orthopaedic hospital in Essex. It was the Afghanistan Support Committee, looking for someone to run ambulances into Russian-occupied Afghanistan, in support of resistance operations. I was sorely tempted at first, paying several visits to a shady-looking office in London’s Shaftesbury Avenue. In the end I declined, mainly because information available about Russian troop movements was inadequate, making the venture too unsafe. By then I had also received an alternative, second offer from a Cambridge-based charity, Action Health. Perhaps I am becoming soft in my old age, I thought, but the small hospital of Padhar, in India’s terra incognita, was enthusiastic for my help.

  Study a map of India and the village of Padhar is nowhere to be seen. Situated 220 kilometres from the city of Bhopal, it is truly in the heart of the subcontinent. The village is in the state of Madhya Pradesh, a region of 450,000 hectares, an area that sprang to fame in the mid-1980s when the leakage of methyl isocyanate gas ostensibly caused tens of thousands of casualties. Defenceless locals died and choked while they slept. Their problems continue to this day. Chronic lung conditions, due to damage from the effects of poison, are a terrible way to die. Imagine being breathless to the last, when even minor exercise such as tying a shoelace makes you pant. It is awful. I have seen patients die from it and would not wish such a fate on anyone.

  From Bhopal, a tiny road passes south, winding through mile upon mile of teak jungle. This is not the jungle of the Far East or Central America. It is dry, fairly open, with frequent clearings. It is not so oppressive, nor so claustrophobic, as the humid, tropical rainforests in which I had spent much of my SAS life. There is barely any habitation. This is the home of the monkey, the panther, the elephant and every other form of jungle wildlife imaginable. It is truly an unknown land — terra incognita - named by the British during their Indian rule. It was not a region that early mapmakers would happily enter. If they did there was a fair chance the dacoit would see them as prey.

  Yet one man had the foresight to go against the grain. Not only did he travel freely through the area, but also lived and worked in the villages around Padhar as a missionary. His name was Clement Moss. He began work in 1939, but after twelve years felt he could do something more for the enormous health problems of India’s rural peoples. He decided at the age of thirty-six to become a doctor, entering medical school in India’s Punjab, despite being British to the core. As a highly articulate, intelligent man, qualification did not take him long. Medical degree in hand, off to Padhar he went. At that time there was nothing in the area beyond an orphanage, a dispensary, a church and a once warlike tribespeople - the Gond. Quite illogically, or so it appeared, Clement decided to build a hospital in Padhar, the very heart of the Indian jungle. To many, placing a hospital there, for it is truly isolated, was a futile exercise. The essence of hospital construction is to place them near populated areas. What use is a hospital without any patients to treat?

  Clement guessed correctly, being driven by a faith that few have the privilege to understand. With the help of local tribespeople he physically built the hospital himself. He even supervised the manufacture of the bricks. He estimated it would make no difference where a hospital was positioned. If it was good, people would travel to it. Furthermore, Padhar was a market village, on a road of sorts and so easier than most to reach. He was right - it was a well-chosen site. Now, with 200 beds to its name, Padhar is a thriving institution that sees more than 3000 patients each month. It is a true phenomenon.

  Isolation unfortunately has its perils. In particular, staff become lonely and it is difficult to fill posts as a result. That was where I was needed. Having turned my back on Afghanistan, I was looking to use and develop my surgical skills somewhere that people both needed and appreciated them. Padhar seemed ideal.

  A feature of primitive areas, particularly if local people are uneducated, is the variety of disease one sees. They are often different to those back home. I was fortunate that SAS service had done me proud. I was used to living in isolated surroundings, coping with contaminated water and the strange diagnoses that go hand-in-hand with the Third World. In Britain we have our share of bunions and back pain, coughs and colds, arthritis and epilepsy. In Padhar it was more common to see diseases like tuberculosis, polio, vitamin deficiency or cancer of the throat. Your medical perspective changes once you get there.

  Neglect is a problem. Patients travel for miles to visit Padhar and appear with conditions that have been present for ages. It would not be strange to see someone with a broken leg, for the first time, four weeks after the accident that caused it, or an infection that had been discharging pus for a year. Because diseases are so advanced, treatments that are effective at home do not necessarily work in the Indian jungle. Take a child’s dislocated hip. In the UK I would hope to solve the problem easily with mild, albeit prolonged, treatment. The same condition in Padhar, because it will have been present for longer before detection, would require lengthy, high-risk surgery without guarantee of success.

  It was into such an environment I was thrust one sunny Monday morning in September. Struggling from a Land Rover that collected me from Bhopal airport, I extended my hand to greet the hospital’s superintendent, Vincent Solomon. I was feeling awful. Already, a brief stop in Delhi had managed to poison me when I had foolishly downed an ill-cooked hamburger. Vincent, an experienced orthopaedic surgeon, smiled broadly, as if he had known me for years. ‘Dr Richard? Welcome,’ he said. ‘This is Padhar Hospital.’ Though I had never met him befor
e, Vincent’s reputation went before him. He had trained worldwide, not just in India and, though an orthopaedic surgeon, was just as skilled at a variety of other operations - Caesarean sections, womb removals, opening skulls for bleeding, even repairing a birth-deformed heart. He was also brilliant at badminton. This level of surgical talent is only rarely seen in the more developed countries as specialization has intervened. In Padhar there was no choice. If the job was not done there, the chances were the patient would die. You could not be surgically choosy.

  I was given little time to think or prepare. As Vincent walked with me the short distance to the hospital buildings, he described the situation in a precise, efficient tone. ‘Once we heard you were coming, Dr Richard, we advertised in the newspapers and on radio and television. You can do that here. We have had an enormous response. More letters than you can imagine. We have filtered out the serious ones… Watch out!’ He grabbed my shoulder tightly, pulling me back from the edge of the dirt road. A massive, overladen truck whisked by, horn blaring, exhaust fumes pouring into the atmosphere. Even in terra incognita I could see pollution was a problem. I watched the tail end of the vehicle disappear into the jungle, scattering chickens, cows, children and dogs before it. The driver had no intention of stopping, whatever stood in his way.

  Crossing the road to the main hospital gates, I could see everywhere the thriving community that had developed around the complex: dozens of roadside stalls offering food, refreshments, odds and ends, even a haircut. Some poor fellow was being assaulted by the barber as I stared. A fine head was being reduced to a pale shiny pate before me. The barber saw my gaze, shouting incomprehensibly to me as he brandished his comb and scissors. Vincent shouted something equally impossible back. I saw the barber recoil in horror at his words. ‘He says you are next, Dr Richard,’ explained Vincent, obviously enjoying the occasion. ‘I told him he can cut your hair after you have done his operation. I think he will keep quiet for a while now.’