Medic: Saving Lives - From Dunkirk to Afghanistan

by John Nichol

  The recovery of the Falkland Islands, British territories in the remote South Atlantic Ocean, which had been seized at gunpoint by the military dictatorship running Argentina, was to be like no other operation of its age. Modern British forces were trained to fight either a global (and, swiftly, nuclear) war, against the Soviet Union, or a localized one, as on the streets and in the border lanes of Northern Ireland. A long-distance conflict of the sort now demanded by the prime minister, Margaret Thatcher, had not been on anyone’s radar. It popped up from the history books like some Redcoat adventure in Britain’s imperialist past – in South Africa or India or the Crimea, say – but happening, by some extraordinary quirk, in the last quarter of the twentieth century. Unlike the 1944 D-Day landings, it was also hurriedly conceived, woefully under-resourced and, some said, over-ambitious to the point of folly. But national pride demanded it, and the consensus across all political parties supported it. RAMC medic Mick Jennings expressed the thoughts of civilians and soldiers alike when he recalled: ‘I was pleased when Maggie said, right, we’re going to go and sort this out.’7 Not that he knew anything about the Falklands. ‘I couldn’t point to them on a map – I had no idea where they were. My first thought was that they were in the Hebrides, off Scotland. A lot of people did.’ Nonetheless, there was an absolute determination that the Malvinas, as the Spanish-speaking Argentinians insisted on calling the windswept, snow-chilled outcrops of rock, moorland and peat bog 400 miles from the mainland of South America, would be wrested back from the usurper, their original name8 restored and their three thousand inhabitants returned to British rule.

  As the Task Force troops assembled at Southampton and set off in a fleet of hurriedly commandeered ships for the six-week voyage south, few believed they would actually go into action. This was the nuclear age. Gunboat diplomacy was a thing of the past. It seemed a safe bet that the politicians would posture for a while and then there would be a negotiated settlement. The Task Force would turn round, hopefully not too far short of the equator, so the lads could get in a spot of sunbathing before heading home. Normal service would then be resumed. Except that it wasn’t, and the story told by those on board this armada was of the slowly dropping realization that there would be no turning back. They were going to war, and some of them, perhaps many of them, would not be making the return journey in one piece, or at all.

  As mile after mile of the Atlantic slipped beneath the keels and the water turned from summer blue to winter grey, the vastness of the ocean and the increasing distance from home seemed to underscore the puniness of this force in the face of the daunting task ahead. For those among the men with a sense of history, the campaigns that came increasingly to mind were not the victorious landings of D-Day but the disasters of Gallipoli in 1915 and Norway in 1940. The medics on board were among the first to realize they had to prepare for the worst. More to the point, they had to prepare a gung-ho gang of men and boys for the terrible realities of something they had never really envisaged – a face-to-face, bullet-and-bayonet war.

  The first mountain the medics had to climb – and there would be many in the weeks ahead – was not Tumbledown, or Two Sisters, or any of the other landmarks on the maps of these little-known islands stretched out on ward-room floors and pored over by the military planners. The initial hurdle was getting the men to take seriously the prospect of being wounded and that their lives might come to depend on what the medics could contribute.

  Captain Steven Hughes, recently recruited as regimental medical officer of 2 Para, felt himself to be every inch a paratrooper. The stories of bravery at Arnhem were what had seduced him into this hard-nut regiment. But he was well aware that the fighting men of his battalion paid scant regard to people like him. The macho culture of the Paras derided not only ‘crap hats’ – their dismissive term for soldiers from other regiments, ones not entitled to the maroon beret of the airborne elite – but also those within the regiment who were not front-line troops. Bandsmen, cooks, medics – even doctors – were a lower form of life. ‘Other than for in-growing toenails or a blister or two on exercise, the Toms [slang term for Para squaddies] thought they didn’t have much use for us.’9 When he arrived at the battalion nine months earlier, he had found that several companies did not possess a single medic with the most basic knowledge of first aid, and officers were reluctant to release any of their men for him to train. ‘They didn’t really see the need.’ He had to work hard to win them round, and he still had a long way to go.

  Too often he had run-ins with what another soldier, commando Captain Hugh McManners, described as ‘G snobs’, the operations staff, whose snootiness about the contributions of medics could verge on scorn. They could be as dismissive in their attitudes as the cavalry officers in the Crimea who, 125 years earlier, cantered off with the horses that were intended to pull field ambulances. To McManners, there was an unhealthy paradox in the way the army generally considered the men tasked not to take lives but to save them. ‘Few soldiers volunteer to become medics,’ he observed. ‘The best become NCOs, and those unable to make it as combat soldiers are entrusted with the lives of others, required to be able to resuscitate, maintain airways, staunch bleeding, administer pain relief and splint limbs while leaving the “real” soldiers free for the fighting.’10

  In the burst of activity before the Task Force left, Hughes ordered 25,000 sea-sickness pills and stocked up with crate-loads of extra dressings and drips. Amid all the flag-waving ‘off to war’ euphoria around him, and despite his own belief at this time that they were setting out on a wild goose chase, he dug out and scrutinized the statistics of past expeditions and made a sober – and chilling – assessment of potential casualties. What could he do to minimize the death count? He knew the crucial factor would be getting casualties off the battlefield as swiftly as possible for treatment. But this was not something they had trained for. In their peace-time exercises in the Welsh hills and Scottish highlands, they played tough and rough, simulating battle tactics and testing their endurance to the full. But when ‘casualties’ were designated by the exercise umpire, they were merely ordered to report to the regimental aid post, several miles away, on foot. This was laughable. In a real battle with real injuries, that would be impossible. In the Falklands, the absence of a properly rehearsed drill for dealing with casualties could be disastrous.

  Over at 3 Para, which was also heading for the Falklands, Colour Sergeant Brian Faulkner was putting his mind to the same problem. A thirty-five-year-old veteran, he had been the battalion’s assistant air adjutant liaising with the RAF on airborne operations. Now he was assigned to devise plans for evacuating the wounded. ‘I don’t think anybody within the fighting battalions had thought about how to do this,’ he recalled, ‘other than, we’ve got a doctor, a colour sergeant and some medics with aspirins and bandages in Bergen rucksacks on their backs! Medical services hadn’t really been taken too seriously before. But they were once the shooting started. You should hear them shout “Medic” then!’11

  Faulkner was starting from scratch, having to make it up as he went along – largely from film footage of American forces in Vietnam pulling their boys out of the jungle by helicopter. There were no training manuals for this, no real experience to draw on, particularly given the uncertain topography of the Falklands. About all he knew for sure was that, where they were going, there would be nothing like the paddy fields of south-east Asia. Nor would there be the profusion of rescue helicopters the US had had in Vietnam which had enabled the Americans to get wounded men to a doctor in an incredible average of twenty-two minutes.12 Geography and logistics meant things were going to be different in the Falklands. So too did the military strategy thought necessary to win back the islands. It had been decided that an action would not be halted if casualties were taken, as had been the practice for the British Army in Northern Ireland. The wounded would be of secondary concern until the objective of any attack had been secured.

  With this in mind, medical officer Hughes
realized that, in the limited time he had on the journey, he would have to teach the troops to treat themselves as best they could. As the flotilla ploughed its way south, he set up an intensive training scheme to put in place at least one combat medic (and preferably two) with first-aid knowledge in every ten-man patrol. He taught them rudimentary anatomy and physiology, but the emphasis was on the basics – checking breathing and stemming blood flow. They would be the first call in the front line, stabilizing the wounded, saving their lives before they were shipped first to a company or regimental aid post staffed by doctors and specialist medics and then to a field hospital, where surgeons would be waiting.

  He gave regular briefings to the Toms on what they could do to help each other. As the weeks progressed, he noticed the numbers in attendance – and their concentration on the advice he was dishing out – creeping up. Reality was sinking in. Men who had been drilling in soft gym shoes to avoid marking the wooden decks of the Norland, the converted North Sea car ferry on which they were travelling, were now in heavy combat boots. An air of seriousness replaced the party atmosphere in which they had set out from England. ‘If you are hit,’ Hughes instructed them, ‘you put your own finger in the hole, then drag yourself behind a rock and start your own treatment while your mate secures the ground to make it safe for evacuation. There’s no point in stopping to bandage a casualty if you can’t move him anywhere. And you’re more likely to lose the ground if, for every man injured, another one has to stop to look after him.’ The men of action listened intently. Hughes could see a new respect for him and his medics. ‘We were no longer considered “idle knackers”.’

  He coaxed the Toms to open up about their fears – not easy. When he managed to get them to talk, he noticed their relief at discovering they all had the same deep-seated (and often misinformed) concerns – about pain, about dying slowly but inevitably from abdominal wounds, or how it would be if they ended up with ruptured intestines and a colostomy bag. He told them that 70 per cent of all wounds were to limbs, not heads or guts, ‘which came as a great relief to them. If they were shot in the guts and were still alive, they were going to stay alive, because they’d be treated properly. I told them that most colostomies can eventually be joined back up again.’ Even if their bellies were split open and their intestines fell out, they shouldn’t panic. Guts could be shoved back in and sewn up.

  He warned them to go easy on administering morphine, however great the temptation to ease a mate’s pain, however much he begged for it. ‘If a guy is screaming and shouting, then he’ll be happier being alive at the end than if you’d filled him full of morphine and he quietly succumbed.’ Screaming, he told them, was good. ‘It keeps a man’s airway open, and the adrenalin running round his system keeps him alive.’ Hughes didn’t pull any punches about the crucial issue of getting them off the battlefield, the key to survival. It was going to be difficult. There weren’t nearly enough stretcher-bearers. It would be down to company commanders to get their wounded back to the aid posts in any way they could, which was not ideal but was the truth of it.

  In his search for life-saving procedures, he alighted on the Israeli Army’s practice of issuing each soldier with his own supply of intravenous Hartmann’s saline fluid to carry into battle, rather than these all being kept by the medics. It made sense, and that became the order of the day, despite some opposition. One officer complained bitterly that his already overburdened men were being asked to carry the MO’s supplies, and the MO should damned well carry them himself ! Hughes had the last laugh. ‘The same officer learnt the hard way, after nearly losing his life at Goose Green13 to a shrapnel fragment in his liver.’

  If they were to carry their own bags of fluid, then it was also sensible that they should all know how to administer it rather than have to wait for specialist medics to do the job. Some Toms leapt at the idea of being able to stick needles into each other. But finding a suitable vein and inserting an intravenous drip was a skill that not everyone could master on a well-lit hospital ward, let alone at night on a battlefield. But there was another way of getting liquid into the bloodstream quickly – thrust up the backside like an enema. Rectal infusion, as it was properly called, was not a proven technique (and it was subsequently discredited as being largely ineffective), but Hughes considered it worth having a go. It wasn’t going to be harmful, and it might be better than nothing. The Toms were affronted by the very idea. Geddes and his mates reckoned they would rather bleed to death than drop their trousers and have a tube rammed up them in the freezing Falklands wind. The practice sessions were riotous. Major Philip Neame recalled ‘everyone running around the deck shoving drips up any bare backsides that happened to be around.’ He made sure he went everywhere with his back to the bulkhead ‘so no one could have a crack at me’.14

  That apart, however, the Paras lapped up everything that ‘Arsey’ Hughes – now, inevitably, his nickname – had to teach them, as he handed out what he called their ‘puncture repair outfits’ of field dressings. Geddes remembered the instruction to slap one on the bullet entry wound, one on the exit wound, then tie them in place with an elasticated crepe bandage. They were assured that this would ‘keep it all nice and tight until help arrives’.

  Across on the Canberra, the requisitioned P&O luxury liner that was now the main troop ship, Surgeon Commander Rick Jolly of the Royal Navy, a senior medical officer attached to the Royal Marines, was handing out the same sort of advice to the green berets of his command, though it felt bizarre to be doing so. He was acutely conscious, embarrassed even, that his shipmates were his potential customers. The shadow of death and pain hung over the men he was working and joking with. What lay ahead would be no laughing matter. He came up against the same sort of ‘G snob’ bluster as Hughes was experiencing on the Norland: an officer refused to release his men for medical training because they would be the first ashore on the Falklands and needed to concentrate on weapons training and fitness rather than worrying about what to do if they were wounded.

  At a heated briefing, he made it clear he had no time for ‘bloody medics’. Jolly calmly asked the obstreperous officer to spell out his surname, ostentatiously wrote it down and then explained that he would have it posted in the emergency unit with a tag beside it stating ‘Not to be resuscitated’. The bluff worked. ‘Quite suddenly he conceded the point,’ Jolly noted in his diary.15 Like Hughes, he spent much of his time on board instructing his fellow Marines on the injuries to expect and how to deal with them. His colour slide-show of graphic and gory gunshot wounds turned many a stomach, and one sergeant major tried to stop his company being shown ‘Doc Jolly’s Horror Show’ on the grounds that it might put the blokes off and undermine their willingness to go into battle. The doctor persisted, convinced that knowledge was better than ignorance, and reality – a large dose of which was about to hit them – preferable to pretence.

  He didn’t let on but, underneath the appearance he projected of calm confidence, he was fighting demons, holding down his own fears. ‘I realized the enormity of what we were embarking on, and I expected a large number of casualties. I might even be one of them myself. There was a very real chance I might never see my family again.’ But what worried him every bit as much as dying was whether he would find the inner strength to meet the challenges. Would he be able to cope, or would he crumble? He recognized that, militarily, he was a bit of a dud. ‘My talents in organizing fire positions and patrols were what you’d expect from an obstetrician, albeit a commando-trained one.’ But he needed to be strong, and that was where he doubted himself. ‘I remembered being on the last leg of the commando course, and the final endurance test was incredibly tough. I couldn’t hack it, and I began to slow down and fall back. Eventually I stopped. I just didn’t have the strength to go on. One of the younger recruits came running back to help me. “Sir,” he said, “if you don’t get to that finish line with us, we are all going to have to do this bastard thing again tomorrow. Please don’t let us down.” ’ That in
cident lurked at the back of his mind. ‘My fear was always that I would let somebody down.’

  For Tom Onions of 3 Para, the approach of war meant a new job, a dangerous one he felt ill-prepared for. He was an army cook, like his father before him, had joined the Catering Corps at sixteen and then, instead of being attached to a cushy berth on a missile base in Germany, had been posted to the Paras. He was, he freely admitted,16 treated with disdain, hate even, because he didn’t have his wings and wasn’t ‘one of them’. But now he would get the chance, whether he wanted it or not, to prove them wrong, to show that he was every bit as tough as the Toms. Along with other chefs, mess staff, bandsmen and Pay Corps clerks, he would go ashore in the Falklands as a stretcher-bearer. On the Canberra, he went through a crash course in field first aid. ‘To be honest, I was scared stiff. I never expected to go to war, not in a million years. As a chef, my military training had been very basic. I’d only occasionally got into greens to do range work. But now we were actually going to war and people were going to die.’ He was philosophical. ‘That’s what the future held for me. That’s the way it was going to be.’

  One of the many lessons to loom out of the fog of war was that the disdain that front-line soldiers were prone to heap on those they considered non-combatants was utterly undeserved. Many would come to realize that those whose job was to carry the wounded to safety – summoned to where the fighting was fiercest, in the thick of every action, exposed to murderous fire while others were able to keep their heads down – had to be the toughest of all, both physically and mentally.