Medic: Saving Lives - From Dunkirk to Afghanistan

by John Nichol

  His immediate job done, Giles handed the man over to the boss, Captain Harvey Pynn, the A company doctor, who had just made his way through the vicious fighting outside and into the compound. The thirty-two-year-old Pynn was, like Corporal Giles, seeing action for the first time, though he had a long pedigree of military service to draw on. His grandfather had been a Para sergeant major who fought in North Africa and Italy in the Second World War. His father was an RAF pilot. A cousin was on the Sir Galahad when she was bombed in the Falklands. ‘He was burnt, but not badly. I remember it well. I was eight at the time.’3

  Arriving at Camp Bastion, the main British base in Afghanistan, from England, had been a shock – the barrenness, the dust that invaded every nook and cranny, the energy-sapping heat that made even the lightest of exercise a struggle to breathe. The training 3 Para had undergone back in England was an indication that it was no picnic they were embarking upon. ‘Suddenly, the doctor and the medics are everyone’s best friend,’ Pynn recalled. ‘I didn’t need to encourage the guys to come to medical training. They asked for it.’ He taught them how to deal with catastrophic haemorrhage and airway control and schooled them in the use of the new and faster field tourniquet and QuikClot, the powder that stopped bleeding. Even those men who picked up the smallest knowledge of first aid might learn enough to gain the seconds and minutes vital to saving a comrade’s life, or their own, on the battlefield.

  Pynn’s mood, as dark as the wind-blown dirt tornadoes that whipped along the bleak ground at Bastion, had lifted when he joined a platoon of Toms on a foot patrol in the desert town of Gereshk and they tabbed through streets where the smells of fresh baking and barbecued meat from market stalls mingled with that unmistakable Third World stench of rotting faeces and detritus. Inquisitive locals smiled and waved. ‘We stopped cars and motorbikes and checked them without complaint.’ There was no obvious sign of the Taliban. He felt confident. The winning of hearts and minds seemed a real possibility. ‘That was supposedly why we were there – to reconstruct the country, not to blow it up. The Americans had been doing that for ages.’

  The next day he came up against a harsher reality, when an Afghan Army convoy was hit by a roadside bomb, and casualties were brought into the British camp. Three bodies lay in the back of a pick-up truck, ‘blown to smithereens, all severely mangled, with femurs shattered, intestines hanging out, decapitated. It was obvious they were dead, but to double check, I opened the airway of one of them, and his head nearly came away in my hand.’ The doctor was stunned. ‘I’d never seen anything like this before, not even in a textbook on traumatic injuries. All this damage and destruction from what was a fairly small bomb.’ The danger sank in. ‘The enemy are not selective. Doctor, padre, infantry soldier, we are all equally at risk. This could happen to any of us.’ His fourth viewing of Black Hawk Down, in the mess tent, reinforced the message.

  And now here he was in the middle of his first firefight – that moment professional soldiers long for and dread in equal measure, wondering how they will stand up to the test. ‘It was hairy stuff, but this was what I’d joined for – to go on operations with the battalion. And here I was with 3 Para on the most aggressive op since the Falklands. I was very conscious of my own vulnerability but I don’t remember being scared.’ He didn’t have time.

  The rotors of the Chinook screamed as they ripped up the leaves from nearby trees and it slammed on to the landing site. As he raced off down the ramp, Pynn was glad in that instance that he had opted not to wear the latest full body armour. When he had tried it on, it was as restrictive as a suit of armour and felt as if it weighed a ton. He knew he would need to be as nimble as possible on his feet, and he had ditched it in favour of a slip-on chest protector. Now, he was running, keeping as low as possible, heading for cover. ‘Outside the compound, I threw myself into a muddy ditch – probably the urinal cum shitter cum used-needle depository.’ Above his head the Apaches circled, their chain guns chattering as they dumped round after round into the Taliban positions. He was astonished by the enemy’s persistence. ‘They seemed willing to take us on, no matter what firepower we hit them with.’ They even blazed away at the helicopters two thousand feet in the air, and one was forced to wheel away, a bullet in the tail.

  It was in a lull in the skirmishes that two men were seen pushing that wheelbarrow with its bloodstained, badly injured human cargo towards the compound. They were searched for booby traps before being ushered through to the courtyard, where Stu Giles straightened the Afghan’s broken leg and then handed him over to Pynn, who by now had climbed out of the stinking ditch in which he had taken cover and made it inside the walls. The doctor had no doubt whose side this man was on. ‘He was blatantly Taliban, though he adamantly denied it. Nonetheless, I treated him to the best of my ability.’ With gunfire crackling around him, he was putting his own life in danger for an enemy combatant, but this was a not uncommon occurrence in this strange conflict. A paramedic, RAF Sergeant Rachel McDonald, had at one point found herself treating a Taliban fighter with gunshot wounds and discovered clear evidence of explosives on him. She put the incriminating package in her pocket to hand over to the Intel boys later and went on treating the man. The incongruity made her laugh. ‘In one hand I’ve got my first-aid kit to try and save his life and in the other traces of the explosives that he could have killed us with. It was a mad feeling.’

  In the insanity of Pynn’s particular situation, what worried the doctor most was the logistics (not to mention the personal danger) of getting his enemy casualty to hospital for surgery. To save the man’s life, he would have to transport him to a rescue helicopter, which would mean crossing open ground to the landing site with the man on a stretcher or on his back. How was he going to get there without being mown down by other members of the man’s guerrilla unit? In the end, Pynn decided that it simply had to be done, and the quicker the better. He bundled the wounded Afghan back into the barrow, put his own head down and trundled as fast as he could the quarter-mile to the helicopter, risking a sniper’s bullet every step of the way. It was a selfless and thankless act in difficult circumstances and over rough terrain, but they made it to the helicopter in one piece and the Afghan was hoisted on board.

  Pynn climbed in after him. The man’s condition had noticeably deteriorated, and the doctor made the difficult decision to go with him, though it meant leaving behind his own men in an as yet unfinished action. On the flight to Bastion he put in a line, pumped fluids into his patient to keep him going and radioed ahead for a crash team to be ready to operate the moment they touched down. At the hospital, the medics were shocked less by the casualty and more by the sight of Pynn. He was covered in blood and gore from the wounded man. In their pristine smocks and having had little but routine cases to deal with so far, they were suddenly made aware of the stark realities of military medicine. There was a war out there, and it was not going to be pleasant or easy.

  But the Paras were exultant that night. Their mission had ended with eighteen Taliban gunmen dead, and others captured. ‘The guys had fought hard and used lethal force when necessary, but showed admirable restraint when civilians were in the area,’ Pynn noted. Better still, 3 Para had returned to base intact. The nearest they had come to taking a casualty was when a bullet thudded into the chest of one of them, but, by some miracle, the spare magazine he was carrying in his webbing took the full impact. They had been lucky… so far.

  *

  The euphoria of the battle won at Now Zad lasted only a few days, until news came of the British task force’s first death. Captain Jim Phillipson had been killed in a shoot-out at Sangin,4 and the refrigerated mortuary container at Bastion opened up to receive its first, body-bagged occupant. The mood among the men was gloomy, and the latest sandstorm could not explain away all the red eyes seen around the camp that day. ‘It was a stark reminder that we’re not here to play games. At breakfast, there was even less conversation than usual,’ Pynn recalled. He knew much would rest on his should
ers in the increased fighting that now seemed certain to lie ahead. ‘I’d be dealing with serious casualties in the next few months. I had to prepare myself for the worst.’

  The thought galvanized him into creative action. The wheel-barrow at Now Zad had made him aware of a flaw in the ‘casevac’ plans. Flying in helicopters to take out the wounded was all well and good, but what if the only safe landing place was a long way from the action? As well as making himself a target for the gunmen, he had nearly crippled himself pushing the wheelbarrow and its occupant over deep furrows and ditches. ‘In the old days, we had armoured ambulances to take casualties off a battlefield, but they were no use out here. But we did have quad bikes with trailers for ferrying ammunition and other supplies around, so I had these adapted by an army metal-smith and fitted with a special frame to take two stretchers side by side. Although not a comfortable ride, this was quicker and safer than trying to run carrying a stretcher.’ Here was a modern solution to an ageless problem. The quad bikes were every bit as innovative in getting injured men off the battlefield as the horse-drawn ambulance carts of the American Civil War, or the mule panniers and the field litters of the Franco-Prussian War.

  Without realizing it, the men of 3 Para were about to embark on their most dangerous mission. It began with what was intended to be a quick in-and-out insertion into the town of Sangin, on the banks of the Helmand River, to pick up a civilian casualty from the compound of Afghan government offices in its centre. Once there, the casualty was evacuated but they were ordered to remain. Taliban forces were believed to be massing for an attack. Sangin, with its fourteen thousand residents and a farmer’s market crucial to the local economy, must not be allowed to fall into their hands.

  An epic siege lasting several weeks got underway. The Paras bedded in to their dirty and dusty quarters, building sandbag forti-fications (known as sangars) for machine guns on the rooftops of the mud-and-breeze-block compound and in the garden, and strengthening the outer walls. The living conditions were rough – there was no running water, no electricity, no beds and just a handful of plastic garden chairs to sit on. Then again, as one observer noted wryly, no one ever joined the Paras to be comfortable. From the top of a two-storey tower, spotters, their powerful .50 cal machine guns at the ready, had a clear view over the houses and shops of the town and the dead ground between it and their makeshift fort. They were acutely conscious that an attack could come from any one of three sides, and probably from all three at the same time.

  At sundown, the Paras prepared themselves by testing their mortars, the sound of their explosions mingling with the cries of the muezzin from the town mosque just a few hundred yards away. The atmosphere was eerie. As he laid out his aid post next to what had been designated as the ops room, Pynn’s mind drifted back in time to Rorke’s Drift, the British outpost besieged by a Zulu army in southern Africa in 1879. Now he knew how the outnumbered garrison of red-coated soldiers there must have felt as they heard the war cries of the enemy warriors camped around them and waited for the inevitable attack. His illustrious predecessor, Surgeon Major James Reynolds, had won a Victoria Cross for his courage in continuing to treat the wounded, despite the waves of assegai-wielding warriors crashing over the outpost’s makeshift barricades and clawing their way through mud walls into his aid post. Pynn could only hope he would do as much if the worst happened.

  It would mean protecting himself at the same time as treating casualties – being a soldier as well as a doctor. He would also have to prepare himself to carry out real surgery, if lives were to be saved. If a firefight went on for a long time, there would be little chance of rescue helicopters getting in to evacuate the wounded to hospital – in which case he would be left as their only means of treatment. ‘In my head I went through lists of possible injuries, checking off that I had the correct equipment to cope with them.’ He zipped open his medical pouch, containing twenty kilos of supplies, and went through the contents. With these he could handle several seriously wounded casualties. But what if there were more? His mind raced over the possibilities, and he reckoned that the worst-case scenario would be a Chinook trying to land, being hit and crashing. ‘We’d have forty or more casualties to deal with. I had to plan medically what I would be able to do in those circumstances – probably not a lot, but I had to think about it anyway.’ He cleaned his rifle and re-checked his supplies. He was nervous. ‘I had the basic equipment, and I probably had the skills. But I hadn’t got the experience, and I wasn’t sure how I was going to cope.’

  Pynn’s apprehension was matched by increasing truculence in the town itself. Para foot patrols along the streets were met by sullen looks and the occasional stoning. Radio intercepts picked up chatter suggesting fighters were gathering. Shops in the bazaar closed early, and locals were seen to be leaving. Everything pointed to an imminent attack. It didn’t come – not that night, nor the one after. There was sporadic firing, but not an all-out onslaught. The Taliban had the seventy defenders suspended in a state of constant readiness and high anxiety. Pynn was not alone in feeling uncomfortable. ‘I had always imagined myself out on assault operations, not stuck in a defensive location like this, the turkey in a turkey shoot. It’s more stressful to be in a defensive posture. The pressure on the Toms manning the sangars was immense.’

  It was a nail-biting week before the enemy opened up with any seriousness, with a fifteen-minute flurry of heavy gunfire into the compound from a dry riverbed 350 yards away. A rocket-propelled grenade took a chunk out of the front of the main building. Then, after a lull of four days and nights, the Taliban came again, creeping through the dark towards the compound. At 11 p.m., the noise of gunfire startled Pynn out of his sleep. He dived for his helmet and his body armour. Bullets crashed into the walls, and the rounds seemed so close that he had the dreaded thought that the enemy were actually in the compound. After a moment, he came to his senses and realized that couldn’t be the case. Three heavily armed sangars stood in their way, and they wouldn’t easily get past them, not given the hell of a fight the Paras inside them were putting up with machine gun, cannon, missiles and mortar.

  The fact that he thought this possible, even briefly, was an indication of how jumpy he and the whole garrison were becoming. Once again, he cleaned his rifle, making sure it was ready. When this particular flurry of fighting finished, as abruptly as it had started, the Paras could see how close the Taliban had come this time. Thermal imagery showed a dozen bodies littering the open ground immediately outside the compound, cut down by the massive fusillade from the sangars. ‘The surviving few had disappeared with their tails between their legs,’ remembered Pynn, whose work had been confined to treating two minor injuries. ‘A Company, 3 Para had yet again proved a fearsome adversary,’ he noted. Perhaps now it was all over. With his three-month posting in Afghanistan approaching its end, he dared to hope he might manage to get through his tour without any serious incident. But he was by no means certain. ‘We’re right at the sharp end here, so there’s no place for complacency or wind-down. I need to stay sharp until I’m actually on that RAF Tristar out of Kabul.’

  His caution was justified. Taliban reinforcements were now pouring into Sangin, spurred on by the losses they had just incurred, rather than deterred. The insurgents had lost face and badly needed a victory to demonstrate to the locals that they were as strong as ever. Calls for suicide bombers went out over the radio and were picked up in the Signals listening post in a sangar on the roof of the compound. Pynn chanced a trip into the town with a heavily armed patrol and saw families packing up and leaving. A chemist’s shop he had visited before was shut and shuttered. ‘It’s like the OK Corral here,’ he observed laconically. A ‘significant contact’ – deadpan military lingo for an all-out assault – could be expected any time soon.

  The next night, the Taliban attacked with their biggest weapon, a 107mm Chinese-made rocket. It was a powerful but notoriously inaccurate device, which this time found its target, smashing through two concre
te walls and demolishing the rooftop Signals sangar with an almighty explosion. ‘We’ve been hit,’ a voice from a neighbouring sniper’s sangar telephoned down to the ops room. ‘Blood is pouring out of my ears and a lot of blokes are screaming.’ In his aid post, Pynn broke out the stretchers, while rescuers raced to the roof, which was a shambles of red-hot shrapnel, shattered sandbags and concrete. Signallers lay dying; other soldiers were seriously injured and writhing in pain. Sergeant Major Zac Leong tied a tourniquet around the shoulder of one casualty and pounded his chest to try to draw breath. Those who could get to their feet staggered down three flights of stairs to Pynn’s aid post. The doctor got to work on the first two dust-covered figures who fell through his door, bloodied and in agony from shrapnel wounds in their buttocks and thighs.

  As he was dressing their wounds, a party of soldiers appeared carrying a limp, bloodstained body that showed no sign of life at all. The man’s left arm had been sliced off at the shoulder, leaving just a stump. He wasn’t breathing and had no pulse. With no electricity and just a gas lamp to work by, Pynn pumped the soldier’s chest to try to re-start his heart, but he knew it was futile. The soldier was dead. There was blood in his mouth and wounds behind both ears, indicating a brain injury that would probably have ruled out survival anyway. ‘The first death on my watch,’ the doctor noted later. ‘I was devastated.’ He said a quick prayer before turning his attention to the other casualties, stabilizing them as best he could, because he knew he wouldn’t be able to evacuate them until first light at the earliest, seven hours away.

  Minutes later, the inert body of another soldier was carried in from the roof, grey and unresponsive, with a large hole in his chest. But one of the stretcher-bearers desperately believed he could detect a pulse, and Pynn thrust his hand inside the gash and felt for the heart to massage it with his fingers. It wasn’t even flickering, let alone beating. The life had gone. A local interpreter was also dead, still lying in the wreck of the sangar, his brains dashed against a concrete wall by the force of the blast. The only consolation the doctor could find in all this slaughter was that all three must have died instantly and not have felt a great deal of pain.