Battleworn: The Memoir of a Combat Medic in Afghanistan Page 13

  The fighter that I had engaged had already dropped, which meant that I could look to engage others. It would never be right to claim a kill as a medic; my job is to save lives. The fighter no longer had the ability to engage us, and that’s all that concerned me. Faced with the choice of him or me, I chose me. I would still do the same.

  The Taliban had timed their attack on us perfectly. They chose the hottest part of the day, which was just another tactic to slow us ‘infidels’ down; it would give them time to at least maim or kill a few of us.

  ‘Man down! Man down!’ I could hear the radio traffic through the back of the vehicle. The boss and driver were still in the front. ‘One casualty in the rear vehicle, Sgt T,’ Maj. Clark shouted through to the back, jumping out as I climbed through the back door of the vehicle to meet him.

  From there, we started moving from cover to cover, making our way towards the rear of the patrol. We were vulnerable to enemy fire. I struggled beneath the burden of my heavy medical pack, the straps digging into my shoulders as I shuffled along.

  Halfway to the rear of our convoy, the boss stopped, turning back towards our vehicle. Without asking why, I just followed him. My lungs were desperate for oxygen, needing it far more than I needed an explanation for the boss’s decision to return to our vehicle.

  I jumped back into the wagon, struggling to breathe.

  ‘You okay, mucker?’ Kev laughed.

  I wanted to share the joke with him that I was in and out of our vehicle like a fucking yoyo, but it was still too hard to breathe, much less talk. Continuing to struggle for air, I took off my med pack and dropped it at my feet.

  The interpreter taking cover in the back moved it away, placing it on the seat beside him.

  ‘Thanks, Naveed,’ I said quietly.

  Our vehicle shunted forward as we hastily moved off.

  Back on top cover, I cooled down, slowly recomposing myself. Kev was still laughing at my ordeal of running in the midday heat. Soldiers worldwide were all the same; I laughed at friends of mine getting beasted up and downs hills with a GPMG in Brecon. When it wasn’t you on the receiving end, it was always funny.

  We stopped near some open ground, and two company snipers set up on the roof of a compound nearby. ‘Kingy’, a young Jock from Stirling, was one of our snipers. These snipers were a godsend. Along with the Apache which just arrived on task, they set about tracking the Taliban of Marjah. The insurgents here weren’t amateurs: they knew what they were doing and had just educated us in a textbook L-shaped ambush (from the left and the rear).

  By this time, it was safe to attend to our casualty. The injured soldier was Chuckie, a tiny Scot, who was shot in the abdomen. LCpl Tom Rooke (‘Rookey’) has been taking care of him. Chuckie was the rear gunner manning the .50-cal. machine gun. His entry wound looked pretty high, so I was inclined to think that he might be in danger of developing a chest wound. No clinical signs as yet, but as a medic, it was my job to always think a few steps ahead. The nine-liner quickly went out, listing Chuckie as an urgent surgical cat-B. Our gunner needed a hasty evacuation.

  Our company snipers, along with the Apache, were now even busier: they had to shield the casevac now under fire. Kev was busy on the net, and the rest of the company provided an all-round defence.

  The Chinook came in swift and heavy. Attaching Chuckie’s paperwork to his chest, I grabbed the first person that came off the rescue bird. I screamed all the important stuff in his ear, hoping that he heard my concerns about Chuckie’s chest – his breathing rate had increased to a worrisome level, so my initial thoughts were correct. The MERT commander gave me the thumbs up before heading back up the ramp and into the helo. His force protection followed.

  As the Chinook took off again, I looked around at the faces of our company. It was not such a great feeling being left in Marjah, knowing that we had to somehow get ourselves out of this shithole and back to Lashkar Gah.

  We had the Apache escort us out of Marjah. There was sporadic small-arms fire, but nothing major. We made the desert leger unscathed and headed back to the MOB.

  Kev and I were silent on the way back, with minimal chat and no banter.

  As we got close to Lash, Kev said, ’You were right, mucker.’

  ‘How so?’

  ‘About us getting smashed,’ Kev laughed.

  I smiled grimly. Thirsty, I licked my lips, tasting the salt on the skin at the corners of my mouth. I had no energy left. The drive back had taken hours, and trying to stay alert as the sun was going down after such an eventful day had left me weary. Before heading back to my tent, I emptied a Lucozade rehydration sachet into my now boiling-hot bottle of water.

  My recollection of Marjah has held my mind longer than I wished or intended, and I struggle to shake it off. Thinking about that time, though, I challenge anyone to tell me that women cannot handle being in combat or on the front line. We all share fear, and we all bleed the same. I would show Flashheart no mercy on the subject of women serving in front-line units. It takes a certain type, so go find them.

  Sandbag chat over; back to the reality and the peace of PB Argyll. Resting on my bivvy, I catch a glimpse of Capt. Wood. He always finds ways to amuse himself, and now he is busy in his own little routine. I notice that he has the red iPod – that is, Flashheart’s red iPod.

  As I watch everyone going about their business, I almost forget to do my own chores.

  I continue observing the company, amazed at the resilience of the young Jocks. They are surviving as best they can, just as we all are. I am drawn to the ordinarily common events that they make fun of. Someone only has to trip over in a gun position, or say something remotely feminine, for the place to erupt with laughter. They abuse each other all day long, but it’s what gets them through the day. In fact, it’s what gets all of us through. One minute, you might be the subject of ridicule, but if you are wounded the next minute, your section will carry you as many miles as necessary. Every man knows it. That’s because when you get hurt, the lads get straight back to the serious business of being there for each other.

  Capt. Wood is all over the fact that a much-needed injection of morale is required to motivate individuals carrying out the mundane tasks of equipment husbandry outside in the area housing the WMIKs. ‘Sgt T,’ he says with a smile, ‘I think you may be developing a man-crush on Flashheart.’

  Ham jumps on the bandwagon, adding, ‘Aye, sir, that’s why she keeps going on about him… she’s after his other knee pad.’

  Laughing, I shake my head. I realise I’m in a no-win situation, so I just go with it. ‘Maybe I do have a man-crush on Flashheart. So what?’ I try to keep my face stern, but one look at Ham has me giggling. ‘You are a dick, Ham, but you are right about the knee pad.’

  Cpl Ham McLaughlin is a driving force of antics around base; he finds comedy in everything. Even when he is pissed off, he can still manage to make a joke of something. He is constantly messing with people and their kit. If you fall on your arse when you go to sit down because your chair is suddenly missing from where it’s always been, you can be sure that Ham has had something, or everything, to do with it.

  Ham spends most of his time between the wall and the roof. He is another soldier suffering from the ‘at war, ten years older’ makeover. He constantly pesters me about what I know about when we are getting out of here. Ham was in Marjah with Kev and me, so we are all a tight-knit group

  Everyone is still laughing because of the joke about my ‘man-crush’ on Flashheart, lifting morale for a moment. This is as it should be – soldiers never let the truth get in the way of a good lie. We all eagerly wait for another resupp. Information relayed over the net says that the mentoring team’s medic is inbound. This is great news, because it means that I get Sean back. Afghan special ops are sending a team out with two British mentors. This is more good news, as they usually come with decent kit, and, moreover, better support.

  Low on manpower, Davey needs a hand coordinating getting these guys off the heli
copter and back to the base. I get my kit on, preparing myself for the trip out. Monty is taking a well-earned break, sleeping in the aid post. He and his men have been getting smashed these last few days. I am becoming more aware of just how much the boss achieves with this company, albeit not at full strength. Once every mission is complete, Maj. Clark ensures that there is a value-adding debrief: no bullshit, just anything that went well, and anything that could be done better.

  When his men stand down, that’s exactly what they get to do: relax. The boss leaves them alone. They respond by giving him total respect and 100 per cent effort at all times. These Jocks depend on each other, and they will die for one another without question. That’s a rare commodity in this day and age, and I admire it.

  I often chat with Monty about home and what he will do when he gets there. He is an old-fashioned family man who misses his wife and two daughters. He keeps a picture of his wife and girls beside his roll mat, just as Davey does.

  Heading out to the HLZ, I catch up with Davey at the gate. He relays information that it is wheels up from Camp Bastion, so the helo will be arriving shortly. As we take up our positions I see that Davey is very close to where the bird normally sits when it lands. It’s dark so his shadow is illuminated by the cylums. With the threat of attack on our helicopter so high, a short period of time on the ground is paramount. The coordination must be exact and smooth.

  The Chinook lands heavy on the ground; large crates are dropped, followed by my medic and the guys mentoring the Afghan team. I grab hold of the first man and instruct him to follow me and stay close. Getting off a helicopter into an unknown area can be disorientating, and that’s why I guide them in. The Chinook quickly lifts off as we make our way back into the PB.

  Davey soon reveals that he was nearly squashed by the Chinook, reaffirming my earlier thought that he was way too close to where the bird normally sits. His team all get busy sorting through the stores, and Ham gets involved with the ATV and trailer stuff, still making time to mock Davey for his near-death experience, though.

  I get back to the ops rooms with the new guys. As I take off my helmet, I see they seem shocked to be met by a woman. Quickly introducing myself in what now feels like an awkward first date, I hand them over to Maj. Clark. I take one of the mentors to where they will be housed along with their Afghan team. He asks me how long we have been here, and I give him the low-down of our time in Nad-e Ali thus far.

  Making my way back to the ops room, I see that Davey is unpacking the stores, so I join the team and help out. It’s been nearly three weeks, but our kit has finally arrived. Colleagues back in Lash have packed our bergens and sent them down to us.

  I am excited that I will now have at least three pairs of socks and an equal amount of pants. I pull out a clean T-shirt that smells of washing powder; it reminds me of home. Planning to use the newly erected shower first thing in the morning, I leave a set of clean clothing at the top of my pack. Snuggling down in my bivvy bag, I look forward to tomorrow’s shower and fresh clothes – what a treat. I am out of it within seconds and don’t stir until first light. I’ve only slept for four hours, but it feels like longer.

  The PB is alive this morning, with an extra spring in the step of every man. We are all so excited about the socks and pants. If I were anywhere else doing something different, these basic things wouldn’t even cross my mind.

  Out here, the sight of shower gel is like the discovery of the Holy Grail. My planned use of the shower is already on hold, though. A long line has formed, including the new arrivals. These two probably only showered six hours ago, and here they are wanting another one. I already know what unit they must derive from: shower-obsessed Royal Marines, no doubt.

  Jen, Abbie, and I sit patiently outside the med room, waiting our turn. It crosses my mind that the shower cubicle is in open ground, next to the mortar line. The thought of taking a round while covered in soap suds suddenly decreases my desire to get in it. We busy ourselves making scoff and a quick brew. As I hand Abbie my ration pack, I notice one of our visitors has decided against having a shower and is now having a strip wash right in front of us. Like cavewomen, we all instinctively look at him. It is a genuinely funny moment. We all went into bloke mode, and the sight before us is far easier on the eye than Ferris’s lily-white arse. Snapping quickly back into reality, I realise that my sausage and beans are far more important to me. It will take more than a six-pack to part me from my breakfast.

  One by one, everyone gets some much-needed shower time, and it is definitely worth the wait. I am reluctant to wash my hair at first, as it has styled itself into a manageable bird’s nest, but it has to be done. Scrubbed clean and with fresh clothing on, we wash our threadbare items; they are still serviceable, so no need to trash them.

  Today, planning has started on upcoming operations that the company will mount on Taliban strongholds in Nad-e Ali. The boss is focused and has been given orders from command about key objectives that he must achieve. The area of Shin Kalay keeps appearing on the operations board. Shin Kalay is a Taliban haven, and brigade HQ wants us to patrol into the area to draw the Taliban out. The trouble is that the enemy knows the area far better than we do; the higher echelons are expecting a little too much from the troops on the ground. This type of patrolling is risky; our numbers are dwindling, so in my opinion, the gain does not outweigh the risk. The calculation seems disjointed.

  Monty looks tired this morning. He and Lt Du Boulay have been commanding the fighting troops between them for days, even weeks now. Du Boulay borrows my single knee pad for most of his patrols; I suggest that, should the worst happen, Flashheart will have his second one at hand to give to anyone who requires it. Lt Du Boulay thanks me for the suggestion and moves off, with Abbie in tow. She is out this morning, so I say my ‘stay safe’ mantra and then get back into the medical room. Jen, Sean, and Gurung, our new OMLT medic, all are with me. Gurung was a part of our squadron back in Colchester, so it’s great to have him back with us.

  The patrol gets fifty metres out of Argyll before the rounds start pinging around the base. We are under attack, and it’s come at a random time. This onslaught outside ‘attack’ hours catches the Afghans unawares.

  It’s not long before I hear the strained scream of ‘medic!’ Looking out from my cover, I see that one of the Afghan soldiers has been hit. The rest of his team carry him to the medical room; it is pointless pushing too many people out in the open, as we are still taking incoming.

  The soldier wasn’t wearing his body armour or helmet, and has taken a round through the upper chest. We drag him in and get to work. There is no exit wound. This means that the round must have travelled through some key organs, causing a fair amount of mess not visible to my anxious eyes.

  Our systematic approach to casualties is what makes these situations work. A casualty in free fall requires quick interventions if life is to be sustained. Maybe a subclavian artery is clipped? We treat as we find, I want to make sure we do everything we can so I go through the detail of the MARCH-P process.

  M – Initial diagnosis amounts to an internal bleed not visible to the eye. One entry, no exit wound. Sitting the casualty up alleviates any chest bleed at this point. Air rises and fluid falls, so if he is bleeding into the lung, it will pool at the bottom, allowing some chest movement. Chest seal in place occludes the entry hole. A decompression needle is on standby if and when it’s required.

  A – Quick insertion of a nasopharyngeal tube; the casualty tolerates it. Airway is open and clear. Jen maintains, with some assistance from oxygen, as I continue to run through possibilities.

  R – Listening for breath sounds in a combat environment is not without its problems. Casualty stops breathing, and the side of injury is dull on percussion. Jen assists ventilations, and Gurung carries out needle decompression to injured side to buy us some time whilst we set about preparing an improvised chest drain. Further diagnosis indicates possible pneumohaemothorax, which is a mixture of air and blood, pos
sibly trapped in the pleural space, with no chance to escape. This will result in compression of the heart and lungs, ultimately causing death via a complete mediastinal shift.

  C – Major bleed; casualty is in hypovolaemic shock, and there is no radial pulse. In layman’s terms, this means blood loss amounting to low blood volume. A team medic gains IV access; patient starts shutting down and goes into cardiac arrest.

  CPR or cardio pulmonary resuscitation starts, and blood begins to push out of the decompression needle in the chest. Cardiac arrest in a patient through trauma is the worst-case scenario. His eyes are fixed, with pupils non-reactive. There is no palpable pulse, and with no defibrillator at point of wounding or in the aid post, manual CPR is continued.

  Although hopeless, we crack on for the sake of the troops around us. Lt Col Nazim, the kandak commander, is with us throughout the ordeal, and the other Afghan soldiers are helping to pass kit and equipment to my medics.

  The medical room is full of emotionally charged, armed Afghans. I take this into consideration as I decide to call time on our efforts to resuscitate the soldier. We do not have the luxury of an endless array of kit. I instruct Jen to stop the use of our only chest drain. Further use would achieve nothing; we could not turn off the tap inside the body, so the soldier has bled out internally.

  With a lump in my throat, I tell my medics to stop. As a med team, we agree on this. I check for any signs of output, finally checking his pupils one last time. It’s a bad moment for us all. Expressing my sympathy to the kandak commander and his men, I turn away. I update the boss, who in turn updates brigade HQ. They will call off the Chinook and MERT team and then wait for a suitable time to retrieve the soldier. His comrades don’t wait around. They take his now-lifeless body away; they will wrap his body and pray for him, as is their tradition.