Battleworn (19 page)

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, possibly 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.

My medics look deflated, and it doesn’t matter what uniform the soldier wore. His loss is shared by us all – it could have been any one of us lying there. We start the task of another clean-up. To be honest, I am getting sick of the sight and smell of blood. It has become too much of the norm. We sort through the medical kit quickly, and at the back of my mind, I know that the day is far from over.

With a patrol out on the ground, I move to the ops room to listen to their progress. From the net we soon learn that our call sign is already in trouble. The ICOM chatter reveals that the Taliban already has eyes on Du Boulay and his men. They continue to push forward, patrolling into an inevitable ambush. As crazy as it sounds, these are directives from higher command. They have air support which will allow enemy positions identified to be taken out, but it still doesn’t explain the madness of patrolling into the kill zone of a determined enemy.

The 16 Air Assault Brigade is unlike anywhere that I have served before. Hard, fast, and aggressive is how they train, and, ultimately, how they fight.

‘Contact wait out!’ bellows across the net. At that moment, it’s ‘game on’ again. The net is chaotic. Du Boulay is calling for CAS, and Capt. Wood is all over it; both Fast Air and Apache pilots are hungry for targets. Dangerously close to munitions being dropped, the platoon still hold their position. The Taliban stronghold is exactly that: as soon as they get eyes on the Apache they go to ground. As quick as they hide, they pop back up again, and now they are engaging our call sign from multiple firing positions. The firefight is relentless. Our ‘not here’ JTAC calls in fast air, and the sound of low-flying jets gets the nod of approval from everyone in our area.

The contact goes on for some time, so I start to plan for potential heat casualties. Two steps from the ops room door, I hear, ‘Man down’; the words are repeated several times, and the news of a casualty shocks no one.

Capt. Wood turns to me. ‘You all good, Channy?’

‘Who is it, and where are they hit?’ I say, asking Kev to message Monty when there is lull in the fighting.

Kev relays the answer as soon as he gets it. ‘Boydy, gunshot wound to the thigh.’

The Taliban have the platoon pinned down one and a half clicks away. In this situation, a fighting withdrawal is the only option for Monty and his crew. Boydy (Pte Boyd) is a big lad who will need to be carried back to Argyll.

The firefight continues; even the Apache does not subdue the insurgents housed in Shin Kalay.

After what seems like a lifetime, I see the lads carrying Boydy; every man on the stretcher is in turmoil. We get hands on our casualty, and I am relieved to see he is still smiling. He’s been shot straight through the shin, and the 7.62 mm round has come straight out the other side, embedding itself into the back of the thigh of the same leg.

With all my normal medical checks, I find no evidence to support that an artery was hit; Boydy’s gotten lucky today. The other lads are in desperate need of water, as the heat has turned this casevac into a marathon. Guzzling water by the litre, Monty looks exhausted, and he’s a fit soldier.

Boydy is surprisingly upbeat, and after assessment and treatment, he is stabilised. The only thing concerning him is a cigarette. In normal circumstances, I would hesitate, suggesting that he shouldn’t have one. His vital signs are good, and he has responded well to treatment, so I decide to let Boydy have his cigarette. Right or wrong, I say yes; medical professionals the world over will probably frown upon it, but standing here in shitsville Nad-e Ali at this very moment, I choose not to be the medical ‘cigarette police’. Boydy is a grown man who knows his own body, and his nerves are likely screaming for nicotine right now.

From a clinical perspective, Boydy’s oxygen saturation is high, and he has a steady blood pressure. No tourniquet is required with the minimal blood loss he has sustained. He’s doing well, all things considered. We prepare him for transportation, as the Chinook is inbound. Carrying him to the HLZ reaffirms what the guys have just faced getting him out of contact. Shots are fired at the incoming Chinook, and this sets the tone for the coming weeks. The RAF pilots aren’t deterred – it would take more than a couple of rounds to stop them coming in to get us, of that I am sure.

As Boydy and our dead soldier are lifted, stories begin to emerge of the events that just passed. Monty tells me that Abbie carried the stretcher along with the blokes all the way back into Argyll. When I ask her about it she plays it down, joking about Boydy’s weight. She’s done herself proud and looks for no recognition for it. Abbie is the sort of medic that every commander wants: she doesn’t moan, and she’s able to hold her own amongst the platoon. I’m lucky to have her to rely on. Looking around at my medics, I know I’m lucky to have them all. Each one of them would perform above and beyond anything ever asked of them.

My attention shifts across the room as Monty collapses onto the floor. I learn that he fell into a ditch during the withdrawal, his face contorted with the pain. His body is now rigid, and he’s unable to bend or move. By far the worst patient that I have to deal with, he is struggling to accept help and has no plans to make life easy for us. His lower back muscles have gone into spasm, caused by the fall itself or a combination of the fall and extraction under fire of Pte Boyd. Diazepam is my drug of choice this time, as it’s an enabler that works wonders very quickly. The spasms stop, and Monty relaxes onto a stretcher. He’ll be bedridden for at least two days.

The situation here is becoming truly unbearable. There are so many highs followed in quick succession by so many lows that it feels like one big fat test followed by another big fat test – and another and another.

For now, Monty is out of the game, and the boss asks me if we need to replace him. I learnt a fair amount from the physiotherapists that I’ve worked with in the past, so I tell the boss that I will work on Monty here in the PB.

‘Thanks, Sgt T,’ says Maj. Clark. He knows that Lt Du Boulay will have to take on the platoon alone; Cpl James Henderson will step up and assume Monty’s role. Hendy is an experienced section commander, so he’ll have no problem in taking up the slack for the platoon. Du Boulay is a quiet, unassuming officer; he has already proved his worth amongst his men, and they have warmed to him quickly. Tonight, he will move out for the first time without Monty.