Knife Edge: Life as a Special Forces Surgeon (19 page)

The evacuation went well, without any radio jamming by the Russians, and all ended happily. By the time the child reached Koussi, the overdose was beginning to wear off and the boy starting to recover. By the time he reached his hospital bed he had returned to normal, without any long-term damage. I received the credit for the cure, having created the problem in the first place, and the
waalee
had been shown to be of sufficient standing to merit an official Skyvan to fly out his family. It was a narrow escape that I never wish to repeat.

Running a Bedouin clinic is an experience for which any amount of training in the United Kingdom cannot prepare you. The numbers are enormous. It was not unusual to find a hundred people waiting outside the surgery door each morning, sitting patiently in the sand. Rosie would take the girls and I the boys, and between us we would struggle through. Patient identification was a challenge. Firstly, the women were fully covered, making recognition impossible. Secondly, so many of the men had identical names. In one morning alone I treated eighteen called Hamed. I tried to solve the problem by asking a medical orderly to issue each new arrival with a left-luggage ticket. Instead of Abdullah, Ali or Ahmad, the patient simply became number 357 or whatever. This worked perfectly for several days, with patient records being kept by number rather than name. I then began to notice certain ticket numbers appearing more than once and not attached to the same patient. Apparently a thriving Black Market had developed outside the clinic, with luggage tickets being sold to see the foreign doctors. I abandoned the idea immediately.

While Rosie and I ploughed our way through the morass of sickly Bedouin, SAS patrols throughout the area were doing the same. As well as treating patients they were doing their best to recruit young men to form a local
firquat
. They were doing well, with several tough young Bedouin signing up for duty almost daily. Generally the Ramlaat Bawiti was a safe region, but the presence of opposition dhows offshore, combined with occasional reports of border incursions, did give an air of unease to the situation - no more so than early one evening as I was returning to Haruj from an outlying village.

I had gone to see for myself whether patrol reports of a measles outbreak had been correct. Measles in the Bedouin had an unusual appearance and it was possible their diagnosis had been wrong. In fact they were correct. I should not have doubted it for a moment, but it was refreshing to escape the packed dispensary at Haruj if nothing else. It was getting dark as I drove the open-top Land Rover along a narrow rocky track, within a short, low gulley that briefly blinded me from the desert around. The track turned sharply to the left at the gulley’s end. As I heaved on the steering wheel to negotiate the bend I saw before me two figures, one on either side of the track. I thought they were large boulders at first. The figure to my right raised his arm, indicating I should stop. The one to my left was lying prone and motionless behind a few scattered, low rocks. I could see the glint of an ancient machine-gun pointing at me. An ambush? Who the hell were these guys anyway?

I looked again at the figure to my right. Dressed as a typical Bedouin, his face was cracked and weatherbeaten, his teeth chipped and broken. In his arms he held an AK47 rifle, partially levelled at my chest. He began to chatter loudly, and aggressively, in a dialect I could not understand. My sweating palms gripped the steering wheel tightly. I tried to stay calm by taking small, short breaths. I did not want the Arab to see how I really felt. As I could not comprehend him, I shrugged my shoulders and waited for his next move. I had no idea what he wanted. Then, suddenly, he stopped talking, took one step back and aimed his weapon directly at me. I braced for what I was sure would come next. There was nothing else I could do, stuck behind the steering wheel of the Land Rover.

For what felt an interminable period I sat very still, hands in full view on the steering wheel, waiting to be shot. In reality it was probably less than a minute. No shot came. Then, very slowly, the Arab lowered his weapon and started to talk incessantly again. He was still incomprehensible. Walking across to my Land Rover, he looked into the driver’s compartment, still talking. As before, I remained motionless, not wishing in any way to upset either him or his companion, still lying prone to my left. I could tell I was being sized up, his gaze flicking from one side to the other of the compartment. As the Arab talked, his eye caught a paperback novel I had been reading, wedged on the narrow dashboard to my front - Jeffrey Archer’s
Kane and Abel
. He raised his eyebrows quizzically, as if to say ‘What’s that?’

‘Jeffrey Archer,’ I replied. I could not think of an Arabic translation for his name.

The response, however, was instant. ‘Jeffrey Archer?’ replied the battered Arab, in an accent that made the name barely recognizable. I nodded, very slowly and very cautiously. Then stretching out one hand, the Arab indicated I should hand the book to him. Gingerly, holding it very obviously between finger and thumb, just like plastic explosive, I passed it over. No sooner had I done so than the Arab grabbed it, clutched it tightly to his chest and repeated the words ‘Jeffrey Archer!’ once more. Then with a flourish from his AK47 he waved me on.

To this day I have no idea who those two men were or what they had planned. Nor do I know if they had genuinely intended to harm me. All I do know is that Jeffrey Archer, now Lord Archer, did both the Arab and me a service that day.

As a doctor to the Bedouin I had to turn my hand to many things. Human illness was only part of the task. Animals featured highly, in particular the local goats. I was glad I had guessed correctly before leaving UK, though my Melton Mowbray training was not a great help. Herriot’s
All Creatures Great and Small
certainly was. It was one lunchtime, three weeks into Globe Trotter, that an elderly Bedouin woman brought me her goat. Black, scraggy and becoming bald in places, it was obviously unwell. The story the woman gave was one of having insufficient water for the beast and feeding it a local form of Coca-Cola instead. I could well imagine it. There appeared to be an endless supply of a dark, sweet, fizzy liquid for all to drink. Genuine water supplies were frequently contaminated, as both animals and men drank from the same source. This was an open well, without any protection from the outside world, not a deep dark hole in the desert. I would frequently see camel droppings floating on the water’s surface.

The goat was unable to walk and panting furiously. The only abnormality I could find was a massively swollen abdomen, distended like a huge bass drum. There is a medical technique called percussion where you rest one finger face down, flat on the surface of any of the body’s cavities, such as abdomen or chest, striking it sharply with a fingertip of the opposite hand. It allows you to hear whether the cavity is full of fluid, or air, or is perhaps a solid expanding tumour. The technique is used all the time. I tried it on the goat. Bang-bang-bang! Percussion confirmed the animal’s belly was most likely distended with air, perhaps even bowel gases. I next listened to the abdomen with my stethoscope. Could I hear the gurgling sounds of bowel activity? With many human abdominal problems, the bowel sounds disappear altogether, particularly when a piece of intestine has burst, resulting in life-threatening peritonitis. But the goat did have bowel sounds, faint, tinkly ones - very high-pitched in nature. Such noises are, in the human, classically associated with bowel obstruction. For whatever reason, the intestines can occasionally become blocked. Perhaps they twist, or a tumour begins to grow, or even a lump of excrement fails to move on. This can cause massive distension of the guts upriver from the blockage. If the distension is not resolved, the guts can burst like a balloon. The pressure build-up can be enormous.

Once, when working for one of the UK’s top bowel surgeons, I was helping in the operating theatre to relieve an elderly woman’s blocked lower bowel. To do this the patient was anaesthetized and laid supine on the operating table with legs held elevated and to the side, out of the way. Deftly, my boss inserted the sigmoidoscope, a shiny steel cylinder about eighteen inches long, up the woman’s tail end. As he did so there was an enormous explosion. I was sure it could be heard in the pub across the road. Faeces went everywhere, and certainly hit both my boss and the far wall of the operating theatre. The surgeon had simply, and skilfully, slipped the sigmoidoscope past the patient’s lower bowel obstruction, releasing days of increasing pressure taking place higher up.

With my goat diagnosis made - intestinal obstruction - I had to act. Fascinated by my diagnostic methods, I had by now gathered a throng of Bedouin onlookers, perhaps a hundred altogether. Nearest to me was the elderly woman, visibly distressed by her animal’s plight. Goats are valuable assets to a Bedouin. The animal panting before me would cost her a local fortune to replace.

I was stuck without any idea of what to do. I assumed my diagnosis was correct, though had no way of proving it. I certainly could not ask the animal and could barely understand the emotional outbursts from the owner that were becoming increasingly frequent. Gradually I could hear the low rumble of voices from the assembled crowd become louder. There was obviously intense discussion taking place between individuals, and an air of increasing dissatisfaction.

‘You’re going to have to do something, Doc’, whispered Trooper B, one of our most capable Regimental medics. ‘**** knows what this lot will do if you don’t.’ He indicated the restless crowd behind me as I knelt on the sand beside the breathless animal, wondering what to do next. I nodded. Trooper B was right. I had to perform.

Before leaving the UK I recalled seeing a film, or perhaps a television series, where a vet thrust a large metal cannula, a form of surgical tube, into an animal with a swollen abdomen. I believe it was a cow. Well, I thought, if it is good enough for cows, and the BBC, it is certainly good enough for this goat. I knew also, for the restless Bedouin crowd and the now hysterical owner, I would have to make a ceremony of what I did. I rose to my feet and turned to the crowd, trying to look each one of them in the eye as I spoke. ‘I am now,’ I shouted, ‘going to save the life of this poor animal. It has suffered too long.’

For a brief moment the throng fell silent, then a few heads nodded their agreement as the voices began once more. With a flourish I slipped on a pair of surgical gloves from my medical bag, not an easy task when under stress, and produced a needle and cannula with a grand gesture. As I did so, I whispered out of the corner of my mouth to Trooper B, ‘For God’s sake help me! What the **** do I do next?’

‘Stick it in, Doc. You know, just stuff it in. We’ve both seen it on the telly. The bloody animal’s buggered if you don’t.’

He was right. I was going to do it anyway but felt I needed moral support to help me with the task. Together the two of us knelt down beside the animal, the poor beast’s abdomen swelling visibly by the second. It was in desperate straits. Eyes now closed, its mouth was open as it panted in agony. Trooper B held the goat steady while I made a great show of what I was about to do. The crowd fell silent. You could have heard a pin drop. Even the desert wind appeared to stop blowing for the occasion.

With the needle and cannula held in both hands I raised my arms well above my head. There was a gentle murmur of fascination from the crowd as I briefly glanced over my shoulder to see them still frozen to the sand. I looked back towards the animal, identified the most distended spot, and thrust the needle and cannula firmly downwards. I was like some ancient Aztec priest in the process of sacrificing his first human victim of the day. The needle and cannula thumped home with a resounding ‘pop’, followed by the steady hiss of a deflating balloon. As I struck, for a brief moment the animal opened its eyes, then gave a loud, agonized ‘Baaaa!’, and died. I was horrified. My theatrical performance had gone badly wrong. For perhaps a minute my Bedouin audience remained silent, uncertain as to what had happened. Then, one by one, they realized Doc Villar had skewered their prize goat. The elderly owner fell to her knees, sobbing in the sand, while discontent in the voices of the crowd began to reappear. There was no way I could escape what I had just done.

After my disaster with the goat, the clinics became quieter for a while. I had made the cardinal error of any bush doctor — allowing a patient to die on my doorstep. The patient may only have been a goat, but there is an unwritten contract in Third World medicine. If you agree to take a case on you must get it right. What I should have done was to tell the animal’s owner that the beast was going to die and not attempted to save it at all. Like many things in the SAS, they are often learned the hard way.

As well as general medicine and animals, teeth and eyes are common causes for local complaint. Though it would horrify an ophthalmologist, an excellent way of winning over the hearts of a population is to arrive laden with assorted pairs of spectacles. You do not need to be obsessive about the exact power of each lens. It is the elderly male population in particular that likes these things. Partly it is because it allows them to see better but, more importantly perhaps, it makes them appear dignified. If a tribal elder wishes to be seen as statesmanlike and wise, a pair of glasses goes a long way to help him. Spectacles are a simple way of ensuring the help of those who make the decisions in local society.

Teeth are a different matter. I had always wondered why it takes dentists so long to train when all they are dealing with are thirty-two tiny white structures crammed into the human mouth. Now I have tried basic dentistry myself, with all its associated hazards, I understand. The Bedouins’ teeth were terrible. Brushing them was a technique they had never heard of, while chewing and gnawing sickly sweet dates were commonplace. When I opened the average tribal Bedouin mouth, I was faced with a sea of holes, stains and awful breath. Abscesses were two-a-penny. I exhausted tube after tube of temporary dental filling. Some mouths would need more than twelve holes filled at a time.