Knife Edge: Life as a Special Forces Surgeon (9 page)

Despite my initial experience, I learned to love the Mess in no time. Home from home, it was lovingly tended by two permanent staff members. The officers would come and go on their various attachments, but the permanent staff gave the continuity. With SAS officers in short supply and overseas for much of their time, the place was often like a morgue. Its walls were littered with trophies of various Regimental actions around the globe. Kalashnikovs, killing knives, flags, and pictures of assorted buildings and embassies in disrepair. The prize trophy, certainly from my viewpoint, hung from the barbed wire over the entrance gate. A small, decaying strand of worsted wool. ‘What’s that?’ I once asked an SAS colleague as we walked from the Mess to the main camp opposite.

He smiled. ‘It is the only medical trophy we allow to be displayed, Doc,’ he replied.

‘I don’t understand.’

‘Doc B’s trousers,’ he continued. ‘One of your predecessors. He snagged them trying to climb into the Mess one night. I think it was his attempt to escape a lady friend led to that.’ He pointed upwards to the limp woollen strand, blowing jerkily in the wind. I realized then it was not only your medicine the SAS assessed, it was your whole personality. Doc B was possibly the most respected SAS Medical Officer in the Regiment’s modern life. For a long time my own efforts were judged by standards he had set years earlier.

The epicentre of any Officers’ Mess life is the bar, no matter how warlike the regiment concerned. In Hereford, this was a simple wooden arrangement. VIPs and politicians from every party could be found there on occasion. Some of the most successful SAS actions of recent times started off life as ideas over a pint in that room. Civilian clothes were frequently worn, so it was impossible to know who was who most of the time. Often, officers would seek my medical advice at the bar, rather than coming to my official clinic, where they would be in full public view. As a doctor, you were also regarded as the resident scientist, frequently being asked advice on matters that only rarely formed part of earlier medical training. I was naturally keen to make a good impression.

At the end of my first week, and still terribly earnest, I remember discussing heatedly over a drink with a troop commander how to administer local anaesthetic when stitching up an open wound. If truth be known, I knew very little about it. The officer started firing intelligent, searching questions I found hard to answer. I had not at that stage learned that 22 SAS makes short shrift of bluff. It will see through you instantly, to your great discredit. I started to hum and ha, hypothesizing furiously in my attempt to appear all-knowledgeable. It was a mistake. So heated and blustered was I becoming that I failed to notice someone entering the bar area behind me. I had thought the troop commander and I were alone.

‘That’s bullshit, Richard,’ came a voice I was sure sounded familiar. ‘Absolute cock in fact. Lignocaine doesn’t work like that at all you know.’

I turned to meet the challenge, somewhat ashamed I had been caught out. There before me, smiling broadly, was the dynamic and powerful James R. We had been at school together, though had lost touch once we had left. The decade or more we had been leading our separate lives melted in an instant. We shook hands briefly and then, suitably humbled, I listened to James the non-medic, lecture me, the doctor, on the exact mechanics of lignocaine’s actions. I never bluffed again.

Over the years I saw many outsiders trapped in the same way. An SAS operative, whatever rank he holds, assumes a responsibility far greater than the equivalent rank outside the Regiment. It would be completely normal for a young SAS Captain to negotiate directly with a senior politician, for example. Such a situation would be unheard of outside the SAS. This responsibility makes an operative question everything. Nothing is assumed and nothing is taken at face value. It is one of the major attributes of SAS success.

The SAS, particularly its officers, forms a tight knit community. Everyone is bonded like Superglue by mutual discomfort, danger and extreme responsibility. During my first days in Hereford I was astonished how many old friends I met. Friends I had no idea were involved with the Regiment. Not only was there James R, but another close school friend and two operatives who had been my playmates as a child. It was like some grand family or school reunion, bumping into one familiar face after another. SAS friendships are particularly intense. There are Regimental friends I have now for whom I have the deepest affection, even though we left active service long ago. It is a bond I cannot logically explain, but James R certainly formed part of it. This is a problem for a doctor. His friends are patients and his patients are friends. It is not possible to hide behind the impassive wall of the civilian practitioner. As an SAS doctor you are involved, to the hilt, emotionally and professionally, in everything that happens to your patients. It is an enormous obligation, the greatest I have assumed in my life.

Security was vital. Not so much personal security, which by now was intuitive, but the ability to keep what you were told to yourself. Times have changed since then, as one so-called secret revelation follows another. But whatever is written, whatever is said, I cannot imagine any SAS operative knowingly putting his colleagues in danger by speaking out of turn. The Army takes it particularly seriously and puts all such operatives, and their doctors, through a process known as vetting. Vetting can be normal, the so-called ‘NV’, or positive, the so-called ‘PV’. I imagine the Army is unaware that the initials ‘PV’ stand for vaginal examination in medical jargon. My own PV came a few days after I first arrived in Hereford.

I do not know from where the security system obtains its vetters. However, to a man they are very easy to talk to. They have a way of making you pour out your innermost thoughts and secrets without hesitation. My vetter looked like a retired policeman. Mid fifties, ordinarily dressed and well-spoken. It did not matter what I said, studiously he would record my details without raising even the tiniest eyebrow.

‘Ever had VD?’

‘Of course not.’

‘Slept with anyone’s wife?’

‘Of course not.’

‘Drugs?’

‘I give them, not take them.’

The object was to go back in time at least five years, justifying every action and deed for each day of that period. Referees had to be given for anything I reported, so I dragged up old schoolmasters, holiday tour operators, even the occasional casual acquaintance. I heard later that many had been approached and asked to verify my stories. Heaven only knows what they thought I was up to.

The beneficial spin-off from vetting is the immense feeling of inner cleanliness with which it leaves you. All of us, however eminent or otherwise, have a few dark secrets we will take with us to the grave. They may be simple, such as forgetting to brush your teeth on your eighteenth birthday, or more sinister, such as an approach for information by an overseas power. Whatever the secret, the vetter has to know it. Consequently, by the time a vetting session has finished, you feel completely expunged, purged of all guilt and conscience. It is a marvellous feeling. I strutted around for months afterwards, a bounce to my step, as if I could do no wrong. I felt the system had given me its blessing to accumulate another pile of sin before the next vetting session.

If you hear nothing from the vetter once he has left you, then all is fine. Every so often he will return to update his records, though I would often wonder who vetted him. He will also return if, for any reason, you choose to let the side down. I did once and will forever feel guilty as a result. It was years later, away from Hereford, when I was sitting in a surgeons’ coffee room in southern England. A senior colleague walked in, handing me a letter his son had received that day. It invited the young man, barely twenty years of age, to form part of a statistical survey in central London.

‘What do you think of this, Richard?’ my colleague inquired. ‘Does it mean anything to you?’

I knew at once. I only had to look at the letterhead to see the address of Century House. Often called Gloom Hall, and now no longer functional, it was then a major headquarters for our spies. The letter was obviously an initial recruiting approach. I told my colleague so. He went away satisfied, never mentioning the matter again. However, within forty-eight hours, I had received a telephone call from my vetter, asking for updated information. He never once mentioned the letter, but the point was made. It was a warning shot across my bows to shut up and keep silent, of that I was sure. SAS service taught me very rapidly that nothing is ever what it seems. The most unlikely people can do the most unlikely things for the Government.

It did not take me long in Hereford to establish how different my practice was from others around the world. The responsibility was immense. There was me, fresh from basic medical studies, assisted by some of the most capable RAMC medical assistants in the land. These were different to the badged SAS medic. There was intense competition to provide medical support to the SAS. The job attracted all sorts, united by a deep commitment to see things through to the bitter end. We had our stresses, we had our strains, but got to know each other well. Officially I was their leader. In practice, my Medical Centre, often called the MI Room, was run by its sergeant. If you did not take his advice you were mad.

With SAS squadrons scattered throughout the globe, one doctor cannot be everywhere. Hence the need for specialist medical training. The skills of a fully trained SAS medic are remarkable. By the time he has completed his medical course he should be able to do everything expected of a civilian paramedic, and more. Drips, chest drains, setting of fractures, all become routine. Such skills are combined with a detailed theoretical knowledge that can put even a junior doctor to shame. Hence my lecture on the effects of lignocaine by James R. Occasionally enthusiasm can go too far, once the SAS operative has been blooded. For some, to qualify as an SAS medic was licence for anything. Once, when I was running a hearts and minds operation in the Middle East, a small glass pot arrived from an outlying SAS patrol. Inside, floating in liquid formalin, was a yellow, spherical lump. Two stitches had been expertly tied at its north and south poles, securing what must have been the blood vessels feeding it before excision. To the black top of the bottle was fixed a small label that read:

‘Doc - found this inside an Arab’s forearm. Grateful if you could tell me what it is. Thanks. Signed B.’

Out there, somewhere in the vast empty quarter of the desert, an SAS medic was in full throttle, operating on anything he could find. Trooper B was a first-class soldier, well able to cope with the demands of independent, minor surgery. He highlighted the very high levels of ability developed by SAS operatives once their medical training was complete.

You could be certain the SAS would face you with the exotic. My first day in post, not only did I have to deal with a close-range shotgun injury, but diseases such as leishmaniasis, giardiasis and march haematuria came through my door. Few who read this book will have heard of them. They are incredibly rare in UK civilian practice. I certainly had not come across them in those days.

As a doctor caring for such widely travelled individuals, I had always to remember that not every patient in my clinic would have an English disease. Much of what I saw was acquired outside the United Kingdom. Tim M demonstrated this admirably. He came to my clinic one morning looking very concerned.

‘Doc. I’ve got this ulcer on my cheek. I can’t get rid of it,’ he said, his Geordie voice trembling. However tough one is physically, a realization of mortality can be frightening for the hardiest of people. As he spoke he removed the crisp, white bandage from his face. I had seen him around camp for the past few weeks sporting the dressing and had assumed one of the MI Room medics had been responsible for it. As I looked closer, I realized it was not one of our own and had probably been bought from one of the pharmacies in town.

With the dressing removed I could see the huge ulcer on Tim’s cheek, in glorious Technicolor. About two inches in diameter, it was pinkish-violet with rounded edges. Its centre was filled with bloody slough and dead skin pieces. It looked revolting and was obviously getting bigger, not smaller. It also smelt.

‘Does it hurt?’ I asked.

‘No, Doc. Just keeps on growing. If it carries on like this it’ll have eaten half my face away within a few months.’

I nodded. Tim was actually right, though I doubt he realized it. I had seen this before: leishmaniasis, so favoured of Central America. It was a small parasite, injected into the skin by the sandfly. Gradually and insidiously it eats away at its chosen area. Healing is slow or non-existent and eventual scarring severe. Even though Tim had not taken his SAS medical course, he knew something was wrong. He was understandably petrified. At least I could reassure him, I thought, even though treatment would be lengthy and painful. We may not be able to undo the damage it had already made, but we could at least stop it getting worse. Traditional, everyday medicines would not touch it. Leishmaniasis demanded big guns if it was to be cured. Antimony, a poisonous metal, was given. It made hair fall out and did all manner of terrible things to the liver, but slowly the ulcer would fade. It could sometimes take six months or more to disappear.

It took the Army a while to acknowledge the threat of leishmaniasis. When you wake up one tropical morning covered in itchy bumps, there is no way of telling which particular insect has caused which particular bump. The majority of bumps will be completely innocent, minor, inconsequential mosquito bites. Some might herald the onset of strange diseases like dengue fever, Chagas’s disease or filariasis - all equally unpleasant. It was only when we realized each man had acquired his ulcer on return from the same operational area that the diagnosis became clear. Mosquito nets are hopeless as the sandfly is small enough to fly through the holes. That is why nets are now impregnated with insecticide. The net stops the mosquitoes, while insecticide vapour kills the sandfly. Much of the original research on these insecticides was performed on SAS jungle troops. They only had to look at the ulcerated skin of their colleagues to know that cooperation was in their best interests. Prevention was better than cure. For the men who acquired leishmaniasis treatment was possible, but not easy. Tim would settle in the end, I was sure of that. Ahead of him was a long, painful road.