Emily Mayhew - A Heavy Reckoning: War, Medicine and Survival in Afghanistan and Beyond

A Heavy Reckoning

DR EMILY MAYHEW is a military medical historian specialising in the study of severe casualty, its infliction, treatment and long-term outcomes in 20th and 21st century warfare. She is historian in residence in the Department of Bioengineering at Imperial College, and a Research Fellow in the Division of Surgery within the Department of Surgery and Cancer. She is the author of Wounded: From Battlefield to Blight 19141918, which was shortlisted for the Wellcome Prize 2014.

ALSO BY EMILY MAYHEW

The Reconstruction of Warriors
Wounded: The Long Journey Home from the Great War

WELLCOME COLLECTION is the free museum and library for the incurably curious. It explores the connections between medicine, life and art in the past, present and future. It is part of Wellcome, a global charitable foundation that exists to improve health for everyone by helping great ideas to thrive.

A Heavy Reckoning

War, Medicine and Survival in Afghanistan and Beyond

EMILY MAYHEW

First published in Great Britain in 2017 by

PROFILE BOOKS LTD

3 Holford Yard

Bevin Way

London

WC1X 9HD

www.profilebooks.com

Published in association with Wellcome Collection

183 Euston Road

London NW1 2BE

www.wellcomecollection.org

Copyright Emily Mayhew, 2017

The moral right of the author has been asserted.

All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise), without the prior written permission of both the copyright owner and the publisher of this book.

A CIP catalogue record for this book is available from the British Library.

eISBN 978 1 78283 222 5

But if the cause be not good, the king himself hath a heavy reckoning to make, when all those legs and arms and heads, chopped off in battle, shall join together at the latter day and cry all We died at such a place; some swearing, some crying for a surgeon, some upon their wives left poor behind them, some upon the debts they owe, some upon their children rawly left. I am afeard there are few die well that die in a battle; for how can they charitably dispose of any thing, when blood is their argument?

Shakespeare, Henry V, Act IV, scene i (speech by Williams, the Welsh Serjeant-at-Arms before the battle at Agincourt)

Introduction

THE CONSTANT OF ALL WARFARE, whatever the century, is the wounding of soldiers. In the play Henry V, one of the cultural cornerstones of British national identity, Shakespeare introduces a single character whose function is to do nothing other than remind the audience in raw and brutal terms exactly what casualty in warfare means for the dying, the dead and their dependants. Serjeant Michael Williams is an ordinary soldier whose simple voice articulates not only his fears about wounding but also deep misgivings about the likely costs of a military campaign portrayed in the rest of the play as honourable. It is his remonstration with the warrior king Henry that gives this book its title and provides its epigraph. We never find out what happened to Williams whether he lived or died crying for a surgeon but he, like Shakespeare, knew that to be a casualty from a battle like Agincourt in 1415 was almost certainly to be dead.

But not always. This is a book about what happens to those wounded who somehow do not die on the battlefield. It is about the moment and the point of their wounding and what comes afterwards that ensures their survival. Times, weapons, battlefields all change, but for those who somehow do not die, the moment of their wounding when their power is snatched away and replaced with chaos, dependency and pain is the same across the centuries. In that moment, no matter how much the soldier has sought to prepare for the possibility of casualty, everything changes at the most fundamental levels of human existence and function. One question fights its way to the forefront of the casualtys brain as they fall: what is happening to me? In the seconds or moments before help or death arrives, their brain struggles to provide some answers.

The immediate response of a soldier in the seconds after wounding is to rediscover what time it is. Being certain of the time tells them whether or how long they have been unconscious. Knowing when it is helps them remember where they are and allows them to plan their survival. But Time itself has transformed as they fall, fragmenting and dilating all at once, and getting it back under control can be hard. Few soldiers owned watches before 1920, so many of those who came to the First World War battlefield relied on the position of the sun in the sky if the sun could be seen to tell them that they had lain unconscious for hours, as men around them faded and died, as others lay paralysed watching and willing them to wake up. A soldier at the Somme managed to lift himself up from the mud of the shell hole where he had fallen to find white beads scattered around him. Time passed in some form minutes or seconds, he never knew which while he worked out that they were teeth, and that his jaw had been smashed open by a shell and he lay among the fragments of his own face. No soldier in the twenty-first century is without some kind of watch, where time and place can be told in the light or dark, but only if the device is undamaged and there is no crack in the face or fracturing of pixels distorting its output, blood clotting in its cells. Then the owner of the broken watch or phone is no better than their comrade in a muddy shell hole a century earlier, craving certainty, relying on daylight or its absence, prepared to accept even the vaguest hint from the world around them.

Sound, like time, becomes deranged after wounding. Soldiers lie and listen to the sound of their own blood being pumped around their bodies, or drum-dripping on to their uniform or the ground, tiny pats drowning out the sounds of the battle around them. A soldier at the Somme tried to stand and failed, so he lay back down quietly, focusing instead on a gentle, repeating slurp of a sound, like sea surf, whooshing in out, in out. Its regularity gave him a kind of comfort until he realised it was his own breathing and that he could not, no matter how he tried, get it back to normal.

Movement. The ability to move, and to feel oneself moving in time, is crucial. No matter what, soldiers will be desperate to move, terrified that immobility will be mistaken for death. In 1942 an RAF pilot rescued from a downed aircraft awoke to find he was lying on a stone dock wall, completely covered by a heavy tarpaulin, hearing through the thick canvas the last rites being murmured above him. He managed to shift his shoulder, and the tarpaulin was snatched away, a horrified padre replaced by a mortified medic.

Blood. The soldier must find where they are bleeding from and try to stop it if they can, sparking their memory for the fragments of their first-aid training and kit. If they can, and there is much that can prevent it, the soldier lifts their hand and begins to pat along their body to find their wounds. Wounds are always wet, so each touch that finds dry fabric or flesh is a second of relief, before passing on. When one soldier behind a shattered wall after a night attack in Iraq felt his way to a sodden patch on his own back, the moments that it took him to bring his hand from his body to his face, to discover what it was, to taste it in the darkness, those few precious moments of not knowing were infinite and yet not long enough. Hand-to-mouth existence. Finally it was water he tasted on his fingertips, not the saline metal of his own blood. The bullet had struck his water bottle, drenching his uniform. Except that even at the moment when he had almost smiled with relief he knew that there was still a wound to find, because as he twisted to continue his search, it sent pain lancing through him from toes to teeth. Distorted in its path by his water bottle, the bullet had smashed on the edge of his body armour, fragmenting into metal shards, no longer one projectile but several, splattering his spine, his nerves, his intestines, shrouding him in pain.