The Grey Lady Ghost of the Cambridge Military Hospital
She sat alone, waiting patiently, in the dark, but for the light of the half-moon filtering through the tall windows. Her long bony fingers smoothed the invisible creases of her dark grey nursing uniform and white apron. The walls danced to the movement from the light wind on the overgrown bushes outside and those that sought refuge through the neglected cracks in the walls that brushed against the peeling paint that flaked in clumps to the floor. Foxes barked their harrowing calls of the night as they sought the comfort of another whilst the rats scratched along the wooden floors in search of food, little knowing that they would be easy prey for the owl that in turn looked over her, aware of her presence, but not seeing her, only sensing. Soon there would be new souls to care for, to help ease their passage and bring some comfort from the pain of life. These past few years she never understood where her patients had gone, but soon her ward would once again have a new patient for her to tend, she sensed this and waited.
Nahr-e Saraj Helmand Province, Afghanistan: Operation Herrick 19 - 2013
'Dicker on the roof!' barked Sergeant Buchan into his personal role radio to the other members of his eight strong section of 4 Scots. Instinctively all of his men of The Royal Regiment of Scotland checked that their safety catches of their SA80 A2 rifles remained off as they neared the compound, wishing they were back in the safety of their Mastiff along with the two crew left to protect the vehicle as they searched the area. Even Corporal Naomi Scarlet, their medic, from the Royal Army Medical Corps, on secondment from 2 Medical Regiment, automatically did her checks knowing that contact could be imminent. Only for her it was the ritualistic checking of tourniquets, clamps, heavy duty field scissors and med packs strapped to the front of her chest rig. This check, check and check again ritual was drilled into her by Staff Sergeant Taffy Williams during her combat medical technician trade training at Keogh Barracks in Ash Vale near Aldershot. He was a veteran of the First Gulf War and his instruction and experience had proved useful for Cpl Scarlet saving several squaddies lives in the second Gulf War back in 2006. Though with the horrific injuries they sustained she was never sure if she was doing them a favour, they were nicknamed the unexpected survivors. Now, due to advanced trauma support, around 80% of battlefield casualties survived. This automatic medical equipment check done, she then looked through the sight unit small arms trilux of her SA80 to see what the drama was.
'The wee fucker,' swore Private Clarke into the PPR with great anger that only the broad brogue of a Peterhead lad can vocalise in few words, 'the wee rag head looks only twelve.'
'Aye, about the same mental age as you Andy!' joked Private Fraser McAllister, the youngest and cheekiest member of the group. He was fresh out of recruit training and posted straight to The Stan as he called it in his letters home to his mother in Stonehaven.
'Enough chit chat lads', chided Corporal Billie Anderson, 'the next numptee to say anything stupid over their PPR gets put onto shit burning duty when we get back to camp.'
Private Clarke swore under his breath recalling the last time he had the privilege of this dirty job. Anyone under discipline had the horrendous job of dousing the full tin of faeces from their improvised toilet area and adding any fuel he could lay their hands on so that it could be sanitarily destroyed. Only whatever unlucky sod did this usually got covered in crap as it went up in flames, and often it had to be lit several times. Though some didn't mind the duty because it was rumoured that whoever performed this task was awarded with an extra ten pounds tax free in their wage slip when they got back to the UK. Fine and handy for going out on the piss at Mambo's in the Bloo Toon of Peterhead, so named after the rows and rows of the coloured slate roofs in the old fisherman's town. Though his auntie always argued it was because the fishermen wore blue jerseys, or ganseys as she would refer to them, when at sea so that if they fell overboard and drowned they would be recognised as coming from that area by the colour of their jumper. He was last put onto shit burning duty for falling asleep during stag duty. He knew he got off lightly since sleeping whilst on guard duty was one of the worst offences a soldier could commit since his oppos were relying on him to keep them safe while they tried to catch up on much needed sleep and downtime.
Corporal Scarlet did a double check through her SUSAT, Christ she thought; he's younger than my brother. Though she couldn't resist a small smile at the language Andrew had used knowing that his wife had tried banning him from using foul language since the birth of their daughter three months ago. She thought fondly of her fiancÚ, Scott, safely nursing at Camp Bastion Hospital, who also didn't like her swearing and the recent rude words and phrases the Jocks had taught her.
'Stay alert lads,' commanded Sergeant Buchan, 'there is a Zarang motorbike against this wall we're approaching and no-one around. That's his get the fuck out of here ride and we're heading into something I don't like the look of. The wee rag head is talking into a mobile, something's about to kick off. I bet my big right ball that the fucker is letting the flip-flops know all about us.' He was starting to regret not having a squad of the Afghan National Army, useful for their local knowledge. But this was supposed to be a simple Op with no contact with civilians so no need for an interpreter, and minimum troops needed.
The eight person strong patrol inched closer to the compound, walking carefully for signs of an improvised explosive device and other booby traps, grateful for Corporal Stewart, their ordinance and explosives expert leading the way, sweeping his metal detector, searching constantly with large sweeps close to the ground, knowing that at all times his mates had his back. 'Rory and Ewan, I want you two to set up the Minimi by that low wall where Corporal Stewart is sweeping, cover us as we enter the building,' ordered Sergeant Buchan over the PPR.
'Right boss,' replied Private Morrison, nodding to Private Young as they moved with caution over the hard ground to the low mud wall, giving them a commanding view down into the compound and surrounding fields. Their intended target was inside the compound, which intelligence revealed was deserted, but had a cache of enemy weapons. Their operation today was to seek them out and guard Corporal Stewart as he blew the weapons up to deny their use to the enemy. They knelt down on the packed earth, grateful for the knee pads over their combat trousers to give some protection from the sharp stones that seemed to populate the area. They also acted as a barrier between the ever present goat faeces that seemed to be abundant in this area along with the ubiquitous flies that they attracted. Despite being caked dry by the sun the dung always seemed to be moist and stinking in the middle, especially when knelt upon.
The rest of the patrol followed carefully in the footsteps of Corporal Stewart, their SA80's at the ready as he listened intently for the change in tone which would alert him to danger. Suddenly small arms fire opened up from the main wall of the compound, a Taliban insurgent letting rip with an AK47. The troops instinctively hit the dirt and let off controlled rounds at their new target, not needing the boss to tell them where their target was, training taking over. This threat more immediate than that of IEDs. They laid down covering fire to allow Privates Morrison and Young the valuable few seconds to set up the Minimi light machine gun. Immediately there was the roaring of gunfire as their 200 rounds of belted ammunition leapt to their target, the 5.56mm rounds ripping open the wall to reveal a Taliban insurgent spraying his mates with his AK47 assault rifle. Seconds later rounds tore into his flesh, spraying the dry earth with blood, bone and small pieces of flesh as his white and blue patterned kameez turned a moist dull red. 'Aye ye Choggie gypit hoor', shouted an excited Private Young resorting to the guttural slang of his Doric mother tongue from the streets of Torry in Aberdeen combined with the nickname for the Taliban, 'take that ye bastard,' he screamed as he took his finger off the trigger and applied the safety catch 'one less raghead causing trouble in this fuck awful country.'
As Rory turned to congratulate Ewan on another enemy kill he heard a sharp ping and his face suddenly felt wet, he tasted bitter copper as he instinctively licked his suddenly wet lips in the dry heat and looked in horror as part of Ewan's eye had exploded and blood was now gushing in to fill the empty eye socket, spraying the dry foreign soil. 'Oh fuck no, man, no' he screamed as he raised his rifle in the direction of the high velocity round and shouted a warning to his mates 'Sniper. Ewan's been hit. Man down. Naomi, on me,' he screamed as he knelt down and let loose a volley of rounds to where he thought the sniper was.
All but Naomi rose as one and advanced to the enemy, firing and reloading in perfect unison, listening to Sergeant Buchan's battle commands. Instead she sprinted, despite her heavy kit, to Ewan and Rory, slinging her rifle over her shoulders and back as she ran, not feeling its weight pound upon her heavy kit with each step that seemed to take an eternity. She swiftly donned her protective clinical gloves with practiced ease as her legs carried her to her fallen comrade. Her heart sank as she saw where the sniper's round had hit Ewan, 'Oh my poor boy,' she cried as she reached him. Feeling she had to do something to show Rory that his pal had died instantly, she knelt down and felt for his carotid artery with her index and middle finger, placing them gently and reverently on his neck, close to his windpipe. She shook her head and despite the noise of battle said softly to Rory, 'I'm so sorry, he wouldn't have felt a thing.'
But as she was about to explain that his death would have been instant she heard a roar of pain and looked up to see Corporal Billie Anderson drop to the ground, his left leg spurting blood. Private Fraser McAllister shouted 'Medic, Medic!'
'Mourn later Rory: your other pals need you.' She pulled him to his feet, pointed to his rifle and despite new incoming rounds from the enemy, she raced to Billie who was writhing on the floor as Rory got himself together and joined the firefight. As she dropped down onto her knees by his thrashing body she ripped off the Velcro combat tourniquet from her chest rig. 'Alright mate, you're going to be okay.' This was the new CAT one, which she had perfected putting on within seconds during pre-deployment training, either one handed or two, back at Keogh Barracks. She never liked to think about the one handed application because that would only mean that she was applying it to herself, as all soldiers were now trained to do. No release of pressure every fifteen minutes like the old days - just immediate tightening to stem the pumping blood and let the surgeons at Camp Bastion deal with the damaged flesh, bone and nerves. 'Take the pain Billie and lie still, let me do my job mate.' She wrapped the Combat Application Tourniquet just above the wound, fresh blood furiously pumping out with the pained movement of Billie as he tried to sit up, the weight of his webbing forcing him to lie back. Naomi gagged at the sight of decimated thigh muscle and shattered bone and the smell of fresh metallic blood pumping out from his opened femoral artery as he still thrashed about in shock and pain. She ignored the spurts that splattered their warm thick liquid onto her exposed cheek and remembered her training and went through the automatic drill of MARCHP. She knew she had to control this massive haemorrhage above all else. She was used to such wounds and had seen worse injuries on her soldiers in Basra in Southern Iraq in 2006. The worst sight, that still haunted her dreams was when a militia punishment squad had cut off the fingers, ears and gouged out the eyes of sympathisers of the new government. Though she was first on the scene there was nothing she could do as they had all bled out before her unit could safely approach. The support of her fiancÚ, Corporal Scott Grey of the Queen Alexandra's Royal Army Nursing Corps, had helped her through some dark nights. She was not going to let her friend bleed out, nor lose another comrade.
She was oblivious to all else bar her patient. She did not even realise that the sniper had now been shot dead by their own sniper, Lance Corporal Bruce Taylor, on guard at the Mastiff, but covering the backs of his mates from afar, using his bolt action L115A3 long range rifle with an impressive shot whilst the driver Pte Gary Mitchell quickly acted as spotter through his field binoculars whilst radioing through the battle and casualty update to HQ in Kandahar so that Sergeant Buchan could control the battle. Keeping as calm as possible so that no wrong information would be relayed, he gave them Corporal Anderson's and Private Young's zap numbers. These would alert Headquarters to each soldier's personal identification number with vital information for the medical teams like blood groups and allergies.
Focusing purely on the CAT, ignoring any danger she may be in, like many an RAMC medic over the years, she said to Billie who was roaring in pain and shock 'sorry mate this is going to hurt, now lie still or you'll bleed out' as she pulled the band tight and passed the tip through the buckle, where it locked in place. Billie gave a brief wince, stifled a scream and then a surprised look appeared on his face at how little pain he was now in. Naomi then twisted the rod until the metallic smelling bright red bleeding stopped. 'Now don't get too excited about this,' she tried to laugh as she felt for his distal pulse by his groin. Feeling no pulse she knew that no further bleeding out would occur. But he was still in danger of shock and infection from all the muck that would have gone into his thigh from the bullet, fragments of clothing and dirt. He needed evacuating as soon as possible but first she had to buy him the platinum ten minutes, where immediate first aid in the field by highly trained medics saved lives. Completing her first sweep of the MARCHP she automatically assessed his airway, respiratory and chest, circulation, head injury and motor function and then pain. The initial shock and surge of adrenaline from battle would now have his body pumping with natural endorphins so he wouldn't feel pain for a few minutes, but when it did kick back in she knew it would be excruciating and over-whelming. So ignoring her primary health care pack she delved straight into her battlefield trauma bag for an auto-jet of morphine. In her first tour of Afghanistan she would have used a soldier's own to save her valuable supplies, never knowing when a resupply would take place. But this would have been stored in his left map pocket of his trousers so that everyone out in the field would know exactly where it was, but with so many traumatic amputations from improvised explosive devices, she no longer wasted valuable time looking, too many had been shattered along with limbs. Pulling out her scissors as she knee-crawled to his other side she cut away more of his shredded combat trousers and injected him with the 10mg of morphine deep into his muscle of his uninjured leg. 'There you go mate, that'll see you through to Camp Bastion, we'll have you safe in no time.' Pulling out her notebook and glancing at her watch she made a note of the time the tourniquet went on and the dose of morphine along with the time administered. Barely seconds had passed between both actions, so well drilled and trained was she and other CMT's.
Billie started to ramble, 'Is my dick alright? Fuck, say it is Naomi.' He tried to sit up, but a fresh wave of nausea and pain forced him back down onto his uncomfortable webbing. He impulsively looked around him for his rifle, the soldier in him still trying to take part in the battle. He gave up and resigned himself to his injury and started to think about the future. 'Fiona won't forgive me if I don't come home with that,' he pleaded as his right arm felt down what little remained of his boxers and combat trousers. He was thankful that he had been wearing his combat codpiece, the Kevlar protected underpants issued to frontline troops three years ago. It was designed to help protect every soldier's pelvis and groin area and was worn outside his trousers. He hadn't realised that Naomi had already unclipped the ultra-lightweight ballistic material during her checks for injury and that he was worrying unnecessarily.
Naomi laughed; just as Private Knowles came sprinting over to help, 'You Jocks, you're all the same. It's always the first question you ask! You'll make me blush, and me an almost married girl. Yes it is. Now keep still and tell me if you have any pain anywhere else or feel strange at any time. You're going to be alright mate. Just remember you owe me a beer when we meet up back in the UK. You'll be up and walking in no time and giving Fiona the pleasure of your company. I need to radio through a sit rep so that we can get you out of here.' Only then, as she was tightly wrapping the field dressing, a celox bandage coated with chitosan, a chemical that would bind Billie's red blood cells to form a clot, over his large wound, did Naomi realise the battle had stopped. The other troops had advanced to the compound, or rather what was left of it, the motorbike buried in rubble which had a mangled arm pointed up to the sky as if trying to summon up an alternative lift home. With relief she noted its colour and civilian clothing, one less Taliban supporter. She only hoped that the mission was a success after the sacrifice of Ewan and the life changing wound Billie sustained. If the intelligence about the area being isolated and HQ only sending one small team in was wrong, was it possible that there was no arms cache, or had the Taliban returned to retrieve it? She reached for the mike of her personal role radio to talk to Private Gary Mitchell and Sergeant Buchan whose radios would reach HQ. 'Garry and Boss I need you to send a nine liner to HQ whilst I attend to Billie,' lowering her voice so as not to distress her patient, 'he's in deep trouble, you know our location etc, but please add on Cat B stretcher for Billie, Ewan didn't make it I'm afraid. He was shot clean through the eye and didn't stand a chance. There was nothing I could do. When it's safe I need two stretchers and a body bag from the Mastiff and a safe landing zone from you and the boys for the chopper.' Category B indicated to HQ that Cpl Anderson has life threatening injuries and that he requires urgent surgical treatment. Naomi knew that he may well lose his leg, despite her best efforts and those of the Medical Emergency Response Team who would now be on their way in their specially adapted Chinook helicopter after being given the extraction go ahead by the Major in charge of the medical desk at Brigade Headquarters who would decide on priorities based on whatever else was going on in Afghanistan and what medical facility he would go to. It was up to them to get here as quickly as possible and extract Billie, to give him his golden hour, that valuable time where limb and life could be saved or lost. Though for Billie there was only one option, he needed the expertise of the surgeons at Camp Bastion, probably the finest hospital in the world and able to cope with many horrific battlefield injuries. Swift lessons had been learned over this conflict, and as with any war, medical and nursing procedures changed or were invented, many finding their usage onto National Health Service accident and emergency units, wards and operating theatres. One such example was the use of the refrigeration unit on-board the military evacuation helicopter to safely store blood packs. It is now used by London's Air Ambulance to give civilian patients lifesaving transfusions on route to hospitals. This special fridge can store four units of O-negative blood, the blood group that can be given to anyone, and has already saved lives who would normally have bled out en-route.
The nine liner would also give vital information such as the location of the pick-up site and its security, how it would be marked and any special equipment needed. Cogs would be put into motion and because there was a fatality there would be a shut-down of communication going out until such time as Ewan's family were told the devastating news. Naomi tried not to think of poor Ewan and his parents, his father probably offshore on the rigs and his poor mum alone until her husband could be helicoptered home to Dyce Airport, no other children to comfort her.
'Will do Naomi,' came the short reply: there would be time to talk about what went on later. First they had to secure the area and bring in the extraction team. Knowing that the flight here alone would be about 14 minutes before wheels down, they grimly set about their task of making sure that the enemy were dead, their weapons made safe and the area secure. Then a flat large piece of ground would be made safe and a smoke signal lit to guide in the Royal Air Force pilot whilst two Apache attack helicopters of the Army Air Corps would hover around the area, ready to provide covering fire in the event of an attack, able to scan the ground to protect the medical personnel, troops and casualties. Besides, just like the British Army listened into the ICOM chatter of the Taliban, their leader in turn would be listening to their radio communications and they didn't want to give any valuable intel which would compromise their safety and mission away. Many a Taliban position had been identified through the Coalition listening to their Interim Communications Operations Method as a Taliban Commander talked to his men. The arms cache would have to wait - the priority was the evacuation of the wounded and the dead and the safety of the living soldiers. They would also take away the bodies of the enemy for forensic examination in the hope that they or their belongings revealed any important information.
Just after Naomi had inserted a cannula into Billie's right arm and started some vital fluid replacement, which Pte Graham Knowles was holding up, she noticed that Billie's breathing started to become laboured. 'Billie,' she shouted as she saw that he was starting to lose consciousness, 'tell me how you are feeling Billie?' She got no reply other than rasping noises through bubbles of blood in his mouth. 'Ballocks!' she exclaimed, I think he's developed a traumatic tension hemopneumothorax. Let's sit him up to see if it relieves any pressure. They took an arm each and sat him up, 'remove his webbing and lay him flat again Graham, that's not helping at all.' As they gently lowered Billie so that he was prone again Graham remembered his battlefield casualty training and knowing that Billie's kit would be going with him started to one handedly check and remove any weapons and ammunition, still carefully holding up the bag of intravenous fluid.
'You can do something about that, right?' asked a nervous Graham, the youngest of the section as he fumbled to put a clip of rounds into his own webbing.
'Yes and no,' replied an unsure Naomi as she put on a pair of stethoscopes to listen to Billie's chest. 'He's suffered a catastrophic haemorrhage and needs fresh frozen plasma from the MERT and ideally packed red blood cell transfusions, and lots of them. Blood is pooling into his lungs, causing him to have difficulty breathing. I'll do what I can, but he really needs a chest drain to relieve the pressure, re-inflate his lungs and take away what shouldn't be there.' She assured Graham and herself as she listened intently. 'Not good, but it's just his left side.'
'Have you seen this before?' asked Graham who instinctively reached out for his friend's hand and gently rubbed it whilst telling him he's going to be alright.
'Yes, but the Iraqi died from a mediastinal shift after a bad car bombing. There was nothing we could do. He died in front of us.' Seeing the look of fear suddenly appear on Graham's face she tried to sound reassuring, 'But don't worry that's not going to happen here. Billie owes me a drink! She dug into her battlefield trauma bag and took out a large needle in sterilised packing. With no time for the niceties of hand washing or disinfecting that a hospital doctor would have she ripped open Billie's combat jacket and clothing to reveal his chest. Opening the package she took out a large needle and unsheathed it. She felt along his ribs, counting to herself.
'Bloody hell Naomi, what are you doing with that?' demanded a shocked Graham, not knowing the meaning of half the words Naomi had said or what she was doing.
'Sorry Graham, this looks a bit brutal, but I'm about to do my first live decompression needle aspiration to his chest to relieve his intrapleural pressure. It'll make Billie breath a bit better and save his life. He's pumped up with morphine so won't feel a thing,' she said as she quickly delved into her front pouch, took out a clean latex glove and cut out the tip of the finger. She placed this over the needle. Naomi then quickly swabbed the area with a disposable surgical wipe and then stabbed the two inch needle into his chest, taking no time to add a saline filled syringe which was normal for this procedure to safely extract body fluids and air, time being of the essence, then a rush of blood and air popped out, narrowly missing Naomi's cheek. His rasping bubbly breathing soon stopped and he was breathing as normally as someone with such trauma could. She observed that the needle catheter allowed for the release of air because the latex finger from the glove fluttered as Billie exhaled. Taking her surgical tape, Naomi wrapped it around the catheter that was now sticking out from his chest wall to secure it. Pushing back her sweat soaked black fringe under her combat helmet, she then noted down in her notepad the procedure and time and hoped that the MERT would be here soon.