British vascular surgeon David Nott has spent the last 30 years switching between his role as a consultant at the National Health Service and as a humanitarian surgeon in war zones across the globe. I became a fan of Nott when a clip of him directing an operation in war-torn Syria through Skype went viral on social media. I was instantly converted, eager to proselytise, almost forcing everyone to watch the video.
His memoir War Doctor: Surgery on the Front Line was published in February, and I stayed up till midnight to buy it. Nott has been to almost all the major regions of conflict in recent decades: Bosnia, Afghanistan, Iraq, Sudan, Syria. The tales are gripping and I found myself reading between operations and on cab rides.
War Doctor
David Nott
Pan Macmillan, February 2019
The stories are difficult to read. The horrors of war fill the pages. There are stories of girls as young as nine being raped and miscarrying; stories of families being wiped out in bomb-strikes, villages where mass amputations were conducted as a show of strength. Snipers that play games where they aim at the bellies of pregnant mothers.
Part of the reason why Nott chooses to help the victims of these inhuman acts is the ‘arrogance of altruism’; here an arrogance that assumes that your scalpel can somehow undo the damage done by a sniper’s bullet. On one occasion, while operating on a young girl with a mangled arm in Syria, there was a bomb threat in the hospital and an evacuation was ordered. Nott decided to carry on with the surgery. As he writes, “Staying with her was a pointless act of defiance against the warmongers, but it would have been impossible to do otherwise.”
There is another side to it, this ‘strange mix of altruism and pure selfishness’, as he puts it. He finds its selfish for two reasons. For one, the idea of cheating the grim reaper has always been addictive to those who’ve been there. After his first close encounter with death in Bosnia, Nott writes, “I had to confront another emotion that was more surprising, even a little disturbing. I felt elated, exhilarated, euphoric. I had never felt more alive; it was as if I had been reborn.”
The other bit of the selfish motivation comes from the challenging nature of surgery itself. Any surgery is difficult and to perform them in the resource-limited conditions that David has done is not short of a miracle.
The one surgery that particularly stood out is a forequarter amputation that he had to do on a boy whose arm was gangrened after being bitten off by a hippopotamus. This is where you almost take out the entire arm with a bit of the shoulder. Having never done the procedure himself, Nott texted a colleague back in England from a Nokia phone, “Can you take me through a forequarter amputation using text.” His colleague texted back a 400-odd character reply, Nott scribbled it on a piece of paper, stuck it on the operating wall and went ahead. The boy recovered.
The adrenaline and the itch to help can only take you so far though. To survive the horrors and tragedies of war, and in general, life, one needs a strong reserve of happiness, an ‘internal pot of gold’ as psychologist Simon Baron Cohen puts it.
In one chapter, Nott speaks of his childhood in the Welsh village of Trelech, family dinners, the ‘fragrance of my grandfather’s clothes’.
“It was a very Welsh childhood, and to me completely magical. It was the mould I came from, by which I have always been indelibly marked. It was the making of me.”
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Pitted against genocides and barrel-bombs, these barricades may still be too meek; the pot of gold runs out and the implosion eventually occurs. It reaches a climax on his meeting with the Queen at the Buckingham Palace where, in an acute episode of PTSD, he finds himself at a loss for words when the queen asks him about Syria. The soft rains do eventually come in the form of love and his two daughters.
Somewhere in these pages is the humane story of a surgeon healing himself. Poet Walt Whitman, reminiscing about his time as a volunteer nurse during the civil war, said,
“People used to say to me, ‘Walt, you are doing miracles for those fellows in the hospitals.’ I wasn’t. I was … doing miracles for myself.”
Debayan Sinharoy is training to be an orthopaedic surgeon.