War Doctor PDF Book by David Nott


Click here to Download War Doctor PDF Book by David Nott Language English having PDF Size 1 MB and No of Pages 274.

In London the 2012 summer Olympics were in full flow, with Team GB winning a record number of medals and the country basking in the reflected glory of our athletes and a successful games. It was hard to imagine that only a few hours’ flight away an entire country was descending into violent anarchy. I was busy with my day job for the National Health Service.

War Doctor PDF Book by David Nott

Name of Book War Doctor
PDF Size 274 MB
No of Pages 381
Language English
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About Book – War Doctor PDF Book

For most of the year I work at three hospitals in London: St Mary’s, where I am a consultant vascular (blood vessels and circulation, from the Latin vas, for vessel) and trauma surgeon; the Royal Marsden, where I help the cancer surgeons from various specialities such as general surgery, urology, faciomaxillary and gynaecology remove large tumours en bloc, which then require extensive vascular reconstruction; and the Chelsea and Westminster.

Where I am a consultant laparoscopic (keyhole) and general surgeon. But alongside this work, in most years since the early 1990s I’ve also done a few weeks’ trauma surgery in a war zone. I monitor the television news avidly, keeping an eye out for developing hotspots, knowing at some point soon an aid agency is likely to ask me to help. When I get such a call, my heart begins to race and I develop an irrepressible urge to remove any obstacle that might prevent me from going.

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My immediate response is always, ‘Give me a couple of hours and I will come back to you.’ The call might come while I’m operating or assisting a colleague, or I might be holding a routine outpatient clinic. Wherever I am and whatever I am doing, the desire to go is always intense and almost overwhelming. But I can’t say yes every time. I might get a couple of requests a month from different agencies, and could easily be a full-time volunteer, but I have to earn a living, too.

I do receive £300 or so for a month’s fieldwork, but mostly that’s spent on everyday expenses. Before agreeing to anything, I call the surgical manager at Chelsea and Westminster, where my contract is held, and explain that there’s a humanitarian crisis in which I’ve been asked to help. I then request immediate unpaid leave for the time I’ll be away. There is usually no objection, ‘as long as you can sort out your clinics and your operating and your on-calls’.

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Indeed, I have never yet been turned down. No doubt the carrot of taking unpaid leave while maintaining all my commitments helps to allay any anxieties the NHS might have! So I didn’t need asking twice when, during the summer of 2012, a call came from the head office of Médecins Sans Frontières (MSF) in Paris, asking if I would be prepared to work in a hospital they’d set up in Syria. I made the usual arrangements at home, packed my kit and got on a plane to Turkey.

My natural inclination was to dive in and start doing something, partly to be seen to be acting and partly because doing something is often easier than doing nothing. But was it the right call? She was old, and terribly badly injured. It was likely she would not survive a lengthy operation or a series of different procedures. We also had a finite amount of blood to give her. Should she get it? Or would tomorrow bring a more worthy recipient?

Who was I to decide who was more worthy anyway? It might be better just to give her some morphine, take away any last pain she might be experiencing, and let her go gently. I decided to operate, and began to debride her wounds: cleaning and cutting away dead tissue, removing bone fragments and generally trying to move the odds in favour of the remaining healthy tissue. After about fortyfive minutes of this, however. War Doctor PDF Book

The anaesthetist tapped me on the shoulder and said, ‘She’s gone.’ It was a depressing start. But such was the volume of casualties being brought in that there was little time to dwell on it, and before long the remaining staff came to realize that I did know what I was doing, and could be left to my own devices. We began to work well together as a team, despite the strains and privations and danger.

Most of them spoke a bit of English, and a few spoke very good English, but there would be occasional mix-ups: I remember thinking I was picking up a bit of Bosnian of my own when I’d hear a doctor call for what sounded like ‘Mackadoe! Mackadoe!’ I wondered whether this was some comment on the stage of the operation reached, or perhaps a Bosnian swear-word, until I realized that the cry ‘Mackadoe!’

Was always followed by a nurse handing over a pair of McIndoe scissors, named after the pioneering New Zealand surgeon Archibald McIndoe. The bombs and bullets would usher people into our care, but in many ways the biggest problem was the temperature. The cold was biting in Sarajevo that winter. It seeped through my clothes and permeated my bones. It greatly affected the patients we treated, too. War Doctor PDF Book

The operating theatre in which we were working was freezing. The water was cold when I washed my hands, my theatre gown was soon tatty and torn, and we ran out of surgical masks, so I would watch my breath condensing in the cold air. While uncomfortable for us, it was potentially deadly for the patients, some of whom would die from hypothermia before their wounds could kill them.

Operating theatres need to be kept warm because when you open a patient’s abdomen they lose precious heat very quickly. Temperature directly affects the outcome during surgery and if body temperature falls dramatically, the effects can be devastating. The body’s enzymes stop working so that blood does not clot as easily; the heart does not beat properly and oxygen, our life source, is not used to best advantage. Organs begin to fail.

I don’t know how many lives I have saved over the course of my career: it’s a question I am often asked but never know quite how to answer. There are the very memorable or dramatic interventions, some of which I describe in this book, where I know for certain that if I hadn’t done what I did, the patient would have died. But does that mean that someone else would not have stepped in if I hadn’t been there? War Doctor PDF Book

And, when working in a conflict zone, I very often never discover how my patients fare in the longer term. Have I really saved someone’s life if the post-operative care isn’t available, or good enough, and they succumb to some infection or other a few days later? Maybe such questions are best left to philosophers. For the surgeon faced with someone in need, the instinct to fix that person is powerful.

And, of course, it is felt even more keenly if the person in front of you is someone you love. I hadn’t been able to save my mother, and it was horribly tempting to indulge in the what-if of identifying her problem earlier. Nor was I able to stem the inexorable advance of my father’s illness, although we gave it a good try. Towards the end of 2003 he had a recurrence of the colon cancer that had first been diagnosed the previous year.

Mum and Dad were both living with me full-time. Mum used to go back to Carmarthen for a bit of a break, leaving me with the tricky task of managing his care at home while doing my job at the hospital. I geared everything around making sure he was comfortable and well hydrated. In the mornings, to relieve his bowel obstruction, I would insert a nasogastric tube and aspirate around a litre of fluid from his stomach. War Doctor PDF Book

I came home from work at lunchtime and put a drip on him to make sure he had enough fluids. In a matter of minutes, the patient was being wheeled down to theatre while I found Mike, the American surgeon, and told him what I was about to do. He agreed that we should go ahead with the procedure and said that he would assist me. As we were scrubbing up, we suddenly became aware of a man shouting angrily in Arabic.

Mike continued to scrub but I stopped and turned to confront the objector. It was the original surgeon on the case, who was furious. An Egyptian doctor in his mid-thirties, he demanded to know who I was. A British consultant vascular surgeon working for MSF, part of a team that had arrived that day, I replied. He was adamant that I had no right to operate on his patient and asked me to leave the theatre. It was horribly tense. Situations like this require considerable diplomacy.

No matter how appalled you might be by a colleague’s obvious mishandling of a case, you have to remain calm and courteous. Knowing that the patient’s life was at risk, I was angry and concerned – my heart was beating faster and I could feel the hairs on my arms rising. But I had been here before and knew that the best option was to try to smile my way out. ‘Before I leave your operating theatre.’ War Doctor PDF Book Download

I said, ‘please would you show me how you will manage this patient’s white foot, because I’d be very interested in learning your technique?’ He looked at the foot, unable to deny that there was a problem with the circulation, and shouted at the nurse to take the dressings off. He was going to expose the blood vessels to show us that the vein graft he had performed was working. Once he had done so, he turned to me triumphantly, inviting me to look.

The blood vessels around the knee were indeed working well. However, he had left the artery exposed. It was bound to get infected, which meant that the join between the artery and vein graft would break down. The patient would probably bleed out from the secondary haemorrhage. ‘Why is the foot still white?’ I asked. ‘It will get better,’ was the best he could come up with.

I then mooted the idea of a fasciotomy because the leg was so swollen. I will never forget his reaction – he went puce in the face, and screamed, ‘I never do fasciotomies!’ I operated on the first boy with Abdulaziz. After controlling the blood vessels above and below the injury, we opened up the swelling. Blood immediately poured out of it. We disconnected the artery from the vein and repaired all the holes in the blood vessels. War Doctor PDF Book Download

The patient recovered well and left the hospital two days later. The other boy was about fifteen and he, too, had a fistula with a large false aneurysm in the middle of his thigh. Abdulaziz, who had really benefited from my lessons in vascular surgery, thought we should take him to M10, so that the surgeons there could also learn some of these techniques.

We set off in the back of Abo Abdo’s ambulance, with the patient smiling at me in pleasant anticipation of having his leg fixed and being free of pain. When we arrived at M10 I gave the team a short briefing on what we would be doing and how I was going to do it. His haemoglobin was fairly low, and as this was to be an arterial operation I suggested that we should have some blood available.

One of the nurses took a sample to determine his blood group. By the time the boy was anaesthetized, there were five or six surgeons including Ammar scrubbed up at the operating table. I carefully made the incision on the boy’s thigh and isolated both the vein and artery above and below the lump. We had a discussion about anticoagulation, and the need to prevent thrombosis from occurring when clamping blood vessels. War Doctor PDF Book Free

I asked for 5,000 units of the blood-thinner heparin to be given, and we waited for a couple of minutes for the drug to circulate around the body. I then applied the clamps and gave the knife to one of the other surgeons, asking him to make the cut into the large blood vessel. This he did with enthusiasm, but unfortunately while he did so he knocked off one of the small clamps on the artery, which fell to the floor, and arterial blood pumped out.

We had only two clamps and the other was on the lower end of the artery. Panic took over as we tried to occlude the artery before he bled too much. He had lost about a litre of blood in the space of a few minutes and I asked for a unit to be brought up from the ‘blood bank’, which was an old Coca-Cola machine. There was never enough blood – perhaps only a couple of units of each type.

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