Volume 6 Number 2

“It’s not PTSD – it’s different...” 
“I’m impacted but not injured.”

These are the words of Paul Roach a United States military surgeon. Sitting in the Epilogue of Mayhew’s book, they could have been my words. They hit me like a hammer driving home a nail. I got all the way to the end of this intelligently written, emotionally exhausting, professionally captivating book before my own eyes misted because someone understood. I do not begin to suggest I have been through the same harrowing experiences described in Mayhew’s book. However, when I too came home from Afghanistan after working in the Dutch commanded surgical facility of Tarin Kowt, Uruzgan Province, I described myself as; not injured but different.

Mayhew has captured the Afghanistan experience from a medical perspective in a way that is truly gripping, not always easy to read but unequivocally honest and courageous. Her ability to weave history learnt and lost into the present day, delivers a clear message that should not be ignored.

The book is set out in three sections, Part 1 – Afghanistan, Part 2 – Home and Part 3 – Beyond. Mayhew seamlessly moves between the historical and present day. She captures the reader swiftly and poses the inescapable question of ‘how could we forget so much?’ She does not, however, allow the reader to dive into deep despair following up quickly with a steely determination to not forget again. Although warfare changes, especially with the use of modern technologies, the human body does not. The human body is still wrenched and ripped apart by the violence that war delivers. In the face of this destruction, military healthcare providers from combat first aiders to nurses, allied health personnel and surgeons strive to put the pieces back together. The problems and some of the answers that stem from this is what Mayhew has succeeded in putting into very eloquent words.

The stories of individuals are skilfully woven throughout the book; the wounded, the myriad who provide care along the journey, the families and, the scientists who desperately want to improve the outcomes for the injured – and sometimes these people are the same.

After a historical introduction, Mayhew starts at the point of injury and painstakingly takes us on the journey of the injured soldier. She intricately describes the slowing of time and the number one killer on the battlefield – blood loss. She does not do this gently for the reader, reminding me uncannily of the words written by Daniel Keen in his collaboration with ADF soldiers who returned from Afghanistan:

“The purpose of war is to injure…
Central to this purpose is the body of the soldier. It must be resilient. The soldier must be able to inflict injury while avoiding it. The soldier’s body must outlast the body of his enemy.
But the body bruises, it bleeds, it breaks.”¹

Utilising the personal story of Mark Ormrod, described in his own book, Man Down, Mayhew introduces the concept of unexpected survival. Ormrod’s story is utilised throughout the entire book demonstrating interactions between injured soldiers and the multi layered system that scoops them up and brings them home. Ormrod’s story enables the telling of how personal determination, combined with science, care, human interaction, family and more, come together to provide a fertile ground for continued development in all areas of military medicine.

From the point of wounding through initial treatment, evacuation, damage control resuscitation and surgery to rehabilitation, adjustment and lifetime impacts – battlefield wounding is neither pretty nor delicate yet Mayhew is able to weave hope into the descriptions, including scientific discoveries, simple interventions and the power of gardens.

One incredibly powerful example of non-medical therapeutic inputs comes in the form of the patient diary. Mayhew compassionately describes the diaries written by clinicians and visitors alike. These capture normal interactions, speaking of daily life and things that are happening around (and to) the wounded soldier. Later, Mayhew describes these diaries as revolutionary, for the wounded will not remember their time in critical care. They connect the casualty and their families, helping bridge the gap between wounding and the thousands of little steps and the multitude of people who have been involved in their journey back from the brink.

Although the unexpected survival of soldiers from the battlefields of Afghanistan are woven throughout Mayhew’s book, the stories of health care providers are clearly interwoven as well. Mayhew illustrates the complex impacts that providing care in war zones and beyond has on first responders, initial care providers and long term health care providers alike. She describes the second line injured and for those of us in the business of delivering health care to battlefield casualties,  you may well find a reflection of your own story here. Grit and determination do not solely belong with the casualty but also with health care providers, families and communities. The immense hope that can be found within these pages for all is moving.

Part 2 of Mayhew’s book takes us through the health care system, discusses the science, the physiological impacts of severe wounding and unexpected survival. The use of gardens, games, technology, science, and the incredible impacts of chronic pain that debilitates despite determination. Throughout we are captured by the crashing waves of Mayhew’s storytelling, cresting hope and dumping despair, of getting up and going again.

All the while Mayhew describes the tirelessness of health care providers and researchers, not to mention casualties themselves turned health care researchers. All seeking lessons in their patients or nutting out new ways to do things by looking at history, experimenting and collaborating.

Part 3 focuses on outcomes and lessons, the creation of ongoing learning centres in the face of what is known – that for these unexpected survivors, physiologic outcomes are poorer and what is unknown because there are no long-term outcomes yet.

A highly recommended read for military health care providers but note well; reader beware, there are many, many triggers within this compassionate but uncompromising book by Emily Mayhew.

Dr Emily Mayhew is a military medical historian specialising in the study of severe casualty, its infliction and long-term outcomes in 20th and 21st century warfare.³

Other books by Emily Mayhew:

The Four Horsemen: War, Pestilence, Famine and Death and Hope of a New Age.

The Guinea Pig Club: Archibald McIndoe and the RAF in World War Two.

Wounded: the Long Journey Home from the Great War.

Author(s)

Emma Palmer
Registered Nurse, Master of Nursing, Clinical Education, HQ 2nd Health Brigade, Australian Army
Email emma.palmer2@defence.gov.au

References

1. Keene D. The Long Way Home. The Sydney Theatre Company. 2014.
2. Ormrod M. Man Down. Corgi:London. 2010.
3. Mayhew, E. Bio. Imperial College London. https://profiles.imperial.ac.uk/e.mayhew