Blood, bombs and boys’ talk
The blast tore through Sapper Matthew Weston’s body as he searched the mud compound for mines. The rifle he was carrying sliced off his hand, leaving it dangling by a thread of skin. Both his legs were blown off and he could feel the blood gushing from his two remaining stumps as medics leapt on top of him to stem the bleeding with bandages and tourniquets.
The 20-year-old Royal Engineer struggled to sit up, but his fellow soldiers pushed him back to the ground, afraid he might go into shock if he saw what was left of his legs. “It felt like someone smacking me in the head with a baseball bat. My head was thumping and my ears were ringing,” he told me.
Sapper Weston and his team of mine-clearance experts had been tasked with clearing a dirt track that leads through one of the most dangerous parts of Helmand. Night had fallen when the team from 33 Engineer Regiment began to search for bombs in the compounds that lined the track, known to soldiers as Pharmacy Road.
“I was the man at the front,” he said. “I didn’t have any night-vision equipment. They just didn’t have enough to go round,” he said matter-of-factly, as he sat on his hospital bed. As he turned to his commander to give the all-clear, the bomb that would leave him crippled for life exploded. Seven others were wounded in the blast, some with deep lacerations to their necks.
A quick reaction force was dispatched from the nearest British military base 100 metres down the road to evacuate the casualties.
“I didn’t lose consciousness until they put me on the back of the quad bike. That’s the last thing I remember,” he said.
An American medical-evacuation helicopter flew Sapper Weston to the British field hospital in Camp Bastion, where he was immediately rushed onto the operating table by surgeons who thought he would never survive his wounds.
By the time the doctors had finished operating on him, he had lost seven pints of blood, part of his intestine and his spleen. Shrapnel had shredded parts of his liver. When he got to Bastion he still had his right knee, but the doctors were forced to chop it off, leaving him with two stumps for legs.
The next thing he remembered was seeing his sister by his bedside in Birmingham’s Selly Oak hospital. Both Weston’s arms were in casts, attached to a pulley system above his head, which he could barely turn. He asked where his girlfriend was. “I didn’t want her to see me like this. I didn’t realise I’d been unconscious for a week and that they’d been by my bed all along,” he said.
Two weeks after Sapper Weston lost his legs, my brother, James, a second lieutenant with 2nd Batalion, the Rifles, stepped on an Improvised Explosive Device (IED) in the same part of Helmand. Wishtan, where both men were blown up, is a sprawling maze of narrow alleyways and high mud walls used to lethal effect by the Taliban to channel soldiers into “kill zones” laced with mines. Nicknamed “the devil’s playground”, Wishtan had become a ghost town during the searing summer months where British soldiers ran a one-in-three chance of being blown up every time they left the main base there.
My 24-year-old brother was sent to Wishtan in July to lead a platoon of men who had lost their commanding officer the week before in a string of simultaneous bomb blasts that left five soldiers dead and a further five wounded. I received an email from him a few days before he was due to go out on patrol. He was worried. “Mum and Dad don’t need to know where I’m going,” he wrote.
When James stepped on the Taliban mine, the force of the blast tossed his body in the air, ripping off his clothes and body armour and twisting the barrel of his rifle back on itself. The breastplate from his body armour lurched into his face, breaking his jaw. He saw his lacerated, bloody body in the medic’s sunglasses as he received a shot of morphine to the thigh.
He was still fully conscious when he reached the field hospital in Camp Bastion, high on ketamine and gabbling nonsense to the nurses. But the shrapnel wounds in his neck caused his throat to swell, crushing his windpipe and forcing the doctors to sedate him. They sliced his neck open to relieve some of the pressure, leaving a large scar that runs from his left ear to the base of his neck.
I had seen James two weeks earlier at a British Army base at Sangin, Helmand province, where I had been sent to report for The Sunday Times. I was at Camp Bastion, waiting to go back out into the field, when I received a phone call telling me my brother had been seriously wounded. When I entered the intensive-care unit, he was on a bed, eyes closed, a ventilation tube in the side of his mouth and IV drips dangling from his right arm.
His bloody, puffed-up face was covered in small shrapnel wounds, his left arm was bandaged and his legs were in plaster. His left eye had gauze dressing over it and there was a bloody bandage near his heart. His right hand was icy cold when I squeezed it. He had broken his left ankle and chipped the bone on his right leg. Muscle was missing from his calf and thighs where pieces of shrapnel had torn into him. His left eye was a huge concern. It still had shrapnel lodged inside.
I flew home on the same military plane as my brother and a group of other wounded soldiers. Five days later, James woke from his drug-induced coma. “I’m sorry, Dad,” were the first words he spoke as he lay in Selly Oak’s intensive-care unit, his face still swollen, his hair still caked in blood and Helmand dirt. In the bed next to him lay Lieutenant Alex Horsfall, the platoon commander who James had been sent to replace.
The Ministry of Defence would not let me interview or photograph wounded soldiers in Selly Oak because they said it might slow their recovery. But over the next two months, when I visited daily, I was able to speak to the soldiers as the relative of a wounded soldier, giving me access to a hospital that is closed off to the press. Later, when James was moved to Headley Court, I followed many of the same men as they began the long process of rehabilitation.
On Ward S4, patients are a mixed bag of civilians and wounded soldiers, tended to by an assorted team of nurses and doctors from the Army, Royal Air Force, Navy and NHS. Most of the soldiers had been blown up by IEDs. Many suffered hallucinations as they woke from their sedated slumbers; some thought they saw Taliban snipers trying to kill them. Most of them couldn’t remember how they were wounded; some couldn’t even remember what they had done the day before they were blown up.
They had lost eyes, limbs, fingers, chunks of flesh and muscle; they had broken arms, crushed lungs, brain damage and burns. The amputees suffered crippling pain in legs and arms that did not exist and some were haunted by flashbacks, waking up in cold sweats screaming as they stepped on imaginary IEDs night after night.
Nurses watched the soldiers reach for and then load imaginary rifles as they struggled to wake from their sedation. One sergeant major still thought he was on the battlefield when he woke and began to order imaginary soldiers to attack enemy positions. He only gave up his command when another soldier dressed in combat fatigues ordered him to stand down. Doctors in Bastion have introduced drugs to combat the psychological side effects of the morphine, but the soldiers continue to suffer hallucinations and flashbacks.
Lance Corporal Martin Tye’s last memory of Afghanistan was buying cigarettes from one of the Afghan-run shops on the main British base in Kabul. He awoke from his coma 11 days later, having survived a massive suicide bomb. The broad-shouldered 26-year-old, whose body was blown out of his vehicle by the force of the blast, lashed out at the nurses as he came round, punching and swearing at them. “I thought I was in an Afghan hospital surrounded by the Taliban. The nurses were telling me that they were only keeping me alive so they could behead me later. I was quite scared,” he said, wincing in pain from the 20in shrapnel scar across his belly.
For many, the severity of their wounds also took time to sink in. Some refused to believe they had lost legs and arms; it took others days to accept they were in hospital in England.
Lt Horsfall, a charismatic 26-year-old Eton-educated officer, was told the moment he came round that he’d lost his leg. “What the hell are my parents doing in Afghanistan?” was his first thought. “I couldn’t remember anything. I apologised to my mother, saying I was going to lose the leg. I wasn’t sure my leg was gone. Despite what I was told, I thought they had made a mistake because I could still feel it. It was dangling through the bed at 90 degrees,” he said.
Five days later, he told the nurse that his leg hurt. She explained again that he’d lost his leg in the explosion. He still refused to believe her. “Then she grabbed my hand and made me feel where I thought my leg was. That’s when it sunk in,” he said.
Lt Horsfall, who also lost three fingers on his left hand, broke his jaw, arm and eye socket and was left with a number of gaping flesh wounds all over his body, spent the first night dictating letters to the families of the five riflemen killed when he was wounded. “I couldn’t remember the patrol, so it was hard to come to terms with their deaths. The worst thing about it was that I couldn’t get to their funerals. I was asking the nurses to put me on a chair, but I had blood coming out of my mouth, nose and ears. It wasn’t feasible, but I was bloody annoyed at the time,” he said.
L-Cpl Tye also woke up to news that an American soldier had died when he was blown up. The death of the soldier, whose body was found on top of a nearby building after the explosion, began to play on his mind. Feelings of guilt crept in. “Someone died under my command. It upset me a lot. There’s always the possibility I made a mistake,” he said. “I am not a coward so I am pretty sure I would have done everything, but I like to know things in black and white.”
It was difficult to watch the soldiers come to terms with their injuries. The morphine they were given to numb the pain made their eyes move sluggishly. I thought I could detect cries for help. As I watched them lie on their backs, barely moving, heads lolling to the sides, it was easy to believe that many had given up on life. At first, I found it hard to look at them. I tried not to catch their eyes or look at their wounds.
Rifleman Daniel Shaw, wounded soon after my brother, lay next to James in Selly Oak. He had lost both his legs in a bomb blast in Helmand as he cleared a patch of ground for a resupply helicopter to land on. He remembers watching his right leg hanging off the side of the stretcher, attached only by a flap of skin. “When I woke up in Selly Oak that’s when I started flipping out because the right leg was gone. I thought because the leg was still attached when I got to Bastion they could save it,” the 18-year-old from Milton Keynes said.
He started to scream at the nurses, ordering them to bring him his leg. They told him they couldn’t so he asked where it was.
“I wanted the ashes, but the nurse said she couldn’t get that for me either. I went to sleep and woke up the next day and I just went, ‘Right, my legs are gone, there’s no point in moaning about it. There’s no point in being suicidal. I might as well crack on.’ ”
And it was like that for many of the soldiers in the early stages of their recovery. Most had their low days, days when they battled their demons. I saw it written in their eyes and etched on their faces. I saw it in the way they became unresponsive to their nurses, doctors and family members. In others, despondency turned into anger and frustration, often directed at the family members who fussed over them. But as the weeks passed and the soldiers began to recover, putting on weight, lifting themselves into upright positions and talking to each other, I watched them come back to life. Their resilient personalities began to plug the mental fissures ripped open by the bullets and shrapnel. They didn’t want pity.
Lt Horsfall would use his stump to wave at people as they passed his bed. Some would invite us to look at their wounds, others would let us touch the skin grafts and pieces of grit and rock still lodged in their flesh.
But despite this, it still took the soldiers time to readjust. Weeks after leaving intensive care and arriving at Ward S4, where the soldiers are put in six-man-bays to recover, Rfn Shaw took his first trip outside. A group of his mates pushed his wheelchair onto a patch of grass in the hospital grounds. One of his friends stood up to go to the toilet and Rfn Shaw instinctively followed, pushing himself out of the wheelchair with his hands. He fell onto the grass, stumps first.
“I still thought I had legs. It hurt a bit,” he said.
Ward S4, funded by the military but run by the National Health Service, was set up after the government closed Britain’s seven military hospitals. At the end of the cold war, the armed forces began to reduce the number of its service personnel. An MoD review concluded that this reduction would also decrease the number of military patients needing treatment. The number of military hospitals in Britain was subsequently cut from eight to three, with 300 beds available in the NHS if needed.
In 1994, another government review recommended closing two of the remaining hospitals, leaving only Royal Hospital Haslar in Hampshire open. But in 1998, the government decided to close Haslar as well, arguing that the range and number of cases were not sufficient enough to maintain the skills required by military doctors, surgeons and nurses working there.
Brigadier Chris Parker, who heads the Royal Centre for Defence Medicine (RCDM) at Selly Oak, explained: “If you’re a surgeon you need to be seeing 30 major cases every year to improve. In the military hospitals, we were seeing a lot of knee jobs and not much else. We needed to put our people in a busy hospital like Selly Oak.”
The RCDM was initially set up as a centre for academic research. Breakthroughs in first-aid for battlefield casualties were made with the arrival of quick-clot bandages like HemCon — made from a substance found in shrimp that can stop extensive bleeds in 30 seconds — tourniquets that can be applied with one hand and the ability to produce platelets in the field. Military doctors were soon able to boast that a soldier had more chance of surviving a bomb blast in Afghanistan than a road-traffic accident in Birmingham.
But the RCDM was never meant to perform the additional task of treating the war-wounded. After the invasion of Iraq in 2003, as the number of casualties and the complexity of their injuries started to increase, the MoD and the Department of Health decided that wounded soldiers should be treated at Selly Oak, the UK’s busiest trauma hospital, which is near an international airport. “For the sorts of cases we get, we need lots of specialities to be able to come together. There’s nowhere in the country that’s seeing as many complex cases,” said Brig Parker. “We would never be able to provide the level of care that our wounded soldiers need if we went back to the old military hospitals.”
Selly Oak has come under heavy criticism for treating soldiers in the same wards as civilians. Reports of the wounded waking up next to drug addicts or being verbally abused by Muslims incensed the then-head of the army, General Sir Richard Dannatt, who called the mixed wards “unacceptable”. The NHS denies that soldiers were abused in Selly Oak, saying that the false allegations were demoralising for NHS staff who are “enormously proud to be treating the war-wounded”.
“There were those in the military who would have loved to see the system fail, who wanted to go back to the military hospitals,” said Dr David Rosser, the medical director of the NHS trust responsible for Selly Oak. As the fighting in Helmand intensified over the summer, the number of casualties returning from Afghanistan rose. On average, for every soldier killed in Afghanistan there are another four wounded, many seriously. The six-man bays on Ward S4 were soon packed.
In July 2009, when my brother was wounded, there were 35 soldiers being treated at Selly Oak. The MoD only recently started to publish the number of soldiers wounded in Afghanistan, finally opening the public’s eyes to the ferocity of the fighting in the south of the country.
In April, the total number of soldiers visiting the operating theatre at Selly Oak was 11 a week. In July, this amount rose to 110. “This level is not sustainable unless we do something more permanent. It is sustainable for a week, not for months,” said Dr Rosser. “The problem is that the military can’t tell you how much longer this will go on for.”
Medical staff were extremely dedicated and highly skilled, but often in short supply on S4. Soldiers were often left in pain because nurses and doctors were too busy to sign off on morphine prescriptions. Some soldiers complained that the approach to their recovery was poorly co-ordinated, with no single person in charge of their overall care. Some said they never knew who their doctor or consultant was. Others complained that they were discharged too soon or given the wrong drugs to take. “They were rushing people out of there,” said L-Cpl Tye, who was left without morphine for five hours on one occasion. Soon after he left Selly Oak, the wound in his abdomen opened up, causing him to wince with pain every time he moved in his wheelchair. He was then told it might be infected.
“I don’t blame the nurses because they are rushed off their feet. They do an incredible job. At the end of the day they are under a lot of pressure, but it’s still not good enough. They need to find more staff and more bed spaces,” he said.
Ward S4 is funded by the military, but managed by the NHS. They can buy extra bed space for civilian patients. But some in the army believe the ward needs to be run by the military instead; NHS staff would still work there, but the ward manager would be a military officer. This is a change that many hope will occur when Ward S4 is transferred to the new, state-of-the-art, Queen Elizabeth hospital in Birmingham, which opens in June next year.
Soldiers spend from two weeks to five months in Selly Oak, depending on the severity of their injuries. Amputees who have not suffered injuries to other parts of the body often recover faster once they have reached Ward S4 than those with internal or more complex injuries. Army welfare officers look after the families while they stay for free in accommodation on the hospital’s grounds or in nearby hotels. The military pays for their meals and train tickets if they need to travel to and from the hospital. Military liaison officers bring the soldiers pizzas and organise trips to football games. Psychiatrists are on hand too. On leaving Selly Oak, soldiers will be sent to Headley Court, the military’s rehabilitation centre in Surrey, where they are fitted with prosthetic limbs and given physiotherapy.
In Ward S4 many of the soldiers had lost as much as 3st in weight. Their ashen faces were gaunt and drawn. Some were barely able to speak or move for the first week as the nurses slowly weaned them off the high doses of morphine used to sedate them and to relieve the pain. Men who had once been at the peak of health now looked down to see the outline of their ribs poking through their puffy skin.
Some found that their move onto the ward set them back. Some caught MRSA and were isolated in the ward’s outer rooms. Infections from the dirt blasted into a soldier’s body during an explosion sometimes spread into healthy limbs, resulting in further amputations or more operations. “There have been some fungi that we have struggled to treat,” said Dr Rosser. “It is a process of trial and error. The guys injured in water come back from Afghanistan with different bugs to those injured on land.” Soldiers say the Taliban lace IEDs with bacteria from untreated sewage streams, increasing the chances of infection.
The soldiers in Ward S4 made constant trips to the operating theatre. Flaps of remaining skin were patched or folded on top of open wounds, shark skin was sometimes used to cover burns, and dying tissue was gradually taken from amputated limbs to ensure that the soldiers kept as much of their limbs as possible. The relentless trips weakened them further.
Lt Horsfall’s left hand was mangled in the blast that left him without his leg. Surgeons in Bastion folded back the remaining flaps of skin from the three fingers severed in the explosion onto the top of his hand. Then, in Selly Oak, they sliced open the skin on his stomach and stitched his hand, still attached to his arm, inside the pouch this created, allowing the blood vessels to regenerate the tissue. After his hand was removed from the pouch, he could feel his belly every time someone touched his hand.
Despite the constant operations, flashbacks, phantom pains, raw memories and life-changing wounds, the soldiers remained stoic. There were only six legs between the six wounded soldiers in my brother’s bay. And yet I watched them laugh about their wounds, hit on the nurses and play practical jokes on each other.
Lt Horsfall told my brother that the nurses only liked him because they were after his compensation money. Once they were in their wheelchairs they invented a game called “leg jousting”, which involved Lt Horsfall sticking out his remaining leg and charging at my brother in his wheelchair. It inevitably ended in them missing each other. Both of them only had one hand that worked.
Before going to Wishtan, my brother had posted a message on Facebook that read: “Jim is treading lightly,” a reference to the IED threat there. After he was wounded, a fellow officer, who had passed out from Sandhurst with him, posted the reply: “Clearly not lightly enough, clumsy.”
Rifleman Paul Jacobs, who lost his right eye in an explosion and took shrapnel in the left, leaving him partially blind, would deliberately bump into the food trolley and then roll a marble across the ward’s blue linoleum floor, shouting “my eye, my eye”. The nurses were horrified. The 20-year-old, who boasted about earning the “Queen’s shilling”, would ask the nurses for their hands and then begin to feel along their fingers in search of wedding or engagement rings.
“They’re unbelievably positive and they always surprise you,” said Alice Croft, an intensive-care-unit nurse at Selly Oak. “They make us laugh, they ask us out when they wake up. They find a way of dealing with the massive injuries they have and taking it on the chin. Sometimes you’ll see them beating each other with crutches.”
The soldiers played Top Trumps with their injuries, asking each other to swap parts of their bodies or to exchange their wounds. They argued over who had the most disgusting wound and joked that they could probably find parts in horror films if they tried. “Once you can talk about your wounds then they become something so boring you get past them and come to terms with them,” said Lt Horsfall, who asked visitors to use their fingers to plug the hole made by the tracheotomy in his neck so he could clear his ears.
Many refused to accept that they’d done anything heroic. I asked one of the soldiers whether he’d get a medal equivalent to America’s Purple Heart, automatically awarded to US soldiers wounded in action. “No. That would be like admitting you’ve got shit drills,” he replied. There was laughter when they received care packages from a local nursery school that included socks. “What the hell do they think I need these for?” grinned a double-leg amputee.
At times, the mood on S4 turned sombre. The death of a friend, a commander or a comrade reminded them of the soldiers still serving in Afghanistan. Most felt guilty that they were not back with their men. Many itched to return to the front line. Nor were the soldiers afraid of making political statements. When Gordon Brown came to visit them on the ward in September, the majority drew the curtains around their beds and refused to talk to the man they felt had failed to provide them with the resources needed to carry out their job effectively in Helmand.
You only had to look around the ward to see the brutality of war. The complexity of the counter-insurgency being waged in Afghanistan was reduced to the four walls of Selly Oak. We — the families — were seeing the war up close. We sat in the hospital’s cafeteria discussing amateurishly the pros and cons of the war. We tossed our penny’s worth into the ring of public opinion, arguing about the lack of helicopters, troop increases and battlefield tactics. We picked holes in military strategy and expounded the virtues of our brave lads and the sacrifices they made. We were all armchair generals for a while. I still ask the same questions. But the answers are never clear.
All I can say is that when I saw my brother standing in the pouring rain on a grassy field in Northern Ireland, clutching his Afghan campaign medal in the hand that still worked, I cried. I remember Lt Horsfall telling me after the medals parade that he would have found it extremely difficult to lead his men in Helmand if he believed that what they had been sent to do was wrong. And I would want to believe that too, if I had sacrificed men and limbs for a cause.
To my surprise, nearly all the men I spoke to wanted to return to an active role in the army. They said they had no regrets about joining. “I am one of the Queen’s soldiers. This is me until I die,” said the partially blind Rfn Jacobs from London’s Kennington Park. “Once I have a sword and an eye patch I’ll be fine.”
Few had thought about the consequences of signing up. “You are immortal,” said one officer. “Before you’re wounded you just feel untouchable. You don’t think people are going to get blown up even if you’ve seen others get hit.” But some of the soldiers felt angry. “There were days when I felt shit,” said Sapper Weston. “I didn’t see the point in going on. You see murderers in prison that are completely fine. They don’t contribute at all, they waste oxygen. You think, ‘Why did it happen to me?’ I never harmed anyone.”
Rifleman Craig Wood, who lost both his legs, his arm and part of his nose and lips when he was blown up three months after his 18th birthday, said he also questioned why others were better off than him. “I had one really bad day in critical care. It was a good day of crying. It was more that I felt sorry for myself. But then I thought, no, you have to overcome it. My girlfriend is 16 and really mature. I thought, ‘If she’s not breaking down then I am not going to,’ because I couldn’t have a 16-year-old behaving better than me.” Rfn Wood also suffered a collapsed lung, a swollen brain and a broken jaw. He is still partially blinded from a piece of shrapnel that flew into his left eye. Soon after he woke up in intensive care, his girlfriend proposed to him. He accepted.
My thoughts always returned to their futures and how they’d cope with a life that would be entirely different to the one they had grown up knowing. Sapper Weston, sitting on his hospital bed in Headley Court, the stumps of his legs poking out from the bottom of his torso, told me that he had forgotten what it was like to walk. “That’s another thing that was quite hard. I can’t remember what it was like having legs,” he said.
The hardest part for many was the realisation that they would no longer be able to do what they had done in the past. “As the days progress, you find more things you are going to struggle to do. I can’t cut my food; it is difficult to dress myself, difficult to write anything,” said Lt Horsfall.
Although my brother has made a good recovery, the skin graft on his left arm has stuck to the bare tendon, preventing him from moving his wrist. Smashed bones in his thumb and fingers mean that he can’t move his hand fully, and he walks with a limp if he over-exerts himself. He counts himself lucky, despite not being able to see properly through the scar tissue on his left eye.
To overcome the boredom of hospital, the soldiers set goals for themselves as they lie on their beds — learning to write using hands that lacked thumbs and fingers; learning to walk on prosthetic limbs or using their new legs to drive or ride with. The partially blind Rfn Jacobs wants to climb Mt Kilimanjaro when he left Selly Oak. “All I did was get blown up,” said one officer. “You can see sympathy in some people’s eyes, respect. People call you a hero. But I don’t feel like one.”
When Rfn Shaw went clubbing in Milton Keynes for the first time after leaving Selly Oak, the bouncer on the door let him jump the queue. “I still go out clubbing every time I go home. Going clubbing in a wheelchair with no legs is great. You never have to wait. So getting blown up has its advantages,” he said.