12

Birmingham

GATHERING. While the aircraft is in the air, other messages are going out to the next of kin of the injured soldier. The staff in the casualty’s regiments reach for the records that tell them names and addresses of the families whose lives have changed at the same moment without feeling the heartbeat under the soil or the dust settling. Contact, this the most dreaded of all messages, no easier with speed and emails and smartphones than it was a century ago, when streets’ worth of families with soldiers at the Western Front dreaded the arrival of the postman and the slow walk up to their door. By 1918 one mother could no longer stand even the sight of a letter, so her husband had their post delivered to their neighbour, every piece of it, and she checked it carefully and then put a geranium in a pot on her kitchen window sill to indicate that it was safe for him to come and collect and read out the letters from their son that meant he lived still.1 In the twenty-first century ‘kin’ is a more fluid term than previously. Family members, loved ones, previously loved ones, loved ones who can barely stand to be in the same room as the others – all the complications temporarily swept away by the sudden presence in a drive, on a doorstep, of someone who has somehow always been there but only today become solid and breathing, hand out, introducing themselves.

As the casualty notification officers ask if they might come inside to talk, time, in the lives of the family, gains an extra second, like a leap year, but one that will always be a part of their chronometry. The second before they know, the second when life is normal and ongoing and where they could decide to close the door and not hear the words ever, the second every morning just as they wake before they remember and it all comes crashing down.2 Suddenly, everything becomes very formal, as they are asked by someone they may know well, who is wearing the regimental tie that is suddenly not a welcome sight, who knows perfectly who they are, if they are the person named on the Next of Kin form as the first person to be told. Sometimes, often, when they are asked ‘Are you …?’ they say NO. No, I am not that person. They try to get back to the second before, blink and wake up, but they are asked again and somehow they move inside the building, and then next comes the news, of injury, its severity, or of death. A second officer then joins them, usually from a car waiting outside, and the practical necessities begin.

The heartbeat under the soil, rippling out, round and further, dust settling and then blowing up again in sudden, blinding gusts. Other phones ring, siblings, exes, best friends. Deciding who to ring first, finding they are out, trying again and again. Allocating the job of notification within the family group to those beyond – someone has to ring them, and the others and then more others, and if they aren’t there, find someone who can tell them. Find them today. Minimise will only hold so long at Bastion, and then the news starts to leak out to comrades and families. The military sends out text messages to advise of casualty or loss to the whole battalion. It will be on the news. Mobile phones are wonderful things except when the signal is patchy, as it was for Mark Ormrod’s girlfriend, who was told by his twin sister standing out in a cold garden trying to find a signal on Christmas Eve.³ Sometimes the message coming through is patchy in other ways: Mark’s family were told that he had lost one leg when it was actually two, and an arm.

Telling of death is simpler and yet infinitely harder than telling of injury. What will happen after a death is the same every time, and it will be days before those told are reunited with those gone, standing in the family room at the same RAF station at Brize Norton where the CCAST team wait, while a coffin is unclipped from the stanchions on the Globemaster and slowly brought down to the ground, ordered step by ordered step, in time.

Injury is more complicated. So the casualty notification officers keep it simple. The loved one is very badly injured, but strong enough to move, they will need a great deal of treatment, including surgery and all the details will be explained to you when you get to Birmingham, so you need to gather up yourselves and whoever else you need with you and get there and by then they can tell you everything. And this is when you should aim to get to Birmingham, as close to the arrival of their loved one as possible so there isn’t too much waiting around. Birmingham, as all military families know by now, means the Queen Elizabeth Hospital in Edgbaston, which contains the designated ward and Critical Care facility for military patients and, unsurprisingly, specialises in trauma and orthopaedics. The main military ward used to be at Selly Oak, not far from Edgbaston, but unexpected survivors needed more than the facilities of a hospital that had treated casualties going back a century to Passchendaele in 1917. So the ward was moved inside the brand-new university hospital (although to keep it simple, from now on I’ll use the term ‘Birmingham’ to cover both).

So they get themselves to Birmingham, phones ringing all the way, and meet in the car park. Sometimes as they wait for everyone to get there, they hear the police sirens that escort every ambulance carrying a casualty to the hospital, and then they see another group across the car park, gathering together, waiting, same red eyes and staggered steps as if at any moment the earth would crumble under their feet, and they don’t want to go in with them, because this other loved one is sure to be worse off, closer to death, less recognisable. And then what do they say in the lift up to wherever it is they are both going? What will they say – how will they even be supposed to look the first time they see their own loved one? Other people parking their cars, with ordinary appointments for ordinary conditions in ordinary lives, see them gathered in their tight tangle of arms wrapped around each other, and look up from their appointment letters with the directions to consultants’ rooms and halfway up the stairs realise why the knots of people are there.

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And all the while, in the ambulance, patient and CCAST travel along a carefully planned route into the city, police getting them through the Birmingham traffic as fast as possible, because they could hold the casualty steady for only so long at the end of this journey. Cars, motorbikes, even mountain bikes, who moved around them, and held back lines of traffic so they could pass, evenly, without stopping, with sirens in the background while the CCAST nurse sat with the patient and thought about the conversations to come. Then unloaded and into a separate entrance from the public ones at the hospital. Elsewhere in the building others gathered to wait for the patient in the ambulance with the police siren escort. Much earlier in the day came a signal from Bastion, a bleep to the on-call trauma registrar, and a MIST report – very basic information:

Mechanism of injury

Injury sustained

Symptoms and vital signs

Time of wounding.

The junior trauma surgeon who had been at Bastion had been promoted and had become a military trauma registrar. It was his bleep that went off, just after the 9-Liner was received, and even though he was driving in to Edgbaston, a little bit of him always went back there into the desert, waiting in a trauma bay, knowing what was about to be rushed from the Chinook into his hands. But at home his job was different. Because of his experience in Bastion, he knew what every element of the MIST report meant, and so he could summon exactly the right team – whoever he wanted for the injury on its way to them. The military trauma registrar had the power to get the most senior consultants in the country out of bed, into scrubs and ready to work. They came to The Bunker – a very basic room, not really very bunkerish. Whiteboards populated the walls, and the military trauma registrar started to write on these with the patient’s information, but he didn’t need to write much because they all knew what was coming. Then they started planning what would be definitive repair – hopefully, the repair that would stand the new human being in good stead for the rest of their life. A line was drawn and held by MERT and at Bastion, but at Birmingham patients were in Critical Care for weeks and months, not just twenty-four hours. For multiple surgeries. Back and forth, in and out, again and again, ‘where multiple trips to theatre should not be seen as failure but as providing a high standard of evidenced-based care’.4

And while the men and women in The Bunker planned the restoration, the patient moved from the ambulance, up in the lifts, on to the Critical Care unit. Lines and tubes, take care, just like CCAST, and the next thing, simple: a wash. Their flight was long, and even though the CCAST nurses did their best to keep their exposed skin cool and clean on board the flight, they got hot and sweaty and had to be peeled off the mattress when they arrived. So, before they were put in a proper bed, with sheets and pillows, they were gently cleaned, and their eyes were wiped, and chapped lips tended too, and teeth brushed, with a toothbrush and toothpaste.⁵ Made fresh, so they looked like their old selves, sort of, some of them tanned by the Afghan sun, flip-flop marks on their feet, if they had feet, still recognisable and without the smells and dust of their journey and their suffering hanging about them. Gently into bed, lines changed and checked, the first of so many tests, stumps elevated and supported with specially shaped pillows, sheets carefully replaced, and one of those little round doughnut pillows under their head, so they didn’t get occipital alopecia. (It was common, nevertheless, and became known as the Headley Halo after the Headley Court rehabilitation centre – not dangerous but really upsetting once people are strong enough to see themselves in a mirror.) And then every hour or so, until the patient could do this on their own, movement, rolling, even if it took four or five people, so that their skin wasn’t broken down under the weight of their broken body to form bed sores. And when the first set of tests came back, into theatre, prepped and waiting for them since the first bleep and MIST report, for the first dressing change, definitive repair hopefully beginning.