CHAPTER 10

Sabotage

In 2007 I received an email from a man called Steve Sosebee. He was the chairman of a charity called the Palestinian Children Relief Fund or PCRF. He asked if I would be willing to provide heart surgery for children in the West Bank and the Gaza strip in occupied Palestine. I explained that my entire training in paediatric heart surgery was a mere six-month stint as a registrar in Glasgow, and even that was about 20 years previously, so I truthfully did not feel either qualified or capable of saying yes. He then asked if I would consider operating on adults, since they were just as desperately in need of heart surgery facilities, and he explained that the PCRF, despite its name, was willing to fund and support all types of medical treatment, even if it did not involve children.

At the time, Gaza was in violent political turmoil, but the West Bank had been reasonably peaceful for a while and was, in theory at least, under the administration of a limited form of government called the Palestinian Authority. I said that I would consider going to the West Bank if I could bring with me a medical team with whom I was familiar, and Steve Sosebee readily agreed. We would go for a week in the first instance and, if the mission was a success, consider coming back at regular intervals. We fixed a week in 2008 and I set about securing the necessary leave arrangements from my own hospital and assembling the team.

At the time, Yasir Abu-Omar was a senior registrar approaching the end of his training at Papworth, and he, like me, was of Palestinian origin. It was very easy to persuade him to join the mission as second surgeon. What was surprising, however, was how easy it was to persuade the rest of the team, none of whom had any Palestinian connections. Jon Mackay, consultant anaesthetist, David Gifford, perfusionist, Steve Bryant, surgical care practitioner, Tracey Tritton, scrub nurse, and Karen Marsden, operating department practitioner, all said yes without a trace of hesitation. They were people with whom I had worked for years, and every one of them was highly capable. I also trusted them and, perhaps more importantly, really enjoyed working with them.

We started to make our travel arrangements. I had thought that, being of Palestinian origin, my arrival at an Israeli airport may raise eyebrows, and that I might be given the third degree by immigration officials in terms of questions about my intentions for travelling via Israel; so I resolved to travel through Jordan and to cross the Jordan river directly into the West Bank and, once there, head for our destination city of Ramallah. Yasir, David, Steve and Karen decided to accompany me, whereas Jon and Tracey opted to fly via Tel Aviv. We packed our surgical instruments and set off.

My group landed at Amman Airport in Jordan, stayed one night at the airport hotel and set off for the Jordan river crossing the following day. After barely a two-hour drive through the dramatic scenery of the steep mountain slopes descending towards the river valley, we were at the crossing. We negotiated the formalities at the Jordanian East Bank of the river border without difficulty, then sat on a bus that carried us through no-man’s-land across the Jordan river to the West Bank, where, I must admit, I was surprised to see the immigration building with a large and unmistakably Israeli flag fluttering over it. In my utter ignorance of the practicalities of the status quo, I did not realise that the border crossing between Jordan and the West Bank was actually controlled by Israel. The Palestinian Authority had some autonomy in the West Bank, but this clearly did not extend to border crossings. So much for trying to avoid Israeli immigration officials!

I stood in a queue with our four passports clutched in my hand. When I reached the front, the Israeli officer was all smiles. She asked a few questions, checked the passport photographs against their holders and made pleasant conversation while she stamped them. I even thought for a moment that she was being more than friendly and that she was almost flirting.

‘And where will you visit in Israel?’ she asked as she was handing back the passports.

‘Ramallah,’ I said in reply.

She snatched back the passports and her expression immediately turned formal.

‘Why Ramallah?’ she asked.

‘We’re a medical team, hoping to provide some heart surgery and training,’ I said.

‘Sit there!’ she ordered, and disappeared with our passports.

We sat and waited. Some two-and-a-half hours later she reappeared, gave us our passports and allowed us to continue our journey. We also recovered our bags and noted that every single one of them had been opened and doubtlessly closely inspected, but all our instruments were still there. We climbed into a taxi and set off for Ramallah as previously planned. Our route took us quite close to the huge separation wall that snaked across the West Bank, keeping the native Palestinians well away from the Israeli settlements built on their territory. The wall was covered with graffiti, some of which was quite artistic: the enigmatic British street artist Banksy had in fact decorated the wall with brilliant images full of his usual iconoclasm and sedition, but I do not think he was responsible for the simple and not highly artistic graffito that drew my eye: a section of the wall had ‘CTRL + ALT + DEL’ wittily sprayed on it in very large, pale blue letters.

In Ramallah we checked into our hotel not far from the hospital in the late evening. At four in the morning I knew without doubt that Jon and Tracey had also arrived. They are each blessed with a characteristic and very loud laugh. Their laughter reverberated through the hotel corridors as they searched for their respective rooms. They must have been in very good spirits indeed.

The following morning we went to breakfast at the hotel. There was a huge buffet with dozens of tasty Middle Eastern delicacies and we all overindulged, except for Jon Mackay who stuck rigidly to his hotel portion packet of corn flakes. We then piled into the back of the ambulance sent to carry us to the hospital.

In the hospital lobby it was impossible not to notice the large portrait of a smiling Yasser Arafat, then the Palestinian President, in battle fatigues. Next to the portrait, visitors were also greeted by a black diagram depicting a Kalashnikov AK-47 assault rifle with a red line through it and the legend: Dear citizen, bearing firearms is prohibited inside the hospital.

As the rest of the team panned out to familiarise themselves with the layout of the wards, operating theatres and ICU, I accompanied Dr Edie — a general and vascular surgeon who was charged with being our local medical facilitator — to the angiography viewing room. This was the room in which were kept the results of the investigations on potential heart surgery patients, especially the angiograms, those X-ray films of the coronary arteries and heart chambers which would help us plan an operation.

The room was tiny and windowless. It comprised a small wooden desk with an old desktop computer and two chairs. It also contained what must have been over a thousand CDs of angiograms, each with a sheet of paper or more relating to an individual patient. The angiograms were piled high in cabinets, on shelves, on the floor, in and out of boxes and on the desk itself. I could not fathom a filing system. How on earth to choose patients in this situation? I discussed with Dr Edie and we agreed that, at least to begin with, we should select straightforward and relatively safe operations, and, of those, we would try to favour those patients who were desperately in need of surgery and those who had waited the longest.

Somehow, Edie appeared to have some knowledge of where such patient records could be found amid the chaos, and he selected a few dozen angiograms for us to look at. I explained that we could do only 10 or 12 operations at most in the short time we were there, but he said that we needed to select more, as some patients from our initial selection may not be readily contactable, and we should therefore have back-ups, just in case. We started to review the angiograms and the results of the investigations, a laborious process, since the desktop PC was very old, very slow and often crashed for no apparent reason.

In the meantime, word had spread that a heart surgery team was in town, and a crowd began to gather in the corridor outside the little office, with patients and their families asking to be given priority. Occasionally, they knocked on the door or, more often, they simply barged in to make their case. Despite these constant distractions, we were making slow but steady progress in identifying suitable patients, when Edie suddenly displayed a hitherto uncharacteristic excitement. He delved into a pile of angiograms, produced a CD and said, ‘Here! Look at this one!’

I looked: it was a case of severe coronary disease, needing four or five bypass grafts, but with a heart muscle in good condition in a relatively young male patient in his early sixties. His only risk factor was diabetes.

‘Why specifically this one?’ I asked.

‘Because he’s in the hospital right now, so no need to go looking for him. He came in with a minor heart attack a couple of days ago, has had a lot of troublesome angina for a long time, and what’s more, he happens to be the father of one of our own orthopaedic surgical trainees.’

We had found our first patient.

Several tedious hours later, we had selected a group of patients we considered both in dire need of heart surgery and suitable for our first venture into Ramallah. I met our first patient, whom I shall call Omar, and he was a delightful man. He had type 2 diabetes, but was not particularly overweight, and this was his only risk factor apart from his recent minor heart attack. He had a lot of angina and was really looking forward to life without this debilitating symptom. I promised him that we would deliver that and that the risk of surgery to his life would, in my hands, be less than 1 per cent. He agreed enthusiastically, and the team and I went back to the hotel, hungry and earnestly hoping that dinner would match breakfast for quality. It did. There were no corn flakes, so that even Jon Mackay had no choice but to venture into Middle Eastern food, and I think he was pleasantly surprised.

The following day we again piled into our ambulance-cum-taxi and went to the hospital. Omar was wheeled into the operating theatre and Jon quickly put him to sleep and inserted all the necessary monitoring lines. Yasir opened the chest and took down an artery from within to use as a bypass to the most important coronary artery, while Steve simultaneously took a vein from the leg to bypass the other four. I scrubbed up, put the patient on the heart-lung machine and carried out quintuple coronary artery grafting. The operation was one of the smoothest I had ever done: the leg vein and chest artery we used as conduits were of superb quality, the receiving coronary arteries were healthy and of a good size, and all in all the whole procedure was quick, easy, uneventful and most satisfying. A mere three hours after we started, the operation was over and Omar was being wheeled to the ICU.

The ICU in Ramallah is quite well equipped, but not exactly overstaffed, so there is a natural tendency to wake up patients early, rather than nurse them asleep on ventilators for most of the day, as is often the custom in the UK. Within two hours of the end of the operation Omar was awake in the ICU, having a cup of tea and chatting to the nurses and to his family, including his young surgeon son. I reflected that if all operations in Ramallah went as smoothly as this, we would have done a lot of good with relatively little effort by the time our mission came to an end.

That evening, back at the hotel, we all sat out on a large stone veranda with a post-prandial drink, enjoying the warm climate, listening to the raucous buzzing of the cicadas in the pine trees and generally feeling chuffed with ourselves. Two operations were scheduled for the following day.

The next morning I was awakened by the ringing hotel room telephone just after six o’clock. It was Yasir. For some reason, he’d woken up early and decided to phone the ICU to check on Omar. He was concerned that Omar’s urine output was a little low in the last couple of hours. He said that it probably was nothing, but he was planning to go to the hospital to see what’s what. I immediately got up, dressed and joined him in the lobby. There was no ambulance at that early hour, so we took a taxi to the hospital. Omar was sitting up in bed and feeling fine, and all his vital signs were present and correct, but his urine output had indeed dropped to less than 30 ml an hour.

As a rule of thumb, every hour a person usually pees 1 ml of urine for every kilogram of body weight, so that an 80 kg man should pass 80 ml of urine an hour. We couldn’t figure out why that sudden drop had happened, but we treated him empirically with a small dose of diuretic. There was no response, and we saw only 20 ml the following hour. We tried a bigger dose. Still no response. We tried more powerful drugs. His urine output stopped completely. We did some blood tests which confirmed our fear that he was now in acute kidney failure. Neither of us had the faintest clue why that should happen. His kidney function before the operation was as good as could be expected in a diabetic 60 year old. There was not the slightest hiccup during surgery that could have upset his kidneys. His post-operative course was as smooth as silk. Why on earth had his kidneys seized up now?

Interesting as these questions may be, they were academic. The real problem was that we had a patient with no kidney function and until recovery took place a few days later, he needed to be supported by a kidney machine. We asked for one and were told that the only kidney machines in the hospital were in the renal unit, and they were used 24 hours a day. A severe shortage of such equipment in the West Bank meant the service already could not cope with the demand, that many kidney-failure patients here were left untreated, and that there was not a chance in hell that a kidney machine could be made available for our patient. I made a quick telephone call to the renal unit and confirmed this unhappy fact. While Yasir and I were pondering what to do next, the rest of the team had arrived from the hotel. Then one of the ICU nurses said, ‘What about that machine that the Belgians donated?’

What about it, indeed? It turned out that a machine of some sort was given to the ICU by a Belgian charitable organisation, but it had never been used and was still in its box, kept in a hospital storage room. Nobody was quite sure what it was or how to use it. We asked for it to be brought to the ICU, and a reinforced cardboard box the size of a large fridge was duly wheeled in. We opened the box and, sure enough, it was a state-of-the-art kidney dialysis machine, but there was no instruction manual and the complex array of tubing needed to connect it to the patient was missing. None of us was a kidney specialist, but this machine was our (and the patient’s) only chance.

I phoned Papworth back in the UK and spoke to the two anaesthetists who were most au fait with dialysis, and got as much information from them as I could. We asked the local renal unit staff to provide us with an array of disposable tubes, filters and dialysis solutions and they readily obliged. Then David, the perfusionist, and I went to one of the few internet-enabled computers in the hospital. We googled the machine make and serial number and laboriously surfed the web until we found a PDF document containing the instruction manual. We downloaded the document, printed it out and set to work.

We placed the machine and the tubes on the floor in the middle of the ICU and — watched by incredulous ICU staff and patients — slowly assembled it, doing our best to follow the instruction manual and using whatever bits of tube looked like they might work. David’s many years of experience with heart-lung machines were invaluable in making things fit and joining the incompatible. Finally, after a few false starts, the machine worked. We connected Omar to it and almost immediately he began to feel better. Blood tests showed that the chemistry in his system was on the mend and the level of waste products normally excreted by the kidneys had started to come down.

Unfortunately, that was not the end of the story. Those very same blood tests also began to show liver malfunction. We did not believe it at first and repeated them. The next batch of tests was even worse. Omar was now developing liver failure. We did our best to treat it, to no avail. That very evening Omar’s lungs also failed and he had to be put back on the breathing machine, and overnight he continued to deteriorate. He died the following morning, despite every effort and every intervention we could think of to keep him going. Our first operation in Ramallah had ended inexplicably in tragedy, and the entire team was utterly despondent.

The following day we arrived at the hospital, but with none of the high spirits that had characterised our initial foray. The previous day’s patients had done very well, and so did the two that we took on that day, although they were at somewhat higher risk. By the end of the week, every patient we had operated on had also come through without incident, and we tried, without real success, to push the memory of the first disastrous case to the back of our minds.

We came to our last afternoon in Ramallah and to the last patient we would operate on during this mission. She was an overweight old woman who needed just a single coronary bypass graft. I vividly remembered seeing her at the initial assessment two days earlier. She was the archetypal buxom wife to her husband’s Jack Sprat. He was a thin, sun-beaten and wiry man who had tried hard to monopolise the consultation against my best efforts to direct the questions to his wife. While I was explaining to her that her troublesome angina would be cured by a bypass operation, he was constantly muttering things like ‘Why bother?’, ‘What’s the point, at her age?’, ‘We don’t want dangerous operations’, ‘Why not leave it to Allah to look after her?’ and so forth. I tried to ignore his mumblings as I continued to direct my conversation at the patient herself.

I explained to her that this operation would improve the quality of her life, but not necessarily its length, as her heart disease was not life-threatening. When I finally said to her that an important part of the decision-making is that the risk of surgery includes a small chance of death of about 1 per cent, her husband’s eyes suddenly lit up.

‘You mean she could die as a result?’ he asked.

‘Yes, of course she could,’ I said. ‘The risk of that is small, but she should know about it before making up her mind.’

His subsequent mutterings during the rest of the consultation did an abrupt volte-face: ‘Let her have the operation, then’, ‘Allah will provide’, ‘Let’s take a chance on this’ and so on. His transparently uxoricidal desires were most disconcerting, but, fortunately, the patient herself paid him no attention whatsoever. She asked some intelligent and relevant questions and decided that yes, it would be worth the risk for her to have the operation and she would go ahead.

As I walked towards the operating theatre, I bumped into a very agitated and anxious-looking Jon Mackay just outside the door to the anaesthetic room. I asked him if he was all right.

‘Never mind. Just get in there and do the case,’ he said, ‘and I’ll tell you about it later.’

About what? I insisted that he tell me there and then. He said that something very strange had just happened. He went on to explain that one of the differences between Ramallah and what he was used to in Papworth was the absence of a capnograph. This is a device that confirms that a patient on a ventilator is receiving oxygen and exhaling carbon dioxide. It is a sure-fire way to check that everything in the ventilator and its tubing circuit is in working order. Ramallah had no such machine, so Jon was exceptionally meticulous in checking the ventilator circuit. On that occasion, he and Karen Marston had prepared the anaesthetic drugs and double-checked the circuit carefully. Mrs Sprat’s obesity meant that she could be difficult to intubate for ventilation and so Karen had, in addition, deployed a bougie to help ensure the tube went into the right place, which is the windpipe.

There was a delay sending for the patient, so he and Karen had retired to the coffee room with the local team. On their return, the bougie had gone ‘missing’. This was disappointing but not life-threatening as we had a spare available. However, despite having already checked the ventilator circuit, Jon, displaying some obsessive-compulsive behaviour, decided to check it again and was alarmed to find it had been compromised. There was a disconnection leading to a leak of anaesthetic gases, which he eventually traced and located. In 20 years of clinical practice, he had never encountered such an event in a recently checked system. The location of the anaesthetic machine in the theatre and the location of the disconnection made it extremely difficult to believe that the disconnection was accidental. Moreover, it required specialist anaesthetic knowledge. Had Jon not obsessively repeated his checks, Mrs Sprat would have died from oxygen starvation soon after being put to sleep. It was this discovery of evidence of tampering with the circuit that had made him extremely nervous, and he believed that deliberate sabotage was a distinct possibility. Mrs Sprat was already in the operating theatre and the most immediate and difficult question was ‘Do we continue?’

We decided to continue. Mrs Sprat had an uneventful operation and all went well. When the operation was over, my thoughts went back to our first patient, Omar. As it happened, the rest of the team were having similar concerns and, that evening, Steve was the first to voice them. Given the unexplained and relatively late onset of sudden and fatal failure of Omar’s kidneys, liver and lungs a few days earlier, we had all started to think the unthinkable. Our last case was clearly a near-miss victim of deliberate sabotage. Was our first case equally sabotaged? Could Omar have been intentionally poisoned? This was the Middle East, and Islamic tradition requires burial within 24 hours of demise, so the possibility of a post-mortem examination was out of the question.

We simply did not know. When Omar died, we had put it down to a freak event we were unable to understand, or some complication of a systemic disease that we simply did not know he had, or just terribly bad luck. But the events around Mrs Sprat were far more worrying, because Jon had direct evidence that someone must have interfered with the ventilator circuit in the short time between his careful setting up and the start of the operation. Only our first and last patients were involved, one in a calamity that actually happened and the other in a calamity that we had only just narrowly avoided through Jon’s fussiness and perspicacity.

That night we were all invited to dinner by the Minister of Health to thank us for our efforts. After much deliberation, I decided tentatively to approach him with our suspicions. He did not seem to be unduly surprised, but did promise to investigate the matter fully and send us a detailed report of the investigations. Nine years have now passed and I have still not seen a report.

On our return across the bridge to Jordan, I was accosted by an Israeli man in uniform who declared that he was from the ‘Ministry of Tourism’. He started by asking questions about our stay that could be related to tourism, and I answered these. Then the questions deviated away from tourism into the names and addresses of my family members, friends and acquaintances, and I became suspicious. It was apparent that he was not at all interested in tourism and I refused to answer any further questions.

During that time, Jon Mackay and Tracey Tritton were on their way to Tel Aviv Airport. I had hoped that at least they would sail through the formalities easily. I was wrong. They’d had a hard time, too, and Tracey was quite reticent about it until, many years later, when I started writing this book. I asked her to let me know what happened and also asked her and other members of the expedition to check over my story above to ensure I had indeed got all the details right. She more than obliged: she wrote it all down and, having read her account, I feel that there is little to do other than reproduce it in its entirety and using her own words:

After a week away from my husband and daughter, I am finally going home. I never expected and was completely unprepared for what awaited me as I departed through immigration.

This was my first visit to Palestine. I was very moved by the political situation, in particular the impact of the Israeli occupation of Palestine and what it means to be a citizen of the West Bank.

My experience with border security throughout my visit and upon leaving Israel by plane was beyond surprising. On the drive to the airport, I felt that every one of the many checkpoints would be the one to stop us from actually making it. The second checkpoint was the worst. Jon and I were asked to get out of the taxi and lift our cases from the boot. We were asked to open the cases. One armed guard disappeared after taking our passports; the other armed guard watched us both unzip our suitcases. I felt physically sick. Here I was on my knees opening my suitcase with an armed guard stood behind me.

The other guard returned with our passports and said we could go. I remember sitting with Jon in the back of the taxi, thinking, ‘What if we never get to the airport? What if we never make it home?’ I also recall that my legs wouldn’t stop shaking with fear.

I had witnessed and experienced first-hand the daily oppression of Palestinians, yet still I was unprepared for the direct experience with Israeli security that I met at the airport.

Jon and I arrived at the airport four hours early, because travellers are told to allow three to five hours for security. We had walked what seemed like only a few yards through the terminal doors when a security guard approached us both and asked to see our passports. She asked where we had travelled from and what the nature of our visit was. We said we had been asked by a humanitarian charity to carry out some medical training and heart surgery. When asked where, I replied ‘Ramallah’. She wanted to know who originated this request and if we had any further documentation to prove this. I produced the original invitation from the Palestinian Health Minister, and the guard then walked away with both our passports and my invitation letter. Within minutes she was back and told us we could proceed to the scanning of our bags area. I honestly thought that was it; not too bad if that’s the worst questioning we get. The guard and three of her colleagues kept glancing over. Jon was calm, but I could sense he was worried. Jon normally has a wicked sense of humour, so when he suddenly turns serious and quiet I know this is a time to worry.

There was an unbelievably long queue immediately before us. Before even approaching the check-in counter we had to have our luggage scanned, but this didn’t bother me as it is now common practice in many international airports. Our luggage was scanned and then I was ushered to a nearby table for a ‘random-selection search’, or so I was told. It took a substantial amount of time as the search was meticulously detailed and conducted in the open, just a few feet from the entrance. Every single item of my clothing was taken out and put back. One item they did find of interest in my case was a plaque I had received as a token of thanks from the Palestinian charity and health minister. They kept passing it to each other and laughing, and it appeared as though they were mocking me. It was horrible.

An hour had passed since our arrival and we had yet to check in for our flight. Jon also had his case looked through, but not to the extent that mine was examined. They said he was free to go.

It was not the same for me.

I felt the presence of two guards behind me, and I was asked to go with them for questioning. My case remained open. I asked Jon to keep an eye on what might happen to it. I was petrified they would plant something in the case to prevent me getting on the plane.

As I was escorted to an area on the other side of the airport by the two female guards, I began to cry. I asked why I was being taken away. One guard appeared humane, but the other was what I could only describe as brutal.

I was taken into a room. One guard took my rucksack and passport and the other guard told me to take off my clothes. I asked if I could keep my underwear on. This they refused. Once I was undressed they ran a scanner over all parts of my body. I felt vulnerable and childlike. I could feel tears running down my face, and kept having flashbacks of images of both my husband and daughter. What if I never got home? I kept running over in my head every possible scenario that might occur, and I realised I had no control over my destiny.

They took my backpack and emptied the entire contents on the floor. They looked at the photos in my wallet, while laughing and chatting among themselves. It was horrible and unnecessary.

The guards left me standing naked in a side room of the interview area, and eventually told me to sit on the chair next to a table. One guard sat opposite me, the other stood behind me with her rifle.

I asked if I could get dressed. The armed guard behind me informed me that I could get dressed once they were satisfied with my answers during the interview.

The guard sat down and the following exchange took place:

Guard: ‘What was the purpose of your visit?’

Me: ‘We were asked by a charity to help train some staff at a hospital in West Bank and carry out some cardiac surgery.’

‘Which hospital?’

‘Ramallah.’

‘Which charity?’

‘PCRF, Steve Sosebee and the Palestinian Health Ministry.’

‘Why Palestine?’

‘I would have travelled to Israel if the invitation was from Israel. I don’t support one side more than the other. I am here to simply do my job as a theatre nurse.’

‘Who else was in your team?’

‘Jon Mackay, Sam Nashef, Yasir Abu-Omar, David Gifford, Karen Marsden and Steve Bryant.’

‘Where are the rest of the team?’

‘Still in Ramallah.’

‘Will they be travelling later back through Tel Aviv?’

‘Yes.’ (I knew this was not true, but I didn’t want to cause problems for the rest of the team getting out across the river to Jordan.)

The questions continued for over an hour and a quarter. My legs continued to shake. I remember sobbing, with tears running down my face on to my bare body. I kept asking please could I at least wear my top. The guard with the gun shouted at me and told me to stop crying and be quiet. I think it was at this point that I lost control of my bladder. My dignity was totally destroyed. I felt humiliated. Both guards were laughing at me and speaking to each other in Hebrew. I desperately wanted to get out and go home.

Eventually, the guard who sat opposite me said they were satisfied with the questioning and I could get dressed. They would escort me back to my case and to passport control. This would give me only 15 minutes to get through passport control and board the plane.

I continued to sob. The armed guard threw my clothes at me and said, ‘Be quiet! Get dressed!’

The other guard tried to comfort me by saying that what I have just gone through is routine and normal.

I continued to cry and asked them why they were doing this and they both looked at me and laughed. I was then escorted back into the airport complex.

At passport control I was greeted by Jon. He gave me a huge hug and tried to make light of the situation by saying, ‘You should have told them you’d killed a Palestinian, Tritton!’

Typical Jon humour, but all I could do was sob and think that it wasn’t over until I was on that plane and it had taken off, and I knew for sure I would be safe and on my way home.

I was ignorant of the details of what had happened to Tracey and remained so for many years until I actually read the account above. I was, nevertheless, seriously perturbed by the events that had already transpired, and so, in our last few hours in Ramallah, I had taken the opportunity to ask questions. I found out that similar ventilator ‘problems’ had afflicted and occasionally killed heart patients operated by visiting surgeons in the past. I was told that there was quite a bit of political and professional rivalry in the medical world around Ramallah, and that it was not in some people’s interest for a heart surgery programme to succeed there. I also found out that the Israeli intelligence services are known to recruit collaborators in the West Bank to do their dirty work, and the Israeli authorities had made it abundantly clear that they were not too keen on our mission, but would any of these people stoop so low as to risk killing patients?

To this date I truly do not know the answer to that question. Recently, Amir-Reza Hosseinpour (a superbly skilled paediatric cardiac surgeon from Seville in Spain, who had trained at Papworth in the past) led a mission to Ramallah to start a paediatric cardiac surgery programme there, along the same lines as ours, but aimed at children. Every operation he carried out went without a hitch.

Meanwhile, Jon Mackay read Tracey’s account of the airport shenanigans and, sense of humour still intact, suggested that this book be entitled The Naked Scrub Nurse. Although Tracey laughed at the tasteless joke, neither she nor I were very keen on the idea.