A Heavy Reckoning
War, Medicine and Survival in Afghanistan and Beyond
Emily Mayhew
London : Profile Books, 2017
Paperback 320pp RRP: $26.99
Reviewer: Rowan Story, September 2018
This remarkable and powerful book is about the recent British military medical experience in Afghanistan. It is as far from a dry historical text as it is possible to imagine. The author, Dr Emily Mayhew, is a military medical historian specializing in the study of severe wounding, its infliction, treatment and long-term outcomes in twentieth and twenty-first century warfare. She is historian-in-residence in the Department of Bioengineering at Imperial College in London and a Research Fellow in the Division of Surgery.
It is surely an enlightened country that can facilitate such a position. The histories of medicine in war have in the past often been written after the fact. Dr Mayhew is writing and questioning as events unfold. Her questions about the nature of emergency medical interventions are profound and would perhaps be unlikely to arise from someone from a more scientific background. Between 2001 and 2014, 456 British service personnel died and 1,981 were wounded in Afghanistan. A significant number of those wounded did not die when, going on past experience and previously accepted knowledge, they should have. These casualties have been designated as ‘unexpected survivors’.
‘In the second decade of the twenty-first century there is a small but significant group of people who have lived through situations of physical catastrophe on the battlefield previously thought unsurvivable. And there are people who have enabled that survival by standing at the limits of life and death and refusing to accept them.”
That these ‘unexpected survivors’ did in fact survive is a testament to the rapid advances of military medicine in the wars of the last 15 years. It is a truism to say that human anatomy, physiology and biochemistry are unlikely to change in the foreseeable future. What the last 15 years have shown, however, is that military doctors and scientists have become more adept and agile at recognizing how anatomy, physiology and biochemistry can be managed better for the seriously wounded casualty.
The book is divided into three sections.
Part one - Afghanistan deals with the Field Hospital at Camp Bastion and the work of the Medical Emergency Response Team (MERT) and the Critical Care Air Support Team (CCAST).
Part two – Home describes the Queen Elizabeth Hospital in Birmingham, rehabilitation at Headley Court , the complex nature of the pain associated with blast injuries and an exceptionally clear discussion
Part three – Beyond deals with the research carried out by Royal British Legion Centre for Blast Injury Studies at Imperial College, prosthetic limbs and a further examination of Chronic Pain and PTSD.
The three sections contain many first-person interviews and are linked with a narrative that describes the journey, from point of wounding to eventual rehabilitation, of the United Kingdom’s first casualty to survive a triple amputation blast injury, Mark Ormrod, Royal Marines.
The Epilogue – Medics – is an extremely sensitive, perceptive and humane examination of the almost inevitable effects of exposure to severe wounding on the treating doctors and nurses.
Emily Mayhew writes in a way that is vivid and accessible to all. At times she is blunt and at other times remarkably subtle and sensitive. At all times she is rigorous in looking for the important lessons that can be learned from the chaos of war.
Those who have been involved in the work that she describes will possibly find both resonance and recognition. For others this important book will help them to a better level of understanding.
Due to the generosity of the reviewer a copy of this book is now in the RUSI Library.