Seeking a break with the violence, I've told myself stop reading news before bedtime. They're too disheartening, too harsh, too mean, too terrifying. Gazing at electronic devices in our bedrooms isn't recommended anyway; their blue-spectrum screen light is going to inhibit the production of melatonin and throw off circadian rhythm. That's why I choose to read before sleep.
What do you think I have been reading lately? Another heartbreaking topic, ironically. A book written by David Nott, a Welsh vascular surgeon who has worked voluntarily for twenty-five years in disaster and war zone. He ended up with deafness after a bomb blast near the hospital in Aleppo and post-traumatic stress disorder from the humanitarian work intermingled with inhumane scenes. His book War Doctor: Surgery on the Front Line is basically a story of love which, to quote from David Nott, "isn't always tidy, and isn't always easy."
But first, a story.
One day, David Nott volunteered in Gaza where blast injuries were as common as pneumonia in our emergency room. He came across a girl who looked about seven years old, lying in the corner with extreme pallor and thread radial pulse. David Nott removed the blanket circumspectly and found a fragmentation wound to the girl's left arm without radial pulse. If you thought it was the worst scene you should think again. Alas, it wasn't simply arterial injury from the blast injury; her small bowel was hanging outside her body.
It's almost every doctor's definition of major trauma. David Nott knew very well the girl couldn't wait; her chance of survival dwindled with each passing second. He stared at the girl, mouth agape, and made a quick decision to scrub up. No sooner had the girl been put to sleep by anaesthetist than the door of the operating theatre flew open. It was the hospital security manager. "We've got intel that says the hospital's going to be attacked by shelling in five minutes. Everyone out."
The scrub nurse panicked. The security manager began shouting. "You have to go! Now! Right now!"
David Nott looked at the girl's blood pressure monitor, which read around 60 systolic. He knew he himself might die if he stayed. At the same time, he knew the girl would definitely die (in minutes, not hours) if he left. Leaving the girl alone on the operation table meant that she would die. He turned to the anaesthetist and said, "You can go, you don't need to stay."
"Are you staying?"
"I'm staying."
"Then I'll stay with you."
The story went that only two of them stayed behind to continue the abdomen surgery and radial artery repair, when all other medical and nursing staff were evacuated. The scrub nurse had left a lot of unopened swabs for David Nott. That wasn't a very logical decision, but David Nott could not bear to see another injured child die. The girl did survive miraculously, and so did the altruistic doctor.
David Nott didn't simply save the victims of the war. He saved the life of anyone in need. Once he had to operate on a Taliban fighter who'd been injured making improvised explosive devices. David Nott is often being asked how he can square his humanitarian work with saving the life of someone who might go on to making something that kills British soldiers or innocent civilians.
"I don't get to choose who I work on," David Nott says. "I can only try to intervene to save the life of the person in front of me who is in desperate need of help."
It's difficult to conceive of a doctor who teaches better than Hippocrates. But David Nott does.
