The Dressing Station: A Surgeon's Chronicle of War and Medicine
416
The Dressing Station: A Surgeon's Chronicle of War and Medicine
416eBook
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Overview
From treating the casualties of apartheid in Cape Town to operating on Kurdish guerrillas in Northern Iraq at the end of the Gulf War, Jonathan Kaplan has saved (and lost) lives in the remotest corners of the world in the most extreme conditions. He has been a hospital surgeon, a ship’s physician, an air-ambulance doctor, and a trauma surgeon. He has worked in locations as diverse as England, Burma, Eritrea, the Amazon, Mozambique, and the United States.
In his “eloquent . . . beautifully written” memoir of unforgettable adventure and tragedy, Dr. Kaplan explores the great challenge of his career—to maintain his humanity in the face of incredible pain and suffering (The New York Times Book Review). “Packed with moments of searing intensity,” The Dressing Station is an “extraordinary” look into the nature of human violence, the shattering contradictions of war, and the complicated role of medicine in the modern world (The Washington Post).
“In this refreshingly unsentimental memoir, [Kaplan] offers a vivid look at what it’s like to practice medicine in places where there are always too many casualties and not enough resources. His descriptions of surgery are unflinching . . . Kaplan gives us a remarkable self-portrait of the war junkie.” —The New Yorker
Product Details
| ISBN-13: | 9780802196590 |
|---|---|
| Publisher: | Grove/Atlantic, Inc. |
| Publication date: | 09/01/2018 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 416 |
| File size: | 3 MB |
About the Author
Read an Excerpt
CHAPTER 1
South Africa
I grew up with the expectation that I would serve. One of my mother's brothers went through the Somalia campaign as a regimental surgeon in the King's African Rifles; he'd been commended for bravery. The other had been an army engineer, clearing German minefields under fire in the Western Desert. My father spent five years in uniform, in Africa and Europe, treating casualties in tented field hospitals. His medical colleagues – our family friends – had been there too. His anaesthetist received a medal for diving off the deck of a hospital ship in the shark-thick Mozambique Channel to rescue an African soldier, maddened from a head-wound, who had thrown himself overboard. Even my dentist had a covert fame, from the time when he had worked in an army hospital in North Africa and replaced his uniform badges with ones cast in gold ('Fillings, Officers, for the use of'), easily convertible to cash during abandoned weekends in Cairo's brothels and bars.
We were a medical family: my father the orthopaedic surgeon, his brother the virologist; my mother the pathologist, her brother the urologist. In Durban, as we walked along the beachfront, we got respect. People would approach my father, expecting that he should instantly remember the history of their pain and survival. He used the trick (I have since used it myself) of asking to see their scars, and from the track of the knife he would recall first the operation, then the problem, and often, finally, their names. Among these erstwhile patients, as well as among the nurses and doctors I met as I trailed my father on his rounds through the hospital wards, the assumption was clear: I too would become a doctor, and serve. Exactly what form that service would take was uncertain: with the prospect of political change in South Africa apparently remote, there seemed no great, impending conflict in which I would be tested.
I was accepted by the School of Medicine at Cape Town University and, beneath the loom of Table Mountain, found a new burden of tradition. The university library contained the same leather-bound volumes by Wells and Kipling that my father had read. In the chemical reek of the dissecting rooms I studied the same intricate anatomy texts, and laughed at the old practical jokes involving cadaver fingers slipped into the lunch boxes of the unsuspecting. The senior anatomist – an elderly rake who wore a linen suit and sported the Panama hat, white goatee and moustache that a brand of fried chicken was later to make famous – had been there for four decades, and talked wistfully of the 'gentlemen' he had taught before the war. He would hold tea parties in his office for groups of old ladies, trying to coax them into leaving their bodies to science. Afterwards he led them on a tour of the dissecting rooms, warning us in advance to be on our best behaviour.
'Think of yourselves resting here, girls,' he would say, patting the enamel tables, 'in the hands of these young men,' and the ladies would giggle and gasp, and, presumably, be seduced.
These first years of study were basic blood and bones: anatomy, physiology, pathology and bacteriology, pharmacology. Some took their studies seriously, attending every lecture and reading textbooks into the night, but for myself and my friends there were too many diversions to learn any more than we needed to get through the examinations. The sun shone for nine months a year and white beaches surrounded us, washed on one side by green Indian Ocean breakers and on the other by the cold swell of the Atlantic. There was surfing and diving and cinemas and parties and pinball bars, and the all-night clubs near the harbour frequented by prostitutes and drunken sailors. On weekends we would leave the city to stay on farms in the wine lands or in beach cottages along the striking coastline.
It was extraordinary how frivolously we lived: in student paradise. Cape Town was a cosmopolitan outpost at the continent's tip, created by the first European settlers. Africa began beyond the city, on the bleak sand-plain known as the Cape Flats. This was the site of racially classified townships that supplied labour for the factories, and the domestic servants who maintained white homes to a standard envied by overseas visitors. Few white South Africans – apart from policemen and officials – ever ventured inside the townships, where garbage burned on the streets and the silhouette of Table Mountain shimmered in the summer's heat.
We weren't really callous, or blind to the iniquities of a political system that denied the basic freedoms of most of the country's people. It dictated the identities of our classmates: the university's intake was controlled by government quotas that limited 'non-white' students to ten per cent, few of whom could surmount the deficiencies of their segregated schooling to meet the entrance requirements for medical studies. There were groups trying to raise political awareness on campus, meeting with underground black trade union organizers and discussing revolutionary theory, but such activities seemed of little value in the face of the state's pervasive grip.
Politics had been a significant issue when my father was a medical student. In 1937 he and a friend had decided to go to Spain as volunteers to join the International Brigades fighting for the Republic. They went to tell a much-respected professor of their decision. The man had served in the Great War, and knew something of the impatience of youth. He too had been watching events unfold in Europe.
'This is just the first round in the war against fascism,' he told them. 'It will go on for years, right across the world. You want to go and help the people of Spain. As soldiers [he had the kindness not to call them cannon-fodder] you may kill some of the enemy, or be killed. But, if you really wish to help, you can do much more as trained doctors. There are going to be many sick and wounded who'll need your care.' Persuaded, they had finished their studies, graduating at the end of 1940 and going directly into uniform.
For us the equivalent might have been to leave the country and join the ANC in exile, but few of us had that sort of commitment. I don't think we had much comprehension of being useful in any worthwhile way; we hadn't even seen a patient yet, and would only do so when we started our clinical training a year later. So the first time I got blood on my hands had little to do with my studies. It began, improbably, in the middle of a dull basic-sciences lecture.
A small group of students had marched through the centre of Cape Town that morning, carrying banners calling for an end to apartheid. By lunchtime they were ranged on the steps of the Anglican cathedral near the Parliament buildings, their banners aloft, when the police arrived. A stand-off ensued in the warm sunshine, with motorists steering carefully along the road between the opposing groups. Though the police seemed uncertain about taking action against the students in such a public place, riot squad reinforcements were gathering in the sidestreets, and student messengers were sent to the campus to ask for help.
I was drowsing over my lecture notes when there was a bustle in the corridor outside, and the sound of running feet. The door to the lecture hall opened with a crash. A face peered in and addressed us, ignoring the man at the podium.
'There's going to be trouble at St George's Cathedral; hundreds of cops and riot trucks. We need lots of people there; they can't arrest everyone.'
'Young man!' shouted the lecturer, but the messenger had already left to spread the word. A few of my friends stood up. I joined them. Perhaps ten, in that class of a hundred, made for the door. Some of our classmates hissed at us. The lecturer glowered, and a Catholic girl crossed herself. Outside it was clear that there had been a much better response from the liberal arts faculties, for all over campus students streamed out of the buildings and jostled for lifts, piling into cars and pickups and VW buses that roared off down to the highway that led to town.
We approached the cathedral from the rear, through public gardens unusually empty of sweepers and gardeners and nannies with their charges. From ahead came a thready chanting and a thumping sound that I couldn't identify. Rounding the building, we came to where the battle lines were drawn. A host of students, men and women, occupied the stone steps of the cathedral and the pavement in front of it. Across the street, drawn up in solid rows, stood a phalanx of riot police. Steady as a heartbeat, they struck their batons against the Perspex shields they carried. The crowd flinched at each resounding blow, shrinking back towards the cathedral steps. Then a police colonel stepped to the front of the line, sunlight blinking off the braid on his cap. In one hand he held a yellow megaphone.
'This is a prohibited gathering.' The metallic warp cut through the sudden silence. 'You have thirty seconds to disperse.'
He stood there in his dark uniform, the bright yellow cone raised to his mouth.
'It's Daffy Duck!' yelled a wag in the crowd, and a roar of laughter drowned out the colonel's next words. He turned to the police lines, raising an arm. There was a cracking sound and teargas canisters lofted skyward, trailing arcs of haze. They struck the street, squirting smoke as they rolled towards us. A student scooped one up and flung it back into the police ranks, where it fumed under their feet. Gagging and swearing, the riot cops reeled, then charged in a body, their long batons raised. The banner-holders in the front went down under a storm of blows and were dragged across the roadway to the waiting trucks. The rest of us fled up the cathedral steps, gas canisters churning white clouds under our feet. We kicked them off the top step and stared, horrified, at the melee below, where people screamed and choked in the rising smoke and knots of students cowered under flailing clubs.
Men and women leapt up the steps, their arms outstretched towards us, while red-faced cops grabbed at their clothes and hurled them down, kicking them as they fell. In front of me a grisly tugging match ensued as we dragged at the hands of a girl while a policeman continued to rain blows on her back and legs. There was a shouted command and she fell, sobbing, into our arms. The police line retreated, stair by stair, exposing a wasteland of blood-splashed stone and lost shoes. We stood at the top of the stairs between the open cathedral doors. My eyes streamed; the gas stung my lips and smarted where it found moisture on my sweating face. People retched and coughed. Some helped to pass our injured to the rear, and carry them inside the nave. Others screamed insults at the police, calling them slime and filth and Boer baboons.
A breeze turned the scraps of paper in the street, thinning the tear-gas haze. The noise of the city returned, and I could hear the voices of office workers watching us from the windows of the buildings opposite. Then the colonel's megaphone screeched again.
'You are all under arrest!'
From our step came ragged laughter and shouts of defiance.
'Come and get us, you fuckers!' screamed a girl in a torn coat, then fell silent. Fresh police files were wheeling into line in the street below and lock-up trucks were backing up, their mesh doors open. The colonel waved his swagger-stick; the cops charged and the students recoiled. Those who could fled back into the church, the press of bodies carrying me with it. Over their heads I could see the flash of falling batons and hear the crack as they made contact. A tear-gas canister was bowled through the opening and then the doors shut with a crash on the daylight outside. Some students sprinted down the aisles to escape through the transepts, but those doors too were slammed shut before they reached them. We were sealed inside. From the street came cries, and the sounds of beatings.
The gloomy nave seemed filled with people. Some sobbed, or dashed about frantically, their chests heaving. Others staggered where they stood, their hair matted from bleeding scalp wounds. The shock of confrontation had revealed us for what we were: a bunch of self-styled rebels without cohesion. Someone had clapped a cleaner's bucket over the tear-gas canister, but trails of smoke leaked along the floor around its edge. It was not only the gas that made our eyes burn. I collapsed on a pew and lit a cigarette, my hands trembling.
'Not a fastidious churchgoer, I see,' said a voice beside me. I looked up and recognized the speaker, a medical student in the year ahead of me. Stefan gazed around at the defeated mob and shook his head. 'Looks like Casualty on a Saturday night,' he said. 'Smoke up, and we'll do something constructive.'
This was my first taste of trauma, but Stefan seemed to know what to do. He stood on a pew and addressed the refugees, his voice cutting through the moans and whimpers.
'Let's get the injured seen to,' he said. 'Anyone got some clean cloth?'
A girl pulled a blouse from her bag and held it up. Someone else produced a white lab-coat, and a couple of handkerchiefs were handed forward.
'Bring all those who've been hurt here to the front,' said Stefan, and he began, with the help of a penknife, to tear the fabric into strips. A cavalcade of wounded were assisted from the shadows; limping, shoeless, with bloodied faces and lacerated heads. I looked at their ragged cuts and thought I might faint. I set to work nervously, folding the cloth into pads and holding them against gashed scalps to staunch the bleeding. Other volunteers came forward to help. Stefan appeared at my side.
'Reassure them,' he said softly. 'Tell them head wounds always bleed a lot, but they soon stop. Tell them it's going to be OK.'
Stefan had gathered the worst tear-gas victims at the font. Some, their faces scorched by the irritant gas, could hardly see between their swollen eyelids. He spoke to them gently as he bathed the blistered skin. 'Don't worry, it burns at first when the water reacts with the chemicals. It'll stop after a few seconds.' His voice worked like a tranquillizer, and I began to understand a little of what healing involved.
* * *
I had treated my first casualties, however minor, and embraced my first cause. 'The Siege of St George's' they called it in the papers the next morning, and those of us who had been there gained a brief notoriety. A few went on to make names for themselves as political activists. One of them was my friend Stefan. For a while I occupied a student squat with him and Neil and Nils; the Marxist-Lentilists, who shared an admiration for Albanian communism and a conviction that meat or fruit, or anything but the most rigorous of subsistence diets signified bourgeois softness and a betrayal of the oppressed masses. They shared their spartan meals with some coloured children who slept rough in the cemetery behind the house, and laughed when our possessions were regularly stolen – 'redistributed' – by the most enterprising among them.
I didn't really mind the absence of luxuries. I was short of money and augmenting my living allowance by working as a mechanic, rebuilding the engines of the VW buses and Beetles that were the most popular student transport. And my social life had improved. Our kitchen was always full of people talking socialism through the night. A number of them were young women, attracted to the aura of revolutionary virility that hung around the house. With a few gallon jugs of proletarian wine the gatherings became parties. Though I didn't pretend to be an activist, some of the girls would try to expand my political consciousness through slippery sex, augmented by potent buds of marijuana.
But I was becoming aware of the political aspects of studying medicine in South Africa, as one of the select minority who qualified. The ironies of this privilege became apparent when we started our clinical training. Our professors adhered to the exacting standards of the English medical schools from which most of them had graduated. They had been drawn to the University of Cape Town's Groote Schuur Hospital because it was an international centre of excellence; it was here that the world's first heart transplant had been performed in 1967, and overseas doctors considered themselves honoured to work in the department of cardiac surgery and other specialities. One day we too would enter that elect society of healers, and begin to make a difference to humanity. Our medical training was rigorous and complete, for what we had in abundant supply was 'clinical material': the disinherited and oppressed from the townships and bleak rural homelands.
(Continues…)
Excerpted from "The Dressing Station"
by .
Copyright © 2001 Jonathan Kaplan.
Excerpted by permission of Grove Atlantic, Inc..
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Table of Contents
Prologue,
1. South Africa,
2. South Africa,
3. England,
4. America,
5. Namibia and Zululand,
6. Kurdistan,
7. Kurdistan,
8. The South China Sea,
9. Mozambique,
10. Transit Lounges,
11. Burma,
12. South Africa and Brazil,
13. Eritrea,
14. Eritrea,
Epilogue,
Interviews
Author Essay
How I Came to Write The Dressing Station
A "Dressing Station" is where wounded soldiers receive their first emergency treatment: the ER of the battlefield.
I had never thought that my work -- as a surgeon in war zones, humanitarian crises and other extreme circumstances -- could be turned into a book, until a friend who is an author suggested that I write an account of some of my diverse adventures. Current global insecurity has given the book a resonance far wider than I'd dreamed when I wrote it. In the places where I've worked, death can come suddenly in a rain of explosions, epidemics stalk and carry off the innocent, existence is precarious. In such intense environments there is little time for analysis, no opportunity to make sense of thoughts and feelings. Knowing how these impressions would be lost through fatigue and fear, I got into the habit of confiding them to a journal: a few minutes' writing between operations or before snatching some sleep might be the only privacy I could get. I never looked at the journals again until I came to write The Dressing Station, when I read them for the first time. There are experiences recorded in those battered notebooks which remain too overwhelming to make sense of, even at a distance of time and memory.
I'd describe the book that has resulted as a study in how not to find a secure career in medicine. It is a personal account of the unique, intimate, and sometimes bizarre insights gleaned through being a surgeon; about survival -- my own and that of my patients -- and the responsibilities of failure as well as the exhilaration of success. These experiences come together in The Dressing Station. (Jonathan Kaplan)