A Heavy Reckoning

Emily Mayhew

Profile, £16.99

Review by Mark Smith

A HEAVY Reckoning is not easy to read: there's blood on its pages, and pain; people die and nearly die and some wish they had. But this brief history of what recent wars and conflicts have done to British soldiers physically and mentally is uplifting as well as dispiriting because it is about what a bomb can do to humans but, more importantly, it is also about what medics can do to save lives.

There is one story in particular that I am never likely to forget: the story of Scottish paratrooper Scott Meenagh. Meenagh was on his second tour of duty with 2nd Battalion, the Parachute Regiment, in Afghanistan in 2011, when he and comrades walked into an area littered with IEDs, or improvised explosive devices, and set them off.

There were three explosions in all – the first when a soldier up ahead of Scott stepped on an IED and was blown to pieces. As Scott gathered up the body parts so that the enemy could claim no trophies and buried anything too small to get at – blobs of drying blood, bits of flesh – he remembers seeing crows swooping down to peck at a foot.

Then, a few minutes later, Scott also stepped on an IED. The blast lifted him up and dumped him down on the earth. Both his legs were gone. Every soldier carries torniquets for this kind of situation so Scott, lying in the soil, applied them to each stump to control the bleeding.

Then there was a third explosion. Screams, shrapnel, and a dead body landed on top of Scott. Two of Scott’s team said they would get him out and the last thing he remembers is the rescue helicopter landing in the distance.

In her book, Emily Mayhew, a medical military historian who studies the history of severe casualty in warfare, describes all of this carnage in the most extraordinary, close-up detail and by the end you appreciate her for doing it – after all, why on earth would she spare us? Afghanistan and Iraq, she points out, were a grim continuation of what the human race has always done – a century ago wounds inflicted in the First World War by shells were much the same as IEDs – and if there is any hope of changing that, we need to know the details: we need to see the blood and hear what happens to the soldiers. Sparing the details risks anaesthetising and in the longer term glorifying war.

Mayhew’s strategy is to do the opposite and take us straight into the frontline with Scott and his comrades and then, step by step, she takes us through what happens when a soldier is seriously injured. We climb into the helicopter and watch its medical team, known as MERT (Medical Emergency Response Team), whose job is to keep the casualty alive on the way to hospital. We then head into the field hospital at Camp Bastion, which is not unlike the trauma unit of a large NHS hospital except that, at the height of the conflict in Afghanistan, Bastion saw more patients in a week than most NHS trauma departments see in a year. And finally, we head back home to Britain where casualties begin the physical rehabilitation, with other less obvious problems lurking in the background: anxiety, depression, memory loss.

Of course, the medics can suffer from the same kind of problems too, when, as most of them do, they return from the war zones to work in NHS hospitals. In one of the most vivid passages in a vivid book, Mayhew quotes a doctor who was profoundly affected by what he saw. “The intensity of the experience carved deep channels in my mind,” he says, “and my thoughts as they flow about their daily business easily find themselves rolling downstream into those channels.”

But the section on the medics also raises perhaps the most disturbing point of Mayhew’s book. The doctors and nurses have a huge collective experience of treating blast injuries, built up during their years working in conflicts, but the fact that we are no longer fighting in Afghanistan is not the end of the story. Quite the opposite: sadly, depressingly, the attack in Manchester means that the experience of the doctors and nurses who treated the soldiers on the frontline of Afghanistan is just as likely to be needed now on the new home front of terrorism.