For more than two decades, trauma surgeon David Nott spent several weeks each year volunteering in some of the world's most dangerous conflict zones, including Syria, Afghanistan, Congo, Iraq, Yemen and Sarajevo. Now he's in London, applying some of what he learned in war zones and disaster areas as he treats patients with COVID-19.
Nott likens the current crisis to a worldwide "disaster zone": "When you're in a war zone and you're operating on somebody — any moment the hospital could get blown up or people could come into the operating theater with guns and hold you ransom," Nott says. "It's very similar, really, with the virus, because you have to appreciate that it is an invisible enemy — and you have to make sure that the invisible enemy doesn't get you."
But unlike in his work abroad, Nott says, the health care workers treating COVID-19 did not volunteer for this duty. He warns that many will face profound challenges in the weeks and months to come — especially with shortages of critical supplies.
"You will see things that you have never seen before," he says. "You will have to make very difficult decisions — which are those difficult decisions you actually make in war zones — about saving somebody's life."
Nott's memoir, War Doctor: Surgery on the Front Line, recounts his experiences treating patients in troubled areas throughout the world. He also works to train front-line surgeons through the David Nott Foundation and the Royal College of Surgeons.
On how treating COVID-19 patients is uniquely stressful, but teamwork helps
It's really difficult. We're all in this together, and you don't make those decisions on your own. You make them with a team. ... We call them pods. We all look after about five ventilated patients in our pod. Then we have a senior who is in charge of the whole ICU. So that person then is in charge. You go up to that person, say, "Look, I've got this problem." And so you work at it as a team, rather than individual. And that seems to make it easier to take the stress.
But of course, everybody goes home with their individual problems. ... And sometimes it's quite insidious. Sometimes it will take a while for that to develop. And I'm sure after the end of this week in the U.S. and in the U.K., there'll be a whole host of people with post-traumatic stress after this. And at the time you work like, you know, 20 hours a day. And you come home and you go back to work and you're all in it together. And the good thing about it is it's very collegiate. You work together, you're in it together, and it's like a band of brothers almost — and that's what war is like, too. ... And sometimes when you come back from a war and there [are] those people there that don't understand, that's when it becomes very, very difficult. And that's really when the post-traumatic stress comes in, when you feel isolated and alone.
On how war zones tend to be staffed with younger, less experienced doctors
In war zones, you very rarely see senior doctors around. Most of them have fled, because they've got their families. They want to look after them. ... So it's usually the young doctors that are left — the 24- to 29-year-olds that are left to carry the can, basically — and, of course, those junior doctors aren't very well-trained. They can't really do the operations. The surgery that you have in a war zone is intense. You've got patients with blast injuries, fragmentation injuries, bullet wounds, all sorts of really difficult operating that requires somebody with a lot of skill to be able to do — or knowledge and experience. And those patients are presented directly to those young surgeons or young doctors who haven't got that experience. So your mortality is going to be significant. ...
I felt ... going into a war zone and just being a single surgeon and operating on lots of patients and then coming home — really wasn't the right way to go. And I wanted to have almost, like, a legacy.
So what I started doing [instead] was going into war zones and then ... training the local surgeons on how to do the very difficult surgery. And then you leave your legacy, and then you move on to the next war zone and do that.
On finding a detonator in a shrapnel wound while performing a surgery in Syria
I was operating on a lady who ... was the wife of somebody who was building bombs back in 2012. And the whole house had blown up, and she came into the hospital having had a severe injury to her left leg, and above the knee joint. She was exsanguinated — bleeding a lot through this hole. So we put a tourniquet on, which is the right thing to do, and then [stopped] the bleeding with the tourniquet and then took [her] to the operating theater where I prepared for surgery. And, making the incision ... I felt this sort of round object, which felt a bit unusual. And so I got both fingers around it and just pulled it out. And suddenly the whole attitude in the operating theater just went silent. When [the] Syrian interpreter, standing next to me, shouted ... "detonator!" And so I was holding up this detonator in my hand. My legs started to shake. If it was going to go off, then it would significantly cause a problem — probably wouldn't kill me, but it would certainly blow my hands off. We managed to put it into a bucket of water and gingerly take it out of the operating theater. But it's one of those very dangerous moments that you often find in war zones that you'd never find elsewhere.
On how he feels about saving the life of someone who might be violent toward others or might work for ISIS
You go in as a humanitarian surgeon and your role there really is to help the human being that's in front of you — and you will do everything possible to save the life of somebody in front of you if it's possible to save. ... Your job as a surgeon, as a medical person, is to offer the human being that's in front of you the best chance of life. And that's my ethos, really, wherever I go.
I don't know [what that person has] done in the past. But again, I have the feeling that if I was to save that person's life, that he may well realize that his life was saved by somebody who had no feelings of malice against him and [who] was completely apolitical and realized that he transcended all the issues that that person had, and maybe I might change that man's life again. I don't know. But this is the way that I feel about when I go and operate on people, that I'm doing it purely as a humanitarian act.
On how the COVID-19 pandemic has put conflicts in Syria and Yemen on hold
I'm hopeful in one respect that this pandemic at the moment, which has occurred throughout the whole world, will change people's minds to realizing that we are all human beings, that we're all here to help each other and we must stop killing each other. And the warring factions in Saudi and Yemen now have stopped fighting; the warring parties in Syria have stopped fighting; and I hope then that they will readjust to a new life. ... They've stopped fighting because of the pandemic. ... Everybody's self-isolating — the Saudis are self-isolating. ... Nobody wants to go in. Everybody wants to save themselves. And so the wars have at this moment stopped. ... This is a golden opportunity to say, "OK, we're all in it together. Let's not restart them. Let's talk. Let's communicate."
On performing fibroid surgery on one of Osama bin Laden's wives before the Sept. 11 attacks
I'd never heard of Osama bin Laden. I didn't know who he was and I knew nothing about him, but one of his wives came in with fibroids, and I was told that he was going to come in shortly afterwards because the surgeon before me had treated him for kidney stones. [I was told], "You may well be having to treat him," and [that] he was also a very important person in the Taliban regime. But he never came in, actually. And it's something I always think about — if I knew who he was or, you know ... had had something to do with him, then maybe, perhaps, I could have stopped it all. But that's just fantasy, right?
On feeling close to a higher being when your life is on the line
I don't pray every day. I'm not particularly religious. I don't go to church as often as I probably should ... but it's interesting when you're in such a dreadful situation and when you realize that your life may be coming to an end very rapidly, and the situation is such that the stress is so much that you need to turn to somebody. ... And, of course, you haven't got your parents there. You haven't got your loved ones there, and there's nobody there. So who do you turn to?
And it's quite funny that there is no doubt in my mind that there is a higher being there. There's no doubt — because on occasions where my life has been almost on the line, where I felt that within a split second, I'm going to die here ... something happens in my head and I start to pray and I feel like I have a frequency band on the radio in my head that I turn on to. And I do go on to that frequency and I feel that I am able to talk to God.
And I do feel that he is listening to me and he's listening to my severe anxieties at the time. And it gives me enormous comfort to realize that I am talking to him and that he is giving me some strength back. It's surprising how you feel this — almost, strength — come back into your body. A couple of times I felt [this]: Once, there was a priest in Aleppo who put his hand on my head, and again, the same thing happened to me. I thought I was going to die there, and he put his hand on my head and I could feel the radiation going through my body. It was a very odd experience — but that's getting close to God.
Sam Briger and Mooj Zadie produced and edited the audio of this interview. Bridget Bentz and Molly Seavy-Nesper adapted it for the Web.
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