Inspiring Older Readers

posted on 31 May 2019

War Doctor by David Nott

I’ve written about the new school of surgeon-writers elsewhere on Letterpress, and especially the one I consider to be so far the greatest of the current crop: Henry Marsh.

Judged purely as a writer, I don’t think the consultant vascular and trauma surgeon David Nott is quite up to the standard of Henry Marsh but his story, War Doctor: Surgery on the Front Line, is without doubt the more extraordinary.

For over twenty-five years, David Nott has periodically arranged unpaid leave from the London hospitals he works at so that he can undertake overseas humanitarian missions in some of the cruellest and deadliest war zones around the world. What he has to tell us about these experiences requires the reader to have a strong stomach.

In Sarajevo, Chad and Darfur, Afghanistan, Iraq, Libya, Syria and Israel, working for a variety of humanitarian organisations as well as for the Royal Auxiliary Air Force, Nott has been ready to drop everything and fly into the belly of the beast. Sometimes he has fully expected not to come back. Leaving aside near misses from IEDs, barrel-bombs, heavy artillery, suicide bombers, high velocity sniper rounds and just about every other means whereby civilians can be eviscerated, maimed, burned alive or – if fortunate – instantaneously killed, he has also been sometimes inches away from being kidnapped for ransom or worse.

Along the way, he has established two globally-used trauma and war surgery training programmes for frontline surgeons (specifically aimed at those working in what the medical profession euphemistically calls “surgically austere environments” and we would call under-equipped hell-holes), established a foundation to help fund delivery of these around the world, gained his helicopter and commercial aircraft pilot licenses, and been a qualified flight instructor. Driven doesn’t really begin to describe the man; he makes even the veteran neurosurgeon Henry Marsh appear something of a slacker.

And yet this is not a happy or a healthy book – and I think most readers would draw this conclusion fairly early on, as I did.

For one thing, the supreme selfishness that has enabled him to hold his own life cheap doesn’t always seem to derive from the most balanced of motives. Until six or seven years ago, when he met the woman who became his wife, Nott was able to routinely describe himself as without parents, relationships, siblings, children or dependants. If he didn’t return from a war zone then his loss to surgery might be great, but his loss to others would be limited. But more than this, he is perfectly open in describing his life as otherwise empty: he only felt fully alive when saving the lives of others in the most horrendous of circumstances.

Perhaps when one has surgical skills of the kind that can genuinely, time after time, relieve the suffering of the most appallingly injured, then some degree of alpha-male egotism is inevitable. This is something that Henry Marsh has explored with great self-critical awareness. Notts’ outlook, however, seems closer to being a messiah complex. His own life only made sense – only had value – if he was in some of the worst places in the world, in personal danger and saving people. “I think to skirt death,” he said in one interview, “and then to realise how close you are to death and that you survived it – is euphoric. And that’s the experience I’ve had many times over.”

When Nott collapses into full-blown psychotic breakdown on returning from Syria it seems hardly surprising. The way he has led his life seems so transparently self-punishing, the absurdly excessive demands he has placed on himself somehow a consolation for having no one else who is close to him. His late marriage and young family, then, are something of a personal salvation and he is astonishingly open about his initial inability to come to terms with this. So desperately craving affection and fatherhood he also realises that these are the very qualities that now make him vulnerable, their previous absence are what gave him strength.

Books like this offer us a glimpse into hells that we can barely imagine and I for one – sometimes against my better judgement – find them fascinating. But their subjects often emerge as more rather than less enigmatic. By the time you reach the end of War Doctor you may have a pretty good idea of what drives Nott, but what makes such people and then sets them so resolutely apart from the general run remains as mysterious as ever. A gruelling and sometimes emotionally devastating book by a remarkable man – important and recommended.


Alun Severn

May 2019


Surgeon-writers elsewhere on Letterpress:


Direct Red by Gabriel Weston


Pen and Scalpel: The new school of surgeon-writers


Admissions by Henry Marsh


When Breath Becomes Air by Paul Kalanithi