War Doctor: Surgery on the Front Line by David Nott

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Reviewed by Rebecca Foster

war doctor david nott

Looking out from my inconsequential life, I’m often envious of people who save lives on a regular basis – doctors, surgeons, EMTs, firefighters, and those everyday heroes who dive in to save someone who’s drowning. Maybe I’ve recommended a book that provided some much-needed entertainment or reassurance, or kept overseas scientists from committing embarrassing English usage errors, but actually saving a life? Come on! Perhaps that’s one reason why I’ve become so keen on medical reads over the past decade. There’s a vicarious sense of excitement to be gained from reading about experiences on the edge of life and death, whether they’re narrated by a patient or a doctor.

David Nott, a Welsh vascular surgeon, combines advanced technical skills with what for many of us would seem like extreme altruism: for weeks of every year he takes unpaid leave to volunteer with a medical charity like Médecins sans Frontières or Syria Relief in war zones or disaster areas around the world. The kinds of procedures he has performed in Sarajevo, Kabul and Darfur are a world away from his normal work as an NHS consultant in London: amputations, treating injuries caused by homemade bombs, and delivering the babies of young rape victims. “Helping people who can’t help themselves and taking a risk to do it,” he sums up.

The conditions he has to work in abroad are usually unsatisfactory, to say the least. The hospital where he was stationed in Sarajevo sustained a direct hit while he was trying to apply pressure to a vena cava during a surgery; when the power went out, he had to do everything by feel, shouting out orders into the pitch dark and desperately hoping for the lights to come back on. He’s had to deal with hallucinations from severe dehydrations, intestinal distress in a python-plagued outhouse, and a seasick 16-hour voyage from Malta to a landmine-ridden harbour in Libya – not to mention the standard shortages of medications, equipment and trained assistants so common in the developing world.

Most of Nott’s recent experience has been in Syria, and he finds it difficult to be optimistic about that country’s future. Nearly every injury he treats is due to a suicide attack (especially the nasty “double tap” tactic – waiting until bystanders come to help and then detonating a second device) or a sniper shot. He realised that snipers had a system whereby they were rewarded for hitting particular parts of the body on particular days. It’s hard to see any hope in situations in which people can turn the killing of civilians into a game.

The memoir is mostly structured by countries and/or time periods. In one early chapter and one late chapter, but also in a few segments interspersed throughout, Nott also reflects on his own story. His parents were a nurse and a trainee doctor from India who moved around a lot; he spent his first four years living with his Welsh-speaking maternal grandparents. He studied medicine at St Andrews, and performing an emergency neurological surgery on an elderly woman who had fallen and had a subdural haematoma convinced him he should be a surgeon. Likewise, he can pinpoint exactly when he decided to pursue humanitarian work: after seeing The Killing Fields, about the Cambodian civil war. These epiphanies determined his future.

Obsessed with model airplanes as a boy, Nott eventually got his pilot’s license and dreamed of combining flying and surgery, but never managed it. I found the account of his flying experience irrelevant to the narrative. Other personal information enters through his parents’ illnesses; his marrying and having two daughters somewhat late in life; and a breakdown he experienced in 2014–15. It made for a bizarre scene: at a private lunch with the Queen he nearly collapsed into tears when she asked what Aleppo was like. She saved him that embarrassment by calling in her corgis and having him stroke them and feed them biscuits. It was a wakeup call: he needed to tackle his PTSD through cognitive behavioural therapy and psychiatrist visits.

There are gripping moments here – such as completing a difficult amputation by following instructions texted to him by a London colleague – but also some less fascinating chronology. The book is slow to start and 50 pages too long, such that it took me weeks to get through alongside lots of other reading. However, it shines when Nott recalls particular patients who have stood out: a British soldier whose arm he tried but failed to save in Iraq and who went on to be a Paralympic medallist; the woman in Chad who died during a caesarean section, leaving six orphaned children; and the Haitian girl for whom he pulled strings (and earned MSF censure) to get her to London for surgery. All told, his is an amazing and inspiring story.

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Rebecca Foster is a freelance proofreader and book reviewer from Maryland, USA. She reviews memoirs for the Times Literary Supplement and blogs at Bookish Beck. Her love of medical reads led to her shadowing the Wellcome Book Prize for the last three years.

David Nott, War Doctor: Surgery on the Front Line (Picador: London, 2019). 978-1509337021, 304 pp., hardback.

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