Physician, heal thyself

A doctor considers the inner turmoil experienced when serving in a war zone

In the aftermath of the horrific Kibeho massacre in Rwanda in 1995, one of my soldiers whispered to me, “I guess it's all right for you doctors — you are familiar with death”.

Familiar? Yes; we are certainly more familiar with death than the average person, but that does not mean we are not affected by it. Nobody could reflect on the senseless slaughter of 4000 men, women and children, and not be profoundly disturbed by it. Even in civilian practice, there are few deaths that leave doctors completely unmoved. Trauma and violence and premature demise are not limited to acts of war. But as this soldier's remark demonstrates, doctors are generally expected to carry on regardless.

Those outside the profession seldom have insight into the inner turmoil that military medical officers experience in a war zone. In 1897, when he was a subaltern in the Indian Army, Sir Winston Churchill wrote:

I doubt that any doctor in Malakand or Kigali or Kandahar felt glorious in his work.

Having seen some of the horrors of war myself, it came as no surprise to me, when I was researching the lives of the doctors who served in the Dardanelles campaign in 1915, to discover that two of them shot themselves on their return to Egypt.2 These deaths were hushed up by the authorities for shame, and in the case of one of them, his mother was informed that he had “died of wounds”. Later on, as my researches took me through the remaining years of World War I, I recorded up to 15 Australian medical officers who either definitely or probably committed suicide (Suicide by WWI army doctors: PTSD or something else? Presented at the Australasian Military Medicine Association Conference, Sydney, November 2014). There were also others who spent months or years in psychiatric institutions on their return to Australia, and yet others who never practised medicine again.

On operational service, the medical officer first and foremost shares with other soldiers the risk of being killed or wounded. The risk is certainly less than that of those in front-line combat; in World War I, 34 doctors were killed in action, and another 21 died from disease or accidents. But every war that we have fought has claimed the lives of doctors. As recently as 1993, a medical officer from the Australian Army was killed in an air crash while serving with the United Nations in the Western Sahara.3

In addition to the physical danger, military medical officers face the emotional strain of treating desperately wounded soldiers day after day. In recent times, casualty management has become very much more sophisticated than in either of the World Wars, but men still die — 41 Australians during our deployment to Afghanistan, out of 3500 from the NATO forces.

In World War I, when medical support was very basic, there were many wounded who might have been saved if they had received timely and skilled treatment. As one regimental medical officer wrote in a letter home in 1916:

How much more could he have done if he had been adequately equipped? In 1917, he wrote again:

Such images are not easily forgotten, especially when linked to feelings of helplessness and guilt and professional failure, because every casualty could not be saved. We are familiar with death, yes; but not unaffected by it.

An Australian horse-drawn ambulance in Sausage Valley, Pozières, France, 1916

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Photo courtesy: Australian War Memorial.