Personal Views

The Soho bomb

BMJ 1999; 318 doi: (Published 22 May 1999) Cite this as: BMJ 1999;318:1429
  1. R I P Dornan, locum consultant in anaesthesia
  1. London

    We live our crowded lives on the assumption that our neighbours will hold to certain rules. They will not bring guns to our schools, nor glass into our food, nor bombs into our pubs and marketplaces. For the most part, we live safe in our assumptions.

    The bomb was like nothing I had ever heard and yet it could not be mistaken for anything else. The world stretched and compressed like the opening of a Speilberg film with the sound turned off and time itself sputtered and raced like a poorly balanced video.

    My entire career had been trained for this moment and now I had no equipment

    The clap of thunder, the faces, and the impulse to run—where? Towards or away from the sound?

    Later, an American medic would astonish me by just standing in the street—perhaps he was used to firefights in Los Angeles and did not understand our fear of a second bomb. Or perhaps he was the bravest man I shall ever meet.

    The victims from inside the pub were easily spotted—all had the wide open stares and uncontrollable shaking. What I initially took to be a dusting of sawdust turned out to be the burnt and matted remains of hair. Through blackened faces, without eyebrows or lashes, the whites of their eyes were some dreadful parody of Al Jolson.

    For a brief few minutes it was possible to indulge in insane optimism—everyone was burnt and terrified, but mobile. Hunched over, darting from shaking victim to shaking victim with the mantra of “airway, breathing, circulating” booming in my head, it seemed that burns, shock, and peripheral injuries from flying glass were to be the order of the day.

    It was a short lived moment. The first of the amputees and lower limb injuries began to come out, either crawling under their own steam or being carried by weeping companions. By this time firemen were everywhere and police had begun to cordon off the street.

    Non-surgeons were fumbling to remove clothing not already blown off by the blast, using knives provided by local cafes in an attempt to provide better access to pressure points before makeshift tourniquets could be applied. At the end of the day, my only injury was a neat skin slice on a finger as the knife slipped while I applied pressure to a femoral artery.

    Not all the bomb victims came out. As the street filled with helpers, it was clear that there were still major injuries within the Admiral Duncan. The flickering headlights of the fire service revealed more than I wanted to see. In the dim light provided by a fireman's headlamp, I could see that my man was breathing and moving and that he would lose one arm and at least one leg. I should have perhaps abandoned him when his struggles and the officer's light revealed a woman who was neither moving nor groaning further inside the pub—but the advanced trauma life support programme makes no provision for being rigid with fear inside a glass encrusted bomb site in a floral frock and soft soled shoes. Moments later the fireman's emergency lights came on and I could see the American and the non-surgical knife wielder leapfrogging past me deeper into the pub.

    My man had stopped whispering, “please, please, please,” and was losing consciousness, despite the best efforts of direct pressure. Elevation, in that environment, was out of the question.We scooped and ran to the relative safety of the street, where we dropped to the ground. We needed intravenous access and two litres of balanced salt solution, and for the first time I came close to weeping—the fireman's green box contained neither. My entire career had been trained for this moment and now I had no equipment. But the paramedics and their boxes had arrived, and the buckets of water provided by the street's businesses allowed us to clean off the bomb's debris and visualise veins in his only intact limb.

    I had intended to go back into the street, but the paramedics—how I envied them their helmets and eyeshields—suggested that I went with them. In the end my man went to theatre within 35 minutes of arrival at St Thomas's and I was able to pretend that my decision to leave was purely medical, rather than entirely cowardly.

    The scene at the hospital was impressive. As we came through the door, everyone was primed and ready. And when the time came to stand down, I was given a telephone, money, and hot, sweet tea.

    We live our crowded lives on the assumption that our neighbours—whether strangers or friends—will hold to certain rules. We believe them to be kind and to be helpful and to be sane. In the middle of a bomb site a fireman stopped to exclaim, “sorry love,” for kicking me in the back. As carnage ruled, a nurse had time to make me tea. Receptionists had the sweetness to ask my name and offer help and money when I had no means of getting home, and my neighbours had time to drive me, grubby and bloodstained and tearful, across London to get spare keys for my house. The plainclothes policeman turned up at my door with housekeys, mobile phone, bleeper, and all the other things I had left in the street. My family, friends, and boyfriend have let me talk or not, as I wish.