Contact Wounds: A War Surgeon's EducationBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7538.428 (Published 16 February 2006) Cite this as: BMJ 2006;332:428
Work in any conflict zone and you will run into a diversity of interesting characters. By no standards can medicine in such an environment be regarded as normal. It is uncomfortable, dangerous, unpredictable, and frequently lonely. It is invariably low paid. There is also an almost unwritten rule that no one asks a colleague why he or she has ended up working in such a situation. So often there has been some drama at home—divorce, bereavement, or repossession, scenarios that we all wish to avoid.
I remember an SAS officer once telling me that the SAS was a “bunch of misfits who happened to fit together.” What an apt description that was. Conflict zones seem a perfect escape for such people. So, as I opened the first page of Contact Wounds, I was immediately searching for a character flaw that might have turned the author into the creature he is. Why travel the globe in search of trouble and, by all accounts, make a reasonable living from it?
Initially I was disappointed. I wanted to be thrown into blood and gore from the first paragraph, but that was not to be. The lead-in to the real action was a description of the author's childhood, his family, and a liberal sprinkling of the political history of South Africa, and Israel and Palestine. But that was the clue, I eventually realised. Here was an individual whose early years had been spent surrounded by political turmoil, whose father had been a war surgeon at El Alamein, and whose grandfather had made his weekly mail collection on horseback, armed, through the wilds of South Africa. The pieces of the jigsaw were beginning to fall into place. You need to know what life is like outside one's comfort zone to be happy working there. Kaplan's upbringing certainly seemed to fit this bill.
To stay safe in war is difficult, but it helps if you are seen to be trustworthy. You must be everyone's friend, avoid political discussion like the plague, and have at least a smattering of applicable languages, plus an understanding of local customs. These are possible only through much travelling, much talking, and a wide exposure to as many cultures and people as possible.
An understanding of basic military principles is also of use. Kaplan shows this beautifully as Contact Wounds rushed me from one land to another, from one character to another, from conflict to conflict, with an exposure to a surgical practice that is far removed from anything the modern NHS can provide.
I started the book feeling somewhat suspicious of the author, perhaps even jealous, and I finished it by liking him. After all, what is the ideal surgical career? Perhaps a teaching hospital post, chalk stripe suits side by side in the wardrobe, and a private practice that bulges at the seams? Of course not. It is not our position to judge others as we might judge ourselves. We are here for one reason only—to make patients better, in the best way that we can, whether they are halfway down Harley Street or in a ditch somewhere south of Baghdad.
Kaplan, with due modesty, describes his own career as misspent with squandered opportunities. I disagree. I think he has done well. Medicine needs characters and individuals who are happy to step outside the rut of routine medical life. Particularly so in the modern era, where I view the NHS as a body that is trying to suppress free thought and expression by its workers, irrespective of what it might publicly claim.
Kaplan's earlier book, The Dressing Station: A Surgeon's Odyssey (review BMJ 2001; 323:941), was widely acclaimed. I had even added to his royalties by buying one for myself. Contact Wounds is yet another example of a capable practitioner making the most of life and I commend it to those who might welcome a good read.
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