A doctor always keeps records. In hospitals, even those in the developing world, they are required for clinical and legal reasons. But my first assignment as a volunteer surgeon found me working in a place where written records were almost an absurdity.
In northern Iraq, during the Kurdish uprising at the end of the Gulf War, I operated in a fort about 455m behind the front line where Kurd Peshmerga fighters struggled to hold back the advance of President Saddam Hussein’s Republican Guards.
As the doctor in our small team, my job was to try to stabilise the condition of the wounded and prevent infection and gangrene so that they could be evacuated to some theoretical safe place on the Turkish border.
I operated on the floor, in the beam of flashlights held by Kurdish fighters. When shells fell around the fort they’d flee to man the ramparts and I would have to wait for their return. I was desperately short of sleep, with no time or energy spare for writing.
But I scribbled instinctively, documenting the names of patients, the operations I performed on them, the drugs I administered.
In the grip of hallucinatory fatigue, the notebook served as my memory. It recorded things overwhelming and incomprehensible the sight of 250 000 refugees on the move through the mountains, the dead emerging from the mud of hillsides where they’d been hastily buried, the grossness of wounds. It was also the repository of feelings I had no other place to express: rage at my lack of skill, guilt at my shortcomings, and the constant fear that each next crisis would be the one I’d fail.
Iraqi Kurdistan was the first war I experienced, resuscitating casualties, operating on people who sometimes did not survive. There have been others since then and a stack of battered journals has accumulated on a shelf, their spines held together with tape.
In the field these notebooks have been my sanctuary, where I’d retreat for a hoarded moment of privacy. The act of writing was always tendered an odd respect; those around me assumed I was doing something important and for precious minutes might leave me to my notebook. Sometimes there would even be time to make a quick sketch before gunfire and the cries of the wounded dragged me from this refuge.
When I came back from these missions the books were put away, unread. Sometimes I had nightmares, or suffered lapses where the friendly face of the man at the corner shop would flicker into that of someone I’d seen on a stretcher in a makeshift treatment station.
It was difficult to talk about what I’d seen. If friends asked I would produce a suitable dinner-table anecdote that glossed over my revulsion and fear. Polished by retelling, these became the recollections I could reach, while the distressing stuff sank deeper still.
Then I was approached to write a book, and accepted with unwarranted light-heartedness. There was the burden of having to give an account of myself never a comfortable situation but for narrative I had these well-honed stories and, of course, my journals. So I dug them out, stuck back loose pages and began to read. It was then that I found out what I’d been doing in those places. A few incidents that I had recalled as life-transforming were revealed to be quite banal.
Many encounters I’d forgotten, which were profound and significant, went into my book. And some would be always suppressed; experiences of such visceral intensity that they could not be set down coherently at the time and remain, even with the passage of years, unassimilable, chaotic, impossible to recount.
I have recently heard from the international medical volunteer organisation with which I worked in Kurdistan 11 years ago.
Responding to conflict patterns, they operate in Afghanistan and Palestine, and with a new war pending they are organising a new mission to northern Iraq. They have asked me whether I will go back.
I am overhauling my equipment, and a pile is growing in the corner of my flat. Jammed between my boots and my surgical kit is a pristine, strong-backed notebook. Guardian Newspapers 2002
Jonanathan Kaplan’s The Dressing Station: A Surgeon’s Odyssey is published by Picador (UK)