Leana Wen was working in the emergency room of Massachusetts General Hospital on the day of the Boston bomb. About to end her shift, she was glad to stay on and help. What the doctor saw, however, is still causing nightmares.
Dismounted Complex Blast Injuries, the Americans call them. The product of roadside bombs.
In Afghanistan, American forces treat 20 every month. The results are typical. Loss of limbs, genitals. A recent report by the American military stated there was a shortage of doctors specialising in phallic reconstruction.
At least 14 people lost all or part of a limb; three of them lost more than one in the bombings at the Boston Marathon
Boston firefighter James Plourde carried one of the more than 180 injured away from the scene
It is the danger of the mission to engage with the public. The Americans have got out of their armoured vehicles and walk the streets. At a cost.
As British soldiers have been attempting to win hearts and minds from the day they arrived in Helmand province, foot patrols and the loss of limbs are a fact of life to them, too.
We observe the sorry procession of lifeless bodies home, but it is harder to find numbers for those living with critical wounds.
By 2011, a general figure of 5,000 limbs lost in Iraq and Afghanistan was discussed on BBC1’s Question Time, and the Army Times was reporting increases year on year.
At the height of the surge in Iraq in 2007, the Armed Force Surveillance Center reported 205 troops who were forced to have an arm or leg amputated; the same organisation put that number at 240 in 2011.
In Afghanistan, American forces treat 20 Dismounted Complex Blast Injuries every month
These are American records. The Brits are more discreet.
This week, I bumped into Jim (not his real name), who drives a cab operating out of Manchester Airport. He likes Manchester City and cricket, and used to be in a Guards regiment. There was a lot of marching.
Once he got part of his knee blown off, he wasn’t so good for that any more.
His wasn’t the standard injury in Helmand, because his patrol was on wheels. The driver must have seen the mine, Jim reckons, because the last thing he did before the explosion was sharply turn the wheel.
After that, life and death were a coin toss.
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Jim lost part of his leg, another of his regiment suffered injuries to his face and jaw, one got away with barely a scratch, the driver was killed. Jim told me the age of the deceased. He should have been in school.
He said he visited another former Guard the other week, at his flat in an unimpressive block in East London. When a man has been invalided out of the Army minus a leg it is not the most helpful location.
The old soldier said he wished his amputation had been an inch further up, because then he would be entitled to full disability. As it is, he only gets part.
Jim said if the Prime Minister had been walking past at that moment, he would have shot him. He didn’t mean it. He doesn’t have a gun, and the only time David Cameron gets to Tower Hamlets anyway is when an Olympics is on.
Even if he did break the habit of most political lifetimes, his PR team would run a mile from popping in on a limbless veteran eight floors up who wishes he had been more seriously injured to make ends meet.
The Boston marathon brought home a gruesome reality that is part of everyday existence in Afghanistan. Anyone who works in A & E sees some pretty grim stuff.
Little of it prepares for dismounted complex blast injuries, however, as lurid eye witness accounts from the finishing line confirm.
When cartoonist Gerald Scarfe was sent to draw the Vietnam War, he was most affected by what happened to the human body when shot. It disintegrates. It does not fall, whole but bloody, as in films. It breaks up.
Scarfe said he did not sketch dead people, but bits of them. He didn’t see corpses, he saw scattered arms, legs and torsos.
Death in Afghanistan is so commonplace now that we almost switch off as news bulletins record the names, but the sheer volume of amputation is the campaign’s dirty little secret.
The news is hidden or disguised, with figures cobbled together and barely comprehensible. One has to break a code or rely on anecdotes.
A military father spoke of his soldier son flying home in urgent circumstances when his wife was diagnosed with a serious illness. He was placed on the Globemaster plane bringing the wounded back to Birmingham.
There were eight casualties from the previous 24 hours, including five amputees. The plane leaves most nights.
Who do you think you are, Reese?
Do you know who I am? Is there any more self-defeating phrase in the English language?
Vain, arrogant, it invariably backfires on the asker who alienates everyone within ear-shot. If uttered as a challenge to authority, it almost always ends in humiliation — as American actress Reese Witherspoon discovered this week.
Also, its weakness in any argument is that it is not so much the punchline as the set-up.
Do you know who I am?
No.