The sun is yellow and white. The colours of madness. The journey of our medical team from the harbour to Aden’s only functioning hospital snakes through caramel desert. Seatbelt-free, the driver pushes the three-ton 4x4 beast over 120 km/h. His amused eyes scan us in the rear-view mirror as we buckle up. I don’t return his gaze and crank my head out of the window to the scattered sand. I remember how it feels to be lonely.
My wandering thoughts are interrupted by the car slowing down. A young soldier, with a sun-tanned face, is waving us to stop at a checkpoint built in an ancient stone arch at the entrance of the city. His olive t-shirt hangs loose around his slim body, except for a circle of sweat around the collar. While he checks our papers, I look at the marks of time and bullets impaled on the checkpoint’s cement walls. Other soldiers are scattered around. Some are checking outgoing cars, one is smoking atop a pick-up truck with a mounted heavy machine gun, and another is behind a bullet-proof barrier, waiting for the one moment in a million where his presence might become useful.
I inhale, and the air is bitter like acid. It smells of wrath. Beside me in the backseat sits Frank, our team leader. In the front seat is our Yemeni welcome committee: a young nurse with a fixer attitude called Yehia. I look again at the man behind the bullet-proof barrier. He seems inanimate, and I wonder what he could be thinking of; home, money, love...
Startled, I realise the soldier is speaking to me.
"Excuse me?" I say.
"You like Metallica? Music... heavy metal," pointing his finger towards me while leaning on the car window. He is looking at me as though I were covered in tatts, singing Nothing Else Matters with a black electric guitar. Instead, I am sure I look as stupid as a lobotomised sloth.
Finally, I realize he is pointing at my white t-shirt with the Metallica logo on it. So much for my situational awareness. It was the only clean top I found after I packed two days ago in London. I'm tired after our long connections and the boat trip from Djibouti. My two morning Oxycodones have not kicked in yet against the throbbing pain in my brain. My sight is fuzzy, and my peripheral vision is out of focus.
"Ah, yeah. Metallica. They’re cool." I struggle to remember the last time I listened to them.
"Yes, the best! Unforgiven and Devil's Dance... Black Album rocks, man."
"Indeed, indeed." I nod sagely, with the wisdom of a Buddhist monk.
"So, you are doctors, huh? Doctors who love Metallica," looking inside the car and laughing at his own joke. I glance at Frank who laughs more than the joke deserves. I purse my lips and shrug as if to say, ‘Guilty as charged’. A small tail of cars starts to form behind us. Good luck guessing the reason for the delay.
"You look Arab," the soldier says.
"Yes; I'm originally from Egypt."
He scrutinizes the name under my British passport photo, Luke Lenard. "But your name is Western!"
I smile. "It’s a long story."
He steps away from the window, a bit disappointed, probably assuming they lost another one to the other side. He returns our passports and says, "Ok, ok... you go now."
Yehia tells the soldier that the next car is with us. The latter nods. Our white Landcruiser stops about a hundred metres away, indicators flashing, waiting for its twin sister carrying the rest of our medical team in its dust-caked metal frame.
We merge back into the road when the second car makes it through the checkpoint. We haven't picked up speed yet when the explosion hits. The shockwave slams the seat against my back hard enough to empty my lungs. Then a deafening roar and hot gust of wind fill the air. I look back; the checkpoint is engulfed in a giant jellyfish cloud of grey smoke floating into the sky. The view is surreal and with my lack of sleep, I feel as if I am dreaming. Frank next to me whispers, almost inaudibly, “Sweet Jesus.”
The driver stops the car. He frowns at the flames devouring the checkpoint and the skeletons of the less fortunate cars, before looking back at us. He smiles bitterly and shakes his head while putting the car in gear and moving. "Do not worry. Suicide attacks are common these days. We call them appetizers."
"I'm sure those soldiers no longer do," I say.
The driver squints at me in the mirror. "Welcome to Yemen!"
My pager sits on the instrument tray to my right, the triage code blinking. I ignore it. I'm busy stitching up a 16-year-old kid who got a bullet in his abdomen. The CT scanner is down again, but as far as I can tell, the bullet has not perforated his intestine, which would cause a nasty infection and a slow death. Basically, his chances of survival are either excellent or non-existent. I do not tell him that. Instead, I finish the last stitch and give him his bullet trophy. They love keeping those things.
He asks in Arabic, "So, what do I have?"
"A dangerous obsession with a blood sport," I reply with my broken but functional Arabic.
"You’re good now. Tonight, someone will come to take you to do some scans to make sure that your insides are as good as your outsides."
"I won’t be here tonight," the kid says, trying to sit.
"Whoa... what are you doing? You need to rest in bed for at least a week."
"I have to leave now."
"Your call." At least he will free up a bed, and his mum will take care of him at home. "But make sure that you come back tonight for the scans. “Who's coming to get you?"
"No one is coming. I am going back on my own."
I furrow my brows. "Going back where?"
He eyes me, puzzled. "Where do you think I got this hole in my stomach? eating too much Fahsa?"
Something is very wrong with the youth in this country. They shove themselves in harm's way like moths to the flame. As if they have never heard of death. Most of them are too young. School young. Life young. And all of them have the empty eyes of someone who has seen war.
I put my hand on his shoulder. "You can't be serious? You can't go back to the fight in this state."
He looks at my hand like he is considering biting it. "Yes, I can. You said I am okay. Where is my klash?"
I take my hand off his shoulder and say, "No, I meant–"
"Where is my klash?" He repeats, panicking, trying to look under the bed. Klash is how most Arabs affectionately refer to Kalashnikovs, or AK-47s. The machine gun that killed more people than any other weapon ever invented, including the nuclear bomb.
"One of your friends took it. The one who brought you here."
He relaxes. He is still looking under the bed, but this time for something to wear on his feet. I try to remember how I was like when I was his age. I guess my biggest worry was an algebra exam.
"Hey kid, listen to me," I say, in the firmest tone I can muster, "This is not a game. I just stitched your bloody femoral artery. If your wound opens again, which could easily happen if you strained a bit when taking a shit, you will die within five minutes."
The kid looks at me with glassy eyes. He seems to be thinking for a change, then he suddenly lays back in bed and relaxes. "Okay, if that’s the case, make sure to send me some juice in here. I am very thirsty."
I look at him dumbfounded before I notice Anne pulling my sleeve. Anne is our menacing head nurse and the de facto medical coordinator of our small trauma team of five, along with Frank, Rachel, Greg, and me. I might disagree with her on many things, but she is bloody good at her job and in helping us do ours. She points with her head that she wants a word outside. I grab my pager and follow her.
"What’s all that about? Femoral injury in an abdomen wound? You lied to him," she says in the busy corridor.
If she had met me just five years ago, I would have told her that she is right and that I couldn't help doing something to stop the kid from killing himself. I would've probably apologised, but the oxytocin drip in my brain is long busted. So, I say instead, "You would prefer for him to be dead?"
I check the pager code calling me to the triage tent. Pagers were one of our main additions to the hospital system. Over here they have more individual ingenuity dealing all their lives with meagre resources. But automating operations is a Western speciality.
"This is not your call!" replies Anne, putting her hands on her hips.
I head towards the stairs. "I have to go. And It is my call if the kid does not know what is good for him. It’s called meritocracy."
The triage tent is in the hospital yard which also doubles as the parking lot. I like being there more than in operation theatres. Things are much simpler in triage. Same as back in London when I was in the A&E. Normal people see a mess of blood and pain, a chaos of contorted lips and agonizing screams. Patients shout in your ear about how they got stabbed, hit by a car, or shoved the remote control up their arses on a lonely weekend. Relatives warn you about the patient’s allergy to strawberries or gluten sensitivity. But you do not see or listen to any of them. Whether you are in London or Aden, you only see the simplest of checklists, ABC. Airways, Breathing, and Circulation. It is some sort of liberation.
The tent is busy as usual, but at least there are not many Vascular Sniper cases. That’s what we call the pattern of injuries we noticed recently. Snipers have a lot of time that they don't know what to do with. So, they become imaginative. Head shots are no long the measure of a savvy sniper, or even the best practice. Snipers now compete at hitting arteries and veins. Most famously, the femoral artery in the thighs. By doing this, they hit two birds with one bullet. First, the victim drops out of the battle, with the reaper sucking at his soul like water in a sink. Second, it obliges one or two of his comrades to leave their posts and take him to a medical facility. It also clutters the few medics who can do vascular surgery, and increases demand on beds, food and meds. What a beautiful world we live in.
My first case is already dead. Three gunshots, two in the right lung and one in the heart. Blood spattered on the face and the beard, his eyes staring at the ceiling as if he is gazing through an invisible hole. I draw a black mark on his forehead and close his eyes for the last time. Here we sort cases by colour. Black: deceased, red: immediate, yellow: delayed and blue: minor.
The second case is howling with pain like a wolf in a bear trap. One thing they teach you in triage is to pay attention to the ones dying silently, because those who scream the most at least have the strength to make noise. They were right. The young man has a superficial wound grazing his left triceps. The bullet went through clean. I feel a movement, like a phantom limb of a severed emotion inside me, but I ignore it. I tell him to stop shouting, he will live. I strike a line on his forehead with a big blue marker.
My third triage patient looks different. A bulky white man in his fifties with a goatee and salt and pepper hair. He has a reporter badge on his chest. Karim Helmy, journalist. He is grunting under his anti-bullet ceramic plate. He must have convinced some of the Golden Belt troops who control the city to let him tag along to the frontline, less than twenty kilometres from where he is laying now. It seems that when he got shot, they dropped him by the hospital entrance and went to catch the second half of today's war game. I remove the heavy ceramic plate from his chest and a local nurse helps with the rest of his clothes, checking for hidden injuries. He starts wheezing heavily and the blue colour fades a bit from his face.
I assess his injury. Blood is weeping from a bullet wound that pierced through his right side and stopped God knows how close to his heart. Tough luck considering he was wearing protection. He also has head trauma, with disorientation that screams concussion.
"Got any photos worth your life there?" I say, looking at his bloodied camera that he protectively keeps near him. I am not usually chatty, but I have to keep him from going into shock.
"I got the asshole who shot me on camera. What do you think, doc?"
"You are going to make it."
"No, I mean the photos. I cannot check my camera. I have double vision."
It is incredible how much blood a human has. You get used to it with time but one thing you always need to be careful with is not to slip on the bloodies floors while firefighting death in such settings. Ice skating was never my strongest suit. Karim lost a lot of blood, but his pulse is worryingly slow and weak*, and the nurse tells me his haemoglobin level is 7 which is almost half the normal. I stop the bleeding and order him enough IV fluids to fill the Nile basin.
I finally turn on the camera. The last few photos are very blurry and show a surreal mix of sandals, khaki pants, and desert sand. He must have taken them while running for his life and the result is this useless rubbish. “It looks great, Karim. Well done!” I turn the camera off and give it to him, trying not to look in his eyes.
"Good... I need to be evacuated. We all do. The rebels are coming."
"You are safe here, Karim. You are stable, but you have to undergo an operation now. You have earned a few months of vacation. I’m sure you are missing the wife."
"I am here because of her." He grunts with his eyes closed.
I am about to tag him and leave when his wheezing turns into gurgling as if he is drowning. Well, he is actually drowning, at least his lungs are. A common symptom of lung injuries where, with each breath, the lungs are deflated due to blood or fluids that fill its space in the thorax. This is called tension pneumothorax or collapsed lung. Its only solution is needle drainage or thoracostomy, where you pierce the patient’s body from the side of his rib cage like you would an annoying kid’s balloon at a birthday party. I take a chest tube and get ready.
"Listen Karim, you will feel a bit of a pain now. That is because I am trying to save your life."
He starts cursing and shouting as if I am extracting his soul with rusty pliers.
"Do not move." I get it in, and he finally relaxes. I put a red mark on his forehead. I point to the nurse to take him to surgery.
If you are not bogged down in the triage tent or sticking your hand wrist deep into the belly of a patient in one of the operating theatres, you can sit with a hot cup of coffee and watch the dirty grey clouds of smoke ascending from the gun fights and mutual shelling in the distance. You can find solace that some people in this world are dumber than you or that none of the mortar rounds flying around have pierced you yet. Otherwise, enjoy some of the humble internet connection in the foreigners’ room on the second floor, previously known as the deputy director's room. Last we heard, the deputy director was in a migrant boat travelling anywhere that took him away from Yemen.
So, I am on my way to the foreigners’ room. Greg winks at me when I enter, as though we were old buddies. It is our second mission together after Libya. He is an orthopaedic surgeon. A yank, same as Anne and Frank, but I try not to hold it against them.
There are two types of humanitarians, I realized early in this job; those who are running away from something, and those who are running towards something. Greg is the first type, a chronic travel addict. Not because of love of other cultures or philanthropy, but because he does not want anything with the word ‘permanent’ in front of it. Job, relationship, home... He is probably addicted to short-term, long-distance relationships, with an Isabella or a Pierre.
Greg looks back at the shared desktop computer and exits whatever he was doing. I go to my locker and slip a couple of Vicodins in a pack of Tim Tams I pretend to be fetching. Behind the desk Greg is sitting at is a rectangle of pale paint from where the photo of Ali Saleh has been for more than two decades. I tell Greg that Anne is looking for him for an amputation.
"Sure... sure... I was already on my way there." He grabs his lab coat and dashes out.
Greg is the youngest on our team which causes him a lot of trouble in cultures where age is synonymous with authority. Also, he is a strong advocate for teamwork, especially when he fucks up. In our previous mission, in Mesrata, he always paged me when …