MINISTRY OF DEFENCE
BRITISH FORCES SURGICAL HOSPITAL, IRAQ
Confidential report Subject: Lt Charles Acland 893406
Regiment: Light Dragoon Guards – Royal Armoured Corps
Date of injury: 24 November 2006
Date of admission: 24 November 2006
Date of discharge: 26 November 2006 – 19.30 hours
Onward destination: South General Hospital, Birmingham, UK Reason for return: Reconstructive surgery Current patient status: Unconscious but stable – strapped for immobility Drug treatment: See attached chart
To Whom It May Concern
Lt Charles Acland sustained serious head and facial injuries during an attack on his Scimitar RV. He has fractures of the left supraorbital, zygomatic and maxilla. His wounds have been cleaned, all foreign material, dead and burnt tissue removed and superficial bleeding stopped. Pressure monitor readings of the patient’s brain and arterial flow show nothing significant, although the severity of the patient’s injuries suggest brain damage is likely. An immediate CAT scan is recommended. He has an open wound on the left side of his face – a 2cm wide, 0.5cm deep, 10cm long avulsion – caused by the splitting and cauterizing effects of hot shrapnel. Muscle and nerve damage is extensive and his left eye is beyond repair. An antibiotic regime was introduced on admission and temporary dressings applied to the open wound to prevent infection.
One
WHEN CHARLES ACLAND regained consciousness, he thought he was dreaming about a visit to the dentist. Certainly, the numbness in his mouth suggested novocaine even if the rest of the fantasy was absurd. He was lying on his back, staring up at a moving ceiling, and a bell was ringing loudly behind him. An alarm? He tried to raise his head to see where it was, but a hand descended on his chest and a woman’s disembodied face loomed over him. The dentist? He watched her lips move, but couldn’t make out what she was saying over the insistent clamour of the alarm. He toyed with asking her to turn if off, but doubted that novocaine would allow his words to be understood. She wouldn’t be able to hear him anyway.
Somewhere at the back of his mind was a lurking fear that he didn’t recognize. For no reason that he understood, the closeness of the woman worried him. He’d been in this position before – flat on his back and unable to move – and there was a strong association in his mind with pain. Fleetingly, another woman, slender, dark-haired and graceful, appeared in his line of vision. There were tears in her eyes, but Acland had no idea who she was. His instinctive reaction was dislike.
His only points of reference were the alarm and the ceiling moving above his head. Neither had any meaning for him. He could have floated forever in morphine-induced detachment if increasing awareness hadn’t told him this wasn’t a dream. He started to experience sensations. A jolt as the trolley crossed a threshold. The sympathetic tightening of stretcher straps as his body shifted. A low ache at the back of his jaw. A brief stabbing pain that knifed up his neck. A puzzled realization that only one of his eyes was open.
With a sense of dread, he knew he was awake . . . with no idea who he was, where he was or what had happened to him...
*
Subsequent awakenings increased his dread. He came to understand that the ringing was inside his head. It grew more bearable with each return to consciousness, but he couldn’t hear what was said by the faces that stared down at him. Their mouths opened and closed but nothing reached him. Nor did he know if his own mouth was relaying the signals his brain was sending to it. He tried to speak of his fears, but the lack of response in the faces above him persuaded him his lips weren’t moving. Time was meaningless. He couldn’t tell how often he drifted in and out of consciousness or how long his periods of sleep lasted. He convinced himself that days and weeks had passed since he’d been brought to this place, and a slow anger burned inside him as threads of insight began to knit together. Something cataclysmic had happened. He was in hospital. The talking heads were doctors. But they weren’t helping him and they couldn’t see that he was awake. He had a terrifying anxiety that he was in the hands of enemies – why? – or that he was trapped forever in a paralysed state that allowed him to think and reason, but left him unable to communicate. The dark-haired woman suffocated him. He hated the smell of her and the touch of her hand on his skin. She was always there, weeping soft, round tears down her pale cheeks, but her sadness failed to move Acland. He knew intuitively that the tears were for show, not for him, and he despised her for her lack of sincerity. He felt he should recognize her. Every time he woke and watched her through a half-closed lid, a sense of familiarity swam just below the surface. He knew his father before he knew her. Recognition of the tired-looking man who hovered at the edges of his vision came like an electric shock. In the next moment, he knew who the woman was and why her touch repulsed him. Other memories flooded back. He recalled his name. Charles Acland. His occupation. Lieutenant, British Army. His last deployment. Iraq.
He had a clear recollection, which he played over and over in his mind because it offered an explanation, of boarding an RAF Hercules on the day he left for the Middle East. He guessed the plane must have crashed on take-off, for his last memory was of buckling himself into his seat.
*
‘Charles. Wake up, Charles.’ Fingers pinched the skin on his hand. ‘There’s a good boy. Come on, now. Wake up.’ He opened his eye and looked at the middle-aged nurse who was bending over him. ‘I heard you,’ he said. The words came out as a long slur but he knew he’d said them. ‘You’ve had an operation and you’re now in recovery,’ she told him, answering the question she thought he’d asked. Where am I? ‘If all goes well, you’ll be returned to your own bed this afternoon. You’re connected to a PCA pump –’ she guided his left hand towards a control set – ‘otherwise known as patient-controlled analgesia. It allows you to be in charge of your own post-operative care. You shouldn’t need any pain relief for a while, but if you begin to feel discomfort press the white button. The morphine will help you sleep.’ He jerked his hand away immediately. ‘It’s up to you,’ she said easily, ‘but this way you can manage the pain yourself. The doses are measured and the machine overrides any attempt at self-indulgence.’ She smiled cheerfully. ‘You won’t be on it long enough to become an addict, Charles. Trust me.’ He didn’t. He had an instant understanding that he didn’t trust any woman, although he had no idea why that should be. The nurse held up a black plastic egg-shaped object. ‘I’m going to put this in your right hand. Tell me if you can feel it.’
‘Yes.’
‘Good man.’ She placed his thumb on a button at the top. ‘Push that if you need me. I’ll be keeping a close eye on you, but in case of emergencies, holler. You’re a lucky fellow. If God hadn’t given you a skull like a rhinoceros, you wouldn’t have survived.’