Dr. David Nott: "Adrenaline was too strong" | Society

What inspired you for the first time to become a war doctor?
Two things. The first was Roland Joffé's film The fields of deathwhich had a huge impact on me when I saw her as a trainee surgeon. There is a scene in a hospital in Phnom Penh, invaded by patients, where a surgeon has to deal with an injury by a shrapnel – I wanted to be that surgeon. The second big spur was viewing images of Sarajevo in 1993. There was this man on TV, desperately searching for his daughter in the rubble. Eventually, he found her and took her to the hospital but there was no doctor to help her. I said "yes, I left".

How was this first war experience?
As a young man, he jumped off the plane and ran to the shelter, then jumped into an armored vehicle and was taken to the hospital at high speed. Boy's Own things, just how I wanted it to be. It was perfect. The adrenaline was overwhelming and the amount of endorphins in your head – I felt like I was floating in the air and could do everything. Then, being able to help people as well, by having their own operating room, it was wonderful. Of course, so I wanted to reproduce it all the time. Once I tasted that, I could not stop myself anymore.

Is this adrenaline rush still so strong, 25 years later?
Today, I am less motivated by the desire to care for individual patients than by the desire to pbad on the knowledge and expertise I have accumulated over the years to local physicians. I was recently in Yemen and there were simple medical procedures – life saving procedures – that the doctors were mistaken because they had not seen them before. Most doctors rarely see war wounds. Everyone has forgotten how the injuries caused by explosions affect children, what gunshot wounds or the shock waves caused by the big falling bombs are victims. That's why it's important for me to continue on this path and why I create my foundation [the David Nott Foundation] provide surgical training to doctors around the world on how to work in austere environments [war and disaster zones].

What makes a good war doctor?
You must know a little bit of everything – neurosurgery, maxillofacial surgery, thoracic surgery, abdominal surgery, orthopedics, plastics, pediatrics, how to give birth. You must be able to make decisions about what's right for the patient without the need for advanced investigations, such as CT scanners or x-ray machines, which are rare on the front line.

What is the magnitude of the problem of PTSD among war doctors?
Really big. I was never exactly right when I came back, especially if I had been on a mission for two or three months. I became more irritable and aggressive for a while as I felt uncompressed and rehabilitated to London life. But it was after the meeting with Elly and this last mission in Syria that everything became excessive. I always want to go to difficult places and help people. I have to do it, I find it almost a vocation. But I'm more aware now, I know what not to do. I know some places are too dangerous to go there.

Would you say that you are an emotional person?
Yes, I am a very emotional person. Very early, working in war zones, I developed this type of icy heart. I did not want relationships, I did not want someone coming closer to me because I would not be able to continue doing what I was doing, and that was all I wanted to do. This has changed the most since I had my two daughters.

Are you comfortable to be in the honor?
Not at all. And I'm aware that this book will push me in. But I wrote it to testify. [My friend] Ammar and the other doctors in Syria said that I had to write it because without that, their voices would never be heard and no one would ever really know what happened.