Dr Tighe joined the Navy at university, and became an anaesthetist on the HMS Invincible in 1980. After 18 months, he joined the HMS Glamorgan and RFA Fort Austin, only to find that he was not going home as expected, but ‘turned left at the Bay of Biscay’ to the Falklands Conflict. In this section of his interview, he discusses his experiences at sea in the Conflict, giving the first anaesthetic of the war and his time in a Iraq refugee camp after the first Gulf War. The full transcript is available here.
“Everything was really going far too well…”
On the HMS Invincible, [we] did basic sea trials, but we did have some nice trips as well. We went to Norway and down to the South Coast of France, into the Mediterranean, and once over the Atlantic. The trips were reasonably interesting but they were interspersed with quite a lot of work. I was asked if I wanted to go off early, off the ship, to do a six-month patrol in Armilla in the Persian Gulf. So I changed ship and went off to the Persian Gulf.
I went out on as part of a small surgical team on the supporting vessel called RFA Fort Austin, which is the supply ship that carries the fuel and all the supplies and the beer and keeps the deployment ships supplied. We had some fabulous trips. We went to Muscat, where unfortunately HMS Glamorgan ran aground and very embarrassingly had to limp home. Her Captain and Navigator were Court Martialled. Replaced by HMS Sheffield, and I actually found they wanted one of the doctors to go with them and we went to Mauritius and had a jolly good time! Then I re-joined Fort Austin in Mombasa and I had six weeks in Mombasa over Christmas, just amazing! And everything was really going far too well.
“We’re off to the Falklands. You’re not allowed to write and tell your relatives… You will be transferring to another assault crew to re-take South Georgia”
Then it was time to go home and I was going home with the team on Fort Austin, so off we sailed, but we were very aware that something was happening down in the Falkland Islands and there was a lot of in the press. We didn’t take too much notice ‘cause we were having a jolly good time ashore. We hardly knew what was going on in the world really! And it was only when I got on the Fort Austin that somebody told me this was all quite serious. HMS Endurance had sent in marines and God knows what. I thought oh my God, this sound quite serious. Anyway, [there] can’t possibly be a war or anything! Anyway, instead of turning right to go round the Bay of Biscay and home towards Portsmouth, we turned left and we were told, ‘Well, we’re not actually going home. We’re off to the Falklands. You’re not allowed to write and tell your relatives because not only are we going to the Falklands, you, the surgical team, will be transferring to another assault crew to re-take South Georgia’.
“My parents thought I was still on HMS Sheffield when it was attacked and sunk”
So that was all a bit of a shock really, ‘cause we all thought it was all over and then suddenly we were having to prepare for war, for real action. We never thought that was actually going to happen in those days. But I have to admit it was also rather exiting. I was only 25, 26, something like that, and I had no huge commitments back home, and my only concerns were for my parents, who thought I was still on HMS Sheffield, and that’s when it really hit it of course, HMS Sheffield was attacked and sunk and I knew everyone who was killed on board, I knew them very well indeed and of course I was worried for my parents, who thought I was on it. They were, however, informed that I wasn’t. They weren’t told where I was.
Anyway, we went to Ascension Island and we also had a rather disturbing detachment of SAS with us, whose cabin we shared. I remember one particularly stormy night, lying there hearing a sort of click-click-click-click-click, click-click-click-click-click, and it was driving me mad, this noise going across the deck, and in the morning I woke up to see what was happening and it was a grenade rolling across like this from one side to the other! And I said to the SAS, ‘Do you realise what’s come out of your knapsack there. There’s a bloody grenade rolling across!’ He said, ‘Oh, don’t worry about it. It’s not armed!’ I was slightly reassured to see them go ashore eventually when we got into Grytviken, South Georgia.
The First Anaesthetic of the Falklands
On the way down from Ascension Island to South Georgia, we decided to have a little medical conference about how to prepare for war if it came to it and we decided that we really needed some blood. We had a time scale that we were going to be there within two weeks, so if we took it at a week ahead, we’d probably be alright to administer it down there.
“So there was the doctor who’s trying to arrange this whole thing, collapsed on the floor”
So I decided that I was going to lead the show, and I was going to be first in the queue to show willing and everything like that. I’d never given blood in my life before, so in I went, gave my blood. Navy had to wear white shirts, black ties, and I went in, gave my blood, went out to have my cup of tea, poured my cup of tea, brought it to my mouth and noticed my left arm was red – the whole white shirt had gone red from the top to the bottom! And what had happened was that I’d just leaked from the thing. But I looked at it and then I felt very faint and I collapsed, fainted, in front of the entire crew! So there was the doctor, who’s trying to arrange this whole thing, completely cocked it up, ended up collapsed on the floor. When I woke up the queue was half as long as it was before.
“The blood was never used… we threw it all into the sea and went fishing… caught loads of sharks”
But that blood was never used. In fact, when we got back to Ascension Island on the way back it had all gone off and we noticed on the way down that there were a lot of fish, particularly sharks, Hammerhead Sharks, in the Ascension Island harbour, so we threw all the blood into there and went fishing. We caught loads of these sharks with the blood we threw in.
Disaster in South Georgia
The SAS guys had decided that they were going to try and attack Leith which is where Colonel Astiz and his band were established, and Colonel Astiz was well known to be a very nasty piece of work, he was the one, if you remember, who’d been accused of taking those nuns and killing them, back in Argentina, and he was an international criminal at large I think, awaiting war crimes and things. The SAS had decided that they wanted to go in and retake Leith by surprise at night, by going onto the glacier, called Fortuna Glacier, and then coming down the glacier and attacking them from behind, and they would expect us to take them from the sea of course.
They were warned, these SAS guys, by our SBS Royal Marines on Antrim that this was not a sensible thing to do because it would be very difficult to put them in at 10,000 feet, the weather was very bad up there and it would be very difficult to get them out if they got into trouble.
“The SAS decided… to retake Leith by surprise at night”
They ignored them and went up, and of course six hours later we got a call saying, ‘Help – we can’t see, we can’t move, there’s a complete white-out. We’re stuck.’ So our helicopter went up to pick them up. The first helicopter got them all in but then immediately crashed and flew into the ground. The second helicopter from our ship was called out, did exactly the same! So now you had I think eight SAS and six or seven crew from two helicopters, all stuck up on this glacier in the freezing cold in a blizzard with a whiteout.
Finally the helicopter from Antrim which had a sonar device on it, which the other ones lacked, managed to get up there and with a great feat of aviation, he managed to get all 16 out and he got the Distinguished Flying Medal for that, and it was an amazing piece of flying, because that helicopter at 10,000 feet was struggling to get the lift that it needed.
The sad thing was, having just survived two helicopter crashes, eight of those SAS were subsequently involved in the helicopter that crashed off the back of Intrepid, I think it was, in the Falklands, after an attack on one of the islands, and they were all drowned.
We transferred to Fearless for the landings on Bluff Cove and Fitzroy. We missed the major landings, we missed the San Carlos landings, we missed the attacks on Goose Green and the famous attacks on all the ships in the harbour at San Carlos and we weren’t part of the field hospital that was created in San Carlos Bay by Surgeon Commander Rick Jolly and colleagues, but we were asked to cover these landings, and what happened was having secured that area, the Welsh and Scots Guards and the Royal Marines were asked to converge on Stanley and they did that from two different directions. I remember watching them going ashore, thinking gosh, these guys are going into battle for the first time, they were all very young and a lot of the Scots Guards were all terribly posh as well, and I was just thinking to myself, ‘I bet you didn’t expect this, mate! This was the last thing on your mind. You’re well away from
Sloane Square now.’ But they did a great job, because these are the same guys that ended up fighting on Tumbledown Mountain and all that, on the final assault for Stanley. But we did have three nights of that, and on the day after the third night the disaster of Sir Tristram and Galahad occurred, where they were caught in the open in Bluff Cove, in a freak break in the weather, they were seen by Argentinian aircraft and there were attacked almost immediately and they were set on fire and sunk, and they had a lot of the Welsh Guards on there.
San Carlos Field Hospital
And so that night I will never forget, because we had at least 150 apparently very badly burned Welsh Guards and Chinese crew members. I felt particularly sorry for the Chinese crew members, of whom there were quite a few, because they didn’t speak a word of English and I got the impression they didn’t know what the hell was going on, they didn’t even know where they were. And they looked absolutely terrible because it was all face and hands and their heads and eyes were totally blown up with oedema, and their hands were all terribly blown up. However, they looked far worse than they actually were. We went through our burns protocol and loaded them with fluids and analgesia, and oxygen as and where appropriate.
“We had at least 150 very badly burned Welsh Guards and Chinese crew members”
We were all very concerned about smoke inhalation and we gave them all steroids to cover smoke inhalation, at the insistence of one our senior physicians who had a research interest previously in inhalation injury, insisted that this was a good thing to do; and they were coughing their guts up a lot of them. But it turns out that the majority of these patients were actually flash burns and they were actually surface and there was not a lot of deep second-degree, third-degree burns and they were very, very painful. We had to do a few escharotomies on hands and things.
We had three patients who were ventilated and who went back to Uganda, two of them I think survived, and who did have second degree burns, but all the others almost had quite significant recovery, and of course one of them, one of the very important ones, was that chap Simon Weston is it? Who came quite famous and he actually works and lives near where I am now, and he was one of the ones who got second degree burns quite significantly. There were a few but there were far fewer than looked at the time. And then after that most of those went to Uganda. The system was they went to Uganda and were stabilised, sent to one of our survey vessels, quite small little ships, and they would then take them to Montevideo where they’d be picked up by the RAF and taken home. That was the sequence of events.
“My God, This Isn’t a Game…”
Well, I was quite keen to get home because I’d been away for eight or nine months by now, but it was all very exciting really. I was too naïve to think about it I think. It never really came to me that I was under any personal threat. I’d missed all the main action and what threat I had been under I hadn’t realised I was under, the submarine attacks and things. The only time I saw any real action was when I happened to be on the bridge of HMS Fearless I think, watching what was going on, and I saw HMS Plymouth attacked by an Argentinian aircraft and hit and smoke coming out of it, and I did feel a bit concerned then, because I knew the medical officer on there, and I was concerned that he might have been injured.
The other occasion was when I was again standing on the bridge and I saw one of the ships fire off their Sea Dart missile system, which at that time was the latest state of the art missile system, could pinpoint a flying aircraft and it could even shoot down a shell they said. And there was an Argentinian aircraft going over at 20,000 feet, a brilliantly clear day, and you saw this thing go off like a rocket, this Sea Dart, and the ship had the radio on of the pilots in that aircraft, and I could hear their screams of panic as they realised that this locked onto them and were taking evasive action, and then I heard … it was awful, calling for their mother and all sorts of things, it was terrible. ‘cause they knew it was coming for them. And then you just saw poof in the sky, and then just a glint of … glinting on and off as the aircraft fell to the ground. That made me realise my god, this isn’t a game, this is all dead serious stuff.
“Right underneath where we put our sleeping courses was an unexploded 1,000lb bomb in the wall”
And then of course we were seeing a lot of casualties in that next time, but I never really had time to think about my own personal risk. Part of it was enormous trust in the forces I was with, the Royal Marines, the Parachute Regiment, these are the cream of our military personnel, and I had huge confidence they knew what they were doing. One thing that did concern me a little bit initially was that where we put our sleeping courses, right underneath was an unexploded 1,000 pound bomb in the wall of this refrigeration plant that we were in, and I said, ‘Aren’t you a little bit worried about that?’ I mean it’s enormous this bomb, absolutely enormous, a huge thing, and they said, ‘Oh no, no. It won’t go off. It’s no good without the firing mechanism. There’s a little propeller-thing on the end of it,’ which there was, a little propeller on the end, and he said, ‘You have to set that just right so that it has time to arm it, so it blows up at the right height. And they haven’t armed it properly, look, it’s only half in’ and I thought, well fine then, it’s perfectly alright, and I just slept there for the next three weeks thinking nothing of it. But I’m told by other ballistics experts, that’s not necessarily the case at all!
Training and Equipment
I’d had five months anaesthetics training and I was thrown into this. It was absolutely terrifically exciting and professionally challenging. There I was, rushing around, resuscitating people from severe burns, resuscitating them from peripheral military injuries, and then taking them through to theatre, anaesthetising them, for quite interesting surgery.
I was using the Triservice apparatus. It was a fantastic piece of kit. It’s a credit to it that with only five months’ training and one or two demonstrations I was able to use it with ease. It’s a terrific piece of kit and it’s still in use today in difficult circumstances, and so it should be because it’s a really excellent piece of kit, and it makes you wonder why we have to pay £20,000 for a Plenum anaesthetic machine, when you actually give quite a good anaesthetic with something that costs you £500.
“We didn’t have any oximetry… no windows… poor light… you had to guess whether the patient was blue or not”
We hardly ever used oxygen with [the TSA], because the oxygen supplementation system on it is actually very clever: it’s just a simple T-piece with a reservoir, and you have three choices on the oxygen switch on it that is attached to the oxygen cylinder. The actual device that you connect to the oxygen cylinder, gives you 0, 1 or 4 litres a minute, and 0 you get 21% oxygen, nothing, 1 you get about 35% oxygen, and 4 litres you’re getting about 70-80% and there is a trick to giving 100% if you want to pre-oxygenate: you put a plastic bag on the end and fill the plastic bag up. I learnt that in a later conflict.
In the Falkland’s we didn’t have much oxygen. We had to be careful about how we used it and when we used it. When we needed to use it, we did use it. We didn’t have any oximetry. We were working in bad light. This was a converted refrigeration plant that we were in which had no windows, so once you went in it was just dark, so we had electric lights which were very basic and we had our own generators and they generated really quite poor light to the surgeons and to us, and you had to guess whether they were blue or not. It was a bit difficult!
Casualties and Resuscitation
A statistic that’s widely promulgated about San Carlos and the field hospital was that we had 750 odd casualties through in the total period it was open, and only two deaths, and it’s widely said, ‘Wow, wasn’t that fantastic?’ Well yeah, it was a good record, but there was a problem with interpretation of that data, and that is that 350 of those were trench foot from Argentinians, and some UK, and trench foot was a very big problem out there, which is completely incapacitating and horribly painful. You often saw these gangrenous toes, it was really very unpleasant. And it’s a weird non-freezing, non-cold injury. It’s a very strange pathological process involved in it.
“In the Vietnam War, injury to hospital reception time was an average of 12 minutes… in the Falklands it was measured in hours”
And the vast majority of the others were peripheral war injuries, and the reason that they were peripheral war injuries, was that the injury to reception time was very prolonged. We didn’t have enough helicopters to get them out in sufficient time. Before then in the Vietnam War they had fantastic results of very serious injuries because their injury to reception time to the hospital was an average of 12 minutes I think, but in the Falklands it was measured in hours, and sadly therefore if you were hit in the chest, abdomen or brain, you didn’t survive, before you got to hospital they all died, and so the only time we saw those, and there were a handful, they’d been injured very close by or the helicopter happened to be very close by.
The consultants got together and wrote an article which was published in the BMJ, on resuscitation in the Falkland’s, showing the protocol that we used, which was the first attempt at having an organised resuscitation policy and pre-dates ATLS and used very similar principles of we’re going to do it this way, we’re going in organised, ABC, and we’re all going to do the same, and we all know what we’re doing, and I got involved in ATLS later on in my career and recognised that this was very much where it all started really.
I reckon I did 20 or 30 odd anaesthetics down there and it was the most interesting, probably one of the most interesting and challenging periods of my life. But because we’d been away for 7 or 8 months, they gave us priority to go back, which was rather nice of them, and so we went back with some casualties on one of these survey ships to Montevideo and then we were flown back from there, with the casualties, by the RAF, and arrived back in Brize Norton I think in May/June some time, and without an enormous amount of razzmatazz and everything, it was all a bit low key.
“It was the most interesting and challenging periods of my life”
I was fairly tired and looking forward to a good meal, a good shave and a good sleep in a nice, warm bed, but other than that I can honestly say I didn’t feel any psychological trauma, but I was very aware that after the Falklands Islands, we as a military force became very aware of post-traumatic stress disorder and how serious that was and how incapacitating. There was a doctor, one of the surgical trainees who was on one of the ships as a medical officer, who had a serious episode of traumatic stress disorder actually down there, and it was quite problematic at the time. But the poor guy had actually been blown up in Ambuscade and ended up in the water being rescued and things like that, so he had a pretty rough time.
In 1990 I was a Consultant at Haslar, and the first Iraq war had already happened and I wasn’t required to go to that, happily. It was recognised that we had to have a contingent to staff the baseline hospitals to receive any casualties. In fact there were no casualties from the first Iraq war, and in the second Gulf War there were a few more, as you know. But in between, there was a problem with the Kurdish population, who decided to go and sit on a mountain rather than risk being gassed by Saddam Hussein. And they were all starting to freeze and dehydrate. So we went out there with the Royal Marines to do that operation, we were there for about 9 weeks, we did 90 operations, an awful lot of them were traumatic, a lot of people standing on mines and ordinance and exploding themselves by accident, and an awful lot of children.
“50% of our casualties were children.”
50% of our casualties were children, and one day we had seven kids, all under the age of 12, blown up, and one of them was dead on arrival, exsanguinated from a femoral artery injury. Another one was literally holding his guts out like this. He lived, we got him through it. Another one with intra-abdominal injuries, multiple intra-abdominal perforations and peripheral limb injuries, and several others with other various nasty shrapnel injuries, horrendous situation.
And the other thing we had were these babies coming in with severe malnutrition and marasmus and kwashiorkor, in other words some of these babies looked like bouncing babies, they looked quite fit and well, but of course it was oedema, they were severely anaemic, and their electrolytes were all up the Khyber and they were severely swollen up and they often had nasty infections, and we tried our best but we had no biochemistry, we had some quite good monitoring by then but we had no biochemistry so it’s all done blind, and a lot of them died. I don’t know if you’ve ever heard an Asian lady in distress, but it’s just the most terrible noise you’ve ever heard in your life, they wail and shriek in this high-pitched thing and it goes on for hours, hours, hours on end. I did feel terribly sad for them that they were losing these babies who they clearly loved very much, and sadly we just couldn’t do anything for them and we tried our best.
After the Navy
After Iraq I went down to the Naval Hospital in Plymouth as Head of Department down there and I realised it was highly likely they’d post me back again and I’d have to go to sea again at some point, and if I wanted to have a career in the Royal Navy it would have been quite limited. And it was that time in 1992/93 that the NHS were desperate for consultants. You almost had to be careful what job you chose. So I left the Navy, I resigned prematurely as a Surgeon Commander, with the pension of a Surgeon Commander, and got a job in Chester, and I’ve loved it ever since. A great decision. I’ve got wonderful colleagues, it’s a good hospital, it’s one of the top 40 in the country in terms of the overall results, it’s financially stable, which is rather good in this day and age, and it’s a very nice part of the world. I’ve been Lead Clinician, I’ve been an acting Assistant Medical Director and I’ve been involved in a lot of work outside the trust in regional anaesthesia in particular.
I was Secretary of the British Ophthalmic Anaesthesia Society, one of the inaugural members of that and Treasurer, and I’ve been a memberof the Regional Anaesthesia Society for about 25 years and became President last year. I was elected in 2010 to the AAGBI, and I come to the end of my term this September, having been Chairman of the Independent Practice Committee but also heavily involved in workforce issues, in education and e-education, and other aspects of welfare of anaesthetists in general.
Immediately after the Falkland’s War, we were very honoured to receive the Pask Certificate of Honour, amongst the I think about eight or ten military anaesthetists that were down there, and this was based on the fact that the seniors in our profession recognised that no anaesthetists got any honours or awards or mentions in dispatches, they all went to surgeons if anyone, and so it was absolutely wonderful to be recognised in this way, and in the name of someone who was historically such an innovator and risk taker himself. And association with water as well!