'I thought I've really bitten off more than I can chew now. I am never going to get out of here' Chris Pyke talks to 'war doctor' David Nott about his time as a surgeon in war-ravaged parts of the world from Sarajevo to Syria, finds out how he met the love of his life and how his Carmarthenshire childhood has affected his choice of career...
"I "I thought, 'I have really bitten offmore than I can chew now. I am never going to get out of here. I am going to die. I am going to go in an orange suit'.
"Every day I was scared stiffthe knock on the door wasn't a knock on the door to help someone... I felt it was someone coming to take me away.
"In fact, it got to the stage whereby they [ISIS] had heard I was there, they had heard I was going and when I was leaving Aleppo, they came for me at the Turkey-Syria border.
"There was a shoot-out between the Free Syrian Army and Islamic State and I was in a room, say like this, and outside there was this gunfight going on and it just sent me totally overboard.
"A week later I am having lunch with the Queen and lost the plot."
The room we are sitting in is at the Glamorganshire Golf Club, on the outskirts of Penarth, and the Welsh-born surgeon David Nott is explaining the different levels of stress that come from working in a war zone.
He would know - although it is hard to believe that the gentle man sat opposite is a veteran of 27 conflicts.
That is until he starts describing the horrific scenes he has witnessed. He tells them in a softly-spoken, calm manner.
Over the past 25 years, he has worked in some of the most infamous conflict zones in the world - the list reads like a roll-call of the most dangerous places on the planet - Afghanistan, Sierra Leone, Sudan, Chad, Liberia, Iraq, Libya, Haiti, Gaza and Syria.
The situation he had just described was in Syria and it was an example of the stress brought on by working in a war zone when your life is directly under threat. He also describes the strain when he gets back from the front line and sees lots of people damaged by war.
Here, the example he uses is from when he was working in Chad.
"I had a dreadful, dreadful mission. It was when the Sudanese soldiers were coming and raping lots of girls. These girls became pregnant and they were very young... nine, 10, 11 and 12."
At this age, David explains, their pelvises were not developed enough for childbirth. This led to the need for caesarean births.
The girls were also suffering from low blood levels, malaria, worms, malnourishment and infestations. This meant many were unable to survive the procedure.
"On an operating table, if you lose a young person during a caesarean it is a dreadful, dreadful thing, but if you lose every one in four... it broke me."
We are in Penarth to discuss his book War Doctor: Surgery On The Front Line. It is an unflinching, unrelenting memoir of a life spent operating in war zones over the past three decades. Moreover, it holds nothing back. David goes into great detail about the operations he has performed, the risks and results, and pulls no punches.
He has saved thousands of people across the world, but he is not one to make a big deal of it. There was no ego to find with a man who has been dubbed in the press as "surgery's Indiana Jones".
David's public profile grew dramatically when he recorded an episode on the radio show Desert Island Discs. It led to the writing of this book.
He hadn't wanted to put the focus on himself, but he did want to increase the awareness of what was happening in Syria and also help raise the profile of the foundation he had started to train surgeons working in war zones.
We were having a brief chat in a back room before he went out to discuss the book with the owner of Penarth shop Griffin Books in front of just over 100 guests.
He is unwaveringly polite to everyone he meets and the book tour is new ground for him. He is happy to be led through it all. Although something he learned early on is to have a glass, or two, of wine before it begins.
"Someone asked the other day, 'What are the demons that are making you do this?'" he said.
"There aren't any demons really, it's not some thing."
The book allows you into David's life and there are plenty of clues for the amateur psychologist to draw their conclusions from.
Perhaps David was destined to be a medic. His mother was training to be a nurse at the Royal Gwent Hospital in Newport when she met his father, an Indo-Burmese doctor. David was born not long after.
His mother wanted to complete her training and the newlyweds didn't have time to raise their son, so David was left with his maternal grandparents in Trelech in Carmarthenshire.
He describes the first four years of his life as a "completely magical" Welsh childhood.
His face lights up when he talks of his grandparents, whom he calls 'mamgu' and 'tadcu'. One of his aunts who helped raise him back then has joined him for the night and she and his uncle beam with pride at David.
Once his mother had finished training, his parents were ready to have him back and leaving Trelech was quite a trauma for the young David.
He recalls looking out of the back window of the car at the sad faces of his grandparents as he was driven away to England and what was to be a very lonely childhood.
His heart ached for Wales and his family there. Every time he returned, he says it felt like heaven and he never wanted to leave.
"I know it sounds morbid, but I told my wife the other day that when I die I want my ashes to be poured into a little river in Trelech, that's where I want to be, it's where my heart is," he says.
His parents' marriage was turbulent and they did not know what to do with their young son.
"I think my dad didn't know how to cope with me, to be honest," he says, but then he brought his son an Airfix model.
The joy David showed in putting together the World War II plane finally gave them something to connect over. His father started buying three or four at a time. Soon he had hundreds hanging from the ceiling of his bedroom.
This hobby no doubt helped hone the steady hands that would serve him so well in makeshift operating rooms in some of the world's most inhospitable places.
However, it also fed into his sense of isolation. Having grown up in west Wales, his first language was Welsh. In school, he was subjected to insults, failed to get much attention from teachers and, as a result, suffered academically.
Aside from the Airfix model planes hanging from the ceiling, David was never far away from war growing up.
His father would often tell stories of how he escaped Burma from the Japanese invasion during World War II.
"He was always going on about war," he recalled. "He and I used to love watching war films together."
Not surprisingly, David harboured dreams of becoming a pilot. His father was adamant he would be a doctor.
However, there was a slight problem. "When it came to sitting my A-levels, I didn't do very well. In fact, I failed miserably," he explained. "The fact that I failed so miserably had a significant impact on me and I think that was the first time I ever felt you really need to be determined if you want to do something.
"I didn't want people to laugh at me any more. I thought, 'Right, I'm going to prove to everybody I can do it'.
CONTINUED ON PAGES 6&7 CONTINUED FROM PAGES 4&5 "The determination factor started and that has kept me going throughout all of my life."
After resitting his exams, he went to St Andrews for pre-clinical training and then on to Manchester for the next three years of his training and to start working with live patients.
It was here that he fell in love with surgery. Also, it was here that a trip to the cinema with his father focused his career path.
"It was The Killing Fields. He had watched it and he phoned me up and said he had to take me to see a film. It was a real eye-opener, a huge eye-opener."
There are scenes in the film with a doctor working in a makeshift hospital with hundreds of patients.
David says many people can't believe a film could have led to him to the decision, but he insists it did.
"It had an enormous impact on me," David said. "It was to do with war, it was to do with friendship, love, it was to do with helping people and it was the International Committee of the Red Cross.
"I went back the following day as I was so enamoured with the film. I watched it again and I realised I wanted to be that surgeon."
This is where the determination David learnt when he failed those A-levels kicked in.
His decisions from then on were geared towards getting trained and prepared to be able to go into a hospital in a war zone. It took eight years.
It was the early 1990s. The war in Sarajevo was dominating the headlines and David watched a segment on the news.
"A man was walking around looking for his daughter and he found her under the rubble. He picked his daughter up and took her to a hospital and there were no surgeons there to help his daughter," he recalled.
"As I watched this I thought, 'Right, this is my moment, I am going to go and be that surgeon'. I had only started my job in November and in December I went to the hospital managers and said, 'I am sorry, I have a job in Sarajevo'."
The decision wasn't initially well received. But he went.
Over the years the hospitals David works in have accommodated his trips and colleagues have helped cover when he has had to go away.
His first job found David working in what was known as the Swiss Cheese Hospital because it was so full of bullet holes. It was a baptism of fire and he learnt a lot.
Several weeks into his mission he had an operating theatre to himself with his own staff.
One night a teenage boy was brought in with fragmentation wounds, with a large piece embedded in his stomach.
David started to operate and his hand was on the largest piece of fragment that had stuck in the boy's abdomen when there was a massive crash.
"The hospital moved from side to side. My feet moved, the operating table moved and then suddenly everything went pitch-black.
"But that happened quite often. You would wait for a man with a wheelbarrow to come with a battery and a big light and then you'd continue operating, but then there was another enormous crash and again then everything moved and I wondered if it was going to all fall down.
"At that time it was completely pitch-black. I had my hand on this boy's tummy and I was waiting and waiting for the man to come, but he didn't come."
David could feel the boy was slipping away and called to the anaesthetist, but there was no answer.
As he waited in the pitch-black room, he felt the boy's life slowly ebb away.
When the lights eventually flickered back on, David found he was alone with the dead boy. He walked out of the room and saw his operating team down the corridor huddled under sandbags.
"It was at that moment I realised that in war you probably should look after yourself more than the patients in front of you," he said. "If you are going to operate on more patients, you need to save yourself."
This lesson was one David was to ignore 20 years later. It was 2014 and David was working in Shifa hospital in Gaza City.
He had just spent a night in a bunker while the area was under heavy bombardment. With no sleep, he ventured to the hospital, which was bedlam.
There he found a seven-year-old girl on her own in the corner. At first, he thought she was dead.
A quick examination found that her small bowel was hanging outside her body. He rushed her into an operating theatre. As she was anaesthetised and David scrubbed up, the hospital security manager came in and said there was intelligence that the hospital was about to be attacked by shelling.
Then a security manager for the International Committee of the Red Cross came in and told everyone to leave.
In War Doctor, David poignantly explains what happened next: "The most burning thought was that I could not leave this little girl to die on her own, having suffered the most extreme of injuries. She was an innocent child and did not deserve such a fate. She had to be protected from this dreadful violence, not be a part of it."
The anaesthetist, an Italian man called Mauro Torre, said he would stay with David and they set to work.
"So we stayed with the little girl, waiting for the bomb to drop or the missile to strike, or whatever it might be. I wondered what it would be like."
The operation was a success, the bombs did not come and David has a picture of Aysha in her hospital bed.
"Perhaps it had been irresponsible of Mauro and me to stay, but I felt in that moment that the girl's welfare took priority.
"It wasn't a logical decision. It was based purely on emotion - compassion for her and anger at the forces of war ranged against her. I was so sick of seeing badly-injured children that I could not bear to see another one and stand idly by.
"Staying with her was a pointless act of defiance against warmongers, but it would have been impossible to do otherwise. The nature of the risks I was taking had grown without my really noticing.
"I was prepared to die and I would rather have died than lived with myself knowing I'd left her alone."
Just before David went to the hospital and saved Aysha's life, he made a life-changing decision.
The day before he flew to Gaza, he had been at a charity event for Syria Relief.
"This lady came up to me," David said. "She looked rather nice, gave me her card and sat down next to me. Then I went offto Gaza the next day.
"I remember sitting in Gaza when the whole place was like the apocalypse and the ICRC staffwere sitting in this bunker. It was three o'clock in the morning, the shells were dropping around, things moving and clouds of dust from the top falling down.
"I was just sitting there going through my pocket when I found Elly's card and I thought, 'Well, I am not going to survive this' so I thought I would say I thought she was very nice.
"When I did survive the night, I got on my email and said, 'Hello, do you remember me? I'm in Gaza at the moment, I just wanted to say you were very nice'.
"When I came back from Gaza, we had some time together before going offto Syria. It was love at first sight."
This mission was a return to Syria. As he said goodbye, he believed that he might never see her again - he really didn't think he would survive this trip.
David had been there a year before and had had a number of run-ins with ISIS soldiers, so his trepidation before going was well-founded.
On the previous trip he was mid-operation and six ISIS soldiers had burst into the theatre.
David had his fingers on the pulmonary vein of his patient stopping the bleeding when six or seven black-clad figures came in with AK47s pointing at his surgical team.
"This, of course, was an Islamic State fighter on the operating table in front of us. Not only that, it was the Chechen Brigade - the Chechen Brigade were the worst sort of Islamic State people you could get. They were really ruthless," he said.
"The leader came over to [Abu] Abdullah [a general surgeon] and said, 'What is going on here?' "Abdullah said, 'We are operating on him'. He replied, 'This is one of our brothers, you should have told us that you were operating on him... and who's this?' pointing to me.
"Abdullah replied that I was the senior surgeon and they need to allow him to do the surgery.
"I was trying to control the bleeding and shaking at the same time, thinking, 'Dear oh dear, this is the way it ends if they find out I am a Brit and if he dies on the operating table I am really in the stucco'.
"But we put the stitches in the right place and the fighter, a 19-year-old man, survived the operation."
At this point, David answers the question many in the room in the golf clubhouse, glued to their seats, were probably thinking - how could he save the life of somebody who might go on to do terrible things to people? CONTINUED ON PAGE 8 Doing a tricky operation by text IN 2008 David went to the Congo and, as he was being handed over patients by the departing surgeon, he was introduced to a 16-year-old boy who did not have long to live.
The boy had been bitten by a hippopotamus several months before and each visiting surgeon had removed a bit more of his arm.
By the time David arrived there, the boy had gone septic and the wound had gas gangrene.
"He was going to die with 48 hours," David said. "I thought, 'If only I had learnt how to a forequarter amputation, I could help this boy', but I didn't know how to do it.
"Sometimes what I do is I bring my surgical books on a stick to read on a computer, but I had forgotten the stick."
A forequarter amputation operation removes the shoulder and the scapula, a large bone on the back.
It would have been a hazardous operation even in the UK but, in the jungle, it was extremely complicated. Especially for someone who had never done it before.
"There I was in the middle of the Congo and I thought I would phone my friend, a chap called Meirion Thomas, another Welshman in Royal Marsden, probably the world expert at this operation.
"I called him and, of course, the phone didn't go through. So I sent him a text message - 'Meiron, do you know how to take me through a forequarter amputation'.
"A few hours later the phone went ping.
There it was."
Mr Thomas, who is originally from Llanelli, had texted a detailed step-by-step list of instructions for the operation.
David then had a difficult decision to make.
"I said to the anaesthetist, 'Would you be able to anaesthetise this boy for a forequarter amputation?' He said his wife was ill and if I was to do it I had to do it now.
"So I walked away and came back to the operating theatre and there was the boy anaesthetised and he said, 'There you go'.
"So I quickly took Meirion's text message, copied into a piece of paper and stuck it on to the wall of the operating theatre and followed these instructions."
Despite the conditions, the operation was a success, and the boy made a full recovery. News of the text message between the two Welsh surgeons went worldwide.
CONTINUED FROM PAGES 6&7 "You just have to have the mantra that you are a humanitarian surgeon and you've got to save the life of a human being. Try to do your best for that person in front of you, no matter who he is.
"And the way I look at it, he might realise his life was saved by a Christian surgeon and he may change his mind at a later date. I don't know what he is going to do, but my role is to save his life."
On his return to Syria, David was shocked at the change in Aleppo. Buildings had gone. The population was down to 350,000 from two million the previous year.
In War Doctor, David describes a scene from this mission that is so horrific it can't be described here.
During this mission, the US starts making strikes against Islamic State. However, Syrian civilians were being killed and maimed in the crossfire and David began to feel antipathy from some of the other doctors.
It was also the time ISIS had taken a number of Western hostages, who were then executed.
David started to follow the news online.
"I became obsessed with the internet," he explained. "I began looking to see what was happening with Alan Henning, the Salford taxi driver who I was only about 40 kilometres away from in Raqaa.
"I was watching James Foley being beheaded. I was thinking, 'Gosh, I am only 40km away. I am miles inside Syria. I am deep in Syria and no-one can get me out'. I really felt then that I began to lose it a bit.
"I used to watch the BBC news every morning to see what was happening with Alan Henning, whether he would live or not live. Then, of course, in October he was beheaded. Not only that, one guy was happily showing me the actual beheading on his phone. Of course, I had to sit and watch it and that just sent me over the top."
This was when he endured his terrifying ordeal to get out of Syria, which led to him "losing the plot" while sitting with the Queen.
A few days after landing back in the UK in October 2014, David received word from his secretary that the Queen wanted to have lunch with him.
So within a week of escaping Aleppo, David found himself in a room in Buckingham Palace. The Queen and Prince Philip walked in and they all went into the dining room.
"The Queen was sitting on my right and someone else was sitting on her right. The order is that the Queen speaks to the person on the right for half the lunch then speaks to the person on the left for the other half.
"Here I am having just survived Aleppo. Having been totally deranged, sitting there thinking this is the worst place I could ever be, realising that it was about to be the time the Queen was going to talk to me. I was maybe going into an anxiety attack."
The Queen then turned to David and asked where he had come from and how it was.
"Of course, at the time, I didn't know what to say to her and I sat there and I said, 'Well, Aleppo was dreadful, it was really, really terrible' and, of course, the memories came back of the bombs, the dust and everything else and I really started to go.
"I felt the bottom lip going and I thought, 'I am not going to be able to get through this. I can't talk'.
"Then she turned around to one of the courtiers, who came across and opened the doors and all of a sudden all these corgis ran in.
"Four or five corgis ran into the room and they went under the table."
The Queen then had a small silver box brought to her - which contained dog biscuits - and for the next 20 minutes David fed the corgis with the Queen.
"Then that was the end of the dinner. I didn't eat any of the food in front of me. She didn't eat any of her food in front of her.
"I was told the Queen always wore gloves, but this day she didn't wear gloves and she put her hand on my hand and said, 'It's much better than talking, isn't it?'."
This time he had Elly to help put the pieces back together. She also set up the David Nott Foundation - which got charitable status on the day their first daughter, Molly, was born.
Every six months, at the Royal College of Surgery, surgeons, doctors and nurses attend a five-day course hosted and paid for by the foundation.
David believes there are 50 operations a medic needs to know to be ready for anything in a conflict situation.
The foundation also goes out to train people who are already working on the front line. Last month David was in Yemen and before that Boko Haram territory in Cameroon.
He is also training people to run the course, meaning he won't have to make so many of these hazardous journeys any more.
David didn't just have a lonely childhood - as an adult, his life revolved around the missions and that affected all his relationships.
"I didn't have friendships. I couldn't have friendships," he said. "It's funny, I became so determined to do what I was doing and loved so much what I was doing. I never felt so happy than when I was in these difficult, dangerous places.
"It is a funny thing to say, but once you have done it once, twice, three times, you really get this burst of adrenaline and endorphins in your head and you feel wonderful. Like you have had a shot of something. And you find coming back totally mundane.
"I was unable to have a relationship. I never went to dinner parties. I couldn't sit there listening to rubbish.
"It suited me very well. I enjoyed the loneliness part of it because I was cut off. Although I did my job and I had relationships with the patients and my staffand everything else, I tried to be a nice person to everyone.
"Socially I couldn't mix with anybody. I didn't want to mix with anybody because they didn't understand where I had been or what I had done. I felt I couldn't do that.
"So when I met Elly I was totally blown apart. I didn't know what I was doing, suddenly I fell in love with somebody. This shouldn't have happened and that emotion I couldn't cope with."
Later David added: "In one respect I was lucky to do it the other way around. To spend most of life doing this and then at the very end get married and have the children, so I was extremely lucky to do it the wrong way round, but the right way round for me."
It was the right way round for the thousands of lives saved, improved, changed by this wonderful man and surgeon. It is just that he has found the happy home life that seemed to have eluded him since those magical days in Carmarthenshire.
| War Doctor: Surgery On The Front Line is published by Picador, priced PS18.99
Every day I was scared stiff the knock on the door wasn't a knock on the door to help someone... I felt it was someone coming to take me awayThe hospital moved from side to side. My feet moved, the operating table moved and then suddenly everything went pitchblackI am miles inside Syria. I am deep in Syria and no-one can get me out. I really felt then that I began to lose it a bit
<B David with Hala, a three-year-old Palestinian girl who needed heart surgery
<B David in Sarajevo in 1994 and, below, Darfur in 2005
The 'war doctor'... surgeon David Nott
David Nott in Syria and, left, in Darfur in 2005
<B David with his wife Elly and, left, working for the David Nott Foundation