Dr. Marc Dauphin on treating the Taliban, PTSD and the chaos of war

In conversation with Michael Petrou

Photograph by Will Lew

Marc Dauphin was the last Canadian officer in charge of at the Role 3 Multinational Medical Unit at Kandahar Airfield, from April to October 2009, at a time when NATO forces were engaged in some of the heaviest fighting of the war in southern Afghanistan. His unit treated wounded Canadian and allied troops, Afghan soldiers and civilians, and Taliban fighters. Dauphin is the author of Combat Doctor: Life and Death Stories from Kandahar’s Military Hospital.

Q: You were 56 years old when you went to war for the first time. Why?

A: I wanted to be there for my brothers and sisters in arms. I always said I’d stay in the Canadians Forces as a reservist just in case there was a war. A war came, they needed me, so I went. I felt it was justified. I think Islamism—not Islam—is a cancer that is trying to chew the world up with ignorance and medieval-type thinking. We were helping to fight someone who had attacked our closest friend and ally, the United States. And as a NATO country we had to react and do our part. It’s in the NATO treaty, so it wasn’t a choice for Canada. We just had to go.

Q: Describe the Role 3 Multinational Medical Unit.

A: It was ramshackle. It was made out of plywood. It was held together with duct tape. The holes in the wall from shrapnel were [also] patched up with duct tape. The floors were linoleum, held together with duct tape. But the working conditions were good. There were more ER docs than in a normal civilian emergency room. As the surge was beginning to have its impact, countries were sending more specialists and nurses and everything. We got to be quite a robust team over there.

Q: You say the care there was more advanced than in trauma units anywhere else in the world.

A: Because of the joint-theatre trauma system, where you analyze all the traumas in all the hospitals in Iraq and Afghanistan on a day-to-day basis, trends are spotted, and we changed our medical practices according to those trends. Our blood-replacement therapy was more aggressive. Our use of tourniquets was more aggressive. The survival rate was 97 per cent for everybody, and 98 per cent for the soldiers. That’s a record for all times and all wars and all hospitals, whether civilian or military. And that has Canada stamped all over it. We’re very proud of that.

Q: How differently did you treat Taliban patients?

A: The same. A torn-off limb is a torn-off limb. Actually, most of the guys were just poor bastards that the Taliban had tricked into serving or blackmailed into serving. We very rarely had the real Taliban big guys. I did not like them, but we treated them just the same.

They were housed in a special ward to minimize the stuff they could pick up. We had to keep them until they were fully recovered, so they would stay for weeks at time. We knew that some of them would be released and would probably start over again. Apart from that, in the intensive care unit, they were in the same beds right next to our guys.

We did have security. Some of these guys, the real Taliban, were very fanatical. They wouldn’t think twice about grabbing one of our weapons and trying to go out in a blaze of glory. They tried a couple of times. After I left, there was a lady who tried to blow herself up. And [NATO/Afghan forces] discovered her, so they shot her. But she was still alive, so now we have to treat her. They brought her over to the hospital and she still had her explosive belt on. They had to evacuate the hospital. The guys who stayed to treat her and disarm the belt, well, I think that’s pretty heroic.

Q: Tell me about the boy who sold fruit juice outside the base.

A: He would wander in and out of the minefields that are just beyond the gate. He thought he knew where every one of the mines was, until he found a new one with his feet. Of course he blew up. He was lucky he stayed conscious, so that when the Afghan soldiers rushed into the minefield to fetch him, he guided them through. Both his legs had been ripped off around the knee.

Forty-eight hours later he was sitting in the ward with a million-dollar smile. It was Saint-Jean-Baptiste Day. They brought him to the party. He was smiling all the time. The only time I saw him cry was when he left. We transferred him to the civilian hospital, and he was crying, I guess because he knew that the care was not going to be as good as the care that we gave. He had an absolutely bleak future with no legs in Afghanistan.

Q: There was a little girl who had been smothered by bodies in a suicide bombing.

A: She was brain-dead, so there was not going to be anything salvageable in her, poor little thing. One of our nurses rocked her until she died.

Q: You write that to be a good emergency room doctor, you need to be cold-hearted, devoid of emotion. Were you able to hold to that in Afghanistan?

A: For the most part, yes. We’re human beings, just like anyone else. We all have families, children, grandchildren. So we have to block out all the emotions in order to survive. You have to keep that locked up.

Q: But your nurse rocked that brain-dead girl until she died, and you had a rule that no one dies alone.

A: At least we can do that. At least we can bring back a little bit of humanity in a very inhuman theatre of war.

Q: Tell me about the man who came asking for a shovel.

A: He showed up at a forward operating base with a woman in a pickup truck. The guard bent over and saw that she wasn’t dead. The medic said we can fix her up. But the guy said, no, she’s dead. We’re going to bury her. And they left without the shovel. It was only when we got back that we understood that she had probably been lapidated [ritually stoned] and they were going to bury her. The medic who told me the story thought it was the funniest thing, that they were going to bury her alive. And I thought, oh my God, this country is really screwing us up.

Q: How did you imagine it would feel to come home?

A: I knew I was going to be tired but happy. But after a couple of days I saw myself getting into a pattern of isolation. It was the nightmares. When I was over there, I was sleeping okay. But over here, once the pressure was off my shoulders, I started having nightmares and not sleeping very well. I figured it would wear off, but it just kept getting worse and worse.

Q: What were the nightmares about?

A: It was about working over there and failing to do stuff because my staff was incompetent, or I couldn’t find the right place to intubate somebody, or I couldn’t find the vein, or I couldn’t stop the bleeding. I was failing. It was nightmares about me failing in my job. I was drinking a little too much. I would go to bed drunk just so it would stop the dreams.

Q: When did you realize you were suffering from post-traumatic stress?

A: When I tried to kill myself. I felt so bad inside that I wanted to die. It was February and the Richelieu River was just across the street. I figured I’d put on my heavy army boots, get dressed, and walk into the river, and that will be it. It will be cold as hell, but it’s not going to last too long. And I will stop feeling this bad. By the time I got dressed, the panic attack had started going away. So I postponed my suicide.

But it was months before I would accept the PTSD thing. I always thought PTSD was when you were afraid to die, or put in a life-threatening situation. And I couldn’t figure it out, because I’m not afraid to die, and I’m not afraid of death. I remember one incident over there when a rocket blew up on the other side of a blast wall from me. I fell on my butt. And half an hour later I was fast asleep. I thought nothing of it.

Q: How are you doing now?

A: I’m not doing too bad. We moved into a bigger house since I got out of the Forces. My wife and I can each have our own bedroom, so I don’t kick her or punch her during the night. She says it’s still amazing, the amount of energy I spend during my sleep, tossing and turning and kicking and punching. But I figure I’m doing a lot better.

Q: Is there reluctance among soldiers to talk about PTSD?

A: Of course. It’s very humbling to have PTSD as a solider. It’s doubly humbling as an ER doc, or a trauma surgeon, or an ICU nurse, or a combat medic. It took me years to acknowledge it. That’s why I’m talking freely about it, so if they hear me talk, they might say, oh, that’s how I feel. If Dauphin can have PTSD, maybe I can allow myself to have it, too.

Q: How do you feel about your time in Afghanistan now?

A: I’m extremely proud to have had the chance to contribute, to make a difference, and be part of history.