Chapter Text
In Chapter 1, I talked about the difference between a medical officer and a medic in terms of training and the amount of time they spend actually dispensing medical care. The take-home message was: medical officers belong to the RAMC, have medical or nursing degrees, and spend their time either practicing medicine or managing people who practice medicine. Medics may or may not belong to the RAMC, and their role can be anything from solely medical to almost solely combat. Medics with solely or primarily medical roles may be RAMC or regimental medics, but the more combat-flavored medics are always regimental medics. The RAMC has obligations under the 'protected medical personnel' provisions of the Geneva conventions that mean RAMC personnel cannot have solely, primarily, or even substantially combat oriented functions. We know John is an MD, and he’s got an RAMC mug, so the obvious conclusion at the end of Chapter 1 was that he had finished his medical degree and a year or two of additional training, and then joined the RAMC as a medical officer.
However, I did make a point of setting aside the dream sequence for that discussion. Now, we’re going to backtrack and tackle that. I will try to do this as clearly, fairly, and calmly as I can, but you have to realize, the first ten seconds of BBC Sherlock made me scream with delight, because of the implications of this footage for the character of John Watson.
We’re going to talk about risk exposure and how it relates to medical personnel. I’m going to divide the risk exposure into two types - let’s use the terms ‘chronic’ and ‘acute’, since we’re talking medicine, and I’m going to relate those two kinds of risk exposure to the two different classes of medical personnel that we’re interested in, medical officers and medics.
Chronic risk exposure – I’m using this to mean being somewhere there is a constant significant chance of close, sustained fighting breaking out.
Acute risk exposure – I’m using this to mean being somewhere there is little to no chance of sustained fighting, but there is a significant chance of sporadic events like IEDs, car bombs, etc.
As far as is faintly possible given the nature of the conflict in Afghanistan, medical officers do not have chronic risk exposure. They do not go on combat sorties or on security patrols, they do not frequent isolated fire stations or forward bases in hotly contested areas. They might make visits to operating bases or district centers that are at some risk of attack, but that would be the exception rather the rule, and at the first sign of trouble they'll be moved out of possible harm's way. So, medical officers generally only have acute risk exposure: the possibility of something like a car bomb attack at an otherwise reasonably secure base, or of an RPG or IED attack while travelling between bases.
Medics, because they cover the whole range of roles from ‘practically a medical officer’ to ‘infantryman who can tie a proper tourniquet’, can have wildly different chronic and acute risk exposure depending on their particular role.
Okay, now let’s talk specifically about the very first reference to John’s military career, his dream. This footage comes from the Ben Anderson documentary “Inside Afghanistan”. Personally, I sort of use the entire documentary as extra-canonical material, but for other people’s use I’m confining myself to only the frames we see in the episode. What are we looking at?
We’re clearly not in a city or town or on a military base of any kind
We could, conceivably, be near a road but there’s no evidence of vehicles
There are British and Afghan infantrymen (you can tell the British by their pale brushstroke style camouflage, and the Afghans by the mix of dark brushstroke camouflage and civilian clothing)
There’s a lot of small arms fire, both from behind the cover of a low wall and on open ground
There’s firing an RPG on open ground
There’s an aerial bomb strike in the near distance
There’s a soldier kicking a door or gate in
What are the circumstances under which an RAMC medical officer could see this firsthand? I suppose if I really stretch the limits of reality, I could come up with something like “he was travelling between bases in a convoy that was attacked by the Taliban”. This doesn’t really work, though, because in that situation the convoy commander would be interested in getting the hell out of there, not in having everyone including the flipping medical officer he’s transporting pile out of the vehicles and start a knockdown drag-out fight that included advancing over open ground under sustained small arms and RPG fire. The idea that he would pursue the attackers to the point where he’s kicking in doors and calling in close quarter airstrikes with a medical officer in tow is just outrageous.
So. The only faintly plausible alternative is that despite his medical degree, John isn’t a medical officer, he’s a medic. The genius of this (I felt, as I screamed and shimmied on the couch) is that it makes John’s experience much more analogous to that of ACD canon Watson. Back in 1880, many British army surgeons were willing to wade into the thick of battle to tend to the wounded even as the fighting raged around them; nowadays medical officers are kept as far from the action as possible, and that role belongs to the medics.
But John isn't a medic like the corporal in Chapter 1, grabbing her pack and heading for the guys in the ditch – the fact that the guys in the ditch are calling for a medic to be choppered in means they have stopped trying to advance and engage, and are actually looking for a chance to pull back from the rest of the action to avoid putting the chopper crew and medic in the middle of an active firefight. John is the kind of medic who moves with an advancing line of infantrymen across open ground while they exchange sustained small arms and RPG fire with the enemy, and then pursue the enemy to the point of kicking in doors and calling in close quarter air strikes to drive them out of their defensive positions and into an open engagement.
We’ve talked about how medics can have primarily medical or combat roles; RAMC medics are by definition on the medical side of the spectrum, and the regimental medics can be on either side. John is at best at the very rag-end of the RAMC food chain: an RAMC medic who has somehow ended up running with the infantry on combat sorties, and presumably reverts to his medical personnel function when someone needs him. But this is stretching reality really, really a lot, because RAMC personnel cannot have substantially combat oriented roles. John's presence in an infantry advance over open ground under sustained fire is much more consistent with him being a regmental medic, whose primary role is to fight or lead men who fight, but who can provide medical assistance in an emergency, and who for reasons we can conjecture about later drinks his tea out of an RAMC mug.