by Paul Toohey
Sergeant Andrew Cave of the SAS pictured in Adelaide near the Torrens River. Picture: Matt Turner Source: AdelaideNow
SERGEANT Andrew Cave was in the lawless Chora Valley, north of Tarin Kowt, patrolling with members of the Special Air Service Regiment. They came across a surreal scene - remnants of Afghan security forces leaving the valley, ragged, vanquished and battle-shocked.
The SAS went searching for the cause of this rout.
They encountered a sizeable Taliban force and heavy combat took place.
The Diggers used everything they had - .50 calibre machine guns, 40mm grenades, 7.62mm machine guns and 84mm rockets - but the Taliban were relentless.
They began "whaling", battle-talk for swarming.
Cave thought the troop's right flank was exposed and they were in danger of being over-run.
He led two long-range patrol vehicles to the flank and held position under Taliban fire.
Apache gunships moved in providing cover when an insurgent's rocket-propelled grenade, designed to stop a tank, exploded just metres over Cave's head.
"It felt like I had been hit by a sledgehammer. The blast sent shockwaves through my body. I collapsed to the ground, rose, recommenced firing, however I succumbed to the strike and collapsed to the ground bleeding, very dazed, ears ringing. The world was spinning," he said.
It was 2006. The South Australian soldier's troubles were just beginning.
Cave was one of our most experienced serving SAS soldiers.
He still is. He has had 25 years at the elite level of soldiering. But that blast had a profound effect on him and his regiment. He developed PTSD - post-traumatic stress disorder.
Cave was the first serving soldier in this most exclusive and secretive regiment with the courage to put his hand up and admit he had a problem.
He did the right thing. Now, at 43, he is about to be medically discharged. This is not his choice. His anger is controlled.
He believed that Defence meant a job for life, but there was no job for him. He had given his loyalty and almost gave his life.
The day of his wounding remains close. His carotid artery was exposed in his neck. His head and neck were peppered with shrapnel.
He was deaf from the blast. He wasn't wearing a helmet but his body armour - now laced with metal - had saved him. Ballistic goggles saved his sight.
He staggered back to his vehicle where two of his patrol members were still returning fire. Cave's mates rendered first aid and drove him out of the contact area.
He remembers being loaded on to a quad bike, then a US helicopter, escorted by Apaches, airlifted him to the Tarin Kowt trauma station in the Oruzgan province.
He was attended to by an American surgeon, stabilised, then evacuated further north to a combat surgical hospital at Bagram air field.
Two of Cave's colleagues were awarded Medals of Gallantry that day, and the assisting medic who drove him out under fire was awarded the Commendation of Gallantry.
Cave wishes he was still with the regiment. He's not an ex-army axe-grinder. He wishes he hadn't stayed those extra five minutes on the right flank and instead made a tactical withdrawal.
But the same tenacity that led to his wounding while holding the flank also explains why he is so well regarded in the SAS.
A psychiatrist who has treated Cave said the sense of grief elite troops felt when removed from their band of brothers was intense.
"I tell them they can't do this job until they're 65," he said.
"There's only so much horror any one person can tolerate in their life. You can only reach into the well of courage so many times before the well runs dry."
Cave must now try to find some contentment being, as he calls it, a "warrior diplomat" for veterans suffering blast trauma and PTSD.
It is the SAS Association and the regiment in Perth which have encouraged him to tell his story. They know he's not a spent force. He has the charisma to make difference.
PTSD is not supposed to happen to SAS troopers. They are meant to prevail over mental trauma.
But science now knows that PTSD does not only come about from experiencing difficult events.
It is medically accepted by US and British experts that waves of concussive force from improvised explosive devices and rocket propelled grenades can cause traumatic brain injury.
This can lead to PTSD, which can result in anxiousness, disconnection, hyper-arousal, a constant sense of danger and self-harmful behaviour which can lead to suicide.
Cave outed himself as having PTSD three years ago. The regiment was fiercely protective.
Despite knowledge of PTSD stretching back to WWI, when it was called shell shock, the Defence Department had no procedures to help Cave. He hit the ropes.
CAVE is not talking to attack the SAS, to which he remains devoutly loyal. But, with Afghanistan now an IED war, mental damage from blast trauma is a growing problem. He wonders if Defence is ready.
There are some signs that Defence is finally catching up with mental health issues, but it came too late for Cave. His problems started in Bagram, at the combat army surgical hospital. Australians with serious wounds are now flown directly to West Germany, but not Cave.
"Unfortunately I went from priority one to priority two and I was not airlifted to Germany," he said.
"I stayed in that hospital for seven, eight days. There were dozens of Afghan nationals coming in with IED blasts, bullet wounds, amputations, and children so deformed with burns you could barely make out their features. They were screaming day and night. A Taliban fighter was under armed guard and the lights were on 24 hours a day. I truly to this day am in painful awe of the level of trauma in that ward and my sympathy is with those victims."
SAS commanders wanted him out of Afghanistan, in proper care.
The Australians organised a C-130 Hercules to airlift him to Dubai, to an American civilian hospital. He flew on a commercial flight to Perth, in the care of a doctor. Nine or 10 days after being wounded Cave had neurosurgery, an inexplicable delay.
His wounds were so significant he required subsequent facial surgery and neurosurgery. Aside from head trauma he had sensory-neural loss, which caused loss of balance, hearing loss, an upper cervical condition - commonly called whiplash - and shrapnel wounds.
He spent the next two to three months stabilising and rehabilitating.
"I started to feel significant post-trauma symptoms," he said. "Severe anxiety, anger, nightly hyper-arousal and nightmares - stacking furniture up against your door in the middle of the night is hardly normal," he said.
His memory was poor. A trusted medical officer persuaded him to become an outpatient of a Perth mental health clinic, where he stayed for three weeks.
"I probably was released too early. I was diagnosed with severe post-traumatic stress disorder," he said.
I met Cave in one of those old suburban Adelaide pubs which every other city seems to have killed off.
When he walked in he was not hard to spot. SAS really are a little different, in style and approach. He could have been a senior AFL player, the same fitness but with very different game-day experience.
His hair is sharp rockabilly. He wears boots, jeans, T-shirt - an intelligent, highly evolved Australian soldier.
A former SAS officer describes Cave's place in the regiment: "He's reliable. He's a true warhorse, with immense experience across a broad spectrum of operations - desert, jungle, open savannah, urban, Iraq, Afghanistan. And he's the king of the counter-terrorist environment. You've met him. He's somebody."
The surgeons did a good job. There's no obvious evidence of his facial surgery. He's a little emotional, at times, leaning back to pause and correct himself. On one occasion during the evening his face is gripped by a palsy which freezes the area under his mouth. It passes.
It was the SAS old-boys network - which has fought so hard for better treatment for wounded Diggers and widows - which encouraged him to talk. But a speech given in Townsville earlier this month by Chief of Army, Lieutenant-General Ken Gillespie, has also given Cave hope that Defence might finally be getting real about PTSD.
Gillespie said PTSD had long been under-recognised, under-reported and marginalised. He could have been talking about Cave when he said: "We would be badly mistaken to view those suffering from PTSD as being somewhat less robust, less masculine, less tough - less of a soldier than the rest of us. I would strongly encourage you to confront PTSD where you see these early signs, to call it out and to seek help."
Cave believes Gillespie is sincere. But he wishes Defence had acted earlier on his behalf. After all, Gillespie said PTSD had been around "as long as armies have gathered and wars have been fought".
Cave would become a spokesman for PTSD but first he took himself on a self-destructive journey.
"I believe the SAS Regiment treated me brilliantly, but I don't believe anyone was ready for my descent into post-trauma," he said.
"I did almost an authorised runner. I shot through to Brisbane and lived in a near-empty house for three months. I was heavily sedated. I was living a very Spartan life."
He said he was lucky to come across Dr Michael Norton in Brisbane, who had established a fledgling ADF mental health unit. Norton viewed Cave as one of the four worst cases of PTSD he had ever seen. Cave believes sessions with Norton saved his life.
"I was probably lucky to survive that 12 months. There was a lot of self-harm, a lot of drinking through 2007-08, a lot of waking up in people's frontyards, gardens, parks, sides of roads. I was arrested for fighting. I had every classic sign of severe PTSD. The mental health unit was very good but they gave me enough rope."
He went to Melbourne, to one of his best friends - a commanding officer.
The SAS network came into play and he started getting stability. In Brisbane, another infantry battalion commander took him under his wing.
"I slowly started to piece together my life. This was where the old boys' network helped. I'd become almost catastrophic," he said.
"I am not able to thank them enough. They cut me some slack but the biggest thing was being welcomed back and absorbed. I was getting better.
"Eventually I went back to the SAS Regiment in Perth and I was posted back into a squadron for 18 months. This was a massive morale-boosting moment but not without its troubles. PTSD unfortunately can affect you so you'll never really get over it, and on occasions it came back to bite hard."
Cave's whole mindset was geared towards getting back to Afghanistan. He did a dance between Veterans Affairs, seeking medical assistance for his condition but trying to conceal the fact he was on medication from the Defence Department, because it would deny him a return to active service.
"I kept on trying to get back to the regiment," he said.
"If I didn't have them, I would have necked myself. I was in such a state I needed to get my pride back, my respect, especially when I was combusting. They allowed me to do that. But I was not well."
The SAS encouraged Cave to meet then defence minister John Faulkner, along with senior Defence and DVA personnel, in order to get the message out that PTSD was reality even in Australia's most elite force.
Gillespie said in his recent speech that there was a misconception that diagnosis of PTSD need not result in discharge. Still, that's what happened to Cave. The womb-to-the-tomb Defence philosophy did not come true for Cave.
"I wish it was there for me but it's not. If you destroy that belief by not delivering, it's almost like a benevolent father has discarded you," he said.
"I was treated really well by individuals but I will say Defence didn't have suitable policies in place to better handle my career."
The moment, when it came, was crushing. The decision was made to discharge him on medical grounds.
"Believe me, the regiment were brilliant, they would have kept me. But once the medical officer says a person should be discharged, it's a death sentence. It's the plague, a mark against your door. You're gone. That's the way it was," he said.
Cave said there were not too many jobs out there for an ex-SAS soldier. He spent last year studying at Monash University and will go to Adelaide University next year.
He hopes to get an arts degree and maybe become a school teacher, or perhaps work with people suffering PTSD.
Cave gives you confidence he will be a highly valued member of society. The question is why Defence does not see him that way
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