Is there no balm in Gilead?
Is there no physician there?
Why then is there no healing for the wound of my people?
Jeremiah 8:21–22
Tshiamo and I always used to play Doctor Doctor. He thought it was dumb, but he knew how much I enjoyed the game, so he went along with it. Not always though, not on his down days. It wasn’t like he was a saint or anything. Sometimes I’d have to beg him for hours, and promise to leave him alone for the rest of the day if he agreed to play with me for just a little bit. And I really did mean a little bit. Everything was already set up, the patients were on the table, I was scrubbed up, the anaesthetic agents were drawn and labelled and the instruments ready. I just needed a theatre nurse to assist me.
Tshiamo would look at me in disgust as he walked into my room filled with teddy bears whose throats had been slit, yellow sponge pouring out of them. I’d smile and tell him not to panic, I was going to save them. And I did. I always saved them.
I remember first learning about cells in Grade 10 Biology. Mrs McCartney described them like little factories in our bodies – no, like cities with many factories inside them. She said they were billions of them all packed tightly together. I tried to imagine them, to picture all that activity inside of me. I remember being struck by how much I still had to learn, and wondering if I would ever fully understand the functioning of the human body.
Ma said I worried too much. She reminded me of how concerned I was in Grade 1 that I’d never be able to read. I laughed when she said that. It still amazes me though, how we go from looking at apples and cats on a big colourful chart to memorising the names of the blood vessels of the heart to inserting a central venous pressure line into a patient’s neck. I guess this ability we all have – to go from looking at street signs and roundabouts in a learner’s license study book to overtaking trucks on the highway – makes us a little reckless when it comes to what we think we’re capable of achieving.
I see now that there was actually a lot of luck in my getting to this point, and perhaps a lot of unseen effort by those around me. Like the exam study guides that slowly filled my bedroom and the extra lessons Ma insisted Papa pay for. So when I saw green peas come out of bed A3’s neck, I knew my luck had run out.
Dr Voel-Vfamba said that is how we learn, that she was going to die anyway and that I shouldn’t feel bad.
Patients die all the time. Nobody expects you to save all of them all the time. We do what we can. And with our crumbling health system, our staff shortages, our social challenges, well, what can people really expect? We do what we can. This is the mantra I sing to myself, day and night, night and day. I sing it to others, they sing it to me.
‘We do what we can.’
‘We do what we can.’
They come to hospital so late anyway, what can you do really? They are irresponsible, many of them. They know better, but our people refuse to take responsibility for their own health. And then it’s the government, the district, the minister, the president.
‘We do what we can.’
‘We do what we can.’
Again and again, I sing the words, repeat the speech, sometimes silently, sometimes violently. But when the (irresponsible?) mother of the (now dead) baby is running down the corridor, security behind her, Sister Agnes drawing up Valium, patients watching from their beds, mouths agape, and it’s your call, your shift, your patient, your incident, another death on your watch, the mantra does not work. The Gini coefficients, the shrinking economy, the legacy of apartheid, the unachieved Millennium Development Goals and human resource constraints, these are all disloyal friends who abandon you to face your conscience alone. You kill the patients alone. You kill them alone.
Sometimes you turn your car around, call the referral hospital again. Maybe you will find bed A3 an ICU bed if you call just one more time. Sometimes you leave with packets of donor blood in your pockets that you forgot to drop off at the emergency department on your way out. Sometimes you accept a lift home, neglecting that you had driven in that morning.
You learn a lot in the dead of the night: that if you cry while you are peeing, and hang your head between your legs, the tears collect in your eyelashes, so that when you walk back into the ward, there are no lines down your face but stars before your eyes.
There is also a lot of good. Like the credit you get. That’s always good. And those moments when people try to explain medical stuff to you, like at the travel clinic, only to pick up the patient information card and flush with embarrassment at the ‘Dr’ beside your name. All of that is good. Letters in the post are always nice. Your electronic signature, that’s also nice, all of that is good. But there’s a lot of bad. Like when your tongue twists in your mouth and your neck turns round and round and round, making you want to scream but only knotting tighter each time you try. That sucks. And having to go back every day. That really sucks.
I tell Ma of the many horrific things our people overcome daily that go undocumented. I tell her that somebody must list them, all the bad things that are happening to them, to me, to us. Somebody needs to write them down.
Ma says I must leave them there, the patients. I must walk in their shoes, but try not to bring their shoes home. So I leave them there, stuck between the soiled sheets and the sandwich hidden for the day an appetite returns, between toilets caked in shit and the soap dispenser that only worked once, the day the minister came to visit. But I fail at walking in their shoes. They have no shoes, Ma. How can I walk in their shoes when they have no shoes?
The people at Bible Study advise me to pray to Jesus for them. They ask for their names. They will email them around the church and the congregation will pray for them. They ask and they ask and they ask. ‘What are their names? We will pray to Jesus for them,’ they insist. Names? Are these people stupid? How do they expect me to remember the names of hundreds of people crammed into a ward designed for a couple of dozen? How do they expect me to distinguish individuals among a sea of dying arms and mangled bodies glued to mangled beds?
And besides, Jesus wouldn’t get it. Jesus never failed at anything. He never did a thing wrong. That’s the fundamental difference. Having to live with failure will always set us apart from the Son of God. Having to live with the shame of not being better, not being courageous, not being great.
Prof. Siyatula didn’t warn us about any of this. When we were walking behind him on those grand ward rounds, hanging onto every word he spoke, fingers clutching at the hem of his garment, he, the only black specialist in a white institution, didn’t warn us about the suffering, the helplessness, the fear, the contempt that awaited us. There were no clues, no hints about just how bad things were going to be. We were doctors, mos. Well paid, well heeled. Was there anything we couldn’t handle?
There are heroes. The one’s with a skip in their step, the strange ones that don’t seem to need sleep, who walk around with irritating grins on their faces. But they are a minority. Most are broken and tired people, with bonds and university loans needing to be paid, so they stay on, doing what they can. I like to think I’m somewhere in the middle of that, but probably more broken than hero.
At my best I could be great. The Charlotte Maxeke, Hamilton Naki, William Anderson Soga kind of great. But I am not at my best. I am tired. I have a ward full of patients and no anti-nausea medication I can safely take without developing extrapyramidal side effects, so I must chew gum through my six weeks of post-needlestick injury treatment and just suck it up. I have urine on my last pair of clean scrubs, because Dr Voel-Vfamba asked me to drain a urine catheter bag and the valve got stuck, drenching me and my notes with body fluid. I cannot be great, even if I want to be.
‘Watch one, do one, teach one.’ How many people did we kill monthly, weekly, daily, all in the name of learning? ‘Watch one, do one, teach one.’
I can’t tell you the number of times I heard those words, and how I hated them. Because I was never that kind of junior intern. I had to watch
a million before I could do one, and even then I was likely to botch that one and the next and the one after, so that I had to be taught it all over again. Does it make me a bad doctor that I’m not a cowboy? That I can’t waltz into a ward, grab a pair of sterile gloves, tear them open with my teeth and plunge a central line into Mrs Mazibuko’s neck? She died you know. I couldn’t sleep for days. I remember me and Dr Voel-Vfamba standing on a stool, him trying to hold her still and me pushing the long needle into her neck. Maybe she didn’t die from that. The peas that followed made no sense. Maybe it wasn’t out fault. The central venous pressure line was a last-ditch attempt anyway. She was long on her way. But something tells me that we pushed her over the edge.
Murderers, all of us. Murderers.
That’s why I chewed so many Xanax. You have to be numb. How else are you to survive it all? She looked just like Rakgadi Juice. And worse, she trusted me. I’m the one who convinced her to sign the consent form. To Dr Voel-Vfamba, she was bed A3, the cardiac failure in bed A3. It was my job to protect her from him, from all of them, all those vultures, those third-year students with their logbooks desperate for signatures, signatures at any cost. I should have protected her from the registrars who sought nothing else but to clear the ward so they could study for their exams, from the consultants with papers to write. ‘A rare case of drug-induced cardiomyopathy in an elderly black female’. But I didn’t save her. Instead I aided and abetted, facilitated, won her over – and then handed her over. And now she’s dead.
I want to cry, but it takes too much time, too much energy. I want to run away, to escape, but to where? Escaping requires planning, thinking, organising. I feel like I am drowning in myself. Is that possible? To drown in the blood coursing through your own veins? I feel like the air in my lungs is choking me. Like there is a small me inside the big me that is sinking, struggling. Somewhere deep inside of me there is a thing in need of saving. Something in there is in trouble. It is screaming, it is gasping, it is dying.
Sister Agnes was furious at us. She didn’t think the procedure was necessary, and had said a number of times that Mrs Mazibuko should be discharged and allowed to go home and spend her last days with her family. But the consultants had insisted. What choice did we have? I heard Sister Agnes later say to one of the matrons that these were the kinds of things that made her want to take her retirement package and go watch her grandchildren play at her feet.
‘They are children. They think like children and they behave like children. They may know books, but nothing else. I’m sure some of them haven’t even started menstruating yet.’
I blame the barrel. It’s not me. The barrel was rotten to begin with, before I got into it. I’m a good apple, really I am. The barrel made me rotten, rotten to the core.
Who said we had to enjoy caring for the ill? I mean one ought to do it, it’s morally right to do it, but do you have an obligation to enjoy it? Would it make you a bad person if you said you detested it? Hated every minute of it? Did it, but deplored it?
Sometimes I want to feel stuff. I’m doing a resuscitation and I know I should feel something, but I don’t know how to anymore. There’s something in me that’s blocked, that’s stuck. There’s a weight on my chest, and I try to breathe it off, but I can’t. So when the patients die, I am relieved. I tell myself it’s better for them to die. They’re suffering, they’re in pain. I try to justify it. I’m tired, Lord. I’m tired of seeing them every day, tired of seeing their faces. I’m tired of being reminded of how little I can do. I’m tired of the drips that keep coming out. I’m tired of seeing them eat their poo and drink their pee. I’m tired of seeing them go mad. I’m tired of watching their families come every day and look to me for answers I cannot give them. I’m tired of working with people who don’t care, who are dead like me. I can’t even remember why I did this in the first place, why I was so foolish to think that being a doctor, that six years at medical school, would bring me happiness. All it’s brought me is pain and confusion.
I don’t know how I expected ‘doing good’ to feel. But I didn’t think it would be like this. There’s no magic, no divine enlightenment. It’s as hard as doing bad. You’re just as tired, just as scared, just as disillusioned, just as broken. I thought there was supposed to be some sort of anointing, some filling of the Holy Spirit, some peace that would come with doing God’s work. But there’s none of that.
When Jesus told the Twelve that he knew one of them was going to betray him, was he hoping that once that one realised he knew, he would change his ways and repent from his evil? And if not, if Jesus knew it was all inevitable, how unfair to Judas that he had no way out, that he was predestined to be forever known as the traitor of the Son of God.
Why is this place so broken? Why did You let it get so bad? Why don’t You do something about it? I don’t want to be a part of it, of this. I hate it here. I can’t be happy. You can’t ask me to be happy in this. One has to be crazy to be happy in this. I’m only a human being, I’m not a god. I’m not Jesus. I’m not You. Why do You ask so much of me?
I do not understand what I do. For what I want to do, I do not do, but what I hate I do.
Romans 7:15
Paradoxically, I’d felt sorry for myself when the heavy bleeding stopped. It had been the thorn in my flesh, the burden that was my very own, sorry load to bear. Even though there was never a place I could go without a packet of pads and a box of tampons, they’d become my trusted companions, my loyal childhood friends. So when the crazy bleeding stopped, I found myself without a reason not to put on a white summer dress and go out into the world. There was no excuse for not running, not dancing, not flying. But I was afraid. What if the wings came loose and the pantyliner slipped down the side of my leg, and I fell? What if, while having so much fun, I forgot to be careful, forgot to check?
But being with Nyasha gave me courage. She was so brave, so funny, so unapologetic. Around her nothing seemed impossible. Her womb was completely dried up because she’d had a Mirena put into her uterus as soon as she started working. As she explained, she wanted none of that nonsense getting in her way.
Ma didn’t like her, of course.
‘These kwere-kweres, Masechaba, they’ll use their black magic to steal all your intelligence, your whole future. Everything you’ve worked so hard for will be gone, and you’ll be left with the nothing they arrived in this country with.’
So I moved out of home.
Nyasha and I rented a flat close to the hospital. Often we’d drive together to work if neither of us were on call. It was something I was always going to do anyway, I just hadn’t yet found anyone I felt comfortable sharing a place with. You can’t live under your mother’s roof forever, and anyway, it’s not like I was far away. A person needs space. Tshiamo would probably criticise me for leaving Ma alone in that big house, but what right does he have to criticise me? People who have no respect for life have no right telling others how to live theirs.
I met Nyasha at a minor car accident scene. I’d seen her before at work, on the wards. I noticed her because she had beautiful, jet black dreadlocks and a quiet confidence that was fearsome to behold. She was a medical officer in the Obstetrics & Gynaecology Department, waiting for a specialist training post. However, it was well known in the hospital that if it wasn’t for her foreign nationality, she would already be a consultant obstetrician-gynaecologist, because she was a surgeon extraordinaire.
I watched her one night, joking with a mother who was a heartbeat away from losing a perfectly healthy baby. The baby’s umbilical cord had slipped out of the woman’s vagina during labour, and Nyasha stood for four hours with a damp cloth in that bloody cavity, keeping the cord moist until a theatre space opened up and the consultant had arrived on the premises. All the while she was laughing, Red Bull in one hand, the baby’s life in the other. I knew then that I wanted her as my friend, and that I’d do whatever it took to make sure she was in my life.
I tried to make conversation with her o
n the nights we were on call together. She was polite enough, but always busy. Busy saving lives while us interns fumbled along. Then one morning as I drove to work, I noticed her driving in front of me, and it occurred to me that this might be my only chance. I drove alongside her, in front of her, and then finally let her pass me again. At the hospital there was never time to talk. There was no excuse for long conversations that might end up in a friendship, no environment conducive enough to finding out more about this beautiful woman with piercing brown eyes. So as the traffic light changed from green to orange and then to red, I pushed hard on the accelerator and drove into her.
Tshiamo would be horrified.
‘The lengths you’ll go to, Masechaba!’
But nobody got hurt. I knew she wouldn’t get hurt. I would never hurt her. Not like Tshiamo, who paid no mind to how he might hurt us.
He knew better than to leave a note, that foolish boy. Because I wouldn’t have read it, anyway. I would have torn it to shreds and set it alight. He’s full of nonsense, Tshiamo. We’re all going through shit. Who the hell does he think he is?
Nyasha doesn’t say much about Zimbabwe. I don’t ask too many questions, in case I offend her or expose my ignorance. All I know is that her mother is a nurse in Bristol. I don’t know if there’s a father, and I’ve never heard her speak of siblings, although she did mention she has a cousin specialising as an ENT surgeon in the US.
I feel bad about how our country treats them. We should know better, what with apartheid and all. Nyasha is quite fair skinned, and actually looks South African, so you wouldn’t even know she was foreign until you speak to her.
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