Tuesday, May 29, 2012
i hate kalafong (hell). there are many reasons for this (here, here, here, here, here), most emotional, i confess. but if i am honest there is one incident that stands head and shoulders above the myriad of traumas that i experienced there.
one of the strange idiosyncrasies of kalafong (hell) is that some time during each night shift, all the sisters of each ward get together in the duty room and eat chicken feet. i have no explanation for this. maybe there is an abundance of chicken feet in the area. maybe the sisters are paid in part with chicken feet that absolutely must be eaten before they leave for home after their shift. maybe it is part of some bizarre ritual that initiates all kalafong sisters into some secret evil cult. i simply do not know.
i was a mere fourth year medical student which meant i was at the absolute bottom of the rung that night on call for internal medicine. i knew nothing and was of almost no help to anyone. the only thing that i could do was to put up drips, so the senior medical students would send me to the wards whenever they got a call that a drip needed inserting. for some reason kalafong sisters never put up drips. maybe there was a fear that the patients were allergic to chicken feet and the residue of the no doubt scrumptious delicacy on the fingers of the sisters could potentially cause the patients harm. they were clearly not about to take that chance, so there was plenty of opportunity for me to hone my already very well honed drip inserting skills.
i had just left the female medical ward after inserting a whole host of drips and was quite keen to see what was going on in casualties. i walked in.
"drip to be inserted in female medical." the sixth year student smiled. i don't think it was really meant to be malicious although it felt that way at the time. i think it was more a relief that he had done his years of continuous drip insertion honing and was glad that he honed no more. it was the natural cycle of things and he had passed the batton to the next group. it was simply my turn.
"i was just there!" i protested at no one in particular, turning to leave with my shoulders sagging just enough to be noticable to the discerning eye.
i entered the ward through the back door. the main door had been locked by the sisters. this was another thing one got used to there. it was just something the sisters did at night. the reason for this behaviour elluded me, especially when they had just called for someone to insert a drip. you would think that they would unlock the door in anticipation of that person actually arriving to insert the drip. maybe they needed their privacy while performing strange initiation rites with chicken feet.
as i entered the ward, a patient looked at me.
"doctor, help me! i'm dying!" i froze. it was dark. i could only make out the patient's shape, silhouetted against the dirty cream coloured wall. yet her eyes were so wide with fear that i could see her white sclera. i felt a shiver go down my spine. what was i to do? i was only a fourth year. i didn't know this patient and even if i did, i had no knowledge to actually help her. in my naivety i hadn't yet learned the rule that more often than not, if a patient tells you they are dying, it is because they are in fact dying. the one thing i knew is that i couldn't ignore her.
i walked up to her. she lifted her arm weakly. then suddenly her fingers encircled my arm and all her remaining strenght seemed to go into her grip. her nails bit into my flesh as she pulled me close to her face.
"help me doctor, i'm dying!" she repeated. she scared me, so i pried myself loose and checked her file. she had been admitted the previous day with the diagnosis of meningitis. antibiotics had been prescribed but only one dose had been signed for since admission. probably the drip had been out when the other doses were due and once some poor fourth year had reinserted it, the sisters hadn't bothered to put up the dose that had been missed. at least there was something i could do, i thought. i could check to make sure the drip was working and get the sisters to give the last dose of missed antibiotics. somehow i allowed this thought to make me feel better. i would help this lady and all would be well.
i checked the drip. it was working well.
"don't worry, mamma, i'll send someone to help right away." i said as i turned to leave. she lunged for my arm again when she saw that i was going, but there was no strengh left and she missed. as i walked away a knot developed in my stomach. i felt that i had failed this old lady. i had done the little bit my knowledge had permitted me to but i had also allowed my fear of her and of what she was facing to intimidate me to such an extent that i hadn't really stayed to comfort her. i was determined to be a change in her circumstances and her life. i would speak to the sisters.
i walked to the duty room. the door was closed but there was an almighty din emanating from inside. the sisters seemed to all be shouting and laughing in unison. i knocked and opened the door. for a moment the bright light from their happy little room blinded my eyes that had become accustomed to the darkness of the ward. the light seemed to pour out into the gloomy ward behind me. all the sisters were sitting around the table eating chicken feet. when they saw me they all went silent, but continued eating.
"good evening sisters." no answer, unless silence is an answer. "sorry to bother you but the patient in bed 5 in cubicle d is in a bit of distress."
"we'll check on her now now." i knew what now now meant in our strange south african english. now now was not as soon as now and implied no urgency. now now was not as now as i wanted it to be.
"ok," i said, knowing that if i antagonised them they would purposely postpone checking on her just to teach me a lesson. "also i see that she hasn't yet received her last dose of antibiotics. her drip is working, i checked, so please give it to her when you go to her." the sister looked up from the chicken foot she was now toying with between her fingers. i saw in her eyes that she despised me, although i had never laid eyes on her before in my life. some things in kalafong one learned to accept.
"i said we would see to it now now!" she repeated. then her head dropped back down to give the chicken feet the full attention they seemed to deserve. i stood still for a minute. then i quietly closed the door.
as i walked away to do the drip i had actually come to the ward to do, raucous laughter errupted from that small brightly lit room. it brought me to a stop in the middle of the floor in the dark ward. i felt tears well up. i didn't know if i wanted to cry because the sisters were clearly enjoying a joke at my expense or at the futility of an old woman who lay in bed 5 in cubicle d all alone with the fear of death over her. i just knew there was something horribly wrong with the whole picture.
i got the drip up and running in double quick time. i then rushed off back to casualties, but not before quickly checking on the patient again. when i approached her she still had the same stare. this time her arms lay still on the bed beside her.
"don't worry, mamma," i said, "i have asked someone to come and help you. it is all going to be ok." she didn't react. "i promise i'll also come back myself tonight to check on you." a little of the fear went out of her eyes. only a little.
on the way back to casualties i made sure i composed myself. it wouldn't be good to show the senior students that i had been so affected by something they no doubt had seen quite a lot of. anyway everyone always said not to let kalafong get to you, otherwise it could change you forever. at that moment forever seemed like such a long time. the sixth years were busy doing a lumbar puncture behind one of the flimsy curtains in the casualty unit that seemed designed to give the impression of privacy without actually delivering any real privacy. one of them looked up.
"sorry dude, but they just called for another drip in male medical." i turned and walked out without saying a word. the quiet of the open air kalafong corridors could possibly afford my soul a bit more peace than the overwhelming noise of human suffering of casualties. usually i could handle it, but then i felt a despondency and futility that was too much to bare.
in the end there were three drips in male medical so it took me longer than expected to get them all up and running. this time it didn't bother me. i was in no rush to get back to casualties. also i knew i had told the old lady in female madical i would check on her and i was afraid. i was afraid of what i could not do for her. i was afraid i would be inadequate. i was afraid of the face of fear that i had seen in her eyes. somehow her reality at that moment was too real and i didn't want to face it. i wanted to be at home in my warm bed, ignorant of how terrible life could be. but i knew i had to go to her. if for nothing else, i had to just be with her so that she was not alone. i walked slowly to female medical.
i walked past the duty station. this time the door was open, but besides that there was no discernible difference. all the sisters still sat exactly where they had been. some of them were still eating the last of the chicken feet. the light from their room lit up half the ward, but did not reach all the way to cubicle d. they didn't see me slip past them so their laughter must have been aimed either at someone else or just part of the normal merriment associated with people sharing a meal together. still, just like the light, it seemed to me to be out of place.
"mamma, i'm here" i whispered as i approached her bed, just in case she was asleep. she lay with her head to one side. she didn't stir. i walked closer and took her hand. it was cold and clammy. i leaned towards her face. even in the darkness i could see her eyes were open, but they were fixed in the stare of death. she had died alone and i had failed her completely.
i have hated the sight of chicken feet ever since.