MARIA PHALIME
Postmortem
The Doctor Who Walked Away
TAFELBERG
Author’s Note
The names of many of the people mentioned have been changed to protect their confidentiality.
Where a pseudonym has been used, an asterisk (*) indicates that this is not a real name.
Part I
A Dream
1 | Asive
His name was Asive and he was HIV positive. I met him when I was working at Red Cross War Memorial Children’s Hospital in 1998.
It always felt good arriving at Red Cross. It certainly was a change from the stiffness of Groote Schuur Hospital, the tertiary teaching hospital where Dr Christiaan Barnard had performed the first human heart transplant in 1967. Groote Schuur is one of the two academic hospitals in the Western Cape, a world-renowned centre of specialised patient care, teaching and research. The hospital was officially opened in 1938 and since then it has maintained its reputation as a training ground for South Africa’s best doctors and nurses. As a medical student at the University of Cape Town, Groote Schuur had become my second home, although I had yet to get used to its traditions and strict hierarchy.
Ward rounds at Groote Schuur were a sight to behold. Throngs of doctors in white coats would wander from ward to ward, stopping at selected patients’ beds to discuss diagnoses, agree on treatment options and share information on the latest medical advances and technologies. There was a definite pecking order to these processions, with the specialists leading up front while the junior doctors followed closely, notepads and pens in hand to jot down notes and take instructions. The students would trail behind nervously, desperately hoping to remain inconspicuous in the sea of white. The last thing any of us wanted was to be asked a question.
Red Cross was completely different. For one thing, white coats were seldom worn as they made the children nervous. You were more likely to see doctors wearing brightly coloured, cartoon-character ties, or with small furry toys attached to the ends of their stethoscopes. The mood at Red Cross was different too. Nobody seemed to take themselves too seriously, and there was very little room for observing strict traditions. How could you, when your patients could suddenly begin crying uncontrollably in the middle of a ward round?
I was feeling buoyant when I drove onto the hospital’s Rondebosch premises that Monday morning. I had a spring in my step as I walked to the medical ward, and I exchanged cheerful greetings with the staff and smiled as I strode past the colourful murals that adorn the walls.
I was immediately greeted by the sound of a crying baby. And not just the usual I need a nappy change kind of crying. This was more like I’m pissed off and I want the world to know about it!
“Who’s that?” I asked my colleague Toni*, gesturing in the direction of the screaming.
“He’s been doing that all weekend,” she said, rolling her eyes. Unlike me, Toni had been on call that weekend, and it looked like it had been a rough one. No doubt this particularly vocal pair of lungs had had something to do with it. I walked over to the cot, curious to put a face to the noise. I instinctively reached for the folder at the end of the bed and scanned it for some background information – boy, aged two, HIV positive, diagnosis: pneumonia.
I peered into the cot. He was thrashing his arms and legs about, and screaming his little lungs out. His body was the size of a six-month-old’s, its growth retarded by the virus that was slowly eating away at him. He was so absorbed in his crying that he didn’t see me standing there, so I stuck my head further into the cot, until my face was just a few centimetres from his.
He suddenly noticed me and stopped crying. Just stopped and stared, and then after about ten seconds his face broke into a broad smile. I smiled back at him; it was love at first sight.
I noticed Toni looking over at us curiously. “What did you do?” she asked.
“I don’t know,” I answered. I didn’t know what I’d done to earn such a beaming smile; maybe I reminded him of someone he loved. He’d been brought into Red Cross by his grandmother. His mother had left shortly after he was born, apparently to Johannesburg, though nobody had heard from her since. She was young, unmarried, and I imagine terrified of the disease she had passed on to her son. We knew nothing of his father.
Asive stayed in the ward for two weeks while his pneumonia was being treated. Every so often I would catch him sitting up, looking at me. And whenever our eyes met, he would smile and giggle joyfully. I felt proud to have been singled out for his attention, and I enjoyed our special connection. At every opportunity I got, I would walk over to his cot for a cuddle and a play.
When he was discharged, I was a little sad to see him go. I had grown attached to him and would miss the little games that had become our own. But more than that I was happy, relieved that he had responded to the antibiotics. At the time all we could do was fight the opportunistic infections caused by HIV; antiretroviral therapy was not yet readily available for use in public hospitals.
Asive came back about four weeks later, just as my time at Red Cross was coming to an end. He had developed meningitis, and he looked like he had aged considerably in the interim. He didn’t recognise me, he didn’t smile and he didn’t cry. He just lay in his cot, passively enduring the treatment that was being piped into his emaciated body. We all knew that Asive had reached the end of the road, and all we could do was keep him as comfortable as possible until the end.
He was still at Red Cross when I moved on to my next posting, and I hoped that when the time came, he would at least be allowed to die at home.
I was a fifth-year medical student when I met Asive, and until then I believed that I could cure people, make them well again. But Asive brought me face to face with a harsh reality that would be reinforced over and over again during my brief medical career – not everyone is going to get better, some people will just die. I’ve thought about little Asive often over the years and wondered whether this was where it all started, my gradual falling out of love with medicine.
They are everywhere, the Asives. They come in varying shapes and sizes, young and old, but they have one thing in common – they are desperate and dying, the victims of a dysfunctional health system, of poverty and destitution. They come looking to doctors, nurses and other health care professionals to ease their pain and suffering.
But what happens when those charged with their care are no longer able or willing to come to the rescue with whatever limited resources they have at their disposal?
I left medical practice in 2004, just four years after I graduated. This is my story and the stories of other doctors who chose to walk away. Ours is a private anguish filled with the niggling suspicion that we should have been stronger, more committed, more able to handle the daily realities of practising medicine in South Africa. We move on to other professions where the Asives can’t find us, and we keep our stories to ourselves. But festering wounds can’t heal. The low-grade infection lingers on, feeding off itself and threatening to engulf all around it in its toxicity. It is only when the rot is released and dead tissue is cleared away that new growth can begin.
I do not profess to be a human resources expert and my intention is not to produce scholarly work. This is also not intended as an analysis of the health sector as a whole or as a comprehensive examination of the exodus of doctors from the South African medical profession. At the same time I cannot deny that the stories contained here are a reflection of the broader health care system in the country. Many of the experiences are common to doctors across the board, to a greater or lesser degree. Indirectly, therefore, this book is also a commentary on the health sector in South Africa and the impact it has on its health care professionals.
People often ask why I left and I’ve never been able to give them