by Dawn Garisch
This happened during my two-month stint on the neurosurgery ward where interns were expected to work every day and every second night. Why the senior staff allowed this state of affairs – which amounts to malpractice – I do not know. I was too afraid, exhausted and powerless to speak out. Abusing the junior members of staff meant that the patients received sub-standard care. The system also seemed designed to make us numb.
While still a student, my tutorial group arrived for a clinical session in the surgical ward. The surgeon took us to stand at a bed around which the curtains had been drawn. Lying before us was an unconscious man who was barely alive. The surgeon threw back the bedclothes and pulled up the man's hospital gown. His legs were a deep mottled blue, his penis shrivelled, his chest sucking in air sporadically.
The surgeon proceeded to give us a tutorial around the bed about emboli: blood clots or pieces of plaque that can break off and then lodge in an artery downstream. When blood supply to a limb has been occluded in this manner and the patient is not operated on within six hours, the tissues below the occlusion die off due to lack of oxygen. When muscle tissue dies, it releases myoglobin, a muscle protein. If a large amount of myoglobin is released, it clogs up the kidneys, and the patient goes into renal failure.
This had happened to the patient in front of us. Ischaemia is extremely painful, so it is doubtful that anyone suffering this condition would delay seeking help. The delay lay with the referring doctor, and the surgeon was correctly furious, but the way he expressed his anger was appalling. We stood around this dying man while the surgeon lectured us over his naked body.
***
Recently, I attended my twenty-fifth medical class graduation reunion, a three-day affair. I had kept in touch with only one person from my class of almost two hundred doctors in the intervening years, and she had been a friend since high school. After graduating, I applied for a non-governmental organisation job in industrial health, working with trade unions. There my colleagues were mainly sociologists, industrial hygienists and educators. The people I was working for were largely well, and trying to negotiate for a healthier and safer workplace.
At the time I thought I was working in this area because I believed in socialist principles. It was only at the reunion that I was able to acknowledge that I had been so traumatised by my training in the wards as a medical student and intern that I had run away from both doctors and hospitals.
I could not acknowledge it back then, but I disliked doctors, and I was appalled by a system where I could find myself feeling relief when a patient died en route to the intake ward. Then there would be less work for me to do at three in the morning, and I might be able to snatch a wink of sleep before another full day at work.
***
I am a doctor by default, passively following my sister into medicine because my family decided that it was the best thing for me to do. I do not regret this. It is a real job, where there is plenty of opportunity to make interventions that help others. It is also a privilege, in that you are invited into the lives of strangers to hear their stories. Medicine has also allowed me an economic freedom that many do not have. I have worked part-time for twenty-five years, giving me the space to bring up my children and to pursue my passion.
My first love was always the written word. Books opened their arms to me, offering me a haven, a place to discover a new way of thinking and being. At a young age I got hold of novels that my parents tried to hide from me, like The Old Man and The Sea, and stumbled upon authors at the library such as Krishnamurti, and realised that not everyone construed the world the way my parents did. Later I read Nexus and understood that, to be a good writer, one has to be able to write from the position of the anti-hero. On reading the Martha Quest novels I woke up to my own body through Doris Lessing's powerful writing.
I wanted to be close to books, to the smell of libraries, with their rows of closed stories waiting with folded arms for me to reach out and take a volume, and open it, and thereby open myself.
If I had had the courage of my passion, I might have become a librarian or a copywriter when I left school. I am so pleased that life had other plans for me. Through doing medicine, I have had to work hard with this split between art and science. I have had to heal myself.
Becoming a doctor prepared me to write this book.
***
Interlude
Mankind owns four things that are no good at sea -rudder, anchor, oars, and the fear of going down.
Antonio Machado56
The following is a piece written in 2004 largely from emails I sent friends while on board a ship, and later tacked together. I include it as an example of how identifying and exploring images in both my life and my writing have helped contain my anxiety and distress during times of crisis in health and relationship.
14. Travels in the Eloquent Body
Fire and Ice57
27 February
I have woken to a dream: I find myself surprisingly aboard a ship that life has offered, extracting me from my busy landlocked round and thrusting me upon adventure. Five days ago a corporate stranger phoned to say that their ship's doctor had failed his medical; would I like to take his place and go to Antarctica?
Which proves you must be careful what you wish for. For some time I had felt an urgent need to step back from the cauldron of the past four years, hoping that distance and changed surroundings would help to put into perspective the burning pottage of my life.
So here I am, two days out and sailing towards the southern ice, two days out upon a tiny cradle rocked upon the shifting lap of sea. The sea is bigger than your boat, my tenant pointed out the night before I left – and so it is! Expanse is not a big enough word for such a place. Our ship, the SA Agulhas, represented by a lump of Prestik on the framed map in the corridor outside the bar, moves daily out upon the blue and away from Cape Town through the grid of latitude and longitude. On deck, where I have spent most of my time thus far, I note the ocean is becoming darker and the air colder with the hint of going somewhere.
It is thirty-seven years since I was last on board a ship, yet aspects are familiar: long passageways, coils of thick rope, latched metal doors to keep the sea water out. The smells I also recognise, although this is an old research vessel and the odours are distinctly worse. My shower drain is so offensive I am forced to complain repeatedly to the purser, thus establishing my character early on. The bosun's mate employs chemicals and irrigation to no effect. This olfactory assault together with the rolling motion breaks my determination not to get seasick. The bosun assures me worse is to come, so abandoning the floundering theory of mind over matter, I have resorted to medication while my lurching belly learns to travel with the lift and surge.
Therefore, thanks to a miracle of modern medicine, I am at last able to focus and honour my personal roles as scribe and explorer on this expedition, as well as perform my public function as ship's doctor, without a sweaty queasiness gnawing at my acumen. Also, the Captain has agreed to my changing cabins.
Our main mission is to fetch eighteen Germans from the southern ice. Amongst them, I am relieved to hear, is another doctor, a colleague should anything go horribly wrong.
***
My duties: the hospital must be opened for half an hour twice a day; thus far for the remedy of minor ailments. Third mate is my assistant; however when I diagnose gastritis in a nauseous member of the crew, I later discover he has slipped the patient Avomine. This is his domain, and he knows better than the doctor that even sailors can get seasick.
I note with alarm an anaesthetic machine in one corner of the consulting room, and announce loudly that I am no anaesthetist and that any surgery will be performed under local anaesthetic, hoping to discourage anyone from festering their appendix on the side or chopping off an arm. The hospital is well equipped and stocked, with one surprising exception: there are no morning-after pills. Stories have already reached my ears of voyages where students, researchers and officers party on duty-free
alcohol, having cast off the mooring ropes of their land lives and their wives. There are only three women aboard out of fifty-three, and pheromones have begun to seep into the air.
No routine for me except for the hospital duties and mealtimes, the latter announced through loudspeakers by a gong housed on the bridge. We hurry to the dining room where good food provides variety otherwise lacking in our seafaring lives, and where company is assured. We sit at tables and seesaw to varying degrees in varying seas, on chairs chained to the floor as warning of times to come. The researchers sit around one table, the officers around another. The rest of the crew are never seen to eat.
It is at these banquets that I get to know my companions: the young weatherman who is getting divorced but wants marriage; the professor of meteorology who has a respectful working relationship with the Rain Queen of Venda; the security officer who flies all over the world trying to stay one step ahead of terrorists and who blows up the sea bed to harvest fish for the barbeque; the ex-sea captain now manager of the shipping company who has only been hijacked on land, never at sea; the head of the scientific team, an oceanographer who has watched Bridget Jones's Diary twenty times and finds it hard to delegate, joking her resentment away; a marine biologist who is politically correct and exudes entitlement; a French oceanographer who keeps throwing hugely expensive equipment overboard to study whether climate change is a problem or not; the technical support man who tinkers endlessly in his lab and is supplied by a government research agency that also recommends fishing quotas so that we preserve life in our waters, and whose boss has just been fired but not jailed for poaching massive quantities of abalone; and the government official in charge of overseeing the South African interests in the southern seas who lost his eye to cancer last year and wears an eye patch and, sometimes, a toy parrot pinned to his shoulder.
It is fabulous being the ship's doctor; everyone is nice to me in case they fall under my knife.
***
What I have learnt thus far:
• Antarctica is a huge continent: one and a half times the size of the USA.
• There are sections of sea where water systems collide, causing turbulence, which increases food supply and therefore bird life. We have crossed bands of the ocean alive with birds, and bands where there are none.
• Albatross, that sometimes tail the ship, have a tendon that goes through a hole in a shoulder bone, locking the wing into position. They can therefore glide up to eight thousand kilometres at a time, expending minimal energy by keeping low and using the up-draught over each wave. They go to land to lay eggs and hatch chicks, then leave their chicks a week at a time in order to find food. Their navigational skills are so accurate they can fly straight to a favourite food spot in the ocean two thousand kilometres away.
• I have been advised to stick my laptop to the desk with Prestik, which will prevent it flying across the cabin when we reach the roaring forties.
• The scientists keep dropping things overboard that cost over three million rand in total. The French scientist threw some equipment overboard yesterday that he wasn't supposed to. Last trip the weatherman nearly threw himself overboard with his equipment, as the rope attached to the equipment was also wound around his leg. He tells me in this water you only last fifteen minutes. Even if someone notices you are gone, it takes the ship twenty minutes to turn around. I have to add that it is very hard to fall overboard unless you are a scientist.
***
Having an adventure by oneself has a lot to recommend it. I can invent myself and my day as I please within the margins of the ship. After breakfast and the half hour hospital slot, I lock up and stand a moment, deciding what to do. Join those who are lolling in the weak sun upon the helideck or those watching videos in the lounge, or climb up to the bridge for a chat with one of the mates. First mate is a woman, married to fourth mate, and in charge of cargo and ballast, both of which require complicated management and foresight. Or I can retire to my cabin to tuck myself into my desk where waits my laptop, ready for the next chapter. Or read, or sleep.
Or exercise. This is important as we tend to eat too much. There are two options: a stuffy cabin with artificial light and ventilation crammed with exercise bicycles and rowing machines where you can indulge in the fantasy that you are making a small contribution to the progress of the ship, or a walk around the helipad. I prefer the latter, taking a morning and afternoon constitutional. It is meditational, almost mesmeric. You begin to appreciate the attractiveness of the hamster wheel. One obese colleague noted that if you time it right, you can permanently walk downhill. It is exhilarating to be out in the open with surge of wind and water, and sea birds following in the slipstream.
The bar in the evenings, after a couple of rounds, is rich ground for research. The oceanographer, who cannot abide nudity (why would anyone want to look at that), is firing off sexual innuendos after another day of shooting contraptions into the sea. The men respond variously: the meteorologist puts on boeremusiek and offers to dance with her, the Frenchman gets all guttural and starts making porn video clips with his digital camera using close-ups of his fingers, the technician snuffles off to the lab, the security officer asks her if she frequents certain clubs in Bellville, the marine biologist, who has decided he doesn't want to be one, rereads emails from his girlfriend and the ex-sea captain reminisces loudly about his bachelor days in port.
The weatherman takes me on a tour of his duties. Every three hours he must venture outside in all conditions to record wind speed and direction, cloud formation and wave height, humidity, temperature and precipitation. These observations are relayed from his lab to Pretoria where they serve as some of the ingredients that go into the flopped cake presented on the news each night as the weather forecast. While the computer printer chews through endless numbers, he explains to me that his marriage was a waste of time because it had ended, and that he has moved back in with his parents because he cannot bear to go home to an empty flat. He also cannot face what he must now endure in order to find another mate: clubbing, partying, deodorant and regular brushing of his teeth. I suggest that life might have other plans for him, at the same time noting how the weather outside, translated into the movement of the ship, is suddenly exceeding his latest measurements.
***
A storm is upon us, and I must learn how to trust my feet upon unstable ground; should I knock myself out the ship is lost, for I'm the doctor, employed to keep the crew and passengers alive and well. I therefore concentrate on my next step upon the deck, which shifts from ponderous incline to a weightless falling away.
The ocean's presence requires a certain kind of vigilance, encouraging me to leave land thoughts behind and to concentrate on my recovery; I am convalescing from a long internal illness on discovering I was not to get what I thought I wanted, as my marriage too had ended. Life has prescribed an ancient cure: a long voyage out, regular doses of vigorous sea air, cradled sleep and lots of it, good food prepared by other hands, the gentle massage of all my organs by the constant motion of the ship, and interesting company with stories varied, intimate and impersonal as happens when people are thrown together on the anonymity of an island experience, and they can make up who they are as they go along.
Two years out upon my new uncertain map, I'm sailing away from the land of marriage towards areas marked only as places where the dragons live. Two years out and I'm turning around, starting to face forwards to see what lies ahead, what other plans life has for me. My body is relaxing, my vision clearing, and I feel my love of life alive again. I stand on deck and breathe the spindrift wind that sings strange songs about the ship, and watch the solid rolls of water that wake within the ocean's centre gathering themselves into long, confident gestures until they lay themselves to rest upon some distant shore.
***
I am on the bridge watching the lift and slice of our ship's progress through the corrugated seascape when my core flushes with the memory of my first dream, my very first
, that arrived when I was four or five. I was at the North Pole, North because there were polar bears around. All about was ice and snow, and I saw with wonder – my first experience of awe – that a fire burnt upon the ice. The ice did not melt, and the fire did not go out. These extremes existed together without destroying each other.
I want to tell the Captain: we are going the wrong way.
3 March
Yesterday we sailed into snow on and off, and now the swell is large enough to lift the propeller regularly out of the water, eliciting a low grumbling growl throughout the ship. We are halfway there, sailing down the Greenwich meridian towards the ice shelf near Neumeyer, the German base. The trip there will be further than the trip back, to accommodate the scientists' needs, and slower because we are sailing into wind and swell. Daily we get satellite information about the sea ice which drifts and breaks and packs constantly around Antarctica. The SA Agulhas's bow is ice strengthened, so when we arrive at the frozen sea, the ship can ride up onto it, the weight of the vessel breaking through ice up to seventy centimetres deep.
We saw our first ice floe today. The Captain tells me icebergs form from glaciers and ice floes break off from the ice shelf – that skirt of ice sliding slowly off the continent of Antarctica. Last year an ice floe the size of Ireland broke off, causing havoc with weather patterns. The biggest one the Captain has seen, at night on radar, was twenty-five kilometres long. An iceberg can be the size of an ocean liner above water, but the dangerous ones, called growlers, are no bigger than a piano but can sink a ship. These are often black due to being made of old compressed ice, hardly project above water and are detected with difficulty at night despite using radar and infrared binoculars. The atmosphere on the bridge is tense in these waters.