81   He serves a three year sentence

HENRY FUCKIT'S NURSING NOTES

Part 1 | Part 2 | Part 3 | Part 4

Benny Greenberg entertains his fellow patients.
'In life you can be two things: you can be rich or you can be poor. If you're rich you're alright. If you're poor, you can be two things: you can be sick or you can be healthy. If you're healthy, you're alright. If you're sick there are two things that can happen to you: you can live or you can die. If you live you're alright. If you die there are two things that can happen: you can go to heaven or you can go to hell. If you go to heaven you're alright. If you got to hell you'll be too busy talking to all your old friends to worry about anything else ever again.'

Mr Nobody is quite destitute and yet the Department of Social Welfare asserts that as he is from the Transvaal he is that province's responsibility. He possesses shirt, trousers and a pair of shoes that have been given to him by a sympathetic patient.
He did try to speak to his sister in Johannesburg. He phoned, reversing the charges, but they gave him hassles.
'They started tuning me this and that. Why did you do that? How are you going to do this? Are you alright for doing that? No, I could see it was just telling me not to say anything. I didn't ask them. I've had enough of that. No ways. Better just me on my own. These people just give me hassles.'
Moral: Never try to reform a man - just help him. Especially if he is family.
'The Salvation Army isn't bad. Bed and breakfast for fifteen rand a month maybe. For pensioners and downers, you know.'

'Your watch has stopped, Professor. Here, let me wind it for you.'
'Be careful you don't overwind it.'
A look of contempt and then, with incredulity:
'What for do I want to overwind your watch, Professor? You sound like my grandfather. Cautious, cautious, cautious. Overwinding breaks a watch. Why should I want to break your watch? I don't want to fuck your watch up. I want to wind it for you.'

'That professor, why don't you take him, and when nobody's looking, push the cunt down the stairs? Christ, Man, I had to laugh, the way he moves on those crutches. Like a fuckin' chicken pecking at the ground, the way his head keeps jerking forward.'

In his turn: 'Look at that chap.' Indicating Alberts, the new orderly. 'Why does he have his hair like that? He looks like a Bassett hound.' On another occasion: 'Artistic looking, isn't he?' And: 'Can't have much grey matter.'

He was outraged when the prof told him he had found the Alex Quartet boring, and that he preferred Gerald Durrell. The woman intern who he was trying to chat had not heard of either Durrell.
'You medics are philistines! You haven't heard of Lawrence Durrell?' Staggered. 'You haven't read the Alexandria Quartet?!'

It's a pity that he should persist in such explicit sex talk. He likes to mention lovers, mistresses, affairs, dalliances, his prowess and virility, his broadmindedness, his vast experience. I find it irritating and a little embarrassing. He arouses my distaste for the personality which insists on pushing itself. Why can't he speak in more general terms? Instead, he portrays himself as the male lead in his masturbatory fantasies. I walk away with a yawn of annoyance.

Of an afternoon the sun cuts and slants from the mountain behind the hospital. To the northeast soft patches begin to show and the Tygerberg gains definition, slumping low across the flats. Beyond is Africa, flat and brown and hugely barren.

Tinnitus, for him, manifests itself as a whistling sound, as of wind in telephone wires.
Pyrexia of unknown origin. Extremely irritable and anorexic. Onset of fever a day later with generalised headache, myalgia and arthralgia - finger joints and back. Sweats profusely at night. Severe rigors. Lucid during attack. Extreme exhaustion on day after. Symptom-free periods from six days to months at a time. Constipation - stools hard, pale, float on water, more offensive than usual. Frequently has to disimpact himself.
Osteoporosis - difficulty in defining the ribs by X ray.
Frequent sinusitis and colds.
Right lower lobe pneumonia.
Tickbite fever.
Sand fly fever.
Pneumonia on two subsequent occasions.
Ameobiasis.
Polya gastrectomy after years of peptic ulcers.
Lesion of the larynx.
Malaria.
Tender prostate gland.
Distended seminal vascicles.
Underwent anti TB treatment
Fractured scaphoids and hamate at wrist.
CNS. Fully conscious, orientated, talkative. Restless, repetitive, purposeless movements of hands, arms, shoulders, neck and face. Rapid fine tremor of the hands.
At various centres throughout the world he had undergone extensive investigation.
Smokes cigars.
Alcohol intake formerly very great.

Faith, Hope and Love.
Faith - the suicide, the leap that Camus spoke of. Surrender.
Hope - the futile delusion of an escapist.
Love - voluptuosity and self indulgent martyrdom.

Joe Da Silva is eighteen. He was in the army when he first began to have knee trouble. In a military hospital his leg was put in plaster but the pain grew worse. He was fast losing weight. The cast was removed to reveal a malignant carcinoma. Here he has undergone extensive tests and it has been discovered that the dreaded CA is metastasising and has already infested the lungs. Overs-kedovers. They have amputated just below the hip, for what purpose I do not know. Unlimited analgesics are prescribed. He has not been told.
Unfortunately the morphine causes nausea so they are having to balance his dysphoria by administering an ever increasing number of different drugs. Much of the time he is asleep or in a stupor of discomfort.
Just after lunch today he perked up. His radio was turned up loud and he hummed to the music and sat up in bed, his eyes wide and bright with some strange elation. Dark brown eyes with bottomless black pupils. His face has the first gauntness of death and his head is already becoming a skull. He has aged in the past week.

In B1 I shave a man who is pale grey with fear. He is being prepped for a colostomy.
'Is it a terrible thing?'
'No, it's quite common in here.'
'But you never feel normal again, do you?'
'You've always got this bag.'
'Does it give a lot of trouble?'
'Well, it's probably a little inconvenient but you can do almost anything you used to do, and go anywhere.'
'Does it give a lot of trouble?'
'Well, you have to change the bag instead of going to the toilet. But it's not that bad. Better this than being dead, hey?'
There ensues a pause in which he turns an even paler shade of grey. Then he hastily pushes the towel aside and struggles upright.
'This bowel washout thing I had this morning…. Still working. I must go to the toilet.'
Was it unfeeling of me to mention the shadows silhouetted against the curtain?

Whilst water-skiing he was run over by a speed boat and churned up by its propeller. His shaven skull shows the terrible scar and depression. A broken right arm, smashed knee, left leg with four compound fractures. He is paralysed down the left side. He stares with big round eyes and speaks in a slow quiet voice that is still somewhere else. Deeply tanned, a big man powerfully built - a fine specimen of male meat. But now his round eyes stare unblinkingly, the whites contrasting against his brown face.
'How do you feel?'
'I feel like a vegetable. A mummy.'
An attractive young woman comes to sit with him for long periods, seeing to his needs, reading to him, talking and encouraging without sentimentality. When I see all the little things she does, the thoughtful necessities and the luxuries she brings him, I feel sick with an inexplicable sorrow. Home-made biscuits, a flask of soup, a pot plant, portable TV, radio, clock, tape recorder, shaver, special supports and pillows in bright patterns made by a woman's loving hand. It isn't possible to care that much for very long.

He complained to the sister that when he lifted Maureen, who is sixteen, she swore at him, calling him a 'Fokken poes.' He feigned an outraged shock and distress.
'One so young!'
He repeated the epithet several times.

At tea time I went with the other orderly for a smoke. In his ancient car we drove down into Salt River. He stopped outside one of the houses in a grimy street and ran in for the parcel. Then we went to his place a block away. He had a cubicle at the back of the house. In the yard stood a large kennel and he insisted that we get into it in case the boere came. I crawled in after him. It was dark and stank of dog. We sat cramped together with knees drawn up and heads bent forward sharing the pipe in his cupped hands.
We returned to the ward smelling like curs, our white uniforms covered in hairs. I can't say I felt euphoric but the patients appeared comical and the rest of the morning sped by almost unnoticed.
Now I am calm and sober and bored with the quiet of the afternoon.

This is the start of night duty. It is a warm sultry night and unless a cool wind springs up I don't see myself being able to sleep much tomorrow.

The night seems to have passed much more rapidly than a day.

The world shrinks and closes in. It is an unnatural routine setting one apart from the rest of the world in such a way that there is virtually no contact. They arrive and we leave, they work and we sleep. The two routines complement each other and the creatures of the night become separated, cut off, strangers glimpsed as hurrying shadows at dusk and dawn.

Outside it has been raining and it is cooler but unless a wind picks up it will be very humid and worse than ever.
The activity below increases as the nigh advances. A drunken man covered in blood staggers from an ambulance shouting, 'Waar is hulle? Waar is hulle? Net wys vir my. Waar is die poeste?'
In the lamplight the tarmac is still dark with the wetness of rain. The voices of ambulance men talking, a guffaw of laughter. Already a pattern is discernible and it is possible to make generalisations. Most attempts at suicide occur Saturday afternoon and evening. Stab wound victims between ten-thirty and eleven-thirty. Car accident cases between twelve and two. This predictability casts a steady impersonal light upon faceless citizens barely human.

He believes it was some kind of ESP that made him depart from normal practice and don a crash helmet instead of bathing cap on the day of his dreadful accident.

By no stretch of the imagination could I be deemed a happy man. I am troubled and restless - a godless man. We are all godless men.
It is cool and very quiet this Friday night.

The senior nurse is deranged. She rambles on about being born again and about the glory of the gospel. She relates amazing tales of the Devil and demon worship. She tells an anecdote about enlisting divine assistance in getting her washing dry - she wanted to hang it out but it was pouring with rain so on bended knee she importuned for a change in weather. Lo and behold, within five minutes the sky was clear. It just shows you.

'We have to ask ourselves whether medicine is to remain a humanitarian and respected profession or a new but depersonalized science in the service of prolonging life rather than diminishing human suffering.' I wrote it down but can't remember where I heard or read it. Laing?

A cool night without wind. It is overcast and there is a strongly fishy sea smell, wonderfully fresh as if a northwester is bringing it in from the Atlantic.
The boy has cancer. It is intended that his leg be amputated at the hip. His parents are Jehovah's Witnesses and refuse consent for blood transfusion, but he must also undergo intensive cytotoxic treatment to arrest further spread of the disease. This treatment is so horribly drastic that it is certain he would require blood.
The wrong-mindedness of religious fanatics? The doctors are agreed that the carcinoma has reached a terminal stage and that whatever is done the boy is going to die anyway. The treatment is experimental. Maybe they will learn something from it. So the parents' refusal will save him a whole heap of agony. God works in wondrous ways.
They say that earlier today he climbed out of the window and sat one the ledge, 'sunbathing.' It is feared he might have had intentions of suicide. His surgeon, on being consulted, prescribed ten milligrams of Valium three times a day. The houseman had to lie to get him to take the sedative, telling him it was 'for the blood.'
A precocious but rather nice boy he has been capitalising on his situation and manipulating it to charm the nurses and young girls who come to hold his hand and talk to him. They allow him to kiss them and secretly touch their breasts and run a hand over their cute little rumps. Now he is to be reduced to a zombie this pleasure will be denied him. He will be too drugged to take any kind of interest in such matters.

Like polar cold my discontent penetrates to the bone. I have no choice.

I sit in the office much of the time, one eye on the red light above the door, arguing points of religion with this crazy senior nurse. She has not one but three Bibles open on the desk before her. Also she has any number of those tiresome tracts that pose impossible questions like, 'Where are you going?' and give unbelievably simple answers such as: 'God gave you a free will. You can choose between everlasting life and eternal damnation.'
I argue out of boredom, and yet I find the arguing itself excruciatingly stale and tiring. We are from different galaxies.

Lancelot Brown is sixty-six. He has pinched features, the cheeks falling in, cheekbones, chin, nose, forehead becoming more prominent as if the skin were being stretched tighter and tighter. He has the dirty pallor of the old and gravely ill. Fearful, pain-filled eyes, pleading, at times treacherous and cunning, frightened, frightened. A fractured femur has brought him here but he also has extensive CA.
He does not bear pain well. After groaning and crying he is cringingly apologetic. His bowels work profusely and it is difficult moving him with this goddam fucking useless Thomas splint on the broken leg. He professes pain in every part of his body.
The other patients are embarrassed and resentful and alarmed by his plight. They are often unsympathetic and cruel, laughing at his loss of dignity, complaining about the offensiveness of his smell.
His wife knows the prognosis and needs support. This afternoon she became tearful and turned to a nurse for comfort. What comfort?

Mrs Lomax is an aged female with a history of mental illness. When awake there is a deranged look in her eyes. Asleep, she is particularly graceless, her features hard and masculine. Straight, heavy eyebrows and a large nose. Her mouth loosely open and snoring.
She awoke around four and began moaning.
'I just want to close my eyes and die.'
'Why do you want to die?'
'Because of the pain. I just want to die.'

Recovering from the anaesthetic, whimpering and tearful, covering his face with the sheet, generally acting like a little boy confused and lost and frightened. His new-found lover, a married woman negotiating divorce on his account, looked at me with big shocked eyes and asked whether everybody was like that after an operation. I gave her a hard smile and shrugged my shoulders.
'People act differently under different circumstances. That's how he reacts to pain after anaesthesia.'
I was faintly surprised at her lack of understanding.

Mrs Snow lies in blindness praying to her dear Father in heaven, loudly and in a deep, rasping voice. She is a nice old woman with plenty of spirit and a sharpness that belies her years and physical condition. At times she gets angry and says,
'Orderly, I don't like you any more. I don't want you near me. You're causing me all this pain and you don't want to help. Leave me alone. Oh, Dear Father in heaven. I can't stand the pain. Please help me. Orderly, Someone, please help me to get rid of this pain. Lift me up. Lift me up.'
'Mrs Snow, we're coming to you in half an hour. Just wait half an hour.'
No, no. It might be too late.'
'Too late?'
'I might be dead in half an hour.'
'It doesn't look like it to me.'
'Well, it feels like I'll be dead in half an hour.'

Mrs Snow, ninety-two, is heavily moustachioed and blind. A rotund, white-haired little old lady. She says to me in the dark, the perpetual dark,
'Dear Father in heaven, help me to get my leg comfortable.'
'I'm not your Father in heaven, Mrs. Snow. Nor do I have His far-reaching powers. But I could massage your ankle for you.'
Funny man.

'Oh please, Father in heaven. Help me to be alright. Oh please, Father. For ever and ever. For Jesus Christ's sake. Amen. Oh Father, help me to look after Cynthia better. Is it Wednesday? Dear Father in heaven, is it Wednesday? Oh please, Father, help me to get better.'
Ninety-two and she still worries and clings to life.

She was given a Moore's prosthesis and now after the anaesthetic she is humming an unearthly tune. All night she's been humming, her voice drifting into the quiet, darkened corridor. She lies there beneath the night light, staring up serene, breasts flaccid flaps hanging at her sides, without dentures mouth fallen in.
Once she was like these soft, firm young creatures.

I remember him from A1. Dehydration and pneumonia. A Valkenberg patient, he has been senile for some years. Now he is in with a broken femur. A few days ago he fell down and when they tried to stand him up he kept falling over - like a bewildered animal that is being eaten alive by predators, impervious to pain after the initial shocking blow.
He hasn't been shaved for days and it seems like he is again developing pneumonia. His mouth is furring up with a yellow coating and he chokes and gargles in phlegm, unable to save himself by the simplest of expediencies - spitting. Occasionally he is suctioned, a spatula being forced between his teeth, fingers digging into his jaw muscles to encourage him to open his mouth. It weakens him. He lies huddled in bed, a long, bony, crumpled heap, kept 'alive' by intravenous feeding and the squirting of fluids down his throat using a ten millilitre syringe. On being turned, fed, cleaned or suctioned he struggles feebly, croaking and whispering,
'Put it in …. What …. What you …. It is …. Can't put it …. What you doing …. Give ….'
The unbearable futility of prolonging such an existence.

This is the theory. This is what I am supposed to have discovered and accepted.
Suffering is natural, necessary and inevitable.
Suffering is to be borne and not avoided.
Life must be followed wherever it leads and may never be abandoned.
One must adapt unto death.

Max Cart - Mobile Auxiliary Cardiac Arrest Resuscitation Trolley?
Max was called and the patient was lifted on. The patient did not respond well and the doctor in attendance, a young man seeking excitement, adventure and glory, decided to open the unfortunate man up. A scalpel, surgical saw and thoracic clamps were produced and he set to work. In next to no time there it lay exposed, the vital organ. But, contrary to expectations, manual massage was not sufficient to restore the natural beat. The pioneer surgeon decided that defibrillation was called for and electrodes were placed on the naked heart. Turning the current to full power he pushed the button and we all watched the heart shrivel up and die right there before us. It shrank like a dried out piece of meat left for too long on the grill. A terrible silence ensued with us staring down in disbelief and awe. The magnitude and finality of the fuck-up began to sink in and the surgeon said 'Oh shit!' before tiredly turning away, a beaten man.
The young houseman, who a moment before had been flushed with excitement and a proud sense of self-importance, turned nasty. He shoved a nurse who was in his way, sending her slithering on the blood slippery floor, leaned over the still warm corpse, snarled,
'All for nothing, you old cunt!' and slapped its face. As a final expression of his pique he slammed shut the equipment drawer with such force that Max gave a shudder, there was a hiss of compressed air escaping and an ominous tinkle came from the inner depths of the fabulously expensive organism. Then, following his fallen hero, he strutted off with the bearing of an enraged man who has been deeply insulted.

I have lived through thirty years and read fairly widely. I am part of the technologically most advanced civilization ever seen on earth.
I can follow in general terms the path of scientific knowledge.

In the crucible the synthetic process bubbles.

The realisation is sudden but undramatic: I have had enough. It comes to me abruptly and yet I am not surprised. It is as if it has been with me for a long time and only now have I bothered to look directly at it.

I am sated to overflowing with melancholia and cynicism and yet instead of 'embracing easeful death' I merely groan with boredom and irritation. Enough's enough and I must have a change of air.

Nothing is altered and everything is altered. (I find myself speaking in the paradoxical terms of the mystics, already.)

The last task is the laying out and wrapping up of a man who has died of a 'massive infarction.' I am helped by an irritable staff nurse who grumbles at having to put false teeth into a cold and already unmanageable mouth.
'Why don't they put the bloody teeth in as soon as he dies? How do they expect … Shit!'
We pull out the catheter and bundle the corpse in its clownish plastic shroud and stifling blind white sheet. Oh, we've forgotten the second luggage label for the wrists. Fuck that.
There is an hour to go. The ward is quiet. I slip away unseen, foregoing the indulgence of valedictory charades, leaving by a back door. Past the chapel, up the steps. The turquoise swimming pool. Under the fence, beside the highway, the Devil mountain snarling above. The path. Brickfields below me. Table Bay and the low horizon to the north.