serves a three year sentence
HENRY FUCKIT'S NURSING NOTES
Part 1 | Part
2 | Part 3 | Part
Up the long sloping tunnel that connects the main hospital
buildings to the nurses' home. The lift to the basement and the linen
bank. Low concrete beams and pipes overhead. So much piping, like veins
and arteries and nerves and ducts. It is hot and humid.
They issue me with twelve uniforms that are anything but uniform. Ill-fitting
white cotton trousers and jackets that have been donned by a succession
of orderlies drifting through the big barn. The trousers are too baggy,
or too tight, or too short in the leg. The jackets have high, collarless
necks and button up at the side and give one the appearance of a chef,
or an ice-cream vendor, or a barber.
In the sewing room I look at my reflection in the mirror and fight the
compulsion to run. I have difficulty recognising myself. But is that not
just what I want? Nothing can be done with this impersonal white uniform.
Heavy white cloth to cover the body. This is my identity.
Sickness and excrement
and the accompanying smells, sounds and sights.
The dawn walk starts
with the click of the gate. Palmerston Road in lamplight and right at
the public swimming baths. A man wrapped in a heavy coat leaves his idling
car and closes a garage door, fumbling the cold lock in the dark. Across
Queens Park playing field to the start of the path running along the cliff
top of Brickfields quarry. Towards the mountain beyond the high mesh fence
is Eastern Boulevarde arush with early traffic. The uneven grassy path
winds up towards the top of Hospital Hill and ahead to the east the sky
is lightening and brightening with sunrise colours. I pass the two skeletons
on the cliff edge where they stand gnarled in silhouette. The wind is
drawing out long streaks of smoke from the kiln chimney stacks and below
and beyond them stretch the lights. Two at a time I climb the steps to
the flyover bridge and descend on the freeway pavement past the nurses'
home. At the stone cairn, memorial to the dead, I slip under the fence
and cross the hospital road towards the canteen past the pool. Down the
steps to the chapel and then around to the front entrance, passing the
exhausted, inward faces of night staff shadows.
I am horrified and revolted by human sickness and old
age. Sacks of flesh and bone dying messily in their own shit. Ugly, helpless
and undignified. I am drawn to the idea of suicide. There is an argument
that stresses the importance of man battling on till the last breath,
never giving up hope: but I do not understand or accept it.
Mr Putney is in his seventies, a senile diabetic with pneumonia. He lies
in a huddle, a catheter running down to a bag under the bed. He can do
nothing for himself, not even turn on his side. He remains in an imbecilic
daze, weakening, deteriorating. Why should he be kept alive? Why is this
clinging to life so abject and cowardly?
I solemnly pledge myself before God and
in the presence of this assembly, to pass
my life in purity and to practice my profession
faithfully. I will abstain from whatever is
deleterious and mischievous, and will not take
or knowingly administer any harmful drug.
I will do all in my power to maintain and
elevate the standard of my profession, and will
hold in confidence all personal matters
committed to my keeping and all family affairs
coming to my knowledge in the practice of my
calling. With loyalty will I endeavour to aid the
physician in his work, and devote myself to
the welfare of those committed to my care.
How does it feel when you no longer wish to part your
teeth, open your mouth? When opening your eyes is too much? Waiting to
snuff it, tense and inward as more and more of the body and mind shuts
down for the last time.
I swear by Apollo the physician, Hygeia and Panacea,
and I take to witness all the gods, all the goddesses, to keep according
to my ability and my judgement the following oath:
To consider dear to me as my parents him who taught me this art: to live
in common with him and if necessary to share my goods with him; to look
upon his children as my own brothers, to teach them this art if they so
desire without fee or written promise: to impart to my sons and the sons
of the master who taught me and the disciples who have enrolled themselves
and have agreed to the rules of the profession, but to these alone, the
precepts and the instruction. I will prescribe regimen for the good of
my patients according to my ability and my judgement and never do harm
to anyone. To please no one will I prescribe a deadly drug, nor give advice
which may cause his death. Nor will I give a woman a pessary to procure
abortion. But I will preserve the purity of my life and my art. I will
not cut for stone, even for patients in whom the disease is manifest.
I will leave this operation to be performed by practitioners (specialists
in this art). In every house where I come I will enter only for the good
of my patients, keeping myself far from all intentional ill-doing and
all seduction, and especially from the pleasures of love with women or
with men; be they free or slaves. All that may come to my knowledge in
the exercise of my profession or outside of my profession or in daily
commerce with men, which ought to be spread abroad, I will keep secret
and never reveal. If I keep this oath faithfully, may I enjoy my life
and practice my art, respected by all men and in all time; but if I swerve
from it or violate it, may the reverse be my lot.
Mr Rubinstein is a miserable, whining little Jew. He
said he was a good patient but he's not. He complains, whimpers and groans
in his embarrassment and discomfort. He said he was prepared to pay for
everything. He shakes violently with nervous tensions, makes sudden panic-stricken
movements and repeatedly says he can't take any more. Yet I don't dislike
On the other hand I felt an immediate aversion towards that hugely revolting
Afrikaans specimen, Lambrecht. A brutal, ravaged red face, vomiting and
bellowing. A particularly disgusting heap of humanity.
'When I am at home, if I have difficulty, after a couple
of days I just take a little soap on the end of my finger and massage
the anus, gradually moving up. It helps a lot. Maybe I manage to remove
a clod obstructing the passage. The only problem is causing some bleeding
from a pile a little higher up.'
What a relief! My wash died in the night.
Returning from tea I was in time for my first 'laying
out of a corpse.' He had a distinctly Goyaesque expression on his face
- eyes open to slits, mouth agape in cadaverous leer, black tousled hair.
He looked better dead than alive. Not peaceful by any stretch of the word
but at least no longer so explosively flushed. Also an improvement without
the plastic airway.
I have noticed more than one patient taking a morbid
interest in the obituary columns. They scan the names almost eagerly,
searching for someone they have known, someone they have outlived. The
greatest reward is to spot the name of a fellow patient who 'disappeared'
yesterday. The perversity lies in their dependence on the printed word
for death to become a reality.
Grobelaar: No, I don't want nothing.
must I do with this?
you no appetite?
man. I'll have to have a fuckin' big appetite to eat THAT.
Chronic airways disease complicated by pneumonia has
brought Tom Grobelaar into the ward. He is a skinny little man in his
seventies and, every breath being a battle, is distressed and irritable.
He finds it difficult using the bottle. He prefers to get out and stand
unsteadily beside the bed, wheezing
and moaning and cursing as he pisses onto the floor. And the
sputum mug is a fiddly little thing so he just spits over the edge of
'Chris' Jesus, man! Ohh, Christ. I tol' you, I don't want nothing. Just
leave me alone. Hi, this bloody fucking thing! Christ, man. Oh Jesus,
what is this?'
'Take it away'
'You must drink it.'
'No, Christ man. I tol' you, I don't want nothing.' He coughs a few times
in his characteristic way, exhausting himself. Each cough is a shout of
pain and dysphoria ending in the word 'Mimi,' his wife's name. As his
condition deteriorates he calls for her more frequently.
Bluff, 63, is a confirmed alc in with the DT's. He has
come from William Slater via Valkenberg and before being committed this
time he had been living alone in a room in Tamboerskloof. A bachelor and
a clerk. He has served several stints in William Slater and at Muldersvlei
After four days of the wildest delirium he is recovering fast and shows
surprising resilience. His visual and motor problems have largely resolved
themselves. On first regaining his senses he spoke openly and with considerable
pity for himself, of his aloneness in the world, of his lack of support
and encouragement. As he gains strength he becomes less open and begins
erecting his façade of self-sufficiency and worldliness. When he
has got it all more or less in place he will be released to follow a familiar
pattern: rehabilitation and abstinence, return to society and a job, renewed
acquaintance with loneliness and boredom, recourse to the bottle, unemployment,
a binge grander than the rest. Maybe the next time will be the last time.
Rabkin: I am going to commit suicide.
What's that, Mr Rabkin?
I am going to commit suicide.
Don't do that Mr Rabkin. Rather have a cup of tea. Two sugar?
At the age of thirty-seven Hector Dodds is a fucked-out
Every night I always pray to God until I fall asleep that I can walk again
and get a good job.
Rabkin in a thundering theatrical voice: Oh, the pain!
The pain! God, God, God! Then, enquiringly: When is God going to come
into the business?
Nurse: You think God would make a good partner, Mr Rabkin?
Dodds lying on his side between cot sides. vomiting
into a kidney bowl and over the sheets. A dirty, tattooed, malodorous
heap. Red-haired and phthisic, with long filth-caked fingernails. There
is everything wrong with him: epilepsy, a broken femur, tuberculosis,
alcoholism, impaired vision, hearing and speech. He has been an invalid
for the past six years, cared for by his mother. Whilst in the City Hospital
for TB and alcoholism he fell out of bed and broke a femur and knocked
his head, developing epileptic seizures.
He curls up in bed, his long bony hands touching his face, shielding his
eyes and nose. His filthy nails indicate some kind of anal exploration
or stimulation. 'Cerebral atrophy' is one of the diagnostic terms used
in his case. It's a toss-up between cerebral atrophy and Korsakoff's psychosis.
Vague terms for 'fucked in the head.'
Busy with blood pressures, the five o'clock obs, my
mind vacant but for a growing impatience as knocking-off time approached.
I was suddenly confronted by an ugly incident with an ugly man. When I
inflated the cuff of the Baumanometer stinking clammy Dodds violently
wrenched his arm away, glaring at me with wild hate.
'Fuck off, you bastard! Fuck no, man! No fuck, man!'
Then he said later, when reassured and calmed.
'Take me to my mother's room, please, won't you?'
'You're in hospital, Hector.'
He looked blank, bewildered. Then frustration and rage filled his eyes.
'Fuck it, man! Fuck, fuck, fuck!' He pounded the palm of one hand with
the other fist. 'Christ, man, I forgot! I'm sorry, hey. Fuck it, I'm sorry.'
In his laboured and slurred Woodstock speech.
Prior was on the phone from Casualty. He was with an
old A1 patient and they were on their way to the ward. The man's condition
was 'basically hypertensive.' He arrived conscious, groaning with exhaustion
and misery. As he was getting across from the trolley to the bed he seemed
to lose his strength and rolled over onto his side, his face half buried
in a pillow. He lay there and began to make a snoring, snorting sound.
Lifted forward his eyes bulged glassily. I removed his spectacles and
called Prior. We lifted him up and he lay there quiet, staring with blank
dilated orbs, as if aghast at the emptiness of it all. His breathing had
stopped. Prior felt for the carotid and in amazement said, 'Jesus, he's
just died!' He called to Benny Lipschitz and said, 'Benny, this guy's
just gone and died. There's no output. Nothing.' Lipschitz came over and
gave an experimental shove on the chest. I fetched the cardiac massage
board but they didn't want it. 'No point in calling Max. There's no output.
What could it be?'
The consultant arrived and they puzzled over the body for ten minutes,
tapping here and there, listening with stethoscopes, lifting eyelids,
feeling and prodding. Then they walked off talking of CVA's and PM's,
shaking their heads and scratching their arses.
After his wife had come we washed him and wrapped him up in plastic. There
was the usual hush in the ward, broken by the crisp ripping sound of cellotape,
each rip ending in a snap.
Now a disoriented patient who supposes himself to be
travelling in a car and not lying stationary in a hospital bed. He holds
on tight for corners.
Apart from the quietness I have noticed a stifling feeling
of closeness behind the curtains with the corpse. The air seems warm and
I experience a slightly feverish sensation. I have not discerned any characteristic
odour, yet the air is certainly not bracing and I breathe it reluctantly.
The condition of the clothes of a patient on admission
is noted with ruthless detachment. What might pass without notice in the
street is exposed in all its shabbiness under the disinterested scrutiny
of an orderly kitting in the items. A hole in a sock, worn-down shoes,
a frayed collar, unpressed grimy trousers. And how demeaning toenails
can be! A poor man with a genteel mind is filled with shame and humiliation.
I asked Meyer the time and in his excruciatingly slow
bumbling way he showed me his fancy digital watch which, if you held a
diploma in computer science, could be made to tell the exact time in Santiago
or Peking. It took him some ten minutes to establish correct South African
Then he glared past me to the doorway.
'What's happened to him?' He indicated the empty bed.
I shrugged and he nodded comprehendingly.
'I see.' Behind me in the doorway he had glimpsed Mrs Beck. 'I've seen
that before. A woman in dark glasses being embraced by another woman.
I've seen those expressions.'
There is no conclusion to be drawn. There is no easy
explanation. The evidence does not point to a facile homily. Anyway, why
does every experience, every piece of evidence have to be disposed of,
'assimilated,' accounted for? Before one is content to let a matter drop
why does one have to be didactic?
Stopel is a genially demented old man, unshaven and
dressed and smelling like a vagrant. He was found wandering in the street
with a graze on his forehead and some well-meaning citizen brought him
to hospital. He has been admitted for observation.
He was brought in on a trolley and lifted onto a bed, much to his amazement.
I have persuaded him to take off his shoes, which are lined with newspaper,
and am trying to explain what is happening.
'This is a hospital.'
'Oh, yes? That's very nice. But I think I must go now, thank you.'
'They want you to stay here with us for a while. They want you to stay
He sits up and begins to swing his feet off the bed when Dyer the registrar
and Prior the houseman arrive. They spend ten minutes thoroughly examining
him. Then the truth dawns on them. They ask him to stand, and he stands
up in the bed, causing them some alarm. No, they meant down on the floor.
He gets down and stands out of bed.
'This is very easy,' he says. 'Anybody can do it.'
'Can you walk?'
He takes a few paces and looks back at them and smiles modestly. Then
he heads off down the ward ready to go wherever the door leads. The doctors
turn and walk away shrugging their shoulders and raising their hands,
'There's nothing wrong with him.'
I stop Stopel next to Buchanan and suggest he put his shoes on before
returning to the big wide world. Buchanan reaches over to his locker for
the air freshener (Spring Breeze) and begins spraying Stopel and the air
Nico Swart is a delicately stunted, cerebral palsied
'child' of twenty-three. He lies impassive, ignoring my attempt at communication.
Then a flick of the black eyes - an inhuman child. At night he brightens
up and utters a stream of obscenities like a parrot. Who could have taught
him this? It is thought that he has lymphoma, a disease which should dispose
of him within the next few months.
A turquoise swimming pool set with symmetry in clipped
green lawn. Black stripes below the water, white railed steps in the corners.
An upturned bench on the grass. Rain falls from a heavy sky and from the
shelter of the veranda I watch the drops disturbing the surface of the
pool. The air is clean and cold and does not smell of sickness.
Goodman: I'm a good psychologist. I can sum people up
at a glance. I looked at that man and I could see he was swollen-headed.
I took an instant dislike to him. What does he think? He thinks he is
important, some kind of Very Important Person. You know, the Bible says
all flesh is as grass, and all the glory of man as the flower of grass.
The grass withereth and the flower thereof falleth away.
Suddenly I am very bored. How can I take this?
Goodman has lost a five-cent comb.
My comb has been stolen. Whilst I was asleep. Last time I was in here
I was drugged and someone stole my teeth.
H is seventy-two and has a rare blood disorder called Von Willebrand's
I am busy with research. I have been doing research into my condition
for the past forty years.
I feel indisposed to receive any visitors today. I couldn't be bothered,
they're too much trouble. I'm a very sick man. I'm not one to complain.
I am very independent. And this after having got me to change his pyjamas
for him merely because he likes to feel fresh and enjoys constant attention.
I would have committed suicide long ago if my religion permitted it.
What religion is that?
The Jewish religion. It forbids suicide, otherwise I would have done it
After a hard day, the last hour of which was spent helping
with the restraint of a crazed cirrhotic whilst the houseman performed
a lumbar puncture, I emerged from the hospital to be confronted, on rounding
a corner, by the massive shape of Devil's Peak. It's dark enormity, blown
with cloud and shadow, reared so impossibly high and overpowering that
I was flooded with a sense of foreboding.
Was it the violence of the wind raging up there across
the Devil's face that so filled me with fear?
DEMENTIA, according to Merck's gospel: a syndrome of
progressive irreversible cerebral insufficiency caused by organic factors
and characterised by predominant cognitive functional loss.
The clinical picture is of slow disintegration of personality and intellect
because of impaired insight and judgement and loss of affect. The progression
of the disease is more painful to the beholder than to the patient. Interests
become restricted, outlook becomes rigid, conceptual thinking becomes
more difficult, and some poverty of thought becomes apparent. Familiar
tasks may be performed well, but acquiring new skills is difficult. Initiative
is diminished, and the patient may become distractible. In addition, a
global defect eventually develops, involving all aspects of higher cortical
function. Along with the cognitive dysfunction, specific disturbances
of speech (dysphasia), motor activity (dyspraxia), and recognition of
perceptions (agnosia) may be discernible. Memory impairment increases,
beginning with problems recalling recent events or finding names readily:
the impairment varies greatly from time to time and often from moment
to moment. It can be circumvented at first, but as the defect increases,
remote memory is also progressively impaired. Characteristically, orientation
becomes impaired at first for time, later for places, and finally for
In some patients, cognitive dysfunction is preceded by modifications in
their usual behaviour and emotional responses. Typically, affect is blunted,
but in early stages it may be excessive. Normal personality traits may
become exaggerated or caricatured: an obsessive patient may be unbearably
pedantic and rigid (organic orderliness), or a sociable extrovert may
be facile and inappropriately jocular. The initial affective change may
be dominated by irritability with periods of anger and violence. Depression
is common. If the mood change (depression, anxiety, or elation) is sustained,
the disorder may be misdiagnosed as a primary affective condition. Affect
becomes more and more shallow and evanescent as the condition progresses
and finally gives way to severe blunting, marked perhaps by a fatuous
euphoria without depth.
The patient may embark on foolish and ill-judged, perhaps illegal, activities,
but he cannot sustain them as his motivation and drive decline. Habits
deteriorate, and the patient becomes slovenly, dirty, and eventually incontinent,
culminating with the need for total nursing care in later stages of the
Senile dementia: There is no treatment.
I am irritated by Archie Morgan's whining. He has a
steadily swelling scrotum that is fast approaching the proportions of
a soccer ball, he has the grotesque bloated belly of a starved child,
skinny, stick-like arms and shoulders, and a suppurating anus.
Archie Morgan exudes the foul sweet smell of a septic
wound. At twenty-eight he is a bearded, long-haired derelict with ascites,
liver failure and perineal abscesses.
His stomach works frequently and it is a difficult,
messy procedure. From the moment the curtains are drawn the trouble begins.
He feels the pan:
'Hey, no Man! You want to freeze my arse off?'
This is a delaying tactic which must be ignored. If the pan is warmed
'Hey, no Man! You want to burn my arse off?'
Two pairs of hands are needed, one to help him lift himself, the other
to slide the pan under him. He is weak and in discomfort and does not
like to move or even be moved.
'Now listen, be careful. Please, Man. Don't grab me there! Oh my fuck!
No, don't. I can't take this pain. Nurse, what are you DOING? Hold it.
Jesus no. Careful. Oh my God!'
He is such a wreck. Alcoholism to liver failure to ascites. Generally
deteriorating health and unhygienic personal habits have encouraged the
formation of anorectal abscesses: neglected, they have developed into
a fistula. So each time his bowels move the wound must be cleaned and
dressed. For this he has to be turned on his side - another process punctuated
with yelps, oaths and groans.
The odoriferous combination of 'purulent discharge' and faeces - his especially
- produces a strange effect. Once one has become better acquainted with
this smell it loses its nauseating quality and assumes an esoteric fragrance,
like opium and lust in an oriental brothel.
Archie Morgan employs flattery with such obsequiousness
that I laugh openly.
'You're just the man I wanted to see. You're my friend, hey. I tell you,
when I knew you was coming on duty, when I saw you come through the door
into the ward, you know my heart started beating. You know, kind of fast.
No, really. I'm not bullshitting you. You're my friend. Hey listen. Do
us a favour, won't you? I don't like to ask but would you do us a favour?
Just one little favour. I don't like to ask you.'
'What do you want?'
'You know. The usual. You KNOW.'
'You want another cigarette? They say you've got to cut down, Archie.'
'No, not that. For fuck's sake!' Whispers: 'Come here, Man.'
I bend close and he says, 'Won't you get me a pan?'