Cape Town 15-06-09 JF Jooste hospital in Mannenberg - Picture Brenton Geach

After nine years of study and four years practising, Soweto-born doctor Maria Phalime hung up her stethoscope. This is an extract from her debut book, Postmortem, the Doctor Who Walked Away.

Cape Town - GF Jooste Hospital, in the heart of the Cape Flats, had a phenomenal reputation as the training ground for skilled doctors and so I was thrilled when I was offered a community-service post there. After two months on the wards, I moved to the casualty unit. I joined a team of four doctors and it didn’t take long for me to figure out what was expected of me and my colleagues.

Sure, we were required to save lives, but the real measure of our success in the unit was our ability to assess and manage patients quickly, refer them elsewhere, and create space for more to come in.

This task, however, was not as straightforward as it seemed, because as hard as we were working to offload patients, the people we were referring them to were as reluctant to accept them.

Every day we engaged in endless haggling with medics, surgeons, gynaes, psychiatrists and, in moments of desperation, social workers to justify why they needed to take over the care of these patients. No one wanted the additional burden on their already overflowing workloads.

We worked 12-hour shifts, seven days a week, followed by a three or four-day break. The four-days-three-nights stretch wasn’t too bad, as the bulk of that consisted of relatively normal working hours from eight in the morning to eight in the evening. It was when I worked four nights in a row that I really felt it, because those nights always fell over the dreaded weekend.

Those weekends were particularly horrific. Stabbings, gunshot wounds, car accidents, rape, beatings … All manner of violent trauma made its way into the emergency unit, most of it alcohol related. The injuries themselves were gruesome, but what shocked me more were the perpetrators – friends, lovers, neighbours, family. It was very seldom the proverbial hooded stranger in a dark alley.

These were people who knew each other, lived together, drank together. And on weekends they hurt each other. The wheels came off over the Easter long weekend. The trauma was relentless, and by Monday morning there were so many patients in the emergency room that we didn’t know who had been seen and who hadn’t. When the specialist arrived for the 8pm ward round she must have seen the strange way we were behaving.

We had long since passed exhaustion and had arrived at that giddy state of surrender, knowing that it was futile to keep trying to catch up. She was an internal medicine specialist who probably hadn’t seen surgical and trauma patients in years, but that morning she graciously helped us to assess all the patients and make sense of the prevailing chaos. It was telling that I sometimes volunteered to go to the Thuthuzela Care Centre based at GF Jooste to assess rape survivors brought there by the police. This particular Thuthuzela Care Centre has been in operation since 2000 and provides comprehensive care for rape survivors away from the chaos of the casualty unit.

The women are spared the indignity of having to wait to be attended; their cases are prioritised so as not to further victimise them and to begin the process of restoring their dignity.

The circumstances I was confronted with were tragic but at least the environment at the centre was pleasant. Thuthuzela means comfort in Xhosa, and in a way being there offered me some comfort and respite from the pressures of casualty. Here I could take my time, take a proper history and truly connect with the patients.

I wore the same pair of running shoes throughout my time at Jooste. Over the months they became increasingly blood stained; I made no attempt to wash them. When I arrived home from work, I would put them in a plastic bag, where they would stay until they were needed again. I planned to burn them ceremonially at the end of my community service. The onslaught at Jooste was not without its casualties. Two of my colleagues contracted TB – a combination of being physically run down and the overwhelming exposure to the infective organisms. I constantly feared sustaining a needle-stick injury. I knew that, in theory, the chances of contracting HIV in this manner were low, but with the level of the infection we were seeing I still lived in fear.

The dangers we faced inside the hospital were not only limited to the infections we might contract. We were working in a crime- riddled community and the weapons we sometimes found on patients and the profanities they hurled at us were reminders that the aggression and violence that lay just beyond the hospital gates could so easily be brought inside.

I began to feel unsafe, fearing that one day that world would breach the relative security of the hospital’s confines. My anxiety sometimes got the better of me, even bordering on paranoia.

On the nights when I left the hospital after dark I would deliberately exceed the speed limit as I drove down Duinefontein Road, heading for the N2 highway that would lead me back home to the southern suburbs. I would press my foot down on the accelerator pedal of my little Toyota Tazz, pushing it to the limits.

When I reached the highway, I wanted the speed cameras to catch me, and I constructed an elaborate plan in my mind about how it would all unfold. I imagined myself getting caught repeatedly until the accumulated traffic fines attracted a court summons…

I hoped to draw attention to the conditions under which we worked, to be a mouthpiece for embattled doctors across the country. I never did get caught. Though I didn’t become physically sick the environment still took its toll on me. Day after day I fought to pull people back from the brink of death, with more success than not. But the endless tussle with the angel of death gradually sapped much of my enthusiasm.

I became irritable; I grew impatient and short with patients. Their neediness got to me. I felt I couldn’t provide what they needed, that what they were demanding of me was more than I was willing to give.

Yet, at the same time, one of the specialists based at Groote Schuur took a keen interest in me and encouraged me to specialise in internal medicine.

She offered to be my mentor and provide the support and guidance I would need. This was a golden opportunity; internal medicine was a highly sought-after speciality with a long list of candidates eager to make the grade. And I was being offered a helping hand by one of its leading specialists.

I turned it down. I couldn’t articulate my reasons at the time, but I was finding it increasingly difficult to shake the heaviness inside me. Not that anyone would have guessed. I had always done a great job of coping, or at least appearing to cope …

I felt bad for feeling this way. After all, a good doctor is selfless; she puts the needs of her patients ahead of her own.

Before the start of a shift I would promise myself to be nice to my patients, to enjoy my job more. But it only took one patient calling me “nursie” or a drunken gangster yelling “fokken dokter” and I’d plunge right back into that dark space. I didn’t like the person I was turning into. I felt disconnected from the very people I was meant to be serving.

* Maria Phalime is the winner of the inaugural City Press Tafelberg Nonfiction Award, which sponsors authors to research and write a work of non-fiction. Her debut book is called Postmortem, the Doctor Who Walked Away (Tafelberg).

Cape Argus