I thought this Wakley Prize Essay was poignant and a good read:
Cornelus JG Sanders MDa, aDepartment of Dermatology G02.124, University Medical Centre, Heidelberglaan 100, 3584CX Utrecht, Netherlands Available online 16 December 2005.
The green lawns that once surrounded the tuberculosis hospital had turned into desert, and the flower-beds that once had ameliorated the suffering of the inpatients looked like rubbish heaps. I had been employed in this place for 7 years and had seen it all deteriorating. An increasing number of inpatients now occupied the beds that had refused to multiply along with the sick, and therefore patients, naturally, had spread out over the floors. The suffering of the inpatients oozed from the walls. The oozing was constant so no paint would stick to these walls that were flaking continuously. Nurses were underpaid and scarce, as were the drugs available for the practice of medicine. “Out of stock” was neither a call to arms nor a protest, but rather the standard morning call reverberating through the wards as a loud sigh of resignation. The hospital spilled its corpses into the overflowing morgue and eventually into the deserted flower-beds outside. Notwithstanding their demanding and desperate situation, the patients tried to observe their decency. They struggled hard to convince anyone, including themselves, that they had the “good tuberculosis”. The “good tuberculosis” was “TB1” and not “TB2”. Patients would do anything to obtain a diagnosis of TB1 to avoid being stigmatised and ostracised. TB2 was actually that other disease that one could not talk about, namely HIV or AIDS. Evil spirits caused “TB2”, while “TB1” descended upon us mortals from the damp air and the morning cold. Everyone knew that.
The morning rounds had dragged themselves a long way into the afternoon, together with endless rows of diseased men and women, skin and bones, with feverish sparks of hope in their eyes and bodies ready to collapse from their infections. The best thing I could do was to give them a diagnosis of “TB1” and try to keep them comfortable. The nurse did not blink an eyelid when she told me that painkillers were out of stock, but asked me to speak to an old man who had come to collect the body of his son. I did not realise I was leaving the beaten track.
I sat down in the doctor's office and looked at the man who stared, absentmindedly, out of the window, watching the traffic along the busy road.
“Good afternoon”, I said. “I am sorry about your son. He was very ill when he came here last week and the medicine that we could give him did not help.” I paused, pondering the diagnosis I was going to write on the death certificate.
“Was it AIDS?” he asked. I hesitated with my answer. I hadn't heard this frank reaction before and it caught me off guard.
“You can answer me”, he said, with sincerity in his voice.
“Your son died of AIDS”, I said, “and we have no medicine for that.”
Then he looked at me with his staring gaze and said: “You brought us AIDS.”
After that remark the silence hung heavily in the air, a weight descended on my shoulders and the hairs on the back of my neck stood up.
“You brought us AIDS”, he repeated.
Visions of competing CIA and KGB labs, developing horrid microbes for their warfare, rolled through my head.
“Well, if you mean that I personally imported AIDS into your country, let me reassure you because all I am trying to do is to treat …”
“We never heard about AIDS before you came along.”
The superpowers fighting their wars on the African continent, while keeping its people ignorant and in perpetual poverty, and so gradually destroying these innocent bystanders.
“You brought us AIDS but have not brought your medicine.”
Or the fairytale about these microbes put in contaminated vials and distributed during vaccination campaigns in Africa. I had heard the story before.
“You brought and taught us about AIDS”, he whispered.
I took a deep breath, since this conversation was not going in a direction of my liking.
“And that is all right”, he said.
“You know about the spirits of our forefathers that guide us during our life, or sometimes stand in our way and wreak havoc”, the old man continued.
I nodded my head.
“I have lost my eldest son and, before you brought us AIDS, we would say that ‘evil spirits’ have caught up with him, or that maybe he had done something to upset the good spirits. We would ask the medicine man and he knew what to do, sometimes.”
Like my patients I felt moving sensations in my head and my knees weakened.
“With our young children we always wondered whether this child was going to stay or leave again after some time in our home. We were not used to older children leaving us behind. I never thought that I would see my eldest son leave. I assumed I had seen enough children leave.”
The old man stared out of the window. “Maybe it is like the road out there”, he mused.
I wondered out loud: “What is like the road out there?”
“The life we are leading”, he replied. “You travel along the road from here to there without knowing where to go or what direction to take. Things pass you by, but you are not sure if you should cling to them or push them away, just like people in your life who may come and go, without warning or purpose.”
The pot-holed tarred road was teeming with cars, buses, bicycles, and people. “Before they constructed this road there was only a small dirt track”, the old man continued. “The road construction was not meant for us but for the rubber plantations farther on. Never before or after have I seen so many workers tearing down trees, levelling ground, and working big machines. Some people were meant to stay and eventually built this town and many have left or will be leaving. The road suddenly changed our life and ended the isolation of this remote corner in this land. It brought prosperity. Shops appeared along the way while cars became a regular sight. Before they could spoil me, my father said, that real men were meant to walk and summoned me to help him with his shoemaking business. We started to make sandals from used car tyres and I have been making shoes ever since. This road gave us plenty of raw material. I can spot the difference between a Goodyear and a Bridgestone tyre from a distance.”
His calloused hands lay in his lap. “The sluggish feel of a rundown tyre”, he muttered, looking down, “and my hands putting new life into them. Another pair of sandals ready for the road. The road has brought me my wife along with her sisters. We were very much in love. But after many years she left, one night, in agony, after a week of fever and moving things in her tummy. The doctor could not do anything and said he was sorry. I think it was due to a witch, looking for lovers at night, making them crazy and then leaving one of them in a dead-end street.”
I could see that the pain was still there but life did not pause for him. He told me that he had married his wife's sister and his children were well looked after by his new wife. However, over the years, they had fluttered from the tree like leaves after a thunderstorm.
“I have lost all my girls and two sons”, he said. “We tried to take good care of our children, but how can you keep the thunderstorm out of your backyard or make sure leaves stick to their branches? We used all the potent medicine to comfort the good or fight the bad spirits and we watched out for witches. The doctors in the clinic claimed victory once in a while, just to lose the battle again some time later. The road had brought Father Josiah who carried Jesus and erected a church building. He smoked two packets of cigarettes a day while taking care of the lepers in the settlement and complaining about the injustice of being sent to this God-forsaken place. The reason why God had left was not immediately obvious since everybody tried very hard to contact him by prayer throughout the week and especially during Sunday Mass. But lepers are known to consume spirits so probably God had vanished into their community. That's at least what the medicine man was saying and he sometimes knows.” Despite all the prayers his children still left one by one.
“So this road has brought me my wife and children and now they say it has taken away my children.”
“Who says so?” I asked.
“Those people came to my house and told me to take away my tyres. They said that tiger mosquitoes lived in my tyres and they had given evil spirits to my children that made them disappear.” He looked at me in disbelief. “You know that we tried our best to please the spirits but apparently our medicine was not strong enough. We still have evil spirits that take away our children. Often they take away the young children and not the old ones. They were meant to stay. No person in the world is strong enough to bury his own children, except those that are comforted by good spirits.”
The tears in his eyes reflected the many good spirits that he had needed in his life.
“And now my eldest son has also left”, he mumbled.
As I watched his children fall from his hands like grains of sand, I was beginning to feel lost in his presence. I said that I was sorry for his misfortune.
“Oh, it is not that that you should feel sorry for”, he said. “This road of life that we travel from birth to death has so many secrets and surprises and so little guidance. At the end of life there is no magic that is suddenly revealed to you to live your life better or with fewer worries. There are good spirits that put their hands over your head for protection or arms around your shoulder and we call that love. This is what you have for your wife or children. The lesser spirits are what we call compassion and of course we show that to our friends and relatives. Most people that you meet along the way have to make do with the sympathy that you are prepared to give to them.”
I felt utterly impotent and told him that I wished I had more medicine to help out.
“Oh, but the medicine is all in you.”
I stared at him in confusion.
“You are showing me respect by sitting here with me and listening to my story. I don't need your pills. I need your attention. We have come to the end of this little bit of road that we travelled together. It is your being here, taking a moment in time to let me talk and give me your ear that goes well with you. With that you took some of the load off my shoulders and carried me a little farther down the road. Although you cannot bring my children back, I will be less tired when I arrive at the end.”