COMPASSION FATIGUE IN THE DAYS OF HIV
Some mornings I would go to the death register secretly hoping that a patient or two had died overnight. Are you shocked, horrified maybe? I was too when my friend who had passed through the Medicine rotation before me told me that this would happen - I didn't believe her. But here I was , coming into work early to care for some patients while holding a subconscious wish that the universe had shortened my patient list while I was asleep. I didn't secretly wish death on just any patient , it was usually the ones who came in looking as though death was already dancing with them. Like they just needed some excuse for departure. These were usually AIDS infected holding onto life's last moments being rolled in by families who I knew had the same secret hope as me.
With patient loads into the forties per intern , could you blame us for compassion fatigue? Anticipating a patient intake sometimes made me physically ill. Psychosomatic? Perhaps. A rotation of night duty every five nights then four days catching up from the last shift managing the patients from that intake then another night intake then patients come and go and more names are added onto your list than are scratched off.
It was a game of numbers, a tally of scores.
Kamlia , the other intern, would ask me something like" so how many are you sitting on?"
I'd give her my number of patients .
"I've got a lung ca and pneumonia that may be leaving, " I might have added on hopefully, trying to deflate the load of patients that I was already carrying.
She'd say something like 'shit, that's a lot - and this is before intake tomorrow'
Thanks, I knew that. With a barrage of A-type personalities, there was often a subtle ( sometimes overt ) tone of competition.
Every single patient (less) counted. The good intern was the one who worked the fastest and cleared out the most patients to free up bedspace. Beds were a big issue at Bara. That list of forty patients were usually scattered around the hospital , dispersed in a ward where a free bed was available. A morning ward round could be as much about a good cardiovascular workout around the hospital, as it was about logistics. Sometimes , only sometimes, a patient who had been sitting in the same bed for almost a week unattended, would be pointed out by the nursing staff.
'doctor, what's the instructions for this patient. There's no notes since last wednesday'
The patient was lost in the system - to the system. He had probably fallen off an overworked intern's patient list and lay scattered in some ward with every passing doctor thinking that he belonged to someone else.
If it sounds like I didn't care , I'm not sure that I could honestly tell you that I did. I worked mechanically, wanting ,so desperately wanting to care - like the doctors on TV, like I did when I was a medical student asking about a patient's family history and whether he had running water and a flushing toilet in his home, sincerely asking about every fart and bowel movement. It's just the situation we kept on telling ourselves. The sheer workload just to give each patient basic care left no time for niceties. I still wanted to be nice.
It's strange that at times when I thought that I was the most callous, the most hardened a patient being rolled in on a rickety overused stretcher would knock the compassionate breath out of me. Like that feeling of unexpectedly passing by a long lost love , only its the exact reverse. It was usually the patients with Aids who came to came to take their last breaths at the hospital. I remember an intake night when a skeleton lady in a red polka dotted dress was rolled in. Her skin clung to her bones like a tight fitting leotard. Her eyes bulged out of sockets which looked too small and her cheeks caved into the grooves of her facial bones. It wasn't an extraordinary picture but my reaction was far from normal.At least, I had a reaction. A bolt of guilt-laden pity slammed hard into my conscience. It was revelatory : I was still able to care. It passed as quickly as it arrived- that feeling. But it gave hope that there was still hope, some inkling of humanity in me to be salvaged.
AIDS was (and still is) like that creepy uncle that everybody hates but still has to tolerate. It was so much a part of all that we ever knew. We knew no pre-Aids days when wards weren't a pit stop (to heaven) for the terminally ill. Most of our patients would not really recover. I often think that this must have beaten down on us quite badly in a very slow degrading type of way without us realising it. Yes, AIDS . Our government had missed the boat you see.
At the time when HIV was gaining ground and governments internationally were putting measures in place to cope with the emerging disease, our country was going through the great transition from apartheid to democracy. We seemed to have more pressing priorities at the time. After Mandela and democracy came the aloof technocrat President Thabo Mbeki. A brilliant man by many standards, his messages didn't translate well to people on the ground. Often criticized as inaccessible, Mbeki adopted what was dubbed a 'denialist' approach to HIV. He told the aching nation that HIV did not cause AIDS. In reality, his message was not as simplistic as that - he apparently meant to say that the HIV virus exclusively does not cause AIDS, focusing on poverty as a major causative factor. He was pretty straight on the mark, but the message that reached the general public was that 'HIV does not cause AIDS' . A confusing message at a time when clarity and decisive action was needed. His administration resisted providing widespread antiretroviral medication to patients but later caved into legal pressure from the Treatment Action Campaign - a persistent and powerful NGO. President Mbeki was recalled by his party, the ANC in 2008 amidst a coup-like leadership battle.
His successor President Jacob Zuma had none of the intelligence of Mbeki but much of the charm that Mbeki was lacking. President Zuma's infamous blow to HIV/AIDS education in South Africa was pre-presidency , during a trial where he stood accused of rape. Yes, he admitted, he did have consensual sex with the unnamed lady whom he knew had HIV, but... a very big but ... he thought that he would not get HIV because he took a shower straight afterwards. AIDS activists buried their heads in their hands. It was another few steps backward at a time when HIV statistics were reaching epidemic proportions. So yes, our government definitely did miss the leadership boat when it came to tackling HIV/AIDS head on.
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