The Simple Truth About Nurses

Dear Nurses

In another world I would have been an engineer sitting behind a computer solving other management problems.

But thanks to an inspirational ICU nurse I changed from engineering to medicine.

Now in this world, as a doctor, I am a humble part of the team at Kingsway Hospital that is managing the Covid-19 threat.

We are all, the public and health care workers, faced with the stress of the effect of the pandemic. There are economic fears of retrenchment and real money issues. Then there is the psychological stress of losing our right to move as we please, and with whom we please. 

Covid-19 is a disease whose spread we cannot control. Even worse, some  patients who get a severe infection cannot be cured, and will die in our care. I ask the public to think about the precautions we have to take to reduce the spread of the virus in our hospitals. We have to be vigilant: anyone can spread it in the asymptomatic carrier stage. We screen endlessly. We wash our hands so often our skin cracks. We live in masks, and as the risk increases we spend the day and night in uncomfortable protective gear. I challenge any member of the public to watch a video on the donning and doffing of our PPE (Personal Protective Equipment). Some of this process is not entirely new to people exposed to the operating environment. But I can tell you, as a surgeon, the new processes are not easy for me, and are much more demanding and tiring.

The nurses have been forced to learn so much that is new. This is not like dealing with a superbug in the sense of the word before Covid-19. Superbugs like MRSA and CRE remain a challenge for all hospitals. The management of those is difficult, and we have extended and increased our systems of safety and control for the Corona Virus at least a hundred fold. 

Some of our nurses have been in isolation, and fewer have actually been ill with the virus. Thank you to them for taking time out of your life to keep us safe. Thank you for accepting sometimes blunt orders from your hospital. I understand the trauma you have been exposed to. 

Some of nurses have temporarily lost the job they were so good at. I think especially of the theater staff, where no operations have been undertaken in over ten days. I know you want to contribute. The only way we can contribute is to train even more to deal with this threat.

Other nurses with great clinical skill have been put on point duty to man sieve and screening areas for 12 hours at a stretch, exposed to the elements. Durban is not such a mild place if you are outdoors all day. Thank you for being so patient with the public that still come in needing our hospital.

We all have to pay so much more attention to detail. The equivalent performance by a sportsman or woman would be a hole in one or an ace with every shot, or a goal with every penalty shot in soccer. There is no one that can do that. Let’s not beat ourselves up about failures from which we can learn and do better the next time.

I know we all use Facebook to stay in touch with each other. A lot of good comes out of being in touch with people far and wide, and being able to share your life with them. 

What’s happening with the negativity toward nurses by some members of the public on Facebook is just not right. But Facebook gives strength to the weak, and should never be the judge of the calling you all hold dear to your heart.

What is happening in our community with nurses being ostracized in public and common areas speaks to the lack of understanding of what we face with this pandemic.

Those people, like us, need to learn to manage their stress and ask for help. There is no need take it out on the nurses who will care for them when they are sick.

Our nurses are the superheroes of our new world. Take some time to acknowledge them. 

They will be the ones looking after your loved ones in hospital.

For those patients that die in our care the nurses are the closest they will have to family. They will be with them when their family members who want to be close, cannot. Many of the nurses will feel the pain of their passing as keenly as family, with the added weight that they may feel they failed. They have not failed.

The disease is the killer. Not the nurses. That’s the simple truth about nurses.

Winner of the 2014 MPS/ SAMA Photographic competition

Conversations about Coming Home

Last night I attended a talk by Ian McCallum at the Yellowwood Café in Howick. He has just completed his expedition from the west to east coast of Southern Africa linking various elephant migratory routes and publicising the need for environmental action by focusing on pachyderms, a key species in the ecology of wild Africa and India. You can read about this trip on www.tracksofgiants.org

There are many things that struck me about Ian. He has an aura about him that is not just because of who he is (he is a qualified and working psychiatrist, author, poet, wilderness guide and expedition leader) but rather because he knows he is because of everyone and everything else. He is a true child of uBunthu: “I am because you are”.

He is thankful for everything and everyone that has coloured his life and allowed him to connect to this earth. He is practical as well, and made a strong point in the beginning of his talk of thanking everyone for very little thing they may do for the environment, no matter how small the action. It is these small actions that will make the groundswell that can change the world we leave to our children.

He told of a talk he did at Epworth primary School earlier that day. It was in a room filled with caricatures of wild animals. It was a happy room. He asked the children what they would feel if there were no more animals left in the world.

After some hesitation the first hand went up. “I would feel sad”, the child spoke.

I am sure Ian danced about the stage as he did with us, filled with energetic passion for the earth. He looked for more answers. It came from another child: “I would feel it was our fault!”

And the last child spoke out, sadness stinging his face: “what would we leave our children?”

His expedition was not so much about the giants of the bush as much as the giant within each of us that can change the world. We can all achieve so much, if we commit and try. The tragedy is not that we do not achieve, but that we aim too low.

At dinner I spoke with Ian about his first trail, which he undertook in 1981 with Ian Player and Maqubu Ntombela. It had a profound effect on him and his understanding of the world and himself. I remember it doing the same for me. The Wilderness Leadership School Erythrina leaf emblem encapsulates a simple philosophy of co-existence with the environment and one’s self: each of the three leaflets represents a core relationship in man’s life: Man to Man, Man to God and Man to nature.

I asked Ian why he had chosen psychiatry. “Because it was the one thing I did not want to do. So when I asked myself why I didn’t want to do it, and investigated it, I found it to be the very essence of medicine.” It echoed in me. I remember my time in the bush bring a clarity to my soul to explore the mind through medicine. I never got to being a psychiatrist, but certainly benefited from them.

Ian said of his first trail that he felt like “he had come home.” I know the feeling, and his inspiring talk made me feel like I had seen home again.

Conversations about Not Writing

Its 5:30 a.m. and I am at my computer writing. I have woken early to soft rain dribbling down the gutters and sheeting the veranda. I have started the coffee machine to warm it up, and am drinking a cup of hot water and lemon.

I looked at my writing folder and saw that I had not written since 29 May 2012. I have reposted my essays from my photography site and have published some of those, to keep the blog ticking and I think they are better suited for the blog than the photographic site.

I suppose some feedback is due after I spoke with my grandfather. The episode of losing my patient so soon after surgery unfolded in an emotional turmoil. After just less than two weeks the pathologist informed me that he had died of a heart attack and there was nothing unnatural to record on his death certificate. Common things occur commonly, and that was my first thought when he died but with all the medication we use I needed to know we had not been negligent. We were not.

I was touched by the emails and sms’s many of you sent. I’m not always as sensitive as that episode exposed me, but it has realigned my values into a more simple view of the privilege I hold in treating all patients. Thank you one and all for your feedback.

But that is not why I have not written. I had became a victim of writer’s block. As in all instances in life, claiming to be a victim does not absolve us of any responsibility to a task or in fact life itself. There is no such thing as writer’s block. There is just a fear to write, a fear to tell the truth, a fear to experiment with concepts and stories. A fear that people will laugh at you, or that it may not be good enough. Then you become eligible to claim status as a political victim of writer’s block.

The good thing about claiming victim status is that it is easy to lose that status just by waking up and sitting down and writing. Each moment of each day is a new opportunity to create.

It is with sadness that I have to write about another death, this time in the family: Jako, my brother’s parrot who lived with my mother, died this week. He was over forty years old and was a bigger part of our family than we realise. I did mention him in a previous blog, but there is so much more he could tell. Imagine being a blue and gold Macaw from South America that gets captured in a culture warp of a Geek immigrant family in Alberton, South Africa. There is a real story in that. Jako has been buried in the garden near the house my father built for him, in his dazzling kingly robes. He only knew two words. He could call “Zorba”, one of our dogs and say “hello”. Now he has said “goodbye” at last.

Lunch at my father’s 70th Birthday in 2006. Jako’s house lies on the left behind the olive tree.

Conversations about Birthdays

As children my mother always organised great birthday parties. She would invite our friends and set the table with food and treats. Cold drink bottles would line up to quench our thirst.  I remember everything being set and then having to wait for my father, who would rush back from his busy schedule at the office to be with us.

I know we were spoilt in those days, but there was not a plethora of cheap electronic toys available as there is now. For instance, I never owned a radio-controlled car. I remember going through a phase where I collected Action Man and all his accoutrements. This was disturbing for most men in the family because they thought this was a sign that I was gay. Even in that conservative town in the sixties it was not an unknown entity. One of the sons of family friends ended up having a gender reassignment operation in the seventies, and the pressure was on already from young for him to come out of the closet.

I remember our childhood birthdays as happy uncomplicated affairs. Aunty Kiki would treat us with wonderful gifts, beautifully wrapped, and she would bake a soft moist chocolate cake for the special day. We always had the correct number of candles and it was a big thing to blow them out and make a wish. I am sure I made many wishes over the years, but a line from a poem comes to mind:

“I got nothing I asked for but everything I hoped for

Almost despite myself my unspoken prayers were answered.”

After the singing and cutting of the cake we would drift into the garden. Funny, I do not remember bad weather on any of our childhood birthdays, but that is probably a slant of brightness that comes with age. We would play cricket or soccer, or cowboys and Indians. I think for one year when I had built a puppet theatre and was making paper mache´ puppets whose gowns were supplied by Aunty Kiki, I tortured the audience with a puppet show. The theatre was a made of a wooden frame covered with plywood painted yellow. I always loved mechanisms of any sort, and made a curtain system to open and close both sides simultaneously. The drapes were thick red velvet, probably cut from one of my mother’s old ball gowns.

So the years have moved on to the point where half centuries pass. Children’s birthdays were so innocent and so much fun. Then as we grew they became complicated and a show. We went from a special meal treat at the local steakhouse to meals in other countries, weekends in decadent luxury and sometimes nothing, just a quiet dinner at home.

What made those early birthday parties was an air of simplicity, home backed cakes and my father rushing in like the president from the office for the occasion.

My father at one of my brother’s birthdays.

Conversations with My Grandfather

I do not remember either of my grandfathers. I am named after my mother’s father, Basil the baker. My father’s father, John, owned a corner café in Alberton. I can imagine he would be very proud that one of his grandson’s is an orthopaedic surgeon.

He would open the store early in the morning and close late at night every day of the week, closing only briefly for Sunday lunch. At lunch he would have probably told his children that they must study and become professionals. Become a doctor or a lawyer or an accountant. Make money, but more importantly, have a life and be someone. Don’t slog all day behind the counter.

That is not why I became an orthopaedic surgeon, although one cannot discount the brainwashing effect generations of aspiration and desire to have children pass through university into a profession might have had. One cannot imagine their hunger for that, when they themselves had not even completed primary school and their dreams were vested in their children’s children.

If my grandfather was alive now as I write he would be opening the store. He would have woken up earlier, maybe at four or four thirty in the morning. He would not have had breakfast; perhaps he would have taken a cup of tea. Then he would have walked through the courtyard at the back of the house, down the steps, under the grapevine to open the store from behind. The back door opened into a kitchen, with a small veneered table with chrome legs. He might have taken his tea there.

My grandfather would be tired at the slog that faced him yet again. Worried about having to pay the suppliers, and calling in credit from customers who had no money but needed to pay. He would have been concerned about his daughter who was studying at university, who would later go on to become a lecturer. She was ahead of her time, but beyond vision for an immigrant from the dark days of Greece in the twenties and thirties.

If time and place were one, at the same time today I would be driving back from the hospital. I left at three in the morning after a call from my ward that one of my patients had died. He was only sixty, a pleasant Afrikaans gentleman that I had known as a patient for almost three years. A lecturer at the university. He had a knee replacement two days ago. Everything seemed to be going fine until I answered my phone this morning.

But today my grandfather would have me for company at five as I returned home. A specialist who earns money, has a life and is someone.  Today I was awake before him, and the price I pay to be honoured with my profession is beyond measure. How do I explain to him that I did everything right. That I am a good surgeon. That I care. That I had to phone my patient’s wife and tell her that husband had died, and she was alone from now on.

Wish that today my grandfather could make me a cup of tea at five in the morning, as he opens the store. Wish that we could compare notes about work.

Neither of us have any idea of what it is to wear the shoes that take us to work each day.

My shadow taking making a picture in the Namib Desert

Conversations about Herbs

When I was growing up there was only one herb in our house: oregano.  It was never fresh and it always came from Greece, harvested in the harsh Arcadian mountains around the village.

Whenever my father returned from a trip to the homelands, as he used to call Greece, he would bring a gift, a bag of sweets and a bag of oregano. Sometimes the gift was a CD or a small ornament. The sweets were always made by Greece’s equivalent of Cadbury, Ion. I only found out after many packets of sweets that in fact Old Man Simbonis used to give my father money to buy me sweets at the airport.

This year, three and a half years after my father died and stopped supplying oregano, we finally ran out of stock of oregano. So did most of my close family. So it fell to me to get the herb. I went into Tripolis once while I was there last month, walked around, sat and had a breakfast of Greek coffee and loukoumades, did some shopping but forgot to go to the market where they sell so much oregano the smell overpowers any other produce they hold in the small open square. I eventually bought some at the airport.

I remember opening the packet of gifts, already with an aura of the mountain aroma, and then decanting the oregano into a glass jar, where the strong reminder would remain for a few weeks in the cupboard until it faded. Each time I opened the jar to use the herb the heady mountain smell would jump out and fill the kitchen. As it baked or grilled the smell would sweeten and finally when I snuck a piece of food to taste I would be transported back to my grandmother’s house, and her cooking. There was only one herb in her house as well!

When I married into an Italian family and dinners were shared by both families I remember my father picking at the Sweet Basil, because his Greeks never ate that stuff. They only kept buckets of it potted around the houses and courtyards to keep the flies away. It was also useful at the Epiphany for the priest to bless the congregation and their homes.

Rosemary was someone’s name; although it featured in church as incense, we never cooked with it. Now I have rows of bushes growing in the garden, ready for use. I remember walking the streets off the strip in Las Vegas and brushing my hands against the oily rosemary the city had growing as hedges and ground cover along the sidewalks.

Dagga was legal up to the forties in Greece. Much like it was in South Africa. You could buy it in the corner grocery store. It was an herb that never featured at our house.  I wished it did recently. A friend’s mother who was having chemotherapy called me up to ask how she should use it to control her nausea. I had no idea, but the internet provided some answers. In the end she just needed one puff to halt the waves that overcame her.

Spring wild flowers in an Arcadian Valley

Conversations about Work and Corners

The Greeks use the word work to mean labour as well as to mean trying to pull a fast one. They say the only work left in Greece is the work where you pull a fast one on your neighbour.

Sitting in the lounge at Oliver Tambo Airport after an intercontinental flight is far removed from arriving in Athens and driving into the city. Some stores are flashy and new, like the Zara, while behind it lies a burnt out facade of a building destroyed in riots or set fire by the owners so that they can claim from insurance.

A night in Athens remains, a drive through the ghetto inhabited by Indians and Pakistanis and Chinese, drugs changing hands under furtive glances along dirty side walks with cars parked on and off, crammed and dirty as well. They hover outside windows of stores that hold a foreign nation’s goods, strange in Greece were it not for the fact that Greece had Gypsies before.

After the ghetto we drove out to Paxi, a small village on the Attiki coast between Athens and Corinth. It was filled with young people drinking coffee and cocktails. Some arrived on scooters, some on superbikes and quite a few in Porches. The psarotavernas, the fish tavernas, were empty except for one, where three tables including us enjoyed a meal like we would have had ten years ago for ten times the price. Some of the taverns had been turned into new Russian looking club cafes and were full of designer clad youth.

The next day I left Athens and wondered through Corinth up  to Nemea, through Mycenae, Tolo and Astros and ended up in the village where time seems to have stood still. The road past the house has quietened down, with much less traffic than before. The priest across the corner is never home during the day since his wife died, and in the night the lights are on as he struggles with the insomnia brought on by loneliness. The empty house on the corner remains empty, except for one year when one of the sons used to peep out from shutters even though we continued to park our car on his corner. The remaining corner has a ramshackle house with stables and chicken coups facing our house. She has been moved into a home because of dementia. Our part of the village is made of corners. No where else are there four houses neatly laid out on the corners of a crossroad. Three the same age, with the priest’s new house built in the eighties on the odd corner.

That is about the only sense of order there. All the villagers are working, but not all of it is labour.

Looking into Arcadia from Mycenae

Conversations: Five Things My Father Taught Me

My father did not actively teach, but reinforced ideas. This is what I learnt from him:

Have faith.

Act now.

Be punctual.

Be prepared.

Have compassion.

For all the trials and tribulations he faced, and he faced as much as any of us and sometimes more, he kept his faith. It was a complex religion and culture that he tied himself to. His roots went deep down and could not be disturbed. His faith was mixed with mysticism and philosophy.

He always grasped the opportunity presented with both hands and acted immediately. He spent long days waking up early and going to bed late doing just that. I cannot remember him saying “I should have done that.” He did what he had to do, and did it immediately. He made plans and stuck to them.  I am not sure if any of his plans were written down. When he died I remember seeing some notes on his desk, with cash flow projections for the company for the next two years. I wonder if he ever wrote down his plans, his mission, and his affirmations?

He taught me to be punctual. He said things like for a business meeting it was acceptable to be ten minutes late and for a social meeting thirty minutes late but he was never late. I am not sure how he coped with Greek time, which is notoriously tardy. Most times you are lucky if a Greek gets the right day, never mind the right hour. They might own the fanciest Swiss watches but their time keeping skills are terrible. A bit like their national budgeting skills.

Whatever he did, and whatever I did, he emphasised preparedness. For his meetings he would read the minutes and make notes on the agenda. For cocktails with ambassadors and CEO’s he would have his secretary type up notes of their wives’ names, hobbies, children’s’ details and he would go through these while dressing, slipping on the well used tuxedo. He expected us to study for exams, and most times we did. I had to; I was never clever enough except in mathematics. He was distraught the year I left engineering for medicine. Before my final Applied Mathematics Exam I was notified by the secretary at medical school that I had been accepted. So I celebrated and got drunk. I wrote the exam the next day and passed with distinction.

The last time I rode in his old Mercedes in Alberton we stopped at the traffic light and he fumbled in the console between the seats to find change for a beggar. He had a small Tupperware filled with R5 coins which he handed out all day. He never said things like “I wish the police would remove these people” or “surely they can find a job “or “he’s not really blind”. He just gave. He was religious about visiting friends and family who were sick. He would make arrangements for the surviving family of those who died and he helped many people out by funding their failing businesses and helping them get back on track.

As I think about it I learnt a lot more than these five things. This was a start.

My Mother and Father at the Acropolis circa 1966

Conversations about May Day

I wanted to start this by asking “crisis, what crisis?” but it is unfair. There is poverty and suffering, but there is still a whole lot more living happening in Greece than in most places.

Take May Day. Sure, it is Worker’s Day worldwide, including in Greece. People protested in groups, there was certainly aggravation around the political party stands as they built up to elections in a few days. But May Day was also the day to celebrate spring. My cousin, Panayiotis, invited a few friends and cousins around for lunch. It had to be an early lunch as I was leaving for the airport at that time.  I am not sure if he has ever celebrated his birthday before, because none of his friends knew it was his birthday. But I am sure on the day of the Assumption of the Virgin Mary, on 15 August, his name day, they all call to wish him.

On May Day his wife, Olympia offered me coffee when I walked into the kitchen. She was busy stuffing peppers to be baked. As an aside she told me it was his birthday. Other than my mother and father who celebrated their birthdays while in Greece on holiday, this was my first Greek birthday party. But it was really just a great warm spring day to get together in an Athena garden.

Panayiotis has enough olive trees in the garden in Athens to harvest 120 litres of olive oil. His own to use on salads and to cook with. He had a lamb on the spit by the time I woke up. It was turning slowly over the charcoals, looking like a vestal virgin cloaked in white baking paper. When the paper eventually came off it revealed a small lamb expertly tied to the spit, with an intact head with baked with bared teeth. He had sourced this lamb from a shepherd in the mountains. There were no butcher’s stamps on this carcass. He told the story of some Athenian family that held a baptism in their village in the mountains of Epirus. The bought ten sheep to take up for cooking on the spit for the party. They were city butchered sheep. None of the shepherds ate the meat. To them it smelled off, or otherwise they were mortally offended that the rich Athenian family did not ask for their sheep.

He did nothing to the lamb other than rub it with olive oil and some pepper before he wrapped it up in the baking paper. After three hours he took the paper off and an hour later the lamb was cooked. He removed the lamb from the fire and let the spit and lamb rest against the nearest olive tree for 10 minutes, for the meat to firm up. Then he held the spit over a large dish and cut a few wires, allowing the lamb to slide down the steel spit into the dish. He expertly folded the body into the dish and took it to the table for carving. It was an absolute work of art.

As a snack while the lamb was cooking he had prepared his own kokoretsi and was happily pulling off brown bits of the intestine used to twine the offal to the spit. These spicy crispy bits of meat were so tasty that I could not thing about the offal as I savoured them Bits of heart and lung and kidney and even brain peeped out through the roughly twined intestines.

The table under the shade of the veranda amongst the olive trees sat 20 people. Three salads appeared, a platter of tiropita, baked melanzane, tzatziki, bread and stuffed peppers. Local retsina in plastic bottles appeared and one of the ladies poured  a light home made rose from a jug. The wished each other a hearty meal and tucked in, slowly devouring the food, choosing tasty bits to colour  their plates and slowly demolishing the food. I left halfway through, but by that time the second lamb went on the spit and I knew they would be there the whole day, eating with passion and living through talk and actions.

The really special thing about May Day in Greece is not the fact that it is spring, or a worker’s holiday. Or even that it was the first Greek birthday party I had attended. It is the fact the everyone greets you, and wishes you with “kalo mina – have a  good month” the same way we wish each other at New Year. Each month holds something new for them, and deserves special hope and treatment. As each day should.

White lamb and kokoretsi below

Conversations with My Father’s First Cousin

Panayiotis is the son of my father’s mother’s sister, Christina. He was born between my father and me, and was my father’s most important family connection in Greece, and the only real cousin I adopted in Greece. All my first cousins are in South Africa, Australia or the USA.

Panayiotis is the sort man that will drive four hundred kilometres to share an ouzo with you, then drive back at midnight to work the next day. He is a great guy that has built a small empire in his suburb of Athens, the Forest of Xaidari. The only forest that remains is the olive grove that covers his property, which is the only garden with a house amongst neat apartment blocks. He has green fingers and plants vegetables alongside the olives and has a driveway lined with winter and summer orange trees. The summer trees  are in blossom as spring unfolds in Athens.

I have not seen in him in a year but it is as if we have not called since yesterday. He exudes a genuine caring and he has a mystic mix of spirituality and capitalism. His spirituality comes from annual sojourns to Mount Athos where he fasts with monks and his capitalistic streak emanates from his mother, who, when they were small used to go out at night and move the boundary stones of their Athens  property. Notwithstanding the real estate gains, he started building apartments around the house and now has a collection of non government employees paying rentals. In anticipation of the economic crisis that hit Greece he reduced his rentals in 2010 by twenty percent and again by a further ten percent this year. He has kept all his tenants and they seem t be paying the rent. He delivers basket of home grown produce to each of the apartments as he harvests. His daughter, Dionysea, named after her grandfather Dionysius, and also the god of wine by the same name, knows all the tenants by first name and can list them as if she is repeating the alphabet. She is only seven years old now.

Panayiotis came out for my brother’s wedding. He arrived with a beautifully cut suit, specially tailored for the wedding. In the days before the wedding my mother arranged for the suit to be pressed at the dry cleaners and my father then substituted one of his own suits with the same fabric, carefully placed under the plastic cover with the tag attached. Panayiotis left the suit in the plastic till the day of the wedding. When he dressed he was dumbstruck that his pants were too long and the waist too narrow. He accused the drycleaners of messing up his suit and was so upset he shouted at my father through closed doors that he could not attend the wedding. My father was silently laughing, but egging him. “Imagine what people will be saying: I brought my cousin from Greece for the wedding and he did not want to some because his suit would not fit! Perhaps, Panayiotis, you should try another suit?”

“How will you find one to fit me?”

“Try it anyway”, said my father, proffering it through the crack  door.

As he fitted it he exclaimed “this is just like my suit!” and then he realised he had been duped.

Until he got his own back. Many times. The Greeks call it plaka.

Panayiotis in his garden