The Naming of People

T.S. Elliot wrote a collection of poems on cats. One of the poems is called “The Naming of Cats” and it starts like this:

The Naming of Cats is a difficult matter,

It isn’t just one of your holiday games; 

You may think at first I’m as mad as a hatter 

When I tell you, a cat must have THREE DIFFERENT NAMES.

Luckily I am not a cat and only have one name. However there are more than three Basils in my family. I am one of six first cousins named Basil after my maternal grandfather, the late Basil Moutsatsos, who had come to South Africa from Greece. His legacy was one of love and generosity. He also loved to watch his children (he had five daughters and four boys) perform Greek dancing.

So Basil is from the Greek word meaning “Kingly”. In Greek my formal name is Βασίλειος (Vasileios). The shortened version is Vasili. When I was at university I liked Vasili. Many years later a Rumanian colleague would call me Vasili. He would also call on every 1st of January to wish me for my name day. 

In Greece the villagers who had been to the United States called all the Vasilis “Bill”. So I became Bill, Billy or Billaco in Greece. Bill came from their arrival at Staten Island in New York City. The immigration officers spoke no Greek, so they asked with which letter of the alphabet the name of the immigrant started. Vasileios starts with a “B” in Greek. So they were all called Bill. 

The seven cousins needed to be distinguished from each other. So we had Big Basil (or Sili) and Little Basil, who was the youngest Basil until two younger ones came along: JB and Sil. In the middle was me and cousin Basil, son of my Uncle Basil. I had a few nicknames besides the Bill derivatives: Budgie, Charlie and maybe a few others I cannot remember.

Oh , and my cousin Big Basil married Athena whose brother Basil shared my birthday, along with JB.

Names are important. Sometimes they make who we are. A name can mean recognition and connection.

When we were in the second wave from December 2020 to February 2021 at Netcare Kingsway Hospital, the hospital was all Covid except for one small ward. We all wore full PPE including visors all the time. Everyone looked the same in gowns and visors. Everyone was tired.

“Hey you” was not a polite way to address nurses when at work, and patients had no idea which angel was caring for them. Remember, as a doctor during the Covid wave I was working with teams I had not worked with before as an orthopaedic surgeon.

I decided that we should label everyone’s visor with their name and position in the hospital. So even the head of the gastroenterology unit in theatre got her label: Sister X, Theatre Gastroenterology Sister. She ended up heading up the Rest in Peace Team, so her patients did not see the name on the visor.

My receptionist used my label machine and five cartridges of labels supplied by the hospital to make labels for the whole hospital nursing and administration staff and the doctors. Each cartridges has a ribbon that is twelve meters long, so she printed sixty metres of labels.

Covid-19 has presented like a cricket game with the statistics. All sorts of useful numbers have been extracted and then equally so, misinterpreted and used as a foundation for some outlandish conspiracy theory.

We are now preparing for the third wave at our hospital. Many of the staff have new visors in preparation for the battle. Most have been vaccinated. My labelling machine is doing the rounds as people print their name to stick on their visor. 

What the label does not say is that these nurses are angels. They are the ones sacrificing themselves and their families as part of their calling to care for the sick. The sick are arriving again at our hospital with Covid pneumonia, grey skinned with wide-eyed white eyes searching for oxygen and help.

Thanks to our nurses they will receive more than just help. They will be cared for and connected to their families by these superheroes with names we should remember.

Grass cutting visors from the local hardware store have become the preferred from of protection globally.

The Tree of Life

I had been searching for a year. Because of the pandemic, in spite of the pandemic and to heal from the pandemic. Finally in May this year I was gifted what seemed to have become an impossible task.

I messaged the hospital manager : “the trees have arrived. I’ll come by later in the week to chat about where to plant them.”

“Excellent” was her answer.

We have a garden of remembrance as you enter our hospital. It has two benches, three tall aloes and a variety of African indigenous lilies. There are two glass walls with stainless steel plaques for anyone to pay homage and remember the departed. One wall has become the Covid-19 Memorial.

A few days later I popped into the manager’s office. 

“Hi.”

“ Oh hi Dr Stathoulis” . She always calls me that. We asked about each other. “Can we do a walkabout to see where to plant the trees?” 

“Sure”. She always makes time for me.

We walked into the sun of autumn, a warm day, with the trees huddled in their black plastic uterine bags.

Ziziphus mucronata. The tree of life. That’s what the Zulus call it. uMphafa. If someone dies  in the hospital they bring a  branch from the tree of life and reverently capture the spirit to take it home. They even pay for an extra bus seat on the way home. The branch that has captured the soul of the person who has died is tucked into the eaves of the roof of the homestead to rest. 

I have a plaque in memory of my father’s passing in 2008 on the first glass wall. It reads in Greek: “Η αιωνιότητα είναι ποιότητα, δεν είναι ποσότητα, αυτό είναι το μεγάλο πολύ απλό μυστικό” from Nikos Kazantzakis, who wrote Zorba the Greek. Translated it means “Eternity lies in the quality, not the quantity; that is the great secret.” When I finished school in 1980 I planted a  Ziziphus in the garden of our family home. After my father was buried in Johannesburg I took a branch from that tree and left it at my grandfather’s house in our village in Greece. 

It was difficult to find the trees. I had asked far and wide of nurseries and tree growers and finally a friend of mine, Jane Bedford, who had trained as a traditional healer with the Zulu’s, gifted them to me. A few days later the local nursery found another three small trees for me.

Jane delivered the first three trees as soon as  she got them. The thorns tore at her car seats. He forearms had bright red spots where the thorns had drawn blood.

The tree of life has a straight thorn that points to the future and a curved thorn that connects us to out past. The branch has a zig-zag pattern, much like the path we follow in life.

I had a dream in the beginning of the Covid-19 pandemic. I was moved by the pain of families who could not visit their loved ones in hospital. I thought of these trees after my dream, and knew I should plant them in our Garden of Remembrance. I finally found them. Rather, they found me. So Rachel the gardener at the hospital planted them. Three in a row. The other three small trees were planted in a group a but further away.

This weekend I mixed some concrete and planted a sign to remember the reason we planted the trees of life.

A sense of peace descended over me. Now my soul can rest a little easier.

Rachel, our gardener planted the trees of life.
The tree of life….
The Garden of Remembrance

In Their Memory

I cannot find a title that encapsulates what has happened at my hospital without being alarmist. This is all about death. 

In early January 2021 my hospital was overwhelmed with Covid-19 cases as the second wave of infections hit our coastal holiday town with devastating force. 

The senior emergency doctor contracted the disease and was unwell. The remaining doctors were stretched to cover the extra load. Our infrastructure was stretched. My measure of how we were coping was based on a few rough gauges: 

How many people were lined up outside the emergency department on oxygen? 

How many people were in the emergency department waiting for a bed at my or another hospital? 

A few weeks later I added another measure: how many people were waiting for ICU? 

We were stretched, no doubt. So I went to see how I could help. 

The nurses and doctors knew what they were doing, but it seemed chaotic just because of the sheer deluge of ill patients. We had a ward that was empty and accessible to those needing urgent care for Covid-19 symptoms. But we did not have the staff.  

As I walked through the ward I discovered the real measure of how overwhelmed my hospital was. There was a dead body in each of many rooms. Out of respect for the departed our staff were leaving the dead alone in a room. Their desire for those in the afterlife was to rest in peace with space. 

I am not at liberty to give the statistics as they are part of the information that the Department of Health disseminates. But I can tell you how it affected us. 

To make space for sick patients I seconded a porter and we started moving all the dead bodies into one room. A holding area. As we did this I met some of my operating theatre staff who were delivering a shrouded body to the new holding area. Beds in the ward were at a premium so it was more efficient to move the body to a holding area where the many professional undertakers have taken them away timeously. 

4180. 

That is the switchboard extension the ward staff call to get the RIP (Rest In Peace) team from theatre to prepare and move the body.  

The RIP team is made up of skilled theatre nurses, scrub sisters, recovery and anesthetic nurses. Once they get the call on extension 4180 they go to the ward where the patient has demised. They check the paperwork. They ask the family if they want the clothes left on or removed.  Then they wrap the body in two layers of plastic, each layer with three patient stickers identifying the body. Then they shroud the body with a white bedsheet. The remains are respectfully transferred to the holding area. 

We managed to staff and open the ward the next day and take patients from outside on oxygen and put them inside in a bed on oxygen.  

The odd thing is the number waiting outside remained the same for many days.  

It was sobering that number of dead arriving in the holding area was much more than we ever anticipated. 

The Holocaust Memorial in Berlin

Sometimes I Think

Sometimes I think and nothing happens. That seems to happen a lot during this period of the second wave of Covid-19 that has hit my hospital. Netcare Kingsway Hospital is a community private hospital and has been overwhelmed in caring for patients with Covid-19.

Sometimes I think and something happens. That’s when a story takes shape and I wonder how I will tie it together to make it work.

Sometimes I think about the pandemic. I focus on the problems we face and work out solutions. I reflect on all we have done. I reflect on what we have learnt. Although we were all tired after the first wave, at least for the second wave we had systems in place. Systems to protect staff with PPE, systems to control the flow of patients and systems to deals with patients waiting outside and waiting for an ICU bed.

Sometimes I think that it is affecting everyone. It is affecting every nation. Uniting some and dividing others.

Sometimes I think that it is not only about the nurses and doctors and first responders. It is about the cleaners and security staff, about the porters and the kitchen staff. About the switchboard operator and the admission clerks. They are the ones that make up the scaffolding from which the nurses and doctors flesh out their caring and compassion. Without them risking close contact with sick patients health care workers could not do what they have had to do. 

Sometimes I think about the undertakers I see moving around the hospital. Death certificates in hand if they are lucky, otherwise their unfazed search for the source of that important document. I have seen families cry as a body has been transferred to the undertaker’s van. It was eerie to see a full length leg prosthesis pushed like a spare part above one body.

Sometimes I think about all of these people. I just have not written about them. Now I will write about them.

It may look like it’s only sometimes that I think about them. But today I walked out of my office holding a tray doughnuts. A patient brought them yesterday to celebrate his birthday with us. I didn’t save his life. I am just an orthopedic surgeon. I only fix bones as my clever anesthesiologist insists. I was grateful my patient thought of us but I never got round to having the doughnut.

Sometimes I think clearly. This time I took the doughnuts to the security guard that directs people in crisis to the back of the hospital for them to be triaged. He remains calm and polite and cares as much as any nurse or doctor. I know that because I see him every day he comes on duty. I wave as I drive in and he salutes me.

Sometimes I wish I could do more for them. The doughnuts for the security guard were a start.

Moving mannequins at a Durban outdoor market

Burials: We can’t keep up!

Those were the headlines in one of the Sunday papers.

He was around fifty years old and with his wife. They stood in front of me in the supermarket. He was in shorts and a light blue t-shirt, wearing beach flip-flops. Standard casual wear for the holiday beach town where I work at Netcare Kingsway Hospital in Amanzimtoti, on the KwaZulu-Natal South Coast of South Africa.

I could see him reading the headlines. Then he shook his head and muttered something to his wife.

“News” was all I heard. It was accusatory, devoid of any connection to the surge in Covid-19 infections we are experiencing in this province. 

I was not in my surgical scrubs. I too wore shorts and a t-shirt, although not as smart as his. Instead of flip flops I wore my Crocs. Every day at the hospital I wear closed restaurant Crocs that I wash every day with my scrubs. It was good to be in my beach and bush Crocs.

“It’s true, you know” I said. “ I can take you to Kingsway Hospital down the road and show you the people waiting outside.” I knew they were there,  sucking on oxygen from  battered black cylinders. They would have been triaged by a team of nurses, vital signs recorded and placed on the oxygen as they waited for a cubicle in our emergency department. A colored sticker on their shirt or blouse would identify them: BLUE for family members, YELLOW for non-Covid medical problems ( the minority) and RED for COVID-19 patients.

“I don’t believe it. I don’t know anyone who has it. I don’t know anyone who has died from it. I know hundreds of teachers, and not one has it. But I do know people who have been murdered in the last year.” He was calm and spoke his truth.

His words hurt me.

I chose not to argue. He would not recognize me when he came to the back of the emergency department. All he would see is my eyes above the mask and behind the visor. I would be unable to help him. Not because he did not believe that Covid-19 was a real problem. I would not be able to help him because there would be twenty other patients waiting for a hospital bed. Maybe he would get one on the other side of the city, or even in another town. I would not wish ill on him. But he should see the eyes of those pleading for care and attention. He should see their eyes when the person lying on a stretcher next to them dies. He should see all the bodies waiting in the holding area.

They are waiting for the undertakers who can’t keep up with the burials.

The nurses at my hospital can’t keep up either. I cannot keep up with how many get sick with Covid.

One of the emergency doctors steeled himself before a shift. “I can’t do this anymore.”

He was tired of seeing patients and not having beds for them. He was tired of seeing people die. He was tired because two of his colleagues were sick with Covid and he had to carry the extra shifts.

Still he went out to face the death and destruction that this disease forces on us.

The man in front of me at the supermarket que would not believe any of this.

The amazing thing is he would still be treated at my hospital like anyone else if he needed help. He would be treated by nurses and doctors who just can’t keep up. 

He may end up with a RED sticker on his blue t-shirt…

Begrafnisse: Ons kan nie voorbly – Afrikaaans for Buritals: we cannot keep up

Stay safe..

Dear Nurses

I am so proud of all of you.  You have applied yourself to everything that is new. You have patiently listened as we explain protocol after protocol, and then frustrated  you by changing it the next day. I am proud of how you showed care to my 99-year-old patient whose hair is perfectly coiffed and her makeup is ready for a BBC interview.

Like you I don’t know what day it is. I need to check a calendar to see if it’s a working day or a weekend. Not that it makes any difference to you, working shifts and three-day weekends every second weekend.

I try, and yet I fail to talk to you in the corridors and in the nurses stations and in your offices in management suite.  

I failed to act ten days ago when someone asked me to write something motivational for you. This is a time when failure is commonplace: the only solution is to acknowledge it, learn from it and move on. With this letter I hope to move on.

We are facing a global crisis in our little hospital that has always served our community to the best of our ability. It seems sometimes that nothing we do is enough for our patients, our hospital, the whole world. But we have not failed!

The sense of failure, the fear of not being in control, the quarantine, the concern for our families causes us all to feel anxiety.

Feeling anxious about things in today’s world is completely normal. Although I am no master, I’d like to share with you how I have learnt to deal with my anxiety over the years and what works for me now:

We need to deal with it. Learn from our failures. Consolidate and move in a new direction with calm and strength and compassion. I believe we all, and especially you, have this ability.

In our medical training and our experience at the workplace over the years we have all faced stressful moments: a patient’s death, a complication, a disagreement with a colleague. Think back to those times. Now empower yourself by reminding yourself that you dealt with those crises before, and you have the tools to deal with this crisis. You have achieved so much, and will continue to achieve.

Over the last decade I have been blessed to meet many wise and caring people who have helped me deal with fear and anxiety. The essence of their help for me can be distilled into three words: 

Remember to breathe (even if it is behind a suffocating mask).

Breathing is the essence of life, and we can control it. In the beginning just acknowledging your breath is enough. Start to feel the place where your inbreath gently fades into your outbreath. Feel your diaphragm move. If you want you can pause, and count to four at the end of each breath.

It is as simple as that. Now you have something you can control. In controlling that you can reduce your fear and anxiety. 

I salute you all. For once the world is recognising your calling.  They are appreciating your service for the greater good of humanity. They understand your sacrifice. 

Stay safe.

Ask for help if you need it.

Best wishes

Basil

Sunrise over the Indian Ocean …