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Holes in our medical holism

‘Everything was beautiful, and nothing hurt.’ – Kurt Vonnegut

It’s 2020, just after Covid hit South Africa. I wake up in a hospital bed in a world of pain. I have this massive need to pee, and I’m mighty confused about this, and indeed, about my entire surroundings. Then I remember: after more than a year of waiting in endless queues, a number of consultations and a couple of scans, I’ve come to Helen Joseph public hospital to get a kidney op.

I lift my hospital gown, scratch around for scars and sutures, but there are none. What’s up? What’s going on? By now the urge to urinate is huge, insurmountable; it feels I must push my pee out as hard as I can, though I can barely hold anything in. There’s not a sister in sight, just other patients in the large ward, lying supine or groaning in their beds. I stand up, a move accompanied by crashing waves of dizziness and nausea, and head for the bathroom.

When I went for my op, I got pumped full of antibiotics, anti-inflammatories, painkillers, and who knows what else. I felt kind of pinned down, trussed up ..

As soon as I do so, I hit a snag: there’s a drip attached to my arm, and the wheels of the drip stand aren’t turning smoothly. I wrench and manhandle it along behind me, make it to the loo, and, after much passionate straining, manage to painfully disgorge a few drops of bloody pee. Struggle back to my bed. 

Minutes later, I have to repeat the whole performance. This time, in frustration, I pull the drip out of my arm, spray blood all over the cistern, and leave the wonky drip stand in my wake. I don’t make it back to the ward: I collapse in the passage and vomit, but I lack the strength to move away from the puddle. I lie next to it, trying (not) to draw breath, until eventually a sister comes and, clucking and admonishing me lightly, helps me back to my bed. 

Only days later, when the surgeon finally talks to me, do I discover that all I’ve had is a stent inserted. It’s a temporary measure for my PUJ obstruction – and stents have to be replaced. After another year, after more scans are done and I’ve sat waiting in more waiting rooms, I am told that all I will ever get from the public health system is more stents. They can’t afford to do a proper operation to unblock my ureter. Meanwhile, the health of my left kidney is steadily declining. 

The transition

It’s 2022, and I’m sitting in a tiny courtyard in a private hospital in Randburg, marvelling at a spiky ancient plant that looks somewhat like a cycad. Why is it alive? Why does it carry on living? Why do any of the things that are alive live? Sure: it’s their programme, their reason to carry on: grow, thrive, reproduce, die. Along the way, if they are injured or get ill, cells cluster, a system springs into action, and if the organism is strong or lucky enough, it survives the setback. But why does life exist at all?

I’m probably high on painkillers, but the whole thing, this life thing, seems utterly, utterly absurd. At the same time, that’s what makes it incredible, miraculous, magical. I’m having, like, a revelation. There’s no real rhyme or reason for any of existence, beyond what we make up – even philosophers cannot answer the question of why there is something instead of nothing. It just carries on … this life thing … feeding, shooting seeds, growing babies, surviving, evolving. 

Like the life process itself, I’m realising that in order to recover, I have to be 1000% positive. There is no space here for depression, for negativity, for doubt. My mind now KNOWS that I am going to recover, and it pulls my body with it. This positive mindset is already bearing fruit: the people around me – patients and nurses – are responding, we are having long conversations, and I’m loving it, though I have the physical strength of a minnow with malnutrition. 

Six weeks before my mini-revelation, I had finally had my kidney op. Through the sheer luck of my (middle) class background, and some compassionate work management, I had managed to transition to the privilege of a hospital plan, and escape the over burdened, under-funded public health system. Private hospitals are a different world entirely: suddenly you are flying first-class. If you press your alarm button, a nurse actually arrives. If you ask for more painkillers, you get them. Sleeping tabs? Yes. Heaven. Seriously.

My catheter bag followed me, several times, as I went in and out of hospital. I referred to it as my shopping trolley

But the operation, despite having been done by the best surgeons in the land, somehow went horribly wrong. I was forced to return to hospital several times, as urine refused to flow along the desired paths, and ended up coming out of my side. Then, when that got fixed, my stent was removed, and this time, urine flowed into my abdomen. 

These blockages caused pain that is difficult to describe (passing a kidney stone is supposed to be like giving birth, but, sorry … I cannot vouch for that). I was also well aware of the attendant dangers of infection, and there were massive amounts of anxiety. When I was out of hospital and recovering at home, it was hard to get hold of professional advice. Surgeons are usually busy doing, well, surgery. One is never sure that Google is providing the correct advice. My wife and I were thinking, am I being neurotic to go back to the hospital? Should I stick the pain out? Turns out I was right to seek help. I would have likely died without it – twice.

It’s quite possible that my behaviour after my operation – though I promise I never ran any Iron Man marathons or rode bareback across the plains – is what landed me back in medical care. It could have also just been bad luck: a small percentage of PUJ pyeloplasty patients don’t recover quickly. I have to believe the latter, for my own peace of mind.

Integration, please. Ffs ..

The point is, just as when I awoke from my public health operation, there was a huge paucity of information about how I should proceed with my own post-operative recovery after my private healthcare operation. I didn’t know, for instance, what was causing stabbing pains in my left shoulder, until I Googled it, and found out my belly had been filled with carbon dioxide. This was so the folk doing the op could see what was going on inside me. The gas moves around your body afterwards, causing pain where it settles. Ok! How about telling patients that painkillers cause chronic constipation? Antibiotics fuck your guts up? There’s a whole list of stuff you have to find out about yourself. 

One would think that medical aids and hospitals would provide patients with as much information as possible about how to prepare for an operation and how to recover from it afterwards. This holistic approach could include what to eat to prepare your body for trauma and recover from it faster, as well as mental health regimes that make the ordeal more bearable. Surely it would be to their benefit to have patients recover faster, and have fewer patients return to hospital after operations?

According to Natural Health, traditional Chinese medicine, which has been around for about 2 500 years, is today an accepted medical system alongside allopathic (Western) medicine. A hospital in China will have an acupuncture floor along with other conventional floors such as an oncology floor, where a patient may get acupuncture along with their chemotherapy treatment. Using both ancient and modern practices is gaining acceptance among conventional medical doctors in China, as there are a growing number of studies and patient testimonies that prove the combination works. Makes a whole lot of sense to me.

I’m trying to draw some life lessons from the whole getting ill experience. Maintaining that wonderment at being alive that springs from near-death experiences is difficult. As my health improves and distractions proliferate, that positive feeling I had in my last hospital stay is fading. 

I’m realising that, being nearly 60, a whole lot of people in my social circle are beset with illnesses and conditions. Many live with or are in pain, intermittently or constantly; some of them have dealt with it for years on end. I really don’t know how they do it. Huge respect. Pain fucks with your sanity. It places a huge strain on your relationships. It throws you back onto your deepest mental resources. Hopefully, you are praying to the right deities when the pain is really extreme, and they’re not thinking, ‘jeez, this dude only remembers us when he’s down …’

Some friends know how to respond when you are sick, and some don’t actually appear to have the capacity for empathy. It’s difficult not to judge folk for this, but it is necessary (or you’ll have less friends). None of us want to be sick, and most of us don’t want to be around the people who are. Sometimes when you’re sick you don’t want people to visit or even phone you. Sometimes it is all you want. When a friend asks if there is anything you need, there’s times when you want to say, ja, I want you: I want you to give me some time, some love, some attention. Other times, you just want them to mind their own business. There’s a tendency for the healthy to patronise the ill. Be genuine, be loving, be humorous, or actually, just bugger the fuck off. 

I’ll never forget how our dogs, particularly our old bitch, lay next to me or at my feet throughout my entire recovery at home. There was nothing else she could do, but she did just that, and I’m convinced that in some way it helped me. Was it a mothering instinct? I’ll never know. I’m just really glad she did.

The faithful hounds were mightily concerned about me being horizontal for days on end