Broken Pieces

Early the following morning, I woke with a growling stomach, but I was in a good mood, excited to start our clinical block. Chloe and I hurried over the rough dirt road to the hospital, intent on first finding a place where we could have breakfast.

The bungalows on the other side of ours seemed less decrepit: freshly whitewashed walls and varnished wooden front doors, and in some dusty yards there were even beds with geraniums, daises, and pansies. I guessed they were the doctors’ residences.

The hospital was by far the largest building in the small complex. We climbed the concrete ramp to the heavy wooden front doors. Patients crowded in the square space, like passengers waiting to catch a train, standing close together, or siting on wooden benches that looked like rejects from an abandoned church. The air was thick with dust and sweat. Men and women of all ages laughed and spoke loudly in what almost certainly must have been Zulu. I’d heard from the nurses I’d worked with at the mine that whispering or speaking softly was considered rude. Another reason we’d seemed to communicate well.

“Cafeteria!” I pointed the sign out to Chloe and we took the passage at a trot. There were a few nurses sitting around two of the fifteen tables, each surrounded by four wooden seats. We grabbed white porcelain plates and loaded them with limp brown toast, rashers of bacon, and lukewarm scrambled eggs. I savoured each bite as if it were my last, washing the breakfast down with hot coffee and orange juice.

“Ready?” I asked.

Chloe nodded and we made our way back to the entrance. From there it was easy to follow the signs to our destination, the obstetric ward.

“I wonder what time they have their ward rounds,” Chloe said.

“Maybe we’ll finally get to meet a doctor or two.” I was still kicking myself for not leaving earlier the previous day and for getting lost. Arriving at night had not been the best way to start our block.

The siren sound of labouring mothers—groans and intermittent screams—came from behind the swing doors, and, when we pushed them open, we were greeted with the smell of bleach and Dettol.

“Here goes. Our first baby.”  We’d witnessed a couple of births before, surrounded by many students. This would be the first time we’d be allowed to deliver our own babies. I couldn’t wait to feel the soft wet down of a baby’s head as it crowned, to be the first person to carefully cup the slippery skin of the tiny body after it slid from its mother’s womb.

We stopped at the nurse’s desk. “Hello.” I waited for the nurse examining a heap of patient folders spread over her desk. She had a round face and round cheeks and was about thirty years old.

“I’m Judy and this is Chloe.” I waited for her to respond, instead she gazed at us quietly.

“We’re the new students.” My voice rose with anxiety.

“I am Sister Menzima. I’m the charge nurse.” Her voice was bored, as if she’d recited this one too many times.

“Good morning, Sister. Nice to meet you.”

A loud shout came from one of the rooms, but Sister Menzima didn’t flinch. She carefully jotted more notes, closed the file, then walked around the desk. “You can follow me.” She clutched the patient folders against her large bosom.

“Thank you,” Chloe said, her voice small in the large passageway.

We kept quiet and followed Sister Menzima as she made her rounds, from one room to another. The first room had a nurse in one corner, standing at a poster of a drawing of a mother and fetus. There was a child in bed, a young girl, no more than fourteen, her thin legs sticking out from a white hospital gown that covered her pregnant belly. Her eyes were wild and frightened as she followed the long wooden stick the nurse held, the point tracing out the image of a fetus inside the belly of the mother. A sex education poster for a mother about to deliver a baby.

The second room had another screaming teenager. “She is sixteen,” Sister Menzima said, “and pregnant with twins. She is 31 weeks along and her membranes have ruptured.” She pointed to the intravenous bag hanging on a stainless-steel drip stand. “We are giving her antibiotics.” She shook her head, as if faced with a hopeless cause.

“What about a tocolytic?” Chloe asked. A tocolytic was used to slow premature labour. The drug didn’t always work, but sometimes it gave the fetus more time to mature.

Sister Menzima pursed her lips and went over to the teenager. She palpated her belly and adjusted the drip rate. “We don’t stock tocolytics here.” Her voice was crisp and matter of fact.

“Aren’t they allowed to have someone with them?” I asked. The kid seemed terrified. “Where is her mother?”

Chloe’s face was drawn with worry; we stared at the nurse.

“Her mother has to work.”

The next two rooms had one older and one younger woman, both in the throes of labour. They too were alone.

“Sister! I need you. Now!” A voice boomed from the room down the corridor and the nurse hurried past us. We followed without hesitation, excited at the prospect of witnessing our first delivery at Dingane Hospital.

We entered the room, sunlight streaming through a window, lighting the large bulk of a young woman wailing and writhing on damp and crumpled yellowed sheets. Her hospital gown was pulled up over her belly and her legs were in stirrups. Two nurses on either side of her bed leaned over her, holding her down. Yelling at her to lie still. Be quiet. At the end of the bed was a doctor, the only male, and, apart from Chloe and me, the only white person in the room.

Sister Menzima reached for a green gown on a trolley between the doctor and the wall and slipped it on, followed by gloves. Chloe and I moved back into the corner of the wall where we could see the delivery better. The nurse glanced at Chloe and I. “Doctor, these are the new students.”

The doctor’s head and shoulders remained tucked behind the green drapes that covered the mother’s legs.

“This is Doctor Provoost.” The nurse said. She added in a hushed voice, “The baby has died. We think a week ago.”

Chloe gasped.

The mother’s face distorted in agony, sweat beading her brow. She had to endure the agony of labour pains knowing her baby had died.

Wet strands of dark hair escaped from under the doctor’s green cap. A five o’clock shadow bordered the sides of his mask. He wiped his shiny white forehead with a sterile cloth which he then threw to the ground. It landed close to Chloe’s feet and she jumped to the side.

“Tell her she must push. Push!” His words were muffled as he dove back between her thighs.

From where we stood in the corner of the room, we could see mostly his back and his arms, his gloved white hand against the woman’s pudendum.

“Push, dammit.” His voice was desperate.

The woman’s screams escalated. The nurses shouted louder, with more urgency. The doctor reached for a pair of scissors lying on the delivery cart and then he bent down, his back between the mother’s legs. He inserted the fingers of his one hand in the mother’s vagina and with the other, using the scissors, he made a deep cut. Skin gaped and red-pink tissue bloomed, blood and fluids spurting. A foul smell saturated the air.

The contraction passed, and the mother’s wails dwindled to tired sobs, the opening at her vagina closing. The nurses stood and wiped their foreheads and the doctor dropped the scissors still dripping with blood on the trolley. Her contractions started again.

I glanced at Chloe. Her hands were curled in fists, her skin ashen.

“Push! Push!”

With the contractions, the opening of the vagina enlarged. The doctor grabbed one spoon-shaped blade of the forceps from the trolley and inserted it into the woman’s vagina, then repeated the procedure with the other blade, the giant salad tong-like blades disappearing in the woman’s body. He leaned backwards, pulling on the ends of the forceps, which looked like the handles of a scissors. He yelled, “Push. Push.”

The nurses screamed their words in Zulu, their voices louder than the woman’s wails. As the shining silverware emerged, I held my breath.

And then. “Fuck, Fuck.” He dropped the forceps as the head plopped out. Sister Menzima caught it inches from the floor. A mucus green ball with purple veins. The edges at the decapitated neck ragged. A macerated baby! The baby has been dead for so long, that the tissues have started to disintegrate. She placed it on the trolley and covered it with a cloth.

The doctor’s forearm disappeared into the vagina. His head now turned in our direction, his eyes unseeing, sweat pouring from his forehead. He cursed while the woman writhed and whimpered.

 I stood frozen, my back against the wall. Staring in front of me. Not daring to move. Not even to see how Chloe was doing.

“Push!” he shouted. “Tell her to push. It’s now or never.” His forearm emerged, then the hand holding a tiny green-purple arm. Finally he sagged back, holding the annihilated body of the baby.

He dumped the body on the trolley. Sister Menzima covered it with a small green drape.

The delivery of the placenta went without any complication and he plopped the tissue in a large silver bowl.

His face was grim as he removed his gloves and gown and threw them on the trolley. “Start her on Ancef 1 g every 12 hours and run Saline. I will see her later.”

He left the room. The nurses wiped the mother’s face, the cloth soon wet, wiping away her tears and sweat, as if her grief were rain. They crooned words of comfort, dried her, and covered her with a clean sheet while she lay spent, depleted. Her eyes closed.

Our first delivery at Dingane Hospital was over. Chloe and I left the room.

“That man is a monster!” She nibbled at a cuticle, and then added, “He left without saying a single word to her. Not an ounce of compassion. He gave her nothing for pain. He’s everything that’s wrong with this bloody system.”

I couldn’t argue, for once silenced by what I’d seen. The rest of that day became a black hole in my memory, but not the delivery. That delivery stayed with me for decades.